Basal Cell Carcinoma With Metastasis to the Thoracic Spine: An Uncommon Case Report and Review of the Literature.

Basal cell carcinoma is an exceedingly rare cause of spinal metastatic disease for which the treatment algorithm is poorly defined. We present a positive patient outcome after treatment of T8 metastatic basal with posterior decompression and fusion followed by later anterior reconstruction, in addition to targeted radiation therapy and pharmacologic therapy. In general, a personalized and comprehensive treatment approach should be used, incorporating surgical, oncologic, and pharmacologic methods as able. Moreover, primary preventive medical and mental health care can help prevent delayed presentation and increased access to timely care.

Return of Scapulohumeral Rhythm in Patients After Reverse Shoulder Arthroplasty: A Midterm Stereoradiographic Imaging Analysis.

Background: Reverse shoulder arthroplasty (RSA) is associated with high rates of midterm complications including scapular notching, implant wear, and mechanical impingement. Scapulo-humeral rhythm (SHR), described by Codman in the 1920's, is defined as the ratio of glenohumeral motion to scapulothoracic motion. SHR is used as an indicator of shoulder dysfunction, as alterations in SHR can have profound implications on shoulder biomechanics. The determination of SHR can be hindered by soft-tissue motion artifacts and high radiation burdens associated with traditional surface marker or fluoroscopic analysis. EOS low dose stereoradiographic imaging analysis utilizing 3D model construction from a 2D X-ray series may offer an alternative modality for characterizing SHR following RSA. Methods: Patients (n=10) underwent an EOS imaging analysis to determine SHR at six and twelve months post-RSA. Leveraging 3D models of the implants, 2D/3D image registration methods were used to calculate relative glenohumeral and scapulothoracic positioning at 60, 90 and 120° of shoulder elevation. Subject-specific SHR curves were assessed and midterm changes in post-RSA SHR associated with follow-up time and motion phase were evaluated. Pearson correlations assessed associations between patient-specific factors and post-RSA SHR. Results: Mean post-RSA SHR was 0.81:1 across subjects during the entire midterm postoperative period. As a cohort, post-RSA SHR was more variable for 60-90° of shoulder motion. SHR for 90-120° of motion decreased (0.43:1) at twelve months post-RSA. Post-RSA SHR could be categorized using three relative motion curve patterns, and was not strongly associated with demographic factors such as BMI. 50% of subjects demonstrated a different SHR relative motion curve shape at twelve months post-RSA, and SHR during the 90120° of motion was found to generally decrease at twelve months. Conclusion: Midterm post-RSA SHR was successfully evaluated using EOS technology, revealing lower SHR values (i.e., greater scapulothoracic motion) compared to normal values reported in the literature. SHR continued to change for some subjects during the midterm post-RSA period, with the greatest change during 90-120° of shoulder motion. Study findings suggest that future post RSA rehabilitation efforts to address elevated scapulothoracic motion may benefit from being patient-specific in nature and targeting scapular stabilization during 90-120° of shoulder motion. Level of Evidence: IV.

Cartilage and Meniscus Injuries Are More Common in Patients Undergoing Delayed Multiligament Reconstruction.

The purpose of this study was to describe the pattern of meniscus and cartilage pathology in multiligament knee injuries (MLKIs) and determine the relationship between surgical timing and injury mechanism with degree of intra-articular injury. Patients with surgically treated MLKIs over a 15-year period were retrospectively reviewed and grouped based on surgical intervention, time to intervention, and injury mechanism. The presence or absence of meniscus and chondral injury were recorded at the time of surgery. Surgical intervention within 6 weeks of injury was deemed acute, while surgery occurring more than 6 weeks from injury was classified as delayed. Over the 15-year study period, 207 patients with MLKIs were identified. Compared with acutely managed patients, the delayed intervention group had significantly more meniscus (p = 0.03) and cartilage (p < 0.01) pathology. Meniscus injury rates in MLKIs sustained during sporting activity did not differ from nonsporting injuries (p = 0.63). However, the nonsporting group had significantly more chondral injuries (p < 0.01). High-energy injury mechanism was associated with increased cartilage (p = 0.02), but not meniscus (p = 0.61) injury rates. In conclusion, surgical reconstruction of MLKIs delayed for more than 6 weeks was associated with increased meniscus and cartilage pathology.

A blood screening tool for detecting mild cognitive impairment and Alzheimer's disease among community-dwelling Mexican Americans and non-Hispanic Whites: A method for increasing representation of diverse populations in clinical research.

INTRODUCTION: Representation of Mexican Americans in Alzheimer's disease (AD) clinical research has been extremely poor. METHODS: Data were examined from the ongoing community-based, multi-ethnic Health & Aging Brain among Latino Elders (HABLE) study. Participants underwent functional exams, clinical labs, neuropsychological testing, and 3T magnetic resonance imaging of the brain. Fasting proteomic markers were examined for predicting mild cognitive impairment (MCI) and AD using support vector machine models. RESULTS: Data were examined from n = 1649 participants (Mexican American n = 866; non-Hispanic White n = 783). Proteomic profiles were highly accurate in detecting MCI (area under the curve [AUC] = 0.91) and dementia (AUC = 0.95). The proteomic profiles varied significantly between ethnic groups and disease state. Negative predictive value was excellent for ruling out MCI and dementia across ethnic groups. DISCUSSION: A blood-based screening tool can serve as a method for increasing access to state-of-the-art AD clinical research by bridging between community-based and clinic-based settings.

Does Smoking Cessation Prior to Elective Total Joint Arthroplasty Result in Continued Abstinence?

BACKGROUND: Smoking tobacco is a known modifiable risk factor for complications in total joint arthroplasty (TJA) patients. Patients are commonly required to quit smoking prior to TJA. After the early postoperative period, little is known about the long-term implications of this preoperative behavioral change. Our aims were to 1) identify TJA patients that had negative anabasine screen prior to elective TJA and 2) determine the long-term rates of continued smoking abstinence. METHODS: At our institution, TJA patients identified as smokers undergo urine anabasine testing prior to surgery. Between 2009 - 2018 all patients that had elective primary TJA with pre-operative urine anabasine tests were queried. Patients were called post-operatively at mean 52 months (range 15 - 126 months) and surveyed regarding smoking status. Long-term smoking cessation rates were then analyzed along with relapse time frame. The use of quit aid and patient perspective on importance of quitting were also analyzed. RESULTS: 249 smokers that had elective TJA were identified. 124 (50%) participated in the survey, and 93 quit to facilitate surgery. 21 (23%) never resumed smoking, and 32 (34%) were currently abstinent. Just over half of the patients relapsed in the three-month post-operative period (55%). There were no differences in quit aid or patient perspectives between these groups. CONCLUSION: With an increased focus on smoking cessation prior to elective TJA, orthopedics contributes to an important public health initiative. Although national quit rates are in the single digits, 23% of patients were able to quit permanently.Level of Evidence: IV.

Inflammatory Biomarkers, Depressive Symptoms and Falls Among the elderly in Panama.

BACKGROUND: Falls are common among elderly adults, and are predictors of hospitalization, institutionalization and mortality. OBJECTIVE: The objective of the present study was to examine the relationship between blood-based markers of inflammation and fall events in a sample of elderly Hispanic adults. METHOD: Data were collected from 190 participants enrolled in the Panama Aging Research Initiative study who completed baseline clinical and cognitive assessments. A non-fasting blood sample was obtained. Self-reported falls were classified as no falls, single falls or recurrent (two or more) falls reported in the 12 months prior to baseline evaluations. Serum levels of C Reactive Protein (CRP), T-lymphocyte secreting protein (I-309), interleukin 10 (IL-10), interleukin 6 (IL-6) and interleukin 7 (IL-7) were measured. Global cognition was assessed with the Mini Mental State Examination and depressive symptoms were assessed with the Geriatric Depression Scale (GDS-30). Multinomial logistic regression was used to assess the link between inflammation and fall events. RESULTS: Depressive symptoms, limitations in Instrumental Activities of Daily Living (IADL), IL-7 and I-309 were significantly related to fall events. Elevated levels of IL-7 increased the likelihood of single and recurrent falls, while increased levels of I-309 were associated only with recurrent falls. Greater IADL limitations and depressive symptoms were associated with an increased likelihood of recurrent falls. CONCLUSION: There is a lack of research investigating the relationship between inflammatory biomarkers and fall events. These results provide evidence of risk factors for falls in Hispanic older adults, and could serve to guide public health professionals to establish clinical guidelines to reduce fall risks.