Decision regret analysis in early URSL vs medical expulsive therapy 1 for ureteric calculi ≤ 1cm.

BACKGROUND: The study assesses the decisional regret following Shared Decision-making (SDM) in patients selecting either early ureteroscopic lithotripsy (URSL) or medical expulsive therapy (MET) for ureteric stones ≤ 1 cm, with the aim to evaluate their decisional Conflict, satisfaction, and regret regarding their opted treatment choices. METHODS: Adults aged more than 18 years with one stone up to 1 cm in either ureter were included. After SDM, the patients were allocated into their opted group viz. URSL or MET. Patients in each group were reassessed at "treatment completion". Cambridge Ureteric Stone PROM (CUSP) questionnaire for HRQoL, Decision Regret Scale and the OPTION scale (SDM) were filled at treatment completion. FINDINGS: 111 patients opted for MET, while 396 patients opted for early URSL. Mean stone size was larger in URSL group (7.16 ± 1.63 mm vs. 5.50 ± 1.89; p < 0.001). Decisional conflict was higher in patients opting for URSL (77.3% vs. 57.7%; p < 0.001). Stone-free rate at four weeks was higher in URSL group (87.1%vs68.5%, p < 0.001). Decisional regret was higher in patients opting for MET (33.24 ± 30.89 vs. 17.26 ± 12.92; p = 0.002). Anxiety, was higher in patients opting for MET (6.94 ± 1.89 vs. 5.85 ± 1.54; p < 0.001). Urinary symptoms and interference in patients' travel plans and work-related activities were more in URSL group (6.21 ± 1.57 vs. 5.59 ± 1.46; p < 0.001 and 6.56 ± 1.59 vs. 6.05 ± 1.72; p < 0.001 respectively). INTERPRETATION: After SDM, decisional regret is higher in patients opting for MET mainly due protracted treatment duration with increased pain and anxiety during the treatment course and the need for additional procedure for attaining stone clearance and the. Despite higher decisional conflict, a larger proportion of patients opt for early URSL with the aim of avoiding anxiety and achieving early stone clearance.

Evaluation of potential human health risks arising from nitrate and fluoride in the groundwater of Aurangabad, Bihar using GIS and chemometric analysis.

This study employed the groundwater pollution index to assess the appropriateness of groundwater for human consumption. Additionally, the hazard index was utilized to evaluate the potential non-carcinogenic risks associated with fluoride and nitrate exposure among children, women, and men in the study region. A total of 103 samples were collected from the Aurangabad district of Bihar. The analyzed samples were assessed using several physicochemical parameters. Major cations in the groundwater are Ca2+ > Mg2+ and major anions are HCO3- > Cl- > SO42- > NO3- > F- > PO43-. Around 17% of the collected groundwater samples surpassed the allowable BIS concentration limits for Nitrate, while approximately 11% surpassed the allowed limits for fluoride concentration. Principal component analysis was utilized for its efficacy and efficiency in the analytical procedure. Four principal components were recovered that explained 69.06% of the total variance. The Hazard Quotient (HQ) of nitrate varies between 0.03-1.74, 0.02-1.47, and 0.03-1.99 for females, males, and children, respectively. The HQ of fluoride varies between 0.04-1.59, 0.04-1.34, and 0.05-1.82 for females, males, and children, respectively. The central part of the district was at high risk according to the spatial distribution maps of the total hazard index (THI). Noncarcinogenic risks due to THI are 47%, 37%, and 28% for children, females, and males, respectively. According to the human health risk assessment, children are more prone to getting affected by polluted water than adults. The groundwater pollution index (GPI) value ranges from 0.46 to 2.27 in the study area. Seventy-five percent of the samples fell under minor pollution and only one fell under high pollution. The spatial distribution of GPI in the research area shows that the central region is highly affected, which means that this water is unsuitable for drinking purposes.

A GIS approach for groundwater quality evaluation with entropy method and fluoride exposure with health risk assessment.

This study used the entropy water quality index to analyse the suitability of groundwater for human consumption as well as the hazard index to identify the probable non-carcinogenic dangers among children, women, and men in Nawada, Bihar (India). A total of 75 groundwater samples were taken from hand pumps and tube/bore wells in the pre-monsoon of 2017, and they were evaluated for various physicochemical characteristics. The region's groundwater major cations and anions are dominated by Ca2+ > Mg2+ and [Formula: see text] > Cl- > [Formula: see text] > NO3- > F > [Formula: see text]. Fluoride, chloride, and hardness exceeded WHO and BIS safe standards. Calcium, sodium, magnesium, sulphate, and chloride showed positive correlations, indicating water-rock interactions and mineral leaching and dissolution. Ionic cross-plots reveal that the dissolution of carbonate minerals was the primary source of calcium and magnesium in the groundwater. Also, silicate weathering contributed to these ions in the groundwater. The entropy water quality index (EWQI) found that 79% of groundwater samples were drinkable, whereas 21% were not consumable. The eastern, western, and some southern study areas have the worst drinking water quality. The main source of fluoride toxicity in people is groundwater. For all sampling locations, the HQ fluoride was calculated to be in the ranges of 0.04-3.69 (male), 0.04-3.27 (female), and 0.05-4 (children), indicating a considerably greater risk than the permissible levels (> 1). The fluoride-based non-carcinogenic risks are 27%, 20%, and 21% for children, women, and men, respectively. Children have higher risks from polluted water than adults, according to the non-carcinogenic health risk assessment. This study establishes a standard for regional and global scientific studies that help decision-makers and planners determine the quality of groundwater and fluoride risk and management.

Recent advances in bioengineered scaffold for in vitro meat production.

In vitro meat production via stem cell technology and tissue engineering provides hypothetically elevated resource efficiency which involves the differentiation of muscle cells from pluripotent stem cells. By applying the tissue engineering technique, muscle cells are cultivated and grown onto a scaffold, resulting in the development of muscle tissue. The studies related to in vitro meat production are advancing with a seamless pace, and scientists are trying to develop various approaches to mimic the natural meat. The formulation and fabrication of biodegradable and cost-effective edible scaffold is the key to the successful development of downstream culture and meat production. Non-mammalian biopolymers such as gelatin and alginate or plant-derived proteins namely soy protein and decellularized leaves have been suggested as potential scaffold materials for in vitro meat production. Thus, this article is aimed to furnish recent updates on bioengineered scaffolds, covering their formulation, fabrication, features, and the mode of utilization.

Risk of radial head arthroplasty revision is correlated with radial head diameter: a multicenter analysis of 405 cases.

BACKGROUND: Radial head arthroplasty (RHA) is commonly used for the treatment of comminuted radial head fractures. Indications as well as implant types continue to evolve. RHA has had good outcomes with midterm longevity. The literature is limited to small case series with varying implant types, and larger studies are needed to determine the optimal implant type and radial head diameter. METHODS: A retrospective analysis of RHA cases performed by 75 surgeons at 14 medical centers in an integrated health care system between 2006 and 2017 was completed. Patient demographics, comorbidities, implant type and head diameter, and indications for revision were recorded. Patients' in-person clinical visit data were recorded. Patients were also contacted via telephone at a minimum of 2 years to obtain abbreviated Disabilities of the Arm, Shoulder, and Hand questionnaire and Oxford scores. Implant survivorship was also captured within our integrated system. RESULTS: 405 cases met our inclusion criteria. Mean age was 51.5 ± 15.5 years (range 16-88 years) and more common in females (62%). Chart review and telephone follow-up was performed at a mean of 68.9 ± 31.5 months (range 24-146 months). Our study found that revision rate was positively correlated with increasing radial head diameter. A 26-mm head had 7.7 odds of revision compared to a size 18-mm head (95% confidence interval 1.2-150.1). More than 95% of revision cases were performed within the first 36 months of the index procedure. Obese patients had a significantly lower mean postoperative Oxford score (35.5) compared to controls (38.3) (P = .02). There was a significantly higher overall reoperation rate for terrible triad (18.4%) vs. isolated injuries (10.4%) (P = .04). There was no difference between Acumed Anatomic and Evolve radial head implants in overall reoperation, implant revision, postoperative range of motion, or patient-reported outcomes. CONCLUSIONS: Risk of revision is directly correlated with implanted radial head diameter. There were no differences in outcomes and complications between the 2 main implants used. Individuals who did not undergo a revision by 3 years' time tend to retain the implant. Terrible triad injuries had a higher all-cause reoperation rate than isolated radial head fractures, but no difference in the rate of RHA revision. These data reinforce the practice of downsizing radial head implant diameter.

Association between same-day discharge shoulder arthroplasty and risk of adverse events in patients with American Society of Anesthesiologists classification ≥3: a cohort study.

BACKGROUND: Same-day discharge for shoulder arthroplasty (SA) is well-supported in the literature; however, most studies have focused on healthier patients. Indications for same-day discharge SA have expanded to include patients with more comorbidities, but safety of same-day discharge in this population remains unknown. We sought to compare outcomes following same-day discharge vs. inpatient SA in a cohort of patients considered higher risk for adverse events, defined as an American Society of Anesthesiologists (ASA) classification of ≥3. METHODS: Data from Kaiser Permanente's SA registry were utilized to conduct a retrospective cohort study. All patients with an ASA classification of ≥3 who underwent primary elective anatomic or reverse SA in a hospital from 2018 to 2020 were included. The exposure of interest was in-hospital length of stay: same-day discharge vs. ≥1-night hospital inpatient stay. The likelihood of 90-day post-discharge events, including emergency department (ED) visit, readmission, cardiac complication, venous thromboembolism, and mortality, was evaluated using propensity score-weighted logistic regression with noninferiority testing using a margin of 1.10. RESULTS: The cohort included a total of 1814 SA patients, of whom 1005 (55.4%) had same-day discharge. In propensity score-weighted models, same-day discharge was not inferior to an inpatient stay SA regarding 90-day readmission (odds ratio [OR] = 0.64, one-sided 95% upper bound [UB] = 0.89) and overall complications (OR = 0.67, 95% UB = 1.00). We lacked evidence in support of noninferiority for 90-day ED visit (OR = 0.96, 95% UB = 1.18), cardiac event (OR = 0.68, 95% UB = 1.11), or venous thromboembolism (OR = 0.91, 95% UB = 2.15). Infections, revisions for instability, and mortality were too rare to evaluate using regression analysis. CONCLUSIONS: In a cohort of over 1800 patients with an ASA of ≥3, we found same-day discharge SA did not increase the likelihood of ED visits, readmissions, or complications compared with an inpatient stay, and same-day discharge was not inferior to an inpatient stay with regard to readmissions and overall complications. These findings suggest that it is possible to expand indications for same-day discharge SA in the hospital setting.

Groundwater quality assessment using SPSS based on multivariate statistics and water quality index of Gaya, Bihar (India).

Groundwater is a valuable resource for developmental activities, and its demand is growing as surface water becoming scarce. Groundwater demand is increasing, resulting in reduction in water level and deterioration in water quality. A total of 156 groundwater samples were taken from Gaya, a district in Bihar (India), to check the safety of drinking water. The quality of groundwater was assessed using a water quality index (WQI). Analysed samples were assessed using a variety of physicochemical characteristics, and statistical methods principal component analysis (PCA) and cluster analysis (CA) were used as they are effective and efficient. As per the Gibbs, plot majority of the sample falls in the rock-water interaction and some evaporation dominance field. The domination of major cation in the order of Ca2+ > Mg2+ > Na+ and the major anions followed the order of HCO3- > [Formula: see text]>[Formula: see text]>[Formula: see text]>[Formula: see text]. The KMO's sample adequacy value of 0.703 and the significance level of Bartlett's test of sphericity (0.0001) were indicating that PCA may be implemented. Using the PCA, the three components recovered explained 69.58% of the total variation. Cluster analysis classified the groundwater sample into three cluster based on the similarities among chemical parameters involved in groundwater quality. HCA exhibit less, intermediate, and heavily mineralized groundwater characteristics of groups I, II, and III, respectively. The major parameters affecting the water quality in the study region are TDS, Ca2+, Mg2+, HCO3-, [Formula: see text]. WQI indicates 17% of the sample were found to be of very poor quality and not consumable. The study's findings offer insights and understanding into groundwater pollution regimes. These results used for water quality assessment leading to improved environmental management and planning and in decision-making for water quality management.

Ultraflat bandpass, high extinction, and tunable silicon photonic filters.

We report on the design and the demonstration of silicon photonic ultraflat bandpass filters with low insertion loss and high out-of-band rejection for an operation near the 1550 nm wavelength band. These filters are based on cascading low (2nd) order Ring-Assisted Mach-Zehnder Interferometer (RAMZI) filter stages. The cascade design enables high out-of-band rejection while keeping the unit cells of each stage low order to be more tolerant to fabrication imperfections. The characterization of filters shows an insertion loss of ∼1 dB, an in-band ripple of <0.1 dB, an out-of-band rejection of >50 dB for a filter 3-dB bandwidth of ∼1.1 nm, and tunable up to ∼6 nm. We also investigate the filter's spur-free dynamic range at high input optical powers, which is important for RF photonics applications, and quantify a dynamic range of >60 dB for a laser power as high as ∼11.6 mW sent to the filter. Such integrated filters are promising for applications in pump wavelength rejection in four-wave mixing photon pair generation, and in RF antenna remoting where multiple RF signals are carried on different coarse wavelengths to be separated.

Stem cells-derived in vitro meat: from petri dish to dinner plate.

Sustainable food supply to the world is possibly the greatest challenge that human civilization has ever faced. Among animal sourced foods, meat plays a starring role in human food chain. Traditional meat production necessitates high proportion of agricultural land, energy and clean water for rearing meat-producing animals; also massive emission of greenhouse gases from the unutilized nutrients of the digestive process into the environment is a major challenge to the world. Also, conventional meat production is associated with evolution and spread of superbugs and zoonotic infections. In vitro meat has the potential to provide a healthy alternative nutritious meal and to avoid the issues associated with animal slaughtering and environmental effects. Stem cell technology may provide a fascinating approach to produce meat in an animal-free environment. Theoretically, in vitro meat can supplement the meat produced by culling the animals and satisfy the global demand. This article highlights the necessity and potential of stem cell-derived in vitro meat as an alternative source of animal protein vis-a-vis the constraints of conventional approaches of meat production.

The association between critical shoulder angle and revision following anatomic total shoulder arthroplasty: a matched case-control study.

HYPOTHESIS: The concept of the critical shoulder angle (CSA) was introduced in 2013, with studies showing that larger CSA is associated with rotator cuff tears (RCTs) and smaller CSA with glenohumeral osteoarthritis. We hypothesized outcomes following total shoulder arthroplasty (TSA) would differ depending on CSA. METHODS: We conducted a matched case-control study using Kaiser Permanente's Shoulder Arthroplasty Registry to identify patients who underwent primary elective anatomic TSA for the diagnosis of osteoarthritis from 2009-2018. Seventy-eight adult patients who underwent revision following the primary TSA due to glenoid component failure or rotator cuff tear comprised the case group. A control group of nonrevised patients were identified from the same source population. Two controls were matched to each case by age, gender, body mass index, American Society of Anesthesiologists classification, surgeon who performed the index TSA, and post-TSA follow-up time. The relationship between revision and CSA as measured on radiographs were analyzed as a 1:2 matched-pairs case-control study with use of multiple conditional multivariable logistic regression. RESULTS: Revised cases had a higher likelihood of a CSA ≥35° (odds ratio [OR] = 2.41, 95% confidence interval [CI] = 1.27-4.59). A higher likelihood of CSA ≥35° was observed for those revised for glenoid loosening (OR = 4.58, 95% CI = 1.20-17.50) and revised for rotator cuff tear (OR = 2.41, 95% CI = 1.18-4.92) compared with nonrevised controls. Every 5° increase in CSA had higher odds of overall revision (OR = 1.62, 95% CI = 1.18-2.21), glenoid loosening (OR = 2.50, 95% CI = 1.27-4.92), and rotator cuff tear (OR = 1.51, 95% CI = 1.07-2.14). CONCLUSION: In a matched case-control study of primary anatomic TSA, individuals who were revised for aseptic glenoid loosening and superior cuff failure had a higher CSA compared with nonrevised individuals. These data suggest that surgeons may consider using reverse arthroplasty in cases of primary shoulder arthritis with a CSA of 35° or greater.

Nanosheets Based Approach to Elevate the Proliferative and Differentiation Efficacy of Human Wharton's Jelly Mesenchymal Stem Cells.

Mesenchymal stem cell (MSC)-based therapy and tissue repair necessitate the use of an ideal clinical biomaterial capable of increasing cell proliferation and differentiation. Recently, MXenes 2D nanomaterials have shown remarkable potential for improving the functional properties of MSCs. In the present study, we elucidated the potential of Ti2CTx MXene as a biomaterial through its primary biological response to human Wharton's Jelly MSCs (hWJ-MSCs). A Ti2CTx nanosheet was synthesized and thoroughly characterized using various microscopic and spectroscopic tools. Our findings suggest that Ti2CTx MXene nanosheet exposure does not alter the morphology of the hWJ-MSCs; however, it causes a dose-dependent (10-200 µg/mL) increase in cell proliferation, and upon using it with conditional media, it also enhanced its tri-lineage differentiation potential, which is a novel finding of our study. A two-fold increase in cell viability was also noticed at the highest tested dose of the nanosheet. The treated hWJ-MSCs showed no sign of cellular stress or toxicity. Taken together, these findings suggest that the Ti2CTx MXene nanosheet is capable of augmenting the proliferation and differentiation potential of the cells.

Correction: Functional male accessory glands and fertility in Drosophila require novel ecdysone receptor.

[This corrects the article DOI: 10.1371/journal.pgen.1006788.].

Postoperative opioid utilization associated with revision risk following primary shoulder arthroplasty.

INTRODUCTION: With a substantial increase in utilization of primary shoulder arthroplasty, it is important to understand risk factors that may signal early failure and need for revision. Recent studies have reported that sustained postoperative opioid use is associated with a higher revision risk after total hip or knee arthroplasty. In this study, we evaluated postoperative opioid utilization as a risk factor for revision after primary shoulder arthroplasty. METHODS: We conducted a cohort study using data from a United States integrated health care system's Shoulder Arthroplasty Registry. Patients who had a primary elective shoulder arthroplasty were identified (2009-2017); those with cancer or who underwent other arthroplasty procedures (either shoulder, hip, or knee) within the preceding year were excluded. Cumulative daily opioid utilization during the first year postoperative, calculated as oral morphine equivalents (OME), was categorized into 3 exposure groups: high user (≥15 mg OME daily), moderate user (<15 mg OME daily), and no opioid use (reference group). The exposure window was stratified into 2 time periods: postoperative days 1-90 and postoperative days 91-360. Multivariable Cox proportional-hazards regression was used to evaluate the association between postoperative opioid use and aseptic revision risk. RESULTS: The final study sample included 8325 shoulder arthroplasty procedures. Of these individuals, 3707 (45%) received some opioid within the 1 year before the index procedure. We failed to observe a difference in aseptic revision risk between opioid utilization in the first 90 days postoperatively, regardless of dose. After the first 90 days, a higher revision risk was observed for high opioid users compared with nonusers (hazard ratio = 1.62, 95% confidence interval = 1.10-2.41), and no association was observed for moderate users (hazard ratio = 1.25, 95% confidence interval = 0.82-1.91). CONCLUSIONS: We found a positive association between opioid consumption and aseptic revision risk after primary shoulder arthroplasty. This study cannot determine if opioids have a direct physiological cause that increases the risk of revision; rather it is likely that opioid consumption is a marker of chronic pain, poor function, and/or poor coping mechanisms. Further study is needed to determine if programs designed to decrease opioid use may impact revision risk after shoulder arthroplasty.

Measuring successful processes of knowledge co-production for managing climate change and associated environmental stressors: Adaptation policies and practices to support Indian farmers.

Poor access to external resources, and a lack of affordable technologies compatible with socio-economic and ecological settings of rural livelihoods lead to high vulnerability of subsistence farmers to climate change and associated environmental stressors. Traditional knowledge (TK) plays a pivotal role in improving the adaptive capacity of such farmers to cope with these stressors. In India, most of the policies aiming to improve farmers' adaptive capacity are based on a top-down approach and barely consider farmers' TK. Policies can be made more inclusive by mainstreaming stakeholders' perspectives, an approach termed as knowledge co-production. Our study uses a knowledge co-production framework to (i) assess the current state of emphasis on TK and knowledge co-production processes in Indian policies on agricultural adaptation to climate change and associated environmental stressors, (ii) understand the status of TK-led knowledge co-production at the practice level, and (iii) assess the successes and gaps in incorporating TK in agricultural adaptation at the policy and practice levels to manage these stressors. Based on a systematic literature review, we found that despite emphasis on integration of TK, no Indian policy was successful in terms of stakeholder participation and in covering various dimensions of knowledge co-production. Most of the policies covered either two (knowledge gathering and application) or three (gathering, integration and application) dimensions. The term TK was also not clearly defined and it was unclear how to mainstream it into the process for successful outcomes. Co-production process was adjudged to be fairly successful at the practice level in some of the sectors (e.g., management of soil and water resources) where most of the dimensions were covered and stakeholders participated in various steps of co-production. There were significant differences in the success of co-production within (e.g., crop varieties) and between (e.g., crop and natural resource management) the sectors. We found a considerable gap at policy and practice levels on success of knowledge co-production. Insights from the study could help policy-makers to improve policies for the agricultural sector to better adapt to climate change and associated environmental stressors through the recognition and integration of farmers' TK.

Grassroots Approaches for Sustaining Biocultural Diversity and Livelihood Security: Insights from Indian Eastern Himalaya.

Bioculturally significant plants, which have played a key role in sustaining the livelihoods of tribal communities of Arunachal Pradesh, India, are facing threats from changing land use patterns, climatic aberrations and socioeconomic stressors. This study highlights two unique grassroots approaches to conserving these species and their associated cultural knowledge within the traditional land use systems of Arunachal Pradesh: Community Knowledge Gardens (CKGs) and Clan Reserve Forests (CRFs). Four CKGs and one CRF, transformed from existing traditional land use systems, were investigated in three socio-ecologically diverse landscapes of Nyishi, Adi and Monpa communities. Study participants, including both men and women, played an active role in devising locally compatible criteria and protocols for strengthening the conservation of key plant species within their traditional land use systems, through CKG and CRF approaches. A total of 86 plant species, conserved through the CKGs and 44 from the Adi CRF, were identified as having high food, ethnomedicinal and cultural values. The Shannon-Weaver index of richness of plant species conserved was highest in the Nyishi CKG, with a value of 38; while for Adi and Monpa it was 30 and 18, respectively. The pattern of Shannon-Weaver diversity index was in the order of 2.91, 2.64 and 2.63, respectively for the CKGs of these three communities. In comparison to individual CKGs, relatively higher species diversity (3.18) was found in the Adi CRF. Increased sharing of traditional knowledge among the community members, regular incomes and equitable sharing of the tangible and intangible benefits of using plant species were identified as important success indicators of the CKGs and CRF. In addition to providing valuable insights on biocultural knowledge and enabling the participants to strengthen their existing local land use practices for conserving valued plant biodiversity, the study outcomes have the potential to inform and strengthen the policies on environmental sustainability.

Correction: Functional male accessory glands and fertility in Drosophila require novel ecdysone receptor.

[This corrects the article DOI: 10.1371/journal.pgen.1006788.].

Functional male accessory glands and fertility in Drosophila require novel ecdysone receptor.

In many insects, the accessory gland, a secretory tissue of the male reproductive system, is essential for male fertility. Male accessory gland is the major source of proteinaceous secretions, collectively called as seminal proteins (or accessory gland proteins), which upon transfer, manipulate the physiology and behavior of mated females. Insect hormones such as ecdysteroids and juvenoids play a key role in accessory gland development and protein synthesis but little is known about underlying molecular players and their mechanism of action. Therefore, in the present study, we examined the roles of hormone-dependent transcription factors (Nuclear Receptors), in accessory gland development, function and male fertility of a genetically tractable insect model, Drosophila melanogaster. First, we carried out an RNAi screen involving 19 hormone receptors, individually and specifically, in a male reproductive tissue (accessory gland) for their requirement in Drosophila male fertility. Subsequently, by using independent RNAi/ dominant negative forms, we show that Ecdysone Receptor (EcR) is essential for male fertility due to its requirement in the normal development of accessory glands in Drosophila: EcR depleted glands fail to make seminal proteins and have dying cells. Further, our data point to a novel ecdysone receptor that does not include Ultraspiracle but is probably comprised of EcR isoforms in Drosophila male accessory glands. Our data suggest that this novel ecdysone receptor might act downstream of homeodomain transcription factor paired (prd) in the male accessory gland. Overall, the study suggests novel ecdysone receptor as an important player in the hormonal regulation of seminal protein production and insect male fertility.

Functional outcomes of ulnar collateral ligament reconstruction with a novel double suspensory fixation.

BACKGROUND: Ulnar collateral ligament reconstruction (UCLR) has allowed the return of overhead athletes to throwing sports. We describe a new double suspensory (DS) technique using a single tunnel in the ulna and humerus, achieving fixation with adjustable loop buttons. METHODS: Inclusion criteria included skeletally mature baseball players with clinical and magnetic resonance imaging diagnosis of UCL insufficiency who failed a trial of structured nonoperative treatment. A total of 36 baseball players underwent DS UCLR, between 2011 and 2017, by 1 surgeon with minimum 2-year follow-up. The graft was fixated with an adjustable button loop on the humeral side and a tension slide technique with a button on the ulnar side. Pre- and postoperative Kerlan-Jobe Orthopaedic Clinic and Single Assessment Numerical Evaluation and postoperative Conway scores were obtained. RESULTS: The mean age was 19.8 ± 4.6 years (range, 14-35 years). All were male. Mean years played before surgery was 14.3 ± 4.6 years (range, 8-28 years). There were 32 (89%) pitchers and 4 (11%) position players. There were 13 (36%) high school, 20 (55%) college, 2 (6%) minor league, and 1 (3%) adult league athletes. The mean follow-up was 55.3 ± 23.7 months (range, 26-97 months). There was significant improvement in Kerlan-Jobe Orthopaedic Clinic (33.2 ± 19.9 to 89.7 ± 15.1, P < .0001) and Single Assessment Numerical Evaluation (20.7 ± 16.7 to 93.6 ± 11.9, P < .0001) scores. Using Conway scoring, 25 (69%) had excellent, 5 (14%) good, 3 (8%) fair, and 3 (8%) poor scores. Mean return to play was 9 ± 1.5 months (range, 6-16 months). Only 1 (3%) athlete required a revision surgery and ultimately returned to play and 1 (3%) hardware removal. None developed ulnar nerve symptoms. CONCLUSION: DS fixation for UCLR in baseball players can lead to excellent clinical results and early return to play.

Is there a difference in the acromiohumeral distances measured on radiographic and magnetic resonance images of the same shoulder with a massive rotator cuff tear?

BACKGROUND: The purpose of our study was to compare the acromiohumeral distance (AHD) between radiographic and magnetic resonance images (MRIs) of the same shoulder with massive rotator cuff tears (MRCTs). METHODS: Thirty-four shoulders with MRCTs that had an MRI and radiograph of the same shoulder within an average of 40.3 days (range: 8-109 days) were identified. AHD was measured digitally on radiograph and MRI by 3 examiners. Shoulders were grouped into Hamada grades <3 (group 1) and Hamada grades ≥3 (group 2). RESULTS: The mean age was 66.4 years (range: 51-89). There were 19 men (59%). The Kappa for inter-rater reliability was 0.982 (95% confidence interval [CI] 0.975, 0.988) for radiographs and 0.88 (95% CI 0.75, 0.94) for MRI. There was a significant difference in the mean AHD of group 1 on radiograph vs. MRI (7.9 mm vs. 2.5 mm, respectively; P < .0001), but no difference in group 2 (1.8 mm vs. 2.2 mm, respectively; P = .45). There was no difference in AHD in group 1 between shoulders with Goutallier stage <3 (8.1 ± 1.9 mm) and those with Goutallier stage ≥3 (7.3 ± 2.1 mm) (P = .3479). There was no difference in AHD in group 2 between shoulders with Goutallier stage <3 (3.0 ± 0.1 mm) and those with Goutallier stage ≥3 (1.5 ± 1.0 mm) (P = .079). CONCLUSION: There is a significant difference in AHD measurements between radiograph and MRI of the same shoulder with MRCT in early Hamada grades. AHDs measured on radiograph and MRI should not be used interchangeably in early Hamada grades to assess outcomes of superior capsule reconstruction and similar procedures.

The association between glenoid component design and revision risk in anatomic total shoulder arthroplasty.

INTRODUCTION: Anatomic total shoulder arthroplasty (TSA) is a proven treatment for glenohumeral joint osteoarthritis, with superior results compared with hemiarthroplasty. However, glenoid component loosening remains a problem and is one of the most common causes of failure in TSA. Multiple component designs have been developed in an attempt to reduce loosening rates. The purpose of this study was to evaluate risk of revision after anatomic TSA according to the glenoid component design. METHODS: We conducted a cohort study including patients aged ≥18 years who underwent primary elective TSA for the diagnosis of osteoarthritis between 2010 and 2017. Patients with missing implant information, who received stemless humeral implants, or who received augmented glenoid implants, were excluded. Glenoid component designs used were categorized into 4 mutually exclusive treatment groups: polyethylene central-pegged ingrowth, polyethylene-metal hybrid, polyethylene all-cemented pegged, and polyethylene cemented keeled. Multivariable competing risk regression was used to evaluate the risk of glenoid loosening as a cause-specific revision by the glenoid component design. RESULTS: Of the 5566 TSA included in the final cohort, 39.2% of glenoid implants were polyethylene central-pegged ingrowth, 31.1% were polyethylene-metal hybrid, 26.0% were polyethylene all-cemented pegged, and 3.6% were polyethylene cemented keeled. At 6-year final follow-up, 4.1% of TSA were revised for any cause, and 1.4% for glenoid loosening. Compared with the polyethylene central-pegged ingrowth design, no difference in glenoid loosening revision risk was observed for the polyethylene-metal hybrid design (hazard ratio [HR] = 1.15, 95% confidence interval [CI] = 0.42-3.20). However, both the polyethylene all-cemented pegged (HR = 2.48, 95% CI = 1.08-5.66) and polyethylene cemented keeled (HR = 3.84, 95% CI = 1.13-13.00) designs had higher risks for revision due to glenoid loosening. CONCLUSIONS: We observed glenoid component designs to be associated with differential risks in revision due to glenoid loosening with polyethylene all-cemented pegged glenoids and polyethylene cemented keeled glenoids having higher risks when compared with polyethylene central-pegged ingrowth glenoids. Surgeons may want to consider the glenoid component design when performing anatomic TSA.