Functional Changes to Achilles Tendon and Enthesis in a Mouse Model of an Adolescent Masculine Gender-Affirming Hormone Treatment.

Many transgender youth seek gender affirming care, such as puberty suppression, to prolong decision-making and to align their physical sex characteristics with their gender identity. During peripubertal growth, connective tissues such as tendon rapidly adapt to applied mechanical loads (e.g., exercise) yet if and how tendon adaptation is influenced by sex and gender affirming hormone therapy during growth remains unknown. The goal of this study was to understand the how pubertal suppression influences the structural and functional properties of the Achilles tendon using an established mouse model of transmasculine gender affirming hormone therapy. C57BL/6N female-born mice were assigned to experimental groups to mimic gender-affirming hormone therapy in human adolescents, and treatment was initiated prior to the onset of puberty (at postnatal day 26, P26). Experimental groups included controls and mice serially treated with gonadotropin release hormone analogue (GnRHa), delayed Testosterone (T), or GnRHa followed by T. We found that puberty suppression using GnRHa, with and without T, improved the overall tendon load capacity in female-born mice. Treatment with T resulted in an increase in the maximum load that tendon can withstand before failure. Additionally, we found that GnRHa, but not T, treatment resulted in a significant increase in cell density at the Achilles enthesis.

Percutaneous posterior instrumentation followed by direct lateral interbody fusion for lumbar infectious spondylitis.

STUDY DESIGN: Retrospective study. OBJECTIVES: To investigate the clinical feasibility and outcomes from direct lateral interbody fusion (DLIF) using autogenous bone grafts and percutaneous posterior instrumentation (PPI) for infectious spondylitis. SUMMARY OF BACKGROUND DATA: As one of the minimally invasive techniques, PPI has been attempted for various degenerative lumbar spine disorders combined with anterior lumbar interbody fusion or transforaminal lumbar interbody fusion. PPI has been played more roles recently as an internal fixation method for infectious spondylitis. However, the clinical outcomes of DLIF using an autogenous bone graft combined with PPI for infectious spondylitis have been rarely reported. MATERIALS AND METHODS: Sixteen patients (mean age, 60.3 ± 18.8 y) who suffered from pyogenic spondylitis underwent single-stage DLIF using an autogenous iliac bone graft combined with PPI. Clinical and radiologic outcomes were evaluated by visual analog scale (VAS), Oswestry Disability Index (ODI), and eradication of primary disease. Radiologic outcomes were evaluated by changes of affected segmental lordosis and fusion status. RESULTS: Bony fusion and eradication of primary disease were obtained in all patient except 1 case during the follow-up (mean, 31.3 ± 13.1 mo; range 14-46 mo). Preoperative VAS (7 ± 1.2) and ODI (61.3 ± 5.4) scores improved significantly at the last follow-up (VAS, 3.4 ± 1.5; ODI, 32.3 ± 15.4). C-reactive protein normalized at postoperative 20.1 ± 0.7 days (range, 15-28 d). Although height and lordosis in the affected segment were restored by surgery, all patients showed loss of the restored lordosis and height at the final follow-up. Loss of the restored lordosis and height were related to subsidence of the grafted bone. CONCLUSIONS: Minimally invasive PPI followed by debridement and DLIF was a feasible surgical alternative in our consecutive 16 cases of pyogenic spondylitis. In most cases, however the subsidence of anteriorly grafted fusion was inevitable despite successful fusion and eradication of the primary lesion.

Does Academic Productivity Correlate With Industry Payments in Hand Surgery Fellowship Programs in the United States?

BACKGROUND: Hand surgeons and the industry share a common goal to improve the care of patients. However, industry support remains controversial, and the current relationship with fellowship programs remains unclear. This study explores the relationship between industry support and research productivity among hand surgeons in the academic setting. METHODS: The Open Payments database, created by the Centers for Medicare and Medicaid Services (CMS) as a result of the Sunshine Act, was used to identify supplemental income paid to physicians of hand surgery fellowships in the United States. Both lifetime individual physician and aggregated fellowship Sunshine Act supplemental income (2015-2021) were collected for review. Supplemental income only reflects royalties, consulting fees, or food and does not include direct research funding. H-index was collected through the Scopus website as a proxy for academic productivity. RESULTS: Six hundred and thirty-four faculty physicians (90.8%) from 94 hand surgery fellowships (100%) were included in the study. The mean individual physician lifetime supplemental income was $67,272 (median $341,861), whereas the mean individual physician H-index was 12.5 (median 9.0). There was a significant and weak positive correlation between individual physician H-index and lifetime income (p<0.001). Similarly, there was a significant and moderately positive correlation between the combined fellowship H-index and total lifetime income (p<0.001). CONCLUSION: Research productivity of an orthopedic hand fellowship group and individual academic hand surgeon correlate with overall industry support from indirect research funding. Further work is required to better understand the advantages and disadvantages of industry support of academically productive hand surgeons at hand surgery fellowships.

Visualization of Speech Perception Analysis via Phoneme Alignment: A Pilot Study.

Objective: Speech tests assess the ability of people with hearing loss to comprehend speech with a hearing aid or cochlear implant. The tests are usually at the word or sentence level. However, few tests analyze errors at the phoneme level. So, there is a need for an automated program to visualize in real time the accuracy of phonemes in these tests. Method: The program reads in stimulus-response pairs and obtains their phonemic representations from an open-source digital pronouncing dictionary. The stimulus phonemes are aligned with the response phonemes via a modification of the Levenshtein Minimum Edit Distance algorithm. Alignment is achieved via dynamic programming with modified costs based on phonological features for insertion, deletions and substitutions. The accuracy for each phoneme is based on the F1-score. Accuracy is visualized with respect to place and manner (consonants) or height (vowels). Confusion matrices for the phonemes are used in an information transfer analysis of ten phonological features. A histogram of the information transfer for the features over a frequency-like range is presented as a phonemegram. Results: The program was applied to two datasets. One consisted of test data at the sentence and word levels. Stimulus-response sentence pairs from six volunteers with different degrees of hearing loss and modes of amplification were analyzed. Four volunteers listened to sentences from a mobile auditory training app while two listened to sentences from a clinical speech test. Stimulus-response word pairs from three lists were also analyzed. The other dataset consisted of published stimulus-response pairs from experiments of 31 participants with cochlear implants listening to 400 Basic English Lexicon sentences via different talkers at four different SNR levels. In all cases, visualization was obtained in real time. Analysis of 12,400 actual and random pairs showed that the program was robust to the nature of the pairs. Conclusion: It is possible to automate the alignment of phonemes extracted from stimulus-response pairs from speech tests in real time. The alignment then makes it possible to visualize the accuracy of responses via phonological features in two ways. Such visualization of phoneme alignment and accuracy could aid clinicians and scientists.

An mHealth App (Speech Banana) for Auditory Training: App Design and Development Study.

BACKGROUND: With the growing adult population using electronic hearing devices such as cochlear implants or hearing aids, there is an increasing worldwide need for auditory training (AT) to promote optimal device use. However, financial resources and scheduling conflicts make clinical AT infeasible. OBJECTIVE: To address this gap between need and accessibility, we primarily aimed to develop a mobile health (mHealth) app called Speech Banana for AT. The app would be substantially more affordable and portable than clinical AT; would deliver a validated training model that is reflective of modern techniques; and would track users' progress in speech comprehension, providing greater continuity between periodic in-person visits. To improve international availability, our secondary aim was to implement the English language training model into Korean as a proof of concept for worldwide usability. METHODS: A problem- and objective-centered Design Science Research Methodology approach was adopted to develop the Speech Banana app. A review of previous literature and computer-based learning programs outlined current AT gaps, whereas interviews with speech pathologists and users clarified the features that were addressed in the app. Past and present users were invited to evaluate the app via community forums and the System Usability Scale. RESULTS: Speech Banana has been implemented in English and Korean languages for iPad and web use. The app comprises 38 lessons, which include analytic exercises pairing visual and auditory stimuli, and synthetic quizzes presenting auditory stimuli only. During quizzes, users type the sentence heard, and the app provides visual feedback on performance. Users may select a male or female speaker and the volume of background noise, allowing for training with a range of frequencies and signal-to-noise ratios. There were more than 3200 downloads of the English iPad app and almost 100 downloads of the Korean app; more than 100 users registered for the web apps. The English app received a System Usability Scale rating of "good" from 6 users, and the Korean app received a rating of "OK" from 16 users. CONCLUSIONS: Speech Banana offers AT accessibility with a validated curriculum, allowing users to develop speech comprehension skills with the aid of a mobile device. This mHealth app holds potential as a supplement to clinical AT, particularly in this era of global telemedicine.