A pituitary cup biopsy is more accurate than reamings for histological diagnosis of intramedullary lesions during nailing of impending and pathologic fractures: a retrospective matched cohort analysis.

INTRODUCTION: Histologic diagnosis of the lesion is important while intramedullary nailing of a pathologic or impending fracture of a long bone. A biopsy can be performed extramedullary using a targeted sampling device such as a pituitary rongeur or intramedullary from the bone removed from the reamer during preparation of the intramedullary canal. The purpose of this study is to compare a cup pituitary rongeur vs. a reaming biopsy from the intramedullary canal during the treatment of pathologic bone lesions with an intramedullary nail. METHODS: An IRB approved retrospective case control study was performed on 46 consecutive patients who underwent an IMN for pathologic fracture or impending pathologic fracture with an obvious lytic lesion with a known metastatic primary. A laryngeal cup pituitary forceps' rongeur was used in 25 patients and the intramedullary reamer as it passed the lesion was used in 21 patients. Histopathology reports were assessed for (1) adequacy of bone sample (defined as containing sufficient bone and marrow-derived tissue to allow complete histological analysis) and (2) tumor tissue diagnosis. A standard approach for IMN was used. RESULTS: Twenty-three of 25 cup biopsy cases (92%) had positive pathology that corresponded to the primary cancer. Eleven of 21 reaming cases (52.4%) had positive pathology that corresponded to the primary cancer (p = 0.0117). CONCLUSION: The use of an intramedullary cup biopsy forceps is better than reamings to diagnose pathological lesions of impending and pathological fractures in long bones caused by metastatic lesions.

Functional evaluation of synthetic flavonoids and chalcones for potential antiviral and anticancer properties.

Flavonoids, stilbenes, and chalcones are plant secondary metabolites that often possess diverse biological activities including anti-inflammatory, anti-cancer, and anti-viral activities. The wide range of bioactivities poses a challenge to identify their targets. Here, we studied a set of synthetically generated flavonoids and chalcones to evaluate for their biological activity, and compared similarly substituted flavonoids and chalcones. Substituted chalcones, but not flavonoids, showed inhibition of viral translation without significantly affecting viral replication in cells infected with hepatitis C virus (HCV). We suggest that the chalcones used in this study inhibit mammalian target of rapamycin (mTOR) pathway by ablating phosphorylation of ribosomal protein 6 (rps6), and also the kinase necessary for phosphorylating rps6 in Huh7.5 cells (pS6K1). In addition, selected chalcones showed inhibition of growth in Ishikawa, MCF7, and MDA-MB-231 cells resulting an IC50 of 1-6µg/mL. When similarly substituted flavonoids were used against the same set of cancer cells, we did not observe any inhibitory effect. Together, we report that chalcones show potential for anti-viral and anti-cancer activities compared to similarly substituted flavonoids.

The Role of Inclusion in Increasing Diversity and Retention Across Surgical Residencies: a Literature Review.

PURPOSE OF REVIEW: Across surgical specialties, residencies are incentivized to improve program diversity, most often through recruitment of underrepresented minority (URM), women, LGBTQ, and disabled applicants. However, residency attrition remains high in these groups, highlighting the need for specific inclusion initiatives to improve retention and support for these cohorts. A better understanding of previous efforts at retention is paramount. This paper reviews the existing literature on inclusion and retention efforts in surgical residencies. RECENT FINDINGS: A literature search was conducted using PubMed Central. Published articles were filtered based on date (2018-2023) and relevancy. Articles were evaluated holistically and focused on methods in increasing diversity and inclusion in residency retention. Through formal literature review focusing on pertinent research topic terms (i.e., inclusion, diversity, residency, surgery, retention), efforts that included inclusion initiatives, improving residency retention, and diversifying leadership were overarching themes. In recent years, there have been marked strides and improvements in encouraging resident diversity and inclusion. However, more widespread efforts with proven efficacy are needed in order to improve residency retention and to increase and maintain diversity in leadership in surgery.

Differences in Immediate Postoperative Outcomes Between Robotic-Assisted TKA and Conventional TKA.

BACKGROUND: Robotic-assisted total knee arthroplasty (TKA) is a growing technique in adult reconstruction. The variations between robotic-assisted and conventional TKA could lead to changes in immediate postoperative outcomes. We aimed to evaluate for differences in postoperative pain, discharge day, as well as post-hospital disposition (home vs subacute rehabilitation facility [SAR]) between robotic-assisted and conventional TKA. METHODS: We retrospectively identified 2 cohorts of patients who underwent either conventional or robotic-assisted TKA between January 2019 and July 2019. Their average pain scores from postoperative day 0, day 1, and day 2 were recorded. Their postoperative discharge day was recorded, as well as their disposition to either home or a SAR. Preoperatively, all patients are offered robotic-assisted TKA, and only those who want the procedure and undergo a preoperative CT scan receive the robotic-assisted surgery. Statistical analysis was conducted using SPSS. RESULTS: One hundred sixty-six patients were identified with 83 in each cohort. No differences between age, race, and gender were found. Despite minor variations in pain levels, the overall postoperative pain score analysis did not strongly favor one technique over the other. The robotic-assisted group had a significantly higher amount of patients discharged to home instead of a SAR and also had a shorter time to discharge than the conventional group. CONCLUSIONS: Robotic-assisted TKA has similar postoperative pain scores compared with conventional TKA. The robotic-assisted cohort demonstrated other benefits including earlier discharge and are more likely to be discharged home instead of a SAR.