Relationship Between Age and Pathology With Treatment of Pediatric and Adolescent Discoid Lateral Meniscus: A Report From the SCORE Multicenter Database.

BACKGROUND: Surgical treatment options of discoid lateral meniscus in pediatric patients consist of saucerization with or without meniscal repair, meniscocapular stabilization, and, less often, subtotal meniscectomy. PURPOSE: To describe a large, prospectively collected multicenter cohort of discoid menisci undergoing surgical intervention, and further investigate corresponding treatment of discoid menisci. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A multicenter quality improvement registry (16 institutions, 26 surgeons), Sports Cohort Outcomes Registry, was queried. Patient characteristics, discoid type, presence and type of intrasubstance meniscal tear, peripheral rim instability, repair technique, and partial meniscectomy/debridement beyond saucerization were reviewed. Discoid meniscus characteristics were compared between age groups (<14 and >14 years old), based on receiver operating characteristic curve, and discoid morphology (complete and incomplete). RESULTS: In total, 274 patients were identified (mean age, 12.4 years; range, 3-18 years), of whom 55.6% had complete discoid. Meniscal repairs were performed in 55.1% of patients. Overall, 48.5% of patients had rim instability and 36.8% had >1 location of peripheral rim instability. Of the patients, 21.5% underwent meniscal debridement beyond saucerization, with 8.4% undergoing a subtotal meniscectomy. Patients <14 years of age were more likely to have a complete discoid meniscus (P < .001), peripheral rim instability (P = .005), and longitudinal tears (P = .015) and require a meniscal repair (P < .001). Patients ≥14 years of age were more likely to have a radial/oblique tear (P = .015) and require additional debridement beyond the physiologic rim (P = .003). Overall, 70% of patients <14 years of age were found to have a complete discoid meniscus necessitating saucerization, and >50% in this young age group required peripheral stabilization/repair. CONCLUSION: To preserve physiological "normal" meniscus, a repair may be indicated in >50% of patients <14 years of age but occurred in <50% of those >14 years. Additional resection beyond the physiological rim may be needed in 15% of younger patients and 30% of those aged >14 years.

Sulfur disproportionating microbial communities in a dynamic, microoxic-sulfidic karst system.

Biogeochemical sulfur cycling in sulfidic karst systems is largely driven by abiotic and biological sulfide oxidation, but the fate of elemental sulfur (S0 ) that accumulates in these systems is not well understood. The Frasassi Cave system (Italy) is intersected by a sulfidic aquifer that mixes with small quantities of oxygen-rich meteoric water, creating Proterozoic-like conditions and supporting a prolific ecosystem driven by sulfur-based chemolithoautotrophy. To better understand the cycling of S0 in this environment, we examined the geochemistry and microbiology of sediments underlying widespread sulfide-oxidizing mats dominated by Beggiatoa. Sediment populations were dominated by uncultivated relatives of sulfur cycling chemolithoautotrophs related to Sulfurovum, Halothiobacillus, Thiofaba, Thiovirga, Thiobacillus, and Desulfocapsa, as well as diverse uncultivated anaerobic heterotrophs affiliated with Bacteroidota, Anaerolineaceae, Lentimicrobiaceae, and Prolixibacteraceae. Desulfocapsa and Sulfurovum populations accounted for 12%-26% of sediment 16S rRNA amplicon sequences and were closely related to isolates which carry out autotrophic S0 disproportionation in pure culture. Gibbs energy (∆Gr ) calculations revealed that S0 disproportionation under in situ conditions is energy yielding. Microsensor profiles through the mat-sediment interface showed that Beggiatoa mats consume dissolved sulfide and oxygen, but a net increase in acidity was only observed in the sediments below. Together, these findings suggest that disproportionation is an important sink for S0 generated by microbial sulfide oxidation in this oxygen-limited system and may contribute to the weathering of carbonate rocks and sediments in sulfur-rich environments.

Age, Sex, and BMI Differences Related to Repairable Meniscal Tears in Pediatric and Adolescent Patients.

BACKGROUND: The incidence of meniscus tears and ACL tears in pediatric patients continues to rise, bringing to question the risk factors associated with these injuries. As meniscus tears are commonly repaired in pediatric populations, the epidemiology of repairable meniscus tears is an important for consideration for surgeons evaluating treatment options. PURPOSE: To describe meniscal tear patterns in pediatric and adolescent patients who underwent meniscal repair across multiple institutions and surgeons, as well as to evaluate the relationship between age, sex, and body mass index (BMI) and their effect on the prevalence, type, and displacement of repaired pediatric meniscal tears. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Data within a prospective multicenter cohort registry for quality improvement, Sport Cohort Outcome Registry (SCORE), were reviewed to describe repaired meniscal tear patterns. All consecutive arthroscopic meniscal repairs from participating surgeons in patients aged <19 years were analyzed. Tear pattern, location, and displacement were evaluated by patient age, sex, and BMI. A subanalysis was also performed to investigate whether meniscal tear patterns differed between those occurring in isolation or those occurring with a concomitant anterior cruciate ligament (ACL) injury. Analysis of variance was used to generate a multivariate analysis of specified variables. Sex, age, and BMI results were compared across the cohort. RESULTS: There were 1185 total meniscal repairs evaluated in as many patients, which included 656 (55.4%) male and 529 (44.6%) female patients. Patients underwent surgery at a mean age of 15.3 years (range, 5-19 years), with a mean BMI of 24.9 (range, 12.3-46.42). Of the 1185 patients, 816 (68.9%) had ACL + meniscal repair and 369 (31.1%) had isolated meniscal repair. The male patients underwent more lateral tear repairs than the female patients (54.3% to 40.9%; P < .001) and had a lower incidence of medial tear repair (32.1% vs 41.4%; P < .001). Patients with repaired lateral tears had a mean age of 15.0 years, compared with a mean age of 15.4 years for patients with repaired medial or bilateral tears (P = .001). Higher BMI was associated with "complex" and "radial" tear repairs of the lateral meniscus (P < .001) but was variable with regard to medial tear repairs. CONCLUSION: In pediatric and adolescent populations, the data suggest that the surgical team treating knees with potential meniscal injury should be prepared to encounter more complex meniscal tears, commonly indicated in those with higher BMI, while higher rates of lateral meniscal tears were seen in male and younger patients. Future studies should analyze correlates for meniscal repair survival and outcomes in this pediatric cohort undergoing knee surgery.

Comparison of Structural Parsers and Neural Language Models as Surprisal Estimators.

Expectation-based theories of sentence processing posit that processing difficulty is determined by predictability in context. While predictability quantified via surprisal has gained empirical support, this representation-agnostic measure leaves open the question of how to best approximate the human comprehender's latent probability model. This article first describes an incremental left-corner parser that incorporates information about common linguistic abstractions such as syntactic categories, predicate-argument structure, and morphological rules as a computational-level model of sentence processing. The article then evaluates a variety of structural parsers and deep neural language models as cognitive models of sentence processing by comparing the predictive power of their surprisal estimates on self-paced reading, eye-tracking, and fMRI data collected during real-time language processing. The results show that surprisal estimates from the proposed left-corner processing model deliver comparable and often superior fits to self-paced reading and eye-tracking data when compared to those from neural language models trained on much more data. This may suggest that the strong linguistic generalizations made by the proposed processing model may help predict humanlike processing costs that manifest in latency-based measures, even when the amount of training data is limited. Additionally, experiments using Transformer-based language models sharing the same primary architecture and training data show a surprising negative correlation between parameter count and fit to self-paced reading and eye-tracking data. These findings suggest that large-scale neural language models are making weaker generalizations based on patterns of lexical items rather than stronger, more humanlike generalizations based on linguistic structure.

Sternoclavicular Septic Arthritis Caused by Cutibacterium acnes in a Previously Healthy 13-Year-Old Male: A Case Report.

CASE: A 13-year-old boy presented with 3 weeks of atraumatic left-sided sternoclavicular (SC) joint pain, swelling, and decreased range of motion. After imaging and laboratory workup, he underwent operative irrigation, debridement, and antibiotic therapy with complete resolution of his symptoms. Surgical cultures were consistent with SC septic arthritis. CONCLUSION: The management of septic arthritis in pediatric patients remains varied. Here, we present the only report of SC septic arthritis due to Cutibacterium acnes in a healthy pediatric patient. Given the similar clinical findings of pain and swelling to affected bones and joints, differentiating SC septic arthritis from other conditions within the clinical spectrum of chronic nonbacterial osteomyelitis remains challenging. Clinicians should maintain a high index of suspicion when patients present with pain and swelling over the SC joint.

Appropriate Use Criteria for Treatment of Pediatric Supracondylar Humerus Fractures With Vascular Injury: Do Our Hospital Practice Patterns Agree With Current Recommendations?

BACKGROUND: Managing the pulseless pediatric supracondylar humerus fracture (PSHF) remains a significant clinical decision-making challenge for the treating surgeon. The purpose of the study is to determine frequency of the treatments according to the American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria (AUC) for the PSHF with vascular injury and evaluate the appropriateness of these interventions. METHODS: We identified all PSHF with concern for vascular injury at one high volume, level 1 trauma center managed by 6 fellowship-trained pediatric orthopaedic surgeons over 4.5 years. Demographic information and other injury and treatment variables were obtained. Each patient was classified as 1 of the 6 patient scenarios specified by the AAOS AUC. Each of the 18 interventions identified in the AUC were documented, including the level of "appropriateness" as specified by AAOS AUC. RESULTS: A total of 638 PSHF were managed identified; of these, 52 were pink, pulseless, or dysvascular (8.2%). Only 7 of the 18 treatment options suggested by the AUC were used in this cohort. Across all 7 interventions used in this cohort, 20.2% (17/84) of interventions were "appropriate," 52.4% (44/84) were "maybe appropriate," 22.6% (19/84) were "rarely appropriate," and 4.8% (4/84) were not listed in treatment options. CONCLUSIONS: Supracondylar fractures are the most common injury to the elbow seen in children and are variable in presentation and management. The pink, pulseless fracture continues to be a major topic for research and discussion due to the morbidity if not treated "appropriately." The AUC were created to help guide practitioners when strong evidence is lacking. In this study at a single, pediatric hospital, there was variation and disagreement with "appropriateness" of treatments that were performed but this discrepancy did not result in any poor outcomes. Although the AUC do offer valuable guidance, our findings highlight a need for continued research in this area to help validate the AUC and help strengthen the recommendations moving forward. LEVEL OF EVIDENCE: Level III-retrospective.

Extensive involvement of the gastrointestinal tract by a de novo presentation of the monoblastic type of myeloid sarcoma: a case report of a rare entity that is often misdiagnosed.

We present the first known case of the monoblastic type of myeloid sarcoma (also known as extramedullary myeloid tumor, chloroma, and granulocytic sarcoma) with diffuse involvement of the gastrointestinal tract. The patient originally presented with diarrhea and crampy abdominal discomfort. Endoscopically, the disease showed a diffuse inflammatory process mimicking a number of benign conditions, such as inflammatory bowel disease and autoimmune enteropathy. Sequential biopsies of the upper and lower gastrointestinal tract showed a diffuse infiltrate of increasingly atypical cells. The disease progressed to systemic involvement, including widespread lymphadenopathy, splenomegaly, and pulmonary deposits; the patient died 13 months after the development of initial symptoms. The immunohistochemical and histologic profiles of this case are diagnostic of the monoblastic type of myeloid sarcoma.

Irritable bowel syndrome: a practical approach.

Irritable bowel syndrome accounts for approximately 2.7 million physician office visits yearly, although only 10%-30% of affected patients seek treatment. The disease is predominantly found in women 20-50 years of age. The etiology of irritable bowel syndrome is likely multifactorial: environmental factors, genetics, gut flora alterations, nervous system alterations (visceral hypersensitivity and motility abnormalities), and psychosocial stressors are thought to contribute. Treatment options are also quite diverse, including both pharmacologic and nonpharmacologic modalities. This article summarizes the proposed pathophysiology of and treatment options for irritable bowel syndrome.