Stemless reverse total shoulder arthroplasty: a systematic review.

BACKGROUND: The use of reverse total shoulder arthroplasty and stemless anatomic total shoulder replacement has been increasing in the United States every year. Stemless humeral components in reverse total shoulder arthroplasty are only approved for clinical trials in the United States with an investigational device exception with limited data. METHODS: A systematic review on stemless reverse total shoulder arthroplasty was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A search was conducted on November 25, 2020, using the MEDLINE/PubMed, Cochrane, and Embase databases. All articles were reviewed by 2 independent evaluators, with any conflicts or issues resolved by consensus or a final decision by the senior author. The primary outcomes extracted were complications, radiographic results, and outcome scores. RESULTS: We evaluated 10 studies that used either the Total Evolutive Shoulder System (TESS) or Verso implant. There were 430 total patients and 437 total procedures; 266 patients in the TESS group underwent a total of 272 procedures, and 164 patients in the Verso group underwent a total of 165 procedures. The mean age at the time of surgery was 73.8 years (range, 38-93 years). The mean follow-up period ranged from 6.4 to 101.6 months per study. There was an overall trend of improved clinical outcome scores, a 0.2% humeral component loosening rate, and an 11.2% complication rate. CONCLUSIONS: This review shows that the clinical and functional outcomes following stemless or metaphyseal reverse total shoulder arthroplasty are quite promising, especially with the low rate of humeral-sided complications. There continues to be a need for additional long-term studies and randomized clinical trials.

Three-dimensional Imaging and Analysis of Mitochondria within Human Intraepidermal Nerve Fibers.

The goal of this protocol is to study mitochondria within intraepidermal nerve fibers. Therefore, 3D imaging and analysis techniques were developed to isolate nerve-specific mitochondria and evaluate disease-induced alterations of mitochondria in the distal tip of sensory nerves. The protocol combines fluorescence immunohistochemistry, confocal microscopy and 3D image analysis techniques to visualize and quantify nerve-specific mitochondria. Detailed parameters are defined throughout the procedures in order to provide a concrete example of how to use these techniques to isolate nerve-specific mitochondria. Antibodies were used to label nerve and mitochondrial signals within tissue sections of skin punch biopsies, which was followed by indirect immunofluorescence to visualize nerves and mitochondria with a green and red fluorescent signal respectively. Z-series images were acquired with confocal microscopy and 3D analysis software was used to process and analyze the signals. It is not necessary to follow the exact parameters described within, but it is important to be consistent with the ones chosen throughout the staining, acquisition and analysis steps. The strength of this protocol is that it is applicable to a wide variety of circumstances where one fluorescent signal is used to isolate other signals that would otherwise be impossible to study alone.

A Medical Student-Driven "Vaccine Blitz" at a School-Based Health Center as an Effective Way to Improve Adolescent Vaccination Rates.

BACKGROUND AND OBJECTIVES: Adolescent vaccine rates are below goal in the United States. We sought to assess a medical student driven "vaccine blitz" at a middle school with a school-based health center (SBHC) as a means to increase vaccination. METHODS: Written and/or verbal consent was obtained for specific vaccines needed. Vaccines were given at the SBHC by a team of medical students, public health students, and SBHC staff. Students who received vaccines at the SBHC or primary care physician's (PCP's) office in the 3 weeks after consent was attempted were included as participating in the intervention. RESULTS: Of 184 potential participants, 183 lacked at least one vaccine. On the day of the vaccine blitz, 48 students were given 94 vaccines. During the entire intervention time, an additional 14 students received 38 vaccines at the SBHC, and 23 students received 34 vaccines from their PCP. In sum, 85 students received 166 vaccines from this intervention. Immunization rates increased above the state average for all recommended vaccines; rates of HPV, hepatitis A, and influenza vaccination were most affected. CONCLUSIONS: Medical student-driven vaccine blitzes within an SBHC are a feasible, replicable, and effective way to increase adolescent vaccination rates. In addition, the blitz provided preclinical medical students' exposure to underserved populations, adolescent health as part of the breadth of family medicine, SBHCs, and community medicine and allowed for multidisciplinary work between medical students, public health students, physicians, and nurse practitioners.

Hyperglycemia- and neuropathy-induced changes in mitochondria within sensory nerves.

OBJECTIVE: This study focused on altered mitochondrial dynamics as a potential mechanism for diabetic peripheral neuropathy (DPN). We employed both an in vitro sensory neuron model and an in situ analysis of human intraepidermal nerve fibers (IENFs) from cutaneous biopsies to measure alterations in the size distribution of mitochondria as a result of hyperglycemia and diabetes, respectively. METHODS: Neurite- and nerve-specific mitochondrial signals within cultured rodent sensory neurons and human IENFs were measured by employing a three-dimensional visualization and quantification technique. Skin biopsies from distal thigh (DT) and distal leg (DL) were analyzed from three groups of patients; patients with diabetes and no DPN, patients with diabetes and confirmed DPN, and healthy controls. RESULTS: This analysis demonstrated an increase in mitochondria distributed within the neurites of cultured sensory neurons exposed to hyperglycemic conditions. Similar changes were observed within IENFs of the DT in DPN patients compared to controls. This change was represented by a significant shift in the size frequency distribution of mitochondria toward larger mitochondria volumes within DT nerves of DPN patients. There was a length-dependent difference in mitochondria within IENFs. Distal leg IENFs from control patients had a significant shift toward larger volumes of mitochondrial signal compared to DT IENFs. INTERPRETATION: The results of this study support the hypothesis that altered mitochondrial dynamics may contribute to DPN pathogenesis. Future studies will examine the potential mechanisms that are responsible for mitochondrial changes within IENFs and its effect on DPN pathogenesis.