Exploring Guolin Qigong (Mind-Body Exercise) for Improving Cancer Related Fatigue in Cancer Survivors: A Mixed Method Randomized Controlled Trial Protocol.

BACKGROUND: Cancer-related fatigue and its associated symptoms of sleep disorder and depression are prevalent in cancer survivors especially among breast, lung, and colorectal cancer survivors. While there is no gold standard for treating cancer-related fatigue currently, studies of mind-body exercises such as Qigong have reported promise in reducing symptoms. This study was designed to evaluate the feasibility and effect of Guolin Qigong on cancer-related fatigue and other symptoms in breast, lung and colorectal cancer survivors while exploring their perceptions and experiences of Guolin Qigong intervention. METHODS: This is an open-label randomized controlled trial with 60 participants divided into 2 study groups in a 1:1 ratio. The intervention group will receive 12 weeks of Guolin Qigong intervention with a 4-week follow-up while control will receive usual care under waitlist. The primary outcome will be feasibility measured based on recruitment and retention rates, class attendance, home practice adherence, nature, and quantum of missing data as well as safety. The secondary subjective outcomes of fatigue, sleep quality and depression will be measured at Week-1 (baseline), Week-6 (mid-intervention), Week-12 (post-intervention), and Week-16 (4 weeks post-intervention) while an objective 24-hour urine cortisol will be measured at Week-1 (baseline) and Week-12 (post-intervention). We will conduct a semi-structured interview individually with participants within 3 months after Week-16 (4 weeks post-intervention) to obtain a more comprehensive view of practice adherence. DISCUSSION: This is the first mixed-method study to investigate the feasibility and effect of Guolin Qigong on breast, lung, and colorectal cancer survivors to provide a comprehensive understanding of Guolin Qigong's intervention impact and participants' perspectives. The interdisciplinary collaboration between Western Medicine and Chinese Medicine expertise of this study ensures robust study design, enhanced participant care, rigorous data analysis, and meaningful interpretation of results. This innovative research contributes to the field of oncology and may guide future evidence-based mind-body interventions to improve cancer survivorship. TRIAL REGISTRATION: This study has been registered with ANZCTR (ACTRN12622000688785p), was approved by Medical Research Ethic Committee of University Malaya Medical Centre (MREC ID NO: 2022323-11092) and recognized by Western Sydney University Human Research Ethics Committee (RH15124).

The spin move to facilitate antegrade coronoid fixation in terrible triad injuries.

BACKGROUND: The role of the coronoid process in elbow instability has been established. When necessary, coronoid fixation can be challenging. Placing fixation perpendicular to the fracture requires achieving a trajectory as close as possible to the midline axis of the proximal ulna, either from anterior to posterior or vice versa. The aim of this study was to determine whether coronoid exposure-and the ability to place fixation from anterior to posterior-is improved via a lateral extensor-splitting approach with forearm supination, that is, the "spin move," with progressive stages of lateral elbow instability. METHODS: The lateral extensor-splitting approach was performed on 9 cadaveric upper extremities. A 0.157-mm (0.062-inch) wire was drilled perpendicularly into the lateral aspect of the humerus just proximal to the lateral epicondyle. A second wire was drilled into the tip of the coronoid, aiming for a drill trajectory as close as possible to the midline axis. The angle between the 2 wires was measured as the initial angle. Three stages of progressive lateral elbow instability were produced by sequential release of the lateral ulnar collateral ligament (LUCL), common extensor origin (CEO), and posterior capsule. At each stage, the spin move was performed and the angle between the 2 wires was measured. The difference between this angle and the initial angle was calculated, with the average value reported as the Δ angle for each stage. The average difference between each stage and the next stage was reported. RESULTS: The spin move resulted in Δ angles of 10.3° with the LUCL released, 20° with the CEO released, and 29.1° with the posterior capsule released. Progressing from LUCL release to CEO release to posterior capsule release, the Δ angle between the K-wires increased an average of 9.6° from the LUCL stage to the CEO stage and 9.1° from the CEO stage to the posterior capsule stage. CONCLUSION: The spin move is a simple maneuver that can improve exposure of the coronoid process regardless of the degree of elbow instability. This may facilitate a more perpendicular screw, bone tunnel, or suture anchor trajectory via the lateral approach, reducing the need for posterior-to-anterior fixation. The improved exposure is inferred from the differences in the K-wire angles with and without the spin move. This study has also quantified the change in coronoid exposure using the angles of the wires with progressive release of the LUCL, CEO, and posterior capsule. If necessary, releasing the CEO or posterior capsule with eventual repair may allow improved coronoid fixation from the lateral approach.

Barriers to family history collection among Spanish-speaking primary care patients: a BRIDGE qualitative study.

Objectives: Family history is an important tool for assessing disease risk, and tailoring recommendations for screening and genetic services referral. This study explored barriers to family history collection with Spanish-speaking patients. Methods: This qualitative study was conducted in two US healthcare systems. We conducted semi-structured interviews with medical assistants, physicians, and interpreters with experience collecting family history for Spanish-speaking patients. Results: The most common patient-level barrier was the perception that some Spanish-speaking patients had limited knowledge of family history. Interpersonal communication barriers related to dialectical differences and decisions about using formal interpreters vs. Spanish-speaking staff. Organizational barriers included time pressures related to using interpreters, and ad hoc workflow adaptations for Spanish-speaking patients that might leave gaps in family history collection. Conclusions: This study identified multi-level barriers to family history collection with Spanish-speaking patients in primary care. Findings suggest that a key priority to enhance communication would be to standardize processes for working with interpreters. Innovation: To improve communication with and care provided to Spanish-speaking patients, there is a need to increase healthcare provider awareness about implicit bias, to address ad hoc workflow adjustments within practice settings, to evaluate the need for professional interpreter services, and to improve digital tools to facilitate family history collection.

Imaging and Laboratory Workup for Hand Infections.

Hand infections can lead to significant morbidity if not treated promptly. Most of these infections, such as abscesses, tenosynovitis, cellulitis, and necrotizing fasciitis, can be diagnosed clinically. Laboratory values, such as white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and recently, procalcitonin and interleukin-6, are helpful in supporting the diagnosis and trending disease progression. Radiographs should be obtained in all cases of infection. Ultrasound is a dynamic study that can provide quick evaluation of deeper structures but is operator dependent. Computed tomographic and MRI studies are useful for evaluating deep space or bony infections and preoperative surgical planning.

Predictors of Septic Wrist: A Dual-Center 10-Year Review of Risk Factors.

Introduction Expeditious and accurate diagnosis of septic wrist arthritis is essential to prevent further cartilage damage, systemic infection, osteomyelitis, and loss of limb. There is limited literature on the incidence and clinical factors that are predictive of septic wrist arthritis. Objective We aimed to investigate the incidence of septic wrist arthritis and identify risk factors and laboratory values associated with septic wrist arthritis. Materials and Methods Data were collected on adult patients presenting with a painful, swollen wrist to two level 1 urban hospitals from 2004 to 2014. Demographics, comorbidities, and laboratory values of patients who had wrist aspiration were collected. Results There was an overall incidence of 0.4%. Increased synovial white blood cells (WBC), being febrile, positive blood cultures, and smoking were significantly associated with septic wrist arthritis on univariate analysis. Synovial WBC was also found to be significant on multivariate analysis. A synovial WBC of 87,750 cells/µL had an optimal sensitivity and specificity of 73% and 86%, respectively, for diagnosing septic wrist arthritis. Conclusion Synovial WBC can be a useful diagnostic tool for septic wrist arthritis. In addition, positive blood cultures, being febrile, and smoking history can help predict septic wrist arthritis in patients with presenting with painful, swollen wrists.

Length of stay and 30-day readmissions after isolated humeral shaft fracture open reduction and internal fixation compared to intramedullary nailing.

INTRODUCTION: Open reduction with internal fixation (ORIF) and intramedullary nailing (IMN) have similar union rates for treating humerus shaft fractures, but IMN leads to increased incidence of shoulder impingement and reoperation. The difference in 30-day readmission rate and length of stay (LOS) between these procedures is unknown. The objective of the study was to compare 30-day unplanned readmissions and length of stay between humeral shaft fractures fixed with either ORIF or IMN. METHODS: The nationwide readmissions database (NRD) was queried for patients with humeral shaft fractures treated with ORIF or IMN between 2015-2016. IMN cases were propensity matched to ORIF cases based on demographic and co-morbid variables. Multivariable logistic regression determined if treatment modality was an independent risk factor for 30-day readmission or length of stay >3 days. RESULTS: There were 406 patients treated with IMN matched to 406 patients treated with ORIF. The 30-day readmission rate was 6.4% for IMN and 4.9% for ORIF (p = 0.45), and the median LOS was 3 days for each group (p = 0.45). Congestive heart failure (CHF)(OR=2.7, p = 0.04), depression (OR=3.3, p = 0.0008), and electrolyte abnormality (OR=3.6, p = 0.0003) were independent risk factors for readmission. Older age (OR=1.02, p = 0.03), CHF (OR=2.4, p = 0.03), electrolyte abnormality (OR=2.6, p = 0.0001), obesity (OR=2.8, p<0.0001), Medicaid (OR=2.1, p = 0.04), discharge to a facility (OR = 5.2, p<0.0001), discharge with home health services (OR=2.4, p = 0.0003), and open fracture (OR=2.3, p = 0.01) were independent risk factors for LOS >3 days. Procedure (ORIF vs. IMN) was not a predictor of 30-day readmission or LOS >3 days. CONCLUSION: Comorbid conditions are risk factors for 30-day readmission and increased LOS. Comorbidity, discharge disposition, and open fractures are risk factors for increased LOS. Treating humeral shaft fractures with either ORIF or IMN did not affect readmission or length of stay.

A Biomechanical Evaluation of the DRUJ After Distal Oblique Bundle Reconstruction.

PURPOSE: Distal oblique bundle (DOB) reconstruction for distal radioulnar joint (DRUJ) instability is an alternative to the Adams 2-incision distal radioulnar ligament reconstruction. The DOB reconstruction offers a single incision and is a technically less demanding procedure requiring a shorter tendon autograft. The DOB and Adams reconstruction may provide similar stability. This study sought to compare the biomechanical stability of the 2 DRUJ reconstructions. We hypothesized that DOB reconstruction would result in equivalent DRUJ translation, cyclic loading to failure, and maximal load to failure compared with the Adams reconstruction. METHODS: Ten fresh-frozen cadaver arms underwent DOB or Adams reconstructions. Volar, dorsal, and total translation of the radius relative to the ulna at the DRUJ were measured before and after each reconstruction. Translation was measured with a 20-N force in neutral position and 60° in pronation and supination. Measurements were obtained using a custom jig and electromagnetic motion-tracking system sensors. Total cycles and maximal load to failure of each reconstruction were measured and recorded using an electromechanical testing machine. RESULTS: There was a DOB incidence of 70%. Distal radioulnar joint translation, total cycles, and failure load were similar for the 2 reconstructions. On average, the DOB reconstruction had less dorsal translation than did the Adams in supination. Translation in the DOB reconstruction was similar to that of native DRUJs. In supination, on average, the Adams reconstruction had greater total, volar, and dorsal translation compared with native DRUJs. CONCLUSIONS: In terms of translation, cyclical loading, and maximal load to failure, the DOB reconstruction for DRUJ instability is similar to the Adams reconstruction. CLINICAL RELEVANCE: This pilot study supports the DOB reconstruction as a possible alternative to the Adams reconstruction for DRUJ instability. The DOB reconstruction may theoretically reduce patient morbidity because it requires only one incision and a shorter tendon graft. However, further clinical and cadaveric studies are required to determine biomechanical equivalence and impact on patient morbidity.

Suprascapular Ligament Release From an Anterior Approach: An Anatomic Feasibility Study.

PURPOSE: The results of spinal accessory to suprascapular nerve transfers have been less reliable than other nerve transfers in the upper limb, possibly owing to compression of the nerve by the suprascapular ligament. The posterior approach has been advocated to allow for release of the ligament. The purpose of this study was to determine whether a ligament release is possible from the anterior approach. METHODS: Nine fresh-frozen cadavers were dissected to determine whether the ligament could be approached and released from the anterior approach. Complete ligament release was demonstrated by subluxation of the nerve out of the suprascapular notch. RESULTS: Ligament release was achieved in all specimens, although in one, confirmation of complete release required a posterior approach. CONCLUSIONS: Release of the suprascapular ligament to eliminate a potential source of compression of the suprascapular nerve during spinal accessory to suprascapular nerve transfer is possible through an anterior approach. CLINICAL RELEVANCE: Release of the suprascapular ligament through an anterior approach allows this procedure to be performed through the same approach as brachial plexus exploration and spinal accessory nerve to suprascapular nerve transfer. This method could reduce surgical time and patient repositioning and avoid additional incisions.

A Comparison of Two Dosing Regimens of ASA Following Total Hip and Knee Arthroplasties.

BACKGROUND: The purpose of this study was to compare short-term side effects of aspirin (ASA) 325 mg vs ASA 81 mg orally twice daily (PO BID) when used as thromboembolic prophylaxis following primary total joint arthroplasty. METHODS: A 1-year prospective cohort study was performed on 643 primary unilateral total joint arthroplasty patients operated on by a single surgeon. Two hundred eighty-two patients were administered ASA 325 mg PO BID and 361 patients were administered ASA 81 mg PO BID for 1 month. A questionnaire assessing the side effects of ASA intake was administered 1 month postoperatively. RESULTS: The overall rate of gastrointestinal side effects (GI upset and nausea) was 1.9%, but ASA 325 mg had a higher rate 9/282 (3.2%) than ASA 81 mg 3/361 (0.8%), P = .04. Overall GI bleeding was 0.9%, with 2/282 (0.7%) in the ASA 325 mg group, vs 4/361 (1.1%) in the ASA 81 mg group, P = .70. One patient in the ASA 81 mg group (0.3%) developed a deep vein thrombosis. No patient developed pulmonary embolism, periprosthetic joint infection, tinnitus, wheezing and/or shortness of breath, chest pain, or headaches. In the ASA 325 mg group, 9/282 (3.2%) discontinued ASA and in the ASA 81 mg group, 8/361 (2.2%) discontinued ASA, P = .47. Four patients in the ASA 325 group (1.4%) changed to ASA 81 mg. CONCLUSION: ASA 81 mg is associated with significantly less GI distress and nausea compared with ASA 325 mg. GI bleeding was equally prevalent between the 2 dosing regimens, so patients need to be informed of this risk regardless of the ASA dose.

Higher Acetabular Anteversion in Direct Anterior Total Hip Arthroplasty: A Retrospective Case-Control Study.

BACKGROUND: Surgical approach is known as a risk factor that influences cup malposition while performing total hip arthroplasty (THA). However, no study has been conducted comparing cup positioning between the supine direct anterior (DA) and supine direct lateral (DL) THA approaches. QUESTIONS/PURPOSES: (1) Is there a difference in acetabular cup positioning between supine DA and supine DL THA approaches? (2) Are there differences in complications based on acetabular cup positioning between the two approaches? METHODS: From 2012 to 2014, 186 patients who underwent primary THAs using DA approach were matched with 186 patients using DL approach by body mass index, age, and gender. Cup anteversion and abduction angles were measured from standing anteroposterior pelvis radiographs by two blinded observers. The Lewinnek safe zone was used as the standard for cup positioning. Cup anteversion, abduction angles, and complications were recorded and compared. RESULTS: Cup anteversion was on average 3° higher in the DA approach compared to the DL approach. The abduction angle for the DA approach was equivalent to the DL approach both averaging 46° to 47°. There were more DA hips outside of the safe zone (10%) for anteversion than DL (3%) hips. There were no differences in complications between DA and DL approaches. CONCLUSION: There is a tendency to antevert the acetabular cup when performing THAs using the DA approach, and one must be mindful of this when implanting the acetabular component.

Epidemiology of Elbow Dislocations in High School Athletes.

BACKGROUND: The elbow is the second most commonly dislocated major joint in the general population. Previous studies that focused on emergency department populations indicate that such injuries occur most frequently among adolescent athletes. PURPOSE: To describe the epidemiological rates and patterns of sports-related elbow dislocations in high school athletes. STUDY DESIGN: Descriptive epidemiology study. METHODS: Sports-related injury data for the 2005-2006 through 2013-2014 academic years from a national convenience sample of high schools participating in the National High School Sports-Related Injury Surveillance Study (High School Reporting Information Online [RIO]) were analyzed. RESULTS: Certified athletic trainers participating in High School RIO reported 115 of 1246 (9.2%) elbow injuries as elbow dislocations. A total of 30,415,179 athlete exposures (AEs) were reported during the study period, resulting in a dislocation rate of 0.38 per 100,000 AEs. The majority of the dislocations resulted from boys' wrestling (46.1%) and football (37.4%). Elbow dislocation rates were higher in competition than in practice. Also, 91.3% of dislocations occurred in boys' sports. Among both boys (60.4%) and girls (88.9%), the majority of injuries occurred during varsity sports activities. Contact with another person was the most common injury mechanism (46.9%), followed by contact with the playing surface (46.0%). Dislocations more commonly resulted in removal from play for more than 3 weeks (23.4% vs 6.9%, respectively) or medical disqualification (36.9% vs 7.0%, respectively) compared with other elbow injuries. Dislocations were also more likely to result in surgical treatment than other elbow injuries (13.6% vs 4.7%, respectively). CONCLUSION: In high school athletes, elbow dislocations result in longer removal from play and are more likely to require surgical treatment than nondislocation-associated elbow injuries. Rates and patterns of elbow dislocations vary by sport. In high-risk sports, focused sport-specific prevention strategies may help to decrease the rates and severity of elbow dislocation injuries.

First-rib stress fracture in two adolescent swimmers: a case report.

First-rib stress fractures have been described in adolescent athletes in various sports, with only one prior case report of first-rib stress fractures in an adolescent female swimmer. There is a need for research on the cause, management, and prevention of these injuries as they lead to significant morbidity and critical time away from sport for these aspiring athletes. We aimed to describe first-rib stress fractures as a potential cause for non-specific atraumatic chronic shoulder pain in adolescent swimmers and to discuss the different presentations, unique risk factors, treatment, and potential injury prevention strategies of such fractures. We discussed two such cases which were successfully treated with activity modification with restriction of all overhead activity, gradually progressive physical therapy and a return to swimming protocol. First-rib stress fractures can vary in presentation and should be in the differential diagnosis in adolescent swimmers with chronic shoulder pain. These injuries can be successfully managed with rest from overhead activities and physical therapy. Gradual return to competitive swimming can be achieved even with non-union of a first-rib stress fracture. Emphasis on balanced strength training in different muscle groups and proper swimming technique is essential to prevent these injuries.

Francis Daniels Moore: one of the brightest minds in the surgical field.

Francis Daniels Moore was a pioneer ahead of his time who made numerous landmark contributions to the field of surgery, including the understanding of metabolic physiology during surgery, liver and kidney transplant, and the famous Study on Surgical Services of the United States (SOSSUS) report of 1975 that served for decades as a guideline for development of surgical residencies. He was the epitome of what a physician should be, a compassionate and dedicated surgeon, innovative scientist, and a medical professional dedicated to quality medical education across all specialties.

Social networks in cardiovascular disease management.

Cardiovascular disease remains the leading cause of death in the USA. Social networks have a positive association with obesity, smoking cessation and weight loss. This article summarizes studies evaluating the impact of social networks on the management of cardiovascular disease. The 35 studies included in the article describe the impact of social networks on a decreased incidence of cardiovascular disease, depression and mortality. In addition, having a large-sized social network is also associated with better outcomes and improved health. The role of pharmacists is beginning to play an important role in the patient-centered medical home, which needs to be incorporated into social networks. The patient-centered medical home can serve as an adaptive source for social network evolvement.