Partial ablation of frontal cortical subplate leads to developmental abnormalities in KCC2 in the prefrontal cortex.

During early brain development, the subplate relays thalamocortical afferents to the overlying cortex. Disconnection of thalamic inputs to the prefrontal cortex by lesions of the subplate of the developing prefrontal cortex at early neonatal periods result in adult-onset behavioral abnormalities reminiscent of positive, negative, and cognitive symptoms of schizophrenia. Delayed maturation of γ-amino butyric acid (GABA) function may contribute to certain abnormalities of the prefrontal cortex and clinical manifestations of schizophrenia. Lesions to the subplate have also been implicated in developmental abnormalities of GABA neurotransmission in somatosensory and visual cortices. Therefore, we sought to examine the effects of subplate lesions in the developing prefrontal cortex of rats on the expression of GABA markers [parvalbumin and glutamic acid decarboxylase (GAD67)] and proteins responsible for GABAergic synaptic maturation [potassium-chloride cotransporter (KCC2) and sodium­potassium-chloride cotransporter (NKCC1)]. Lesioned and control rats were sacrificed between postnatal days (P) 5 and 90 and immunolabeled for parvalbumin, GAD67, KCC2, and NKCC1 in the prelimbic area of the prefrontal cortex. We found decreased immunoreactivity of KCC2 on neuronal cell membranes at P11 compared to control rats. However, the overall immunoreactivity of KCC2 and NKCC1 did not differ between lesion and control animals at all time points studied. Lesioned rats also showed decreased expression of parvalbumin, but not GAD67. Our results indicate that mechanisms underlying trafficking and membrane binding of KCC2 may contribute to altered GABA receptor function during development in schizophrenia.

Acetabular Revision Arthroplasty Using an Uncemented Deep Profile Jumbo Component: A Ten to Sixteen Year Follow-Up Study.

BACKGROUND: The purpose of this study is to evaluate the outcome of revision total hip arthroplasty using an uncemented deep profile jumbo acetabular component in patients who had been followed for a minimum of 10 years postoperatively. METHODS: Between 1997 and 2001, 61 revision total hip arthroplasties were performed in 58 patients, with use of the +5 Deep Profile acetabular shell. The outcome with regard to retention vs re-revision of the acetabular component was determined for every hip. At a mean of 13 years (range 10-16) postoperatively, 30 patients (32 hips) were living. The Harris hip score, radiographic results, complications, and Kaplan-Meier survivorship were evaluated. RESULTS: In the entire cohort of 61 hips, 4 acetabular components have been re-revised. Two shells were re-revised for sepsis: 1 shell was re-revised for aseptic loosening and 1 for recurrent dislocation. In the 32 hips followed for a minimum of 10 years postoperatively, 2 cups have been re-revised: 1 for aseptic loosening and 1 for recurrent dislocation. One additional shell was loose by radiographic criteria. With failure defined as re-revision for any reason, implant survival (95% confidence interval) was 92.6% (81.0-97.2) at 16 years. With failure defined as re-revision for aseptic loosening, implant survival was 97.4% (82.8-99.6) at 16 years. CONCLUSION: Revision total hip arthroplasty with the +5 Deep Profile acetabular component was associated with a good rate of survival at 16 years.

Total Hip Arthroplasty With an Uncemented Tapered Femoral Component in Patients Younger Than 50 Years of Age: A Minimum 20-Year Follow-Up Study.

BACKGROUND: Previously, we reported the mean 16-year results of primary uncemented total hip arthroplasty using a tapered femoral component in patients <50 years. The purpose of this study was to update our previous report using the Taperloc femoral component in young patients who had been followed for a minimum of 20 years postoperatively. METHODS: Between 1983 and 1990, 108 consecutive uncemented total hip arthroplasties were performed in 91 patients of age <50 years, with use of the Taperloc femoral component. Every patient was followed for a minimum of 20 years after surgery or until death. At a mean of 25 (range, 20-29 years) postoperatively, 76 patients (91 hips) were living. The Harris Hip Score, radiographic results, complications, and Kaplan-Meier survivorship were evaluated. RESULTS: In the entire cohort of 108 hips, 9 femoral components (8%) have been revised, none for aseptic loosening. Five well-fixed stems were removed during acetabular revision, 3 stems were revised for infection, and 1 stem was exchanged because of a peroneal nerve palsy. Distal femoral osteolysis was identified around 1 hip. With failure defined as stem removal for any reason, implant survival was 90% (CI = 82-95) at 29 years. With failure defined as stem removal for aseptic loosening, implant survival was 100% at 29 years. CONCLUSION: Primary total hip arthroplasty with the Taperloc femoral component in young patients was associated with a high rate of survival at 29 years.

Uncemented total hip arthroplasty using a tapered femoral component in obese patients: an 18-27 year follow-up study.

The purpose of this study was to evaluate the efficacy of an uncemented tapered femoral component in obese patients at a mean follow-up of 23 years. We retrospectively reviewed 119 consecutive uncemented total hip arthroplasties in 105 obese patients using a tapered femoral component between 1983 and 1987. The mean body mass index of these patients was 34 (range 30-47). Complete clinical and radiographic follow-up was obtained on the 55 hips in 47 patients who survived a minimum of 18 years (range 18-27 years). Three femoral components (6%) have been revised, none for aseptic loosening. One was loose by radiographic criteria. These results demonstrate that an uncemented tapered stem can provide excellent fixation in obese patients out to 27 years.

Virtual Reality for Developing Patient-Facing Communication Skills in Medical and Graduate Education: Protocol for a Scoping Review.

BACKGROUND: Clinician-patient communication is an integral component in providing quality medical care. However, research on clinician-patient communication has shown overall patient discontent with provider communication skills. While virtual reality (VR) is readily used for procedural-based learning in medical education, its potential for teaching patient-facing communication skills remains unexplored. This scoping review aims to evaluate the effectiveness and feasibility of VR applications used for patient-facing communication skills development in medical education. OBJECTIVE: The primary objective is to synthesize and evaluate the effectiveness of available VR tools and applications used for patient-facing communication skills development in medical education. The secondary objectives are to (1) assess the feasibility of adapting VR applications to develop patient-facing communication skills in medical education and (2) provide an overview of the challenges associated with adapting VR applications to develop patient-facing communication skills in medical education. METHODS: A total of 4 electronic databases (ERIC, Embase, PubMed, and MEDLINE) were searched for primary peer-reviewed articles published through April 11, 2023. Articles evaluating the implementation of non-, semi-, and fully immersive VR training for patient- or caregiver-facing communication skills training provided to graduate, medical, or other allied health care professions students were included. Studies that assessed augmented reality, mixed reality, artificial intelligence, or VR for non-communication-based training were excluded. Study selection will include a title, abstract, and full-text screening by 4 authors. Data from eligible studies will be extracted and entered into a database and presented in tabular format. Findings will be reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. RESULTS: As of April 11, 2023, the search strategy has been confirmed and the search has been completed. We are currently at the title and abstract screening stage. Once complete, the articles will undergo full-text screening according to eligibility criteria as described in the methods. CONCLUSIONS: The findings of this review will inform the development of a graduate-level clinical skills research course within the Institute of Medical Science graduate department at the University of Toronto. It is also expected that these findings will be of interest to other health care-specific faculties inside and beyond our institution. Further, our scoping review will summarize the limited field of literature on VR use in medical communications training and identify areas for future inquiry. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/53901.

Uncemented total hip arthroplasty with a tapered titanium femoral component: a minimum 30-year follow-up.

The purpose of this study is to report our updated results at a minimum follow-up of 30 years using a first generation uncemented tapered femoral component in primary total hip arthroplasty (THA). The original cohort consisted of 145 consecutive THAs performed by a single surgeon in 138 patients. A total of 37 patients (40 hips) survived a minimum of 30 years, and are the focus of this review. The femoral component used in all cases was a first-generation Taperloc with a non-modular 28 mm femoral head. Clinical follow-up at a minimum of 30 years was obtained on every living patient. Radiological follow-up at 30 years was obtained on all but four. Seven femoral components (18%) required revision, and none for septic loosening. Four well fixed stems were removed during acetabular revision and three were revised for late infection. One femoral component (3%) was loose by radiological criteria. The mean Harris Hip Score improved from 47 points (SD 4.62) preoperatively to 83 points (SD 9.27) at final follow-up. With revision for any reason as the endpoint, survival of the femoral component was 80% (95% confidence interval (CI) 61% to 90%) at 32 years. With revision for aseptic loosing femoral component, survival was 99% (95% CI 93% to 99%). With regards to aseptic loosening, the Taperloc femoral component provides excellent fixation at a mean follow-up of 32 years.

Randomized trial of personalized psychological feedback from a longitudinal online survey and simultaneous evaluation of randomized stepped wedge availability of in-person peer support for hospital staff during the COVID-19 pandemic.

OBJECTIVE: We tested if automated Personalized Self-Awareness Feedback (PSAF) from an online survey or in-person Peer Resilience Champion support (PRC) reduced emotional exhaustion among hospital workers during the COVID-19 pandemic. METHOD: Among a single cohort of participating staff from one hospital organization, each intervention was evaluated against a control condition with repeated measures of emotional exhaustion at quarterly intervals for 18 months. PSAF was tested in a randomized controlled trial compared to a no-feedback condition. PRC was tested in a group-randomized stepped-wedge design, comparing individual-level emotional exhaustion before and after availability of the intervention. Main and interactive effects on emotional exhaustion were tested in a linear mixed model. RESULTS: Among 538 staff, there was a small but significant beneficial effect of PSAF over time (p = .01); the difference at individual timepoints was only significant at timepoint three (month six). The effect of PRC over time was non-significant with a trend in the opposite direction to a treatment effect (p = .06). CONCLUSIONS: In a longitudinal assessment, automated feedback about psychological characteristics buffered emotional exhaustion significantly at six months, whereas in-person peer support did not. Providing automated feedback is not resource-intensive and merits further investigation as a method of support.

The pursuit of health equity in digital transformation, health informatics, and the cardiovascular learning healthcare system.

African Americans have a higher rate of cardiovascular morbidity and mortality and a lower rate of specialty consultation and treatment than Caucasians. These disparities also exist in the care and treatment of chemotherapy-related cardiovascular complications. African Americans suffer from cardiotoxicity at a higher rate than Caucasians and are underrepresented in clinical trials aimed at preventing cardiovascular injury associated with cancer therapies. To eliminate racial and ethnic disparities in the prevention of cardiotoxicity, an interdisciplinary and innovative approach will be required. Diverse forms of digital transformation leveraging health informatics have the potential to contribute to health equity if they are implemented carefully and thoughtfully in collaboration with minority communities. A learning healthcare system can serve as a model for developing, deploying, and disseminating interventions to minimize health inequities and maximize beneficial impact.

Establishing an interdisciplinary research team for cardio-oncology artificial intelligence informatics precision and health equity.

Study objective: A multi-institutional interdisciplinary team was created to develop a research group focused on leveraging artificial intelligence and informatics for cardio-oncology patients. Cardio-oncology is an emerging medical field dedicated to prevention, screening, and management of adverse cardiovascular effects of cancer/ cancer therapies. Cardiovascular disease is a leading cause of death in cancer survivors. Cardiovascular risk in these patients is higher than in the general population. However, prediction and prevention of adverse cardiovascular events in individuals with a history of cancer/cancer treatment is challenging. Thus, establishing an interdisciplinary team to create cardiovascular risk stratification clinical decision aids for integration into electronic health records for oncology patients was considered crucial. Design/setting/participants: Core team members from the Medical College of Wisconsin (MCW), University of Wisconsin-Milwaukee (UWM), and Milwaukee School of Engineering (MSOE), and additional members from Cleveland Clinic, Mayo Clinic, and other institutions have joined forces to apply high-performance computing in cardio-oncology. Results: The team is comprised of clinicians and researchers from relevant complementary and synergistic fields relevant to this work. The team has built an epidemiological cohort of ~5000 cancer survivors that will serve as a database for interdisciplinary multi-institutional artificial intelligence projects. Conclusion: Lessons learned from establishing this team, as well as initial findings from the epidemiology cohort, are presented. Barriers have been broken down to form a multi-institutional interdisciplinary team for health informatics research in cardio-oncology. A database of cancer survivors has been created collaboratively by the team and provides initial insight into cardiovascular outcomes and comorbidities in this population.

Total hip arthroplasty with an uncemented tapered femoral component in patients younger than 50 years.

The purpose of the present study was to evaluate the outcome of primary uncemented total hip arthroplasty in patients younger than 50 years using the Taperloc (Biomet, Warsaw, Ind) femoral component. We evaluated 94 hips in 79 patients at a mean follow-up of 16 years (range, 11-18.5 years). The average age of the patients at the time of surgery was 36 years (range, 20-49 years). Three femoral components had been revised, none for aseptic loosening. Complete clinical and radiographic follow-up was obtained on the 91 hips that had not undergone femoral component revision. The mean Harris hip score increased from 54 points (range, 20-72) before surgery to 93 points (range, 68-100) at the time of this review. Radiographically, 89 stems (98%) were determined to have fixation by bone ingrowth, 2 (2%) demonstrated stable fibrous ingrowth, and no femoral component was loose. Distal femoral osteolysis was identified in 1 hip (1%). These findings indicate that excellent clinical and radiographic results can be achieved in young patients with the Taperloc femoral component at a mean follow-up of 16 years.

Second-generation uncemented total hip arthroplasty: a minimum 20-year follow-up.

AIMS: We present the clinical and radiological results at a minimum follow-up of 20 years using a second-generation uncemented total hip arthroplasty (THA). These results are compared to our previously published results using a first-generation hip arthroplasty followed for 20 years. METHODS: A total of 62 uncemented THAs in 60 patients were performed between 1993 and 1994. The titanium femoral component used in all cases was a Taperloc with a reduced distal stem. The acetabular component was a fully porous coated threaded hemispheric titanium shell (T-Tap ST). The outcome of every femoral and acetabular component with regard to retention or revision was determined for all 62 THAs. Complete clinical follow-up at a minimum of 20 years was obtained on every living patient. Radiological follow-up was obtained on all but one. RESULTS: Two femoral components (3.2%) required revision. One stem was revised secondary to a periprosthetic fracture one year postoperatively and one was revised for late sepsis. No femoral component was revised for aseptic loosening. Six acetabular components had required revision, five for aseptic loosening. One additional acetabular component was revised for sepsis. Radiologically, all femoral components remained well fixed. One acetabular was judged loose by radiological criteria. The mean Harris Hip Score improved from 46 points (30 to 67) preoperatively to 89 points (78 to 100) at final follow-up. With revision for aseptic loosening as the endpoint, survival of the acetabular component was 95% (95% confidence interval (CI) 90 to 98) at 25 years. Femoral component survival was 100%. CONCLUSION: The most significant finding of this report was the low prevalence of aseptic loosening and revision of the femoral component at a mean follow-up of 22 years. A second important finding was the survival of over 90% of the hemispheric threaded ring acetabular components. While these shells remain controversial, in this series they performed well.Cite this article: Bone Jt Open 2021;2(1):33-39.

Hybrid total knee arthroplasty: 10- to 16-year follow-up.

A cementless femoral component may allow for a smaller surgical incision when a minimally invasive approach is used during primary total knee arthroplasty. Fixation by cement is the gold standard for total knee arthroplasty. The results of cementless total knee arthroplasty are mixed. Cementless femoral components have done well. Although some tibial components have performed well at long-term follow-up, others have been plagued by high rates of loosening and revision. The question remains whether the results of hybrid total knee arthroplasty, consisting of an uncemented femoral component and a cemented tibial component, will equal those of total knee replacement fixed with cement at long-term follow-up. The authors reviewed 148 hybrid total knee arthroplasties performed by a single surgeon between 1993 and 1995. At a mean follow-up of 14 years (range, 10-16) 5 knees (4%) had undergone revision of both the femoral and tibial components. Only 1 knee required revision for aseptic loosening. Two knees were revised for sepsis; 1 knee had been revised for fracture and 1 for instability. No additional femoral or tibial components were loose by radiographic criteria. Mild focal femoral osteolysis was identified in 3 knees (2%), and minor tibial osteolysis was present in 2 knees (1%). The rate of survivorship with revision for aseptic loosening as the end point was 99% (95% confidence interval, 0.97-100) at 16 years for both the femoral and tibial components. In this series, hybrid total knee arthroplasty showed excellent fixation at 16 years.

Uncemented total hip arthroplasty with a tapered femoral component: a 22- to 26-year follow-up study.

The goal of this study was to evaluate the outcome at a mean follow-up of 24.5 years (range, 22-26 years) of a consecutive series of 138 patients (145 hips) treated with total hip arthroplasty (THA) with the use of the Taperloc femoral component (Biomet, Warsaw, Indiana). This was an FDA-approved prospective study. All surgeries were performed by a single surgeon. Each of the 138 patients (145 hips) was followed annually until death, femoral component revision, or a minimum of 22 years. Complete clinical and radiographic follow-up was obtained on 95% of living patients at 5 years, and 100% at 10, 15, 20, and 24.5 years. Of the original series of 145 hips, only 1 femoral component (0.7%) had undergone revision for aseptic loosening, and 1 was loose by radiographic criteria (0.7%). Femoral osteolysis was identified in 8 hips (5.5%). A subset of 63 THAs in 56 patients was followed for a mean of 24.5 years. In this group, no femoral component required revision for aseptic loosening, and 1 was loose by radiographic criteria. Femoral osteolysis was present in 4 hips. Survivorship analysis of the femoral component with revision for aseptic loosening as the endpoint was 99% (95% confidence interval, 0.97-100) at 26 years. This stem demonstrates excellent fixation at a follow-up of 24.5 years with no apparent deterioration of the results with time.

Total hip arthroplasty with an uncemented tapered femoral component.

BACKGROUND: Excellent intermediate-term results with use of tapered femoral components in primary total hip arthroplasty have been reported. The purpose of this study was to update our previous report and to evaluate the outcome of total hip arthroplasty with use of the porous Taperloc femoral component in patients who had been followed for a minimum of eighteen years postoperatively. METHODS: One hundred and forty-five consecutive uncemented total hip arthroplasties in 138 patients were performed between 1983 and 1985, by a single surgeon, with use of the Taperloc femoral component. The outcome of every femoral component with regard to stem fixation, retention, or revision was determined for all 145 total hip replacements. At a mean of twenty years (range, eighteen to 22.6 years) postoperatively, fifty-eight patients (sixty-five hips) were living. In fifty living patients (fifty-seven hips), the femoral component had not undergone revision surgery. Evaluation of the living patients included clinical and radiographic analysis and recording of complications. RESULTS: Of the eighty patients (eighty hips) who had died, five hips had undergone revision of the femoral component. Only one stem had been revised for aseptic loosening, and no femoral component had been definitely loose by radiographic criteria. In the remaining sixty-five hips in the fifty-eight living patients, eight femoral components were revised. No femoral component underwent revision for aseptic loosening. Definite radiographic evidence of femoral component loosening occurred in one hip. In the fifty living patients (fifty-seven hips) who had not undergone femoral component revision, there was a significant improvement in the mean Harris hip score from 49.3 points preoperatively to 85.4 points at the time of latest follow-up (p = 0.001). Survivorship analysis of all 145 hips, with revision for any reason as the end point, estimated that the survival rate for the femoral component was 87% (95% confidence interval, 79% to 93%) at twenty-two years. CONCLUSIONS: Primary total hip arthroplasty with the Taperloc femoral component is associated with a low rate of aseptic loosening at a mean follow-up of twenty years.