Postoperative laboratory testing in the era of outpatient total joint arthroplasty: Targeted patient selection and associated cost savings.

Background: With the advent of outpatient total joint arthroplasty (TJA), the days of routinely drawing postoperative labs (complete blood counts [CBCs] and metabolic panels [CMPs/BMPs]) to monitor for complications are behind us. However, there does exist a subset of at-risk patients that may benefit from diligent postoperative monitoring, though the circumstances under which labs should be ordered remains unclear and subject to surgeon discretion. A systematic review of the literature was therefore conducted to evaluate the utility of postoperative laboratory testing, approaches to targeted patient selection and associated cost-savings. Methods: The PubMed, MEDLINE, EBSCOhost, and Google Scholar electronic databases were searched on August 17, 2023, to identify all studies published since January 1, 2000, that evaluated the role of postoperative lab testing in TJA. (PROSPERO study protocol registration: CRD42023437334). Articles were included if a full-text English manuscript was available and the study assessed the utility of routine postoperative labs in TJA. 19 studies were included comprising 34,166 procedures. The mean Methodological index for Nonrandomized Studies score was 18.2 ± 1.5. Results: Abnormal postoperative lab results were common and infrequently required clinical intervention. Among several identified risk factors for patients that may benefit from postoperative laboratory monitoring, preoperative lab values proved excellent discriminators of transfusion requirement and metabolite-associated intervention. Selective testing demonstrated the ability to generate substantial cost-savings. Conclusion: Routine postoperative laboratory testing offers little clinical utility and produces unnecessary expenditures. Preoperative lab values offer the greatest predictive utility for postoperative transfusion requirement and metabolite-associated clinical intervention, with a preoperative hemoglobin threshold of 111.5 g/L offering an area under the curve (AUC) of 0.93 for predicting postoperative transfusion. Further investigations are needed for metabolic panel predictive models and should incorporate preoperative lab values. The refinement of such models can enable targeted patient selection to avoid unnecessary labs and generate substantial cost savings without compromising patient safety.

A finite element analysis of patellofemoral joint biomechanics: Exploring potential causes of postoperative anterior knee pain following unicompartmental knee arthroplasty.

Purpose: Anterior knee pain is a common complication following unicompartmental knee arthroplasty (UKA). This study aimed to elucidate the mechanism of anterior knee pain after UKA by examining the biomechanical characteristics of the patellofemoral joint. Methods: This study employs the finite element analysis method. A healthy model of the right lower limb was created using CT scans of an intact right lower limb from a healthy woman. Based on this model, a preoperative pathological model was generated by removing the meniscus and part of the articular cartilage. The UKA prosthesis was then applied to this model with five different bearing thicknesses: 5 mm, 7 mm, 10 mm, 11 mm, and 13 mm. To simulate various degrees of knee joint flexion, the femur was rotated relative to the knee joint's rotational axis, producing lower limb models at flexion angles of 0°, 30°, 60°, 90°, and 120°. We applied a constant force from the center of the femoral head to the center of the ankle joint to simulate lower limb loading during squatting. The simulations were conducted using Ansys 17.0. Results: Both overstuffing and understuffing increased the peak stress on the patellar cartilage, with overstuffing having a more pronounced effect. Compared to healthy and balanced models, overstuffed and understuffed models exhibited abnormal stress distribution and stress concentration in the patellar cartilage during knee flexion. Conclusion: Overstuffing and understuffing lead to residual varus or valgus deformities after UKA, causing mechanical abnormalities in the patellofemoral joint. These abnormalities, characterized by irregular stress distribution and excessive stress, result in cartilage damage, exacerbate wear in the patellofemoral joint and consequently lead to the occurrence of anterior knee pain.

A preclinical model for osteoarticular fracture fragment preservation for delayed re-implantation.

Background: Open articular fractures often include contaminated, devascularized osteoarticular fragments that are critical for joint reconstruction. Definitive treatment is often delayed such that decontamination and preservation of critical fragments for joint reconstruction is highly desirable. To validate decontamination and preservation protocols for safe and effective preservation of osteoarticular fragments for re-implantation, a preclinical animal model for inducing type 3 open articular fractures with contaminated, devascularized osteoarticular fragments was developed and validated. Materials and methods: With IACUC approval, purpose-bred hounds (n = 5) were humanely euthanized. Immediately following euthanasia, a penetrating captive bolt pistol with 1.25 grain cartridge centered on the cranial aspect of each distal humerus was discharged to create open fractures in 3 dogs (6 elbows). In 2 dogs, matched osteoarticular tissues from non-injured elbows (controls) were retrieved for comparison. Distal humerus, proximal radius, and proximal ulna osteoarticular fragments (n = 27) were immediately placed in Missouri Osteochondral Preservation System (MOPS) solution and stored at room temperature. Radiographic, chondrocyte viability, and quantitative microbial culture assessments were performed immediately (time-0) and at 7 and 14 days of storage. Results: This preclinical canine model reliably produced type 3 open distal humeral fractures characterized by devascularized and contaminated osteoarticular fracture fragments. All fragments produced extensive microbial growth through 14 days of storage. Without decontamination, viable chondrocyte density in the fragments decreased significantly within 7 days, likely attributable to the profound contamination. Conclusion: These data highlight the importance of developing a reliable method for point-of-care decontamination and preservation of osteoarticular fracture fragments for safe and effective reimplantation of articular fracture fragments for joint reconstruction.

Global research trends and hotspots in rheumatoid arthritis joint replacement:Bibliometric analysis and visualization study.

Objective: This study aims to analyze and visualize global research trends and hotspots in rheumatoid arthritis joint replacement over the past two decades using CiteSpace and VOSviewer software.The findings from this bibliometric analysis will inform and guide future research directions in this field. Methods: We searched for relevant literature on rheumatoid arthritis joint replacement from January 2005 to August 2024 in the Web of Science database.Using CiteSpace, VOSviewer,and Bibliometrix software,we analysed keywords, authors,institutions, countries,and journals,and constructed a network cooperation map. Results: A total of 2888 articles written by 11,723 authors from 70 countries and 3194 institutions were analysed and published in 530 journals.The United States, with 855 publications accounting for 29.61%of the world's total,and the United Kingdom, with 332 publications representing 11.50 %,made the greatest contributions.Additionally,the United States maintains strong collaborative relationships with many countries. According to the analysis of the outbreak keyword map, the joint replacement of rheumatoid arthritis has become mature, and the complications, prognosis and functional rehabilitation of joint replacement are the main focus of research in this field. Conclusion: we conducted a comprehensive summary of the literature on rheumatoid arthritis joint replacement published between 2005 and 2024 using bibliometrics and visual analysis.This enabled us to identify the development trends and research hotspots in this field over the past two decades, offering valuable insights for researchers planning future studies in this area.

Advancements of biomaterial in hip replacement technology incorporating ceramic materials.

The increasing prevalence of hip joint diseases is closely linked to improved living standards and an aging population, leading to a rise in conditions like degenerative arthritis and severe hip injuries. These conditions cause significant pain and functional impairments, greatly reducing the quality of life for affected individuals. Total hip arthroplasty (THA) has become a well-established surgical intervention to address these debilitating conditions. Within the realm of hip replacement materials, ceramics have garnered attention for their exceptional wear resistance and ability to minimize complications, such as bone dissolution caused by wear particles. Ceramics, such as alumina and zirconia, offer biocompatibility and low wear rates, making them favourable choices for hip prostheses. However, despite these advantages, the use of ceramics in hip replacements is not without challenges. Issues such as ceramic fragmentation and abnormal joint noise have been noted, posing significant obstacles to their widespread adoption. This review explores the advancements in hip replacement technology with a particular focus on ceramic materials. It delves into the properties that make ceramics suitable for this application, such as their biocompatibility and mechanical strength, enhanced through advanced manufacturing techniques. Additionally, the review addresses the ongoing challenges, including strategies to mitigate the risk of fragmentation through material toughening and improved prosthesis design. Furthermore, it examines the phenomenon of abnormal joint noise, proposing solutions that involve refinements in implant design, surgical techniques, and post-operative patient management. The aim of this review is to provide a comprehensive overview of current advancements and future directions in the use of ceramic materials in hip replacement technology, highlighting the potential for improved patient outcomes and the need for continued research and innovation in this field.

Mycorrhizal and endophytic fungi structure forest below-ground symbiosis through contrasting but interdependent assembly processes.

BACKGROUND: Interactions between plants and diverse root-associated fungi are essential drivers of forest ecosystem dynamics. The symbiosis is potentially dependent on multiple ecological factors/processes such as host/symbiont specificity, background soil microbiome, inter-root dispersal of symbionts, and fungus-fungus interactions within roots. Nonetheless, it has remained a major challenge to reveal the mechanisms by which those multiple factors/processes determine the assembly of root-associated fungal communities. Based on the framework of joint species distribution modeling, we examined 1,615 root-tips samples collected in a cool-temperate forest to reveal how root-associated fungal community structure was collectively formed through filtering by host plants, associations with background soil fungi, spatial autocorrelation, and symbiont-symbiont interactions. In addition, to detect fungi that drive the assembly of the entire root-associated fungal community, we inferred networks of direct fungus-fungus associations by a statistical modeling that could account for implicit environmental effects. RESULTS: The fine-scale community structure of root-associated fungi were best explained by the statistical model including the four ecological factors/processes. Meanwhile, among partial models, those including background soil fungal community structure and within-root fungus-fungus interactions showed the highest performance. When fine-root distributions were examined, ectomycorrhizal fungi tended to show stronger associations with background soil community structure and spatially autocorrelated patterns than other fungal guilds. In contrast, the distributions of root-endophytic fungi were inferred to depend greatly on fungus-fungus interactions. An additional statistical analysis further suggested that some endophytic fungi, such as Phialocephala and Leptodontidium, were placed at the core positions within the web of direct associations with other root-associated fungi. CONCLUSION: By applying emerging statistical frameworks to intensive datasets of root-associated fungal communities, we demonstrated background soil fungal community structure and fungus-fungus associations within roots, as well as filtering by host plants and spatial autocorrelation in ecological processes, could collectively drive the assembly of root-associated fungi. We also found that basic assembly rules could differ between mycorrhizal and endophytic fungi, both of which were major components of forest ecosystems. Consequently, knowledge of how multiple ecological factors/processes differentially drive the assembly of multiple fungal guilds is indispensable for comprehensively understanding the mechanisms by which terrestrial ecosystem dynamics are organized by plant-fungal symbiosis.

Data-Driven Approach to Development of a Risk Score for Periprosthetic Joint Infections in Total Joint Arthroplasty Using Electronic Health Records.

BACKGROUND: Periprosthetic joint infection (PJI) is an uncommon, but serious complication in total joint arthroplasty. Personalized risk prediction and risk factor management may allow better preoperative assessment and improved outcomes. We evaluated different data-driven approaches to develop surgery-specific PJI prediction models using large-scale data from the electronic health records. METHODS: A large institutional arthroplasty registry was leveraged to collect data from 58,574 procedures of 41,844 patients who underwent at least one primary and/or revision hip and/or knee arthroplasty between 2000 and 2019. The registry dataset was augmented with additional clinical, procedural, and laboratory data from the electronic health records for more than 100 potential predictor variables. The main outcome was PJI within the first year after surgery. We implemented both traditional and machine learning methods for model development (lasso regression, relaxed lasso regression, ridge regression, random forest, stepwise regression, extreme gradient boosting, neural network) and used 10-fold cross-validation to calculate measures of model performance in terms of discrimination (c-statistic), cross-entropy loss, and calibration. RESULTS: All models performed similarly in predicting PJI risk, with negligible differences of less than 0.08 between the best and worst-performing models. The relaxed and fully relaxed lasso models using the Cox model structure outperformed the other models with concordances of 0.787 in primary hip arthroplasty and 0.722 in revision hip arthroplasty, with the number of predictors ranging from nine to 41. The concordances with the relaxed lasso models were 0.681 in primary and 0.699 in revision knee arthroplasty, with a higher number of predictors in the models. Predictors included in the models varied substantially across the four surgical groups. CONCLUSIONS: The incorporation of additional data from the electronic health records offers limited improvement in PJI risk stratification. Furthermore, improvement in PJI risk prediction was modest with the machine learning approaches and may not justify the added complexity.

RNA sequencing analysis reveals distinct gene expression patterns in infrapatellar fat pads of patients with end-stage osteoarthritis or rheumatoid arthritis.

Osteoarthritis (OA) and autoimmune-driven rheumatoid arthritis (RA) are inflammatory joint diseases that share partly similar symptoms but have different, inadequately understood pathogeneses. Adipose tissues, including intra-articular infrapatellar fat pad (IFP), may contribute to their development. Analysis of differentially expressed genes (DEGs) in IFPs could improve the diagnostics of these conditions and help to develop novel treatment strategies. The aim was to identify potentially crucial genes and pathways discriminating OA and RA IFPs using RNA sequencing analysis. We aimed to distinguish genetically distinct patient groups as a starting point for further translational studies with the eventual goal of personalized medicine. Samples were collected from arthritic knees during total knee arthroplasty of sex- and age-matched OA and seropositive RA patients (n = 5-6/group). Metabolic pathways of interest were investigated by whole transcriptome sequencing, and DEGs were analyzed with univariate tests, hierarchical clustering (HC), and pathway analyses. There was significant interindividual variation in mRNA expression patterns, but distinct subgroups of OA and RA patients emerged that reacted similarly to their disease states based on HC. Compared to OA, RA samples showed 703 genes to be upregulated and 691 genes to be downregulated. Signaling pathway analyses indicated that these DEGs had common pathways in lipid metabolism, fatty acid biosynthesis and degradation, adipocytokine and insulin signaling, inflammatory response, and extracellular matrix organization. The divergent mRNA expression profiles in RA and OA suggest contribution of IFP to the regulation of synovial inflammatory processes and articular cartilage degradation and could provide novel diagnostic and therapeutic targets.

Cross Cultural Validation of Oral Health Index Profile for Temporomandibular Disorders in Spanish Speaking Population.

OBJECTIVES: Structured patient-centred assessment is critical for improving care. OHIP-TMDs are a validated English-language outcome measure for temporomandibular disorders (TMD) which evaluates the biopsychosocial impact of TMD. Due to language and cultural changes, the original instrument's phrasing of its items may change when translated to Spanish. This study cross-culturally adapted and validated OHIP-TMDs for Spanish-speaking individuals with TMD. METHODS: OHIP-TMDs was forward-backward translated into Spanish (OHIP-TMDs-Sp) and cross-culturally adapted to a Hispanic population with TMD (Diagnostic Criteria for TMD n = 154) according to international norms. All patients completed the OHIP-TMDs-Sp, the Graded Chronic Pain Scale (GCPS), and Jaw Functional Limitation Scale (JFLS-20). A subsample (n = 30) recompleted the OHIP-TMDs-Sp after a 3-week washout to measure test-retest reliability using an intra-class correlation coefficient (ICC 2.1). OHIP-TMDs-Sp, JFLS-20, and GCPS were analysed for convergent validity and internal consistency. RESULTS: The sample with articular and muscular TMD diagnoses was 85.7% female with a mean age of 29.5. (SD 9.01). OHIP-TMDs-Sp had high internal reliability (Cronbach's Alpha = 0.95) and good test-retest reliability (ICC = 0.82; 95% CI = 0.57-0.93). In terms of convergent validity, the OHIP-TMDs-Sp demonstrated moderate to large positive correlations with the total JLFS-20 score (ρ = 0.72; p < 0.01), Mastication (ρ = 0.68; p < 0.01), Communication (ρ = 0.68; p < 0.001), as well to GCPS disability score (ρ = 0.59; p < 0.01), and characteristic pain intensity (ρ = 0.69; p < 0.01). CONCLUSIONS: The total score of OHIP-TMDs-Sp is reliable for assessing quality-of-life in Spanish-speaking TMD patients.

Genome-Wide Association Study of Temporomandibular Disorder-Related Pain in Finnish Populations.

BACKGROUND: Temporomandibular disorders (TMD) are multifactorial musculoskeletal pain and dysfunctions in temporomandibular joints (TMJs) and masticatory muscles. Genetic factors play a role in TMD-related pain, but only a few genome-wide association studies (GWAS) have been conducted. OBJECTIVE: The aim of this GWAS was to explore genetic factors associated with painful TMD in Finnish populations. METHODS: Data from two epidemiological surveys, the Northern Finland Birth Cohort 1966 (NFBC1966) and the Health 2000 Survey in Finland, including altogether 468 cases and 6833 controls, were used. Case definition was based on pain on palpation of masticatory muscles and/or TMJs. GWASs of the whole data and stratified by sex were conducted from both cohorts using additive models, followed by meta-analysis of the two cohorts. Replications of the previously reported TMD risk loci (rs73460075, DMD; rs4794106, SGCA; rs73271865, SP4; rs60249166, RXP2; rs1531554, BAHCCI; rs5862730, OTUD4/SMAD1; rs10092633, SFRP1; rs34612513, SOX14/CLDN18; rs878962, TSPAN9) were also investigated. RESULTS: Four genome-wide significant loci were found in sex-stratified analysis of NFBC1966, including associations at three loci in males (rs1023114, PRIM2, p = 5 × 10-9; rs4244867, ALG10, p = 3 × 10-8; rs79841648, ADCYAP1, p = 4 × 10-9) and one locus in females (rs148476652, DNER, p = 4 × 10-9). However, the results could not be replicated in the Health 2000 Survey or in the meta-analysis of these two cohorts. The previous TMD GWAS associations did not replicate in our data either. CONCLUSION: Several TMD pain-associated variants were found in sex-stratified analysis of NFBC1966, suggesting the role of neuroendocrine stress responses and central nervous system. These findings need to be confirmed in future studies.

Role of joint interactions in upper limb joint movements: a disability simulation study using wearable inertial sensors for 3D motion capture.

BACKGROUND: Restriction of movement at a joint due to disease or dysfunction can alter the range of motion (ROM) at other joints due to joint interactions. In this paper, we quantify the extent to which joint restrictions impact upper limb joint movements by conducting a disability simulation study that used wearable inertial sensors for three-dimensional (3D) motion capture. METHODS: We employed the Wearable Inertial Sensors for Exergames (WISE) system for assessing the ROM at the shoulder (flexion-extension, abduction-adduction, and internal-external rotation), elbow (flexion-extension), and forearm (pronation-supination). We recruited 20 healthy individuals to first perform instructed shoulder, elbow, and forearm movements without any external restrictions, and then perform the same movements with restriction braces placed to limit movement at the shoulder, elbow, and forearm, separately, to simulate disability. To quantify the extent to which a restriction at a non-instructed joint affected movement at an instructed joint, we computed average percentage reduction in ROM in the restricted versus unrestricted conditions. Moreover, we performed analysis of variance and post hoc Tukey tests (q statistic) to determine the statistical significance (p < 0.05 denoted using *) of the differences in ROM of an instructed joint in the unrestricted versus restricted conditions. RESULTS: Restricting movement at the shoulder led to a large reduction in the average ROM for elbow flexion-extension (21.93%, q = 9.34*) and restricting elbow movement significantly reduced the average ROM for shoulder flexion-extension (17.77%, q = 8.05*), shoulder abduction-adduction (19.80%, q = 7.60*), and forearm pronation-supination (14.04%, q = 4.96*). Finally, restricting the forearm significantly reduced the average ROM for shoulder internal-external rotation (16.71%, q = 3.81*) and elbow flexion-extension (10.01%, q = 4.27*). CONCLUSIONS: Joint interactions across non-instructed joints can reduce the ROM of instructed movements. Assessment of ROM in the real-world using 3D motion capture, for example using the WISE system, can aid in understanding movement limitations, informing interventions, and monitoring progress with rehabilitation.

A bayesian shared component spatial modeling approach for identifying the geographic pattern of local associations: a case study of young offenders and violent crimes in Greater Toronto Area.

Background setting: Traditional spatial or non-spatial regression techniques require individual variables to be defined as dependent and independent variables, often assuming a unidirectional and (global) linear relationship between the variables under study. This research studies the Bayesian shared component spatial (BSCS) modeling as an alternative approach to identifying local associations between two or more variables and their spatial patterns. Methods: The variables to be studied, young offenders (YO) and violent crimes (VC), are treated as (multiple) outcomes in the BSCS model. Separate non-BSCS models that treat YO as the outcome variable and VC as the independent variable have also been developed. Results are compared in terms of model fit, risk estimates, and identification of hotspot areas. Results: Compared to the traditional non-BSCS models, the BSCS models fitted the data better and identified a strong spatial association between YO and VC. Using the BSCS technique allowed both the YO and VC to be modeled as outcome variables, assuming common data-generating processes that are influenced by a set of socioeconomic covariates. The BSCS technique offered smooth and easy mapping of the identified association, with the maps displaying the common (shared) and separate (individual) hotspots of YO and VC. Conclusions: The proposed method can transform existing association analyses from methods requiring inputs as dependent and independent variables to outcome variables only and shift the reliance on regression coefficients to probability risk maps for characterizing (local) associations between the outcomes. Supplementary Information: The online version contains supplementary material available at 10.1186/s40163-024-00235-5.

Ganglion Cysts Arising From the Proximal Tibiofibular Joint: Treatment Approach and Associated Outcomes-A Systematic Review.

Background: Proximal tibiofibular joint (PTFJ) ganglion cyst is a rare condition with a high rate of recurrence. Optimal treatment has not yet been determined. Purpose: We aimed to answer the following questions: (1) What are the most common treatments for PTFJ cysts and their associated recurrence rates? (2) What are the risk factors for failure to completely recover from symptoms? (3) What are the risk factors for cyst recurrence? Methods: A systematic review was performed using PubMed and EMBASE databases. Studies were assessed for inclusion and exclusion criteria, and quality analysis following the PRISMA guidelines. Information on demographic, clinical, and treatment characteristics was retrieved from articles. Results: The most common surgical treatment was cyst excision (75.3%). Patients with PTFJ arthrodesis and PTFJ resection had the lowest recurrence rates at 0% and 4.4%, respectively. Complete recovery from symptoms was more common in PTFJ resection (70.8%) than in PTFJ arthrodesis (42.9%). Risk factors for failure to achieve complete recovery from symptoms included intraneural compromise (odds ratio [OR] = 3.93), cyst recurrence (OR = 6.04), and being a contact sports athlete (OR = 9.85). Ligation of the articular branch of the peroneal nerve (PN) was a protective factor (OR = 0.29). A history of knee arthritis was the most important risk factor for cyst recurrence (OR = 20.01); PTFJ arthrodesis was a protective factor (OR = 0.04). Conclusion: This systematic review of level-IV studies found PTFJ resection or arthrodesis to be the most effective treatment options. Intraneural compromise of the common peroneal nerve, cyst recurrence, and participation in contact sports are risk factors for incomplete symptom recovery, and ligation of the articular branch of the PN is a protective factor. Knee arthritis is a risk factor for cyst recurrence. More rigorous study is needed.

The impact of a payer-provider joint venture on healthcare value.

OBJECTIVE: To examine how a novel payer-provider joint venture (JV) between one payer and multiple competitive delivery systems in New Hampshire (NH), which included value-based payment, care management, and non-financial supports, impacted healthcare value and payer and provider group experiences. STUDY SETTING AND DESIGN: We conducted a mixed-methods study. We used a quasi-experimental longitudinal difference-in-differences design to examine the impact of the JV (which started in January 2016 and ended in December 2020) on healthcare utilization, quality, and spending, using members in Maine (ME) as a control group. We also analyzed patient uptake of the JV's care management program using routinely collected administrative data and assessed payer and provider group leaders' perspectives about the JV via semi-structured interviews. DATA SOURCES AND ANALYTIC SAMPLE: We used administrative and claims data from 2013 to 2019 in a commercially insured population under 65 years in NH and ME. We also used administrative data on care management eligibility and uptake and conducted semi-structured interviews with payer and provider group leaders affiliated with the JV. PRINCIPAL FINDINGS: The JV was associated with no sustained change in medical utilization, quality, and spending throughout the study period. In the first year of the JV, there was a $142 (95% confidence interval: $41, $243) increase in pharmaceutical spending per member and a 13% (4.4%, 25%) relative increase in days covered for diabetes medications. Only 15% of eligible members engaged in care management, which was a key component of the JV's multi-pronged approach. In a disconnect from the empirical findings, payer and provider group leaders believed that the JV reduced healthcare costs and improved quality. CONCLUSIONS: Our findings provide evidence for future payer-provider JVs and demonstrate the importance of having a valid control group when evaluating JVs and value-based payment arrangements.

The Correlation Between Cervical Proprioception and Scapular Dyskinesis in Patients With Neck Pain: A Case-Control Study.

Introduction Neck pain is common among office workers, and the assessment of cervical proprioception and scapular dyskinesis is key in the management of patients with neck pain. While some studies have shown the relevance of both factors in neck pain patients, the correlation between the two parameters has not yet been investigated. Hence, this study aimed to determine the correlation between cervical proprioception and scapular dyskinesis in workplace computer users without neck pain (control group) versus those with neck pain (case group). Methodology A case-control, correlational study was performed within office settings; based on the selection criteria, 88 participants were included and categorized into two groups consisting of 44 workplace computer users without neck pain in the control group (Group A) and 44 workplace computer users with neck pain in the case group (Group B). Cervical proprioception was evaluated by using the joint position error (JPE) test and scapular dyskinesis was assessed using the modified lateral scapular slide test (MLSST). Results There was a statistically significant difference in cervical proprioception and scapular dyskinesis between the case and control groups (p<0.001). Workplace computer users with neck pain showed greater JPE compared to those without neck pain, and scapular dyskinesis was observed in the case group. Moreover, Spearman's correlation coefficient showed a significant correlation between cervical proprioception and scapular dyskinesis in workplace computer users with neck pain. Conclusions The present study provides guidance on the assessment as well as management of JPE with different positions of scapular dyskinesia. The evaluation of scapular dyskinesis is frequent clinically; given its positive correlation, managing JPE in neck pain patients is feasible.

Challenges in Managing Vancomycin Flushing Syndrome Following Vancomycin-Loaded Bone Cement for Periprosthetic Joint Infection: A Case Report.

Periprosthetic joint infection (PJI) is a critical complication following arthroplasties, often treated with a two-stage revision using antibiotic-loaded bone cement spacers. Although these spacers can effectively manage infections, they occasionally cause severe adverse reactions. We reported the case of a 68-year-old female who developed vancomycin flushing syndrome (VFS), previously known as the red man syndrome, following the insertion of a vancomycin-loaded bone cement spacer during the first-stage revision surgery for PJI after undergoing total knee arthroplasty. Six hours postoperatively, she developed pruritus, diffuse rash, tachycardia, and hypotension. VFS was diagnosed based on clinical presentation after excluding other potential causes. She was treated with intravenous epinephrine, antihistamines, steroids, and fluid resuscitation without requiring spacer removal. The patient recovered uneventfully, underwent second-stage reimplantation after 6 weeks, and remained asymptomatic at 2-year follow-up. This highlights the importance of anticipating and managing this potentially severe reaction through a multidisciplinary approach, considering the risks and benefits of retaining versus removing antibiotic-loaded bone-cement spacers.

Foot-Ankle Mechanical Transmission: Age Effects and the Relation to Ankle Push-Off During Walking.

Older adults walk with less push-off power than younger adults. Principally attributed to plantar flexor dysfunction, growing evidence implicates interactions between the foot and ankle as critical for generating effective push-off. Our purposes were to measure age effects on foot-ankle mechanical transmission (FAMT, ie, the ratio between metatarsal phalangeal extension and medial gastrocnemius fascicle length change), and its association with ankle push-off during walking. We hypothesized that (1) FAMT would be lesser in older adults and (2) lesser FAMT would positively correlate with slower preferred speeds and reduced ankle push-off intensity. Fourteen younger adults (25 [6] y) and 15 older adults (71 [5] y) participated. Older adults had 45% to 48% lesser FAMT than younger adults from 0° to 30° metatarsal phalangeal extension-an age-related difference that was not evident from 30° to 60° metatarsal phalangeal extension. However, we did not find any significant correlations with walking outcomes. Assuming our findings can be replicated in future studies and represent a genuine phenomenon of relevance to the biomechanics of aging gait, we suspect that compensations may be discovered in older adults to explain this lack of significance. Future work should include measures of muscle activities and foot mechanics during walking and/or perform more controlled comparisons at fixed speeds.

Radiological Spinopelvic Parameters Can Be Risk Factors for Early Total Hip Replacement After Spine Fusion.

BACKGROUND: Interest in the correlation between the spinopelvic complex and its radiographic parameters in early total hip arthroplasty has been increasing. This study investigated whether radiological spinopelvic parameters are risk factors for early total hip replacement (THR) within 1 year of spinal fusion surgery. The primary research question focused on identifying specific spinopelvic changes that may lead to early THR. METHODS: We retrospectively analyzed patients who underwent lumbar spinal fusion between 2016 and 2021. The patients were divided into 2 groups: patients who underwent early THR (n = 35) and patients who did not (n = 213). Spinopelvic parameters, including pelvic incidence (PI), sacral slope (SS), pelvic tilt, lumbar lordosis, thoracolumbar kyphosis (TLK), sagittal vertical axis, and thoracic kyphosis (TK), were measured before and after surgery. The statistical analyses included inverse probability of treatment weighting, independent t tests, χ 2 tests, and logistic regression analyses. RESULTS: A total of 248 patients were included in the study. The pre- and postoperative TLK and TK angles were significantly smaller in the early THR group than in the late THR group. Increases in the PI and SS after surgery were significant risk factors. The use of interbody fusion techniques was associated with a higher rate of early THR. The difference in the PI minus lumbar lordosis before and after surgery was also significantly correlated with early THR. CONCLUSIONS: Abnormal spinopelvic parameters, especially reduced TLK and TK angles and increased PI and SS, are risk factors for early THR. CLINICAL RELEVANCE: Changes in spinopelvic parameters can lead to rapid hip joint destruction, which highlights the need for careful preoperative evaluation and postoperative monitoring of patients to prevent early THR.

FinSafeNet: securing digital transactions using optimized deep learning and multi-kernel PCA(MKPCA) with Nyström approximation.

With the swift advancement of technology and growing popularity of internet in business and communication, cybersecurity posed a global threat. This research focuses new Deep Learning (DL) model referred as FinSafeNet to secure loose cash transactions over the digital banking channels. FinSafeNet is based on a Bi-Directional Long Short-Term Memory (Bi-LSTM), a Convolutional Neural Network (CNN) and an additional dual attention mechanism to study the transaction data and influence the observation of various security threats. One such aspect is, relying these databases in most of the cases imposes a great technical challenge towards effective real time transaction security. FinSafeNet draws attention to the attack and reproductive phases of Hierarchical Particle Swarm Optimization (HPSO) feature selection technique simulating it in a battle for extreme time performance called the Improved Snow-Lion optimization Algorithm (I-SLOA). Upon that, the model then applies the Multi-Kernel Principal Component Analysis (MKPCA) accompanied by Nyström Approximation for handling the MKPCA features. MKPCA seeks to analyze and understand a non-linear structure of data whereas, Nyström Approximation reduces the burden on computational power hence allows the model to work in situations where large sizes of datasets are available but with no loss of efficiency of the model. This causes FinSafeNet to work easily and still be able to make accurate forecasts. Besides tackling feature selection and dimensionality reduction, the model presents advanced correlation measures as well as Joint Mutual Information Maximization to enhance variable correlation analysis. These improvements further help the model to detect the relevant features in transaction data that may present a threat to the security of the system. When tested on commonly used database for testing banks performance, for instance the Paysim database, FinSafeNet significantly improves upon the previous and fundamental approaches, achieving accuracy of 97.8%.

Therapeutic potential of hyaluronic acid hydrogel combined with bone marrow stem cells-conditioned medium on arthritic rats' TMJs.

Conditioned media (CM) is derived from mesenchymal stem cells (MSC) culture and contains biologically active components. CM is easy to handle and reduces inflammation while repairing injured joints. Combination therapy of the CM with cross-linked hyaluronic acid (HA) could ameliorate the beneficial effect of HA in treating degenerative changes of articulating surfaces associated with arthritic rats' temporomandibular joints (TMJs). This study aimed to evaluate the therapeutic potential of HA hydrogel combined with bone marrow stem cells-conditioned medium (BMSCs-CM) on the articulating surfaces of TMJs associated with complete Freund's adjuvant (CFA)-induced arthritis. Fifty female Sprague-Dawley rats were divided randomly into five equal groups. Rats of group I served as the negative controls and received intra-articular (IA) injections of 50 µl saline solution, whereas rats of group II were subjected to twice IA injections of 50 µg CFA in 50 µl; on day 1 of the experiment to induce persistent inflammation and on day 14 to induce arthritis. Rats of group III and IV were handled as group II and instead, they received an IA injection of 50 µl HA hydrogel and 50 µl of BMSCs-CM, respectively. Rats of group V were given combined IA injections of 50 µl HA hydrogel and BMSCs-CM. All rats were euthanized after the 4th week of inducing arthritis. The joints were processed for sectioning and histological staining using hematoxylin and eosin, Masson's trichrome and toluidine blue special staining, and immunohistochemical staining for nuclear factor-kappa B (NF-κB). SPSS software was used to analyze the data and one-way analysis of variance followed by post-hoc Tukey statistical tests were used to test the statistical significance at 0.05 for alpha and 0.2 for beta. In the pooled BMSC-CM, 197.14 pg/ml of platelet-derived growth factor and 112.22 pg/ml of interleukin-10 were detected. Compared to TMJs of groups III and IV, TMJs of group V showed significant improvements (P = 0.001) in all parameters tested as the disc thickness was decreased (331.79 ± 0.73), the fibrocartilaginous layer was broadened (0.96 ± 0.04), and the amount of the trabecular bone was distinctive (19.35 ± 1.07). The mean values for the collagen amount were increased (12.29 ± 1.38) whereas the mean values for the NF-κB expression were decreased (0.62 ± 0.15). Combination therapy of HA hydrogel and BMSCs-CM is better than using HA hydrogel or BMSCs-CM, separately to repair degenerative changes in rats' TMJs associated with CFA-induced arthritis.