Cognitive and linguistic abilities and perceptual restoration of missing speech: Evidence from online assessment.

When speech is clear, speech understanding is a relatively simple and automatic process. However, when the acoustic signal is degraded, top-down cognitive and linguistic abilities, such as working memory capacity, lexical knowledge (i.e., vocabulary), inhibitory control, and processing speed can often support speech understanding. This study examined whether listeners aged 22-63 (mean age 42 years) with better cognitive and linguistic abilities would be better able to perceptually restore missing speech information than those with poorer scores. Additionally, the role of context and everyday speech was investigated using high-context, low-context, and realistic speech corpi to explore these effects. Sixty-three adult participants with self-reported normal hearing completed a short cognitive and linguistic battery before listening to sentences interrupted by silent gaps or noise bursts. Results indicated that working memory was the most reliable predictor of perceptual restoration ability, followed by lexical knowledge, and inhibitory control and processing speed. Generally, silent gap conditions were related to and predicted by a broader range of cognitive abilities, whereas noise burst conditions were related to working memory capacity and inhibitory control. These findings suggest that higher-order cognitive and linguistic abilities facilitate the top-down restoration of missing speech information and contribute to individual variability in perceptual restoration.

Matrix Metalloproteinases and Their Inhibitors and Proteoglycan 4 in Patients Undergoing Total Joint Arthroplasty.

Osteoarthritis, a degenerative disease of the joints, is the most common form of arthritis in the knee. Total joint arthoplasty is a commonly used treatment for joint degeneration and osteoarthritis, and due to these factors, TJA for hip and knee joints is projected to grow by 137% and 601% between 2005 and 2030. Matrix metalloproteases are enzymes found in the extracellular matrix that cleave matrix components. Normally MMPs are downregulated in tissues by Tissue Inhibitors of Metalloproteases, or TIMPs. The relative concentration of TIMPs also may denote some of the activity of the MMPs found in serum. Lubricin (proteoglycan 4) is a molecule found in the synovial fluid that protects joints by dissipating strain energy during locomotion. Lubricin synovial fluid concentration is also diminished in many patients with osteoarthritis, but not all. Given the importance of these three sets of molecules, our lab investigated the correlation between circulating lubricin, MMP levels and TIMPs levels. Blood plasma samples were obtained from de-identified subjects undergoing total joint arthroplasty at Loyola University Medical Center and the University of Utah. Normal blood plasma from pooled healthy individuals served as a control. We analyzed biomarker levels in plasma using ELISA. Our data show that MMP-1 and 9 were increased in TJA patients compared to normal controls, while MMP-2 and 13 were decreased. We also found decreased lubricin and tissue factor in surgical patients relative to controls. These data support the idea that lubricin is vital in protecting the synovial joint and that MMPs play a complex role in the destruction of the joint.

Return to Play After Hook of Hamate Excision in Baseball Players.

BACKGROUND: Fractures of the hook of hamate in baseball players are significant injuries that can lead to pain and missed time from competition. The diagnosis is typically delayed because of the vagueness of symptoms and normal radiographic findings. Excision of the nonunited fragment has been supported as the primary treatment, but there are currently limited information and data on a timetable for return to competition after surgery. PURPOSE: To report on a large cohort of competitive baseball players with hook of hamate fractures treated with excision of the fragment and to assess the timetable for return to full athletic competition. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Competitive baseball players treated between 2012 and 2017 with hook of hamate excision for acute fractures or chronic fracture nonunions were retrospectively identified. All patients were treated by the same surgeon, and the time to return to full athletic competition was assessed. Return to play was defined as reaching the athlete's preinjury level and being able to perform full sport activities. RESULTS: A total of 41 baseball players were identified, all of whom were documented to have a chronic presentation of a nonunion or partial union. The population consisted completely of male athletes, with a median age of 21 years (range, 18-34 years). All patients were competitive athletes, with 12 professional baseball players, 17 collegiate baseball players, and 12 high school baseball players. All patients were treated with hook of hamate excision, with 7 patients undergoing concomitant procedures as indicated. The median time to return to play was 5 weeks (range, 3-7 weeks). The time to return to play was similar between professional, collegiate, and high school athletes. All athletes returned to their preinjury level of activity by 7 weeks postoperatively. CONCLUSION: This study confirms that excision of the fractured hook provides predictable, early return to play, with a limited complication rate.

Fibrinolytic Dysregulation in Total Joint Arthroplasty Patients: Potential Clinical Implications.

BACKGROUND: The alterations of the fibrinolytic components in osteoarthritic joint disease and their postsurgical modulation are not clearly understood. Preexisting hemostatic dysfunction may lead to both thrombotic and bleeding events in these patients. AIM: To profile fibrinolytic parameters in patients undergoing total joint arthroplasty prior to and on postoperative day 1. METHODS: A total of 98 total joint arthroplasty patients were included in this study. Blood samples were drawn preoperatively and on postoperative day 1 status posttotal knee or total hip arthroplasty surgery. d-Dimer, plasminogen activator inhibitor 1 (PAI-1), and tissue plasminogen activator (tPA) were measured using commercially available enzyme-linked immunosorbent assay kits. Antiplasmin activity was measured by using a functional method. RESULTS: Preoperative PAI-1, d-dimer, and tPA levels were significantly higher in arthroplasty patients compared to healthy controls. Preoperative antiplasmin level was lower than controls. Postoperative levels of PAI-1 and d-dimer were increased compared to preoperative values. Postoperative antiplasmin values were lower than preoperative levels. Changes in tPA was not significant. There was no correlation between preoperative PAI-1 and d-dimer levels. Pre- and postoperative percentage changes in each individual were calculated for PAI-1, d-dimer, tPA, and antiplasmin. There was a positive correlation between d-dimer and PAI-1. Negative correlations between antiplasmin and d-dimer and between antiplasmin and PAI-1 were noted. CONCLUSION: These results confirm the perturbation in the fibrinolytic system of patients undergoing total joint arthroplasty surgery. Surgical intervention may also enhance the observed changes. The alterations in the fibrinolytic system may lead to the observed hemostatic complications such as bleeding, hematoma formation, or potential need for blood transfusion.

Perioperative Factors and Their Effect on the Fibrinolytic System in Arthroplasty Patients.

BACKGROUND: Total joint arthroplasty (TJA) patients are mostly of advanced age and with comorbidities such as increased body mass index (BMI) and impaired glucose tolerance. These factors and type of surgery may affect the fibrinolytic system. AIM: To investigate the effect of age, sex, BMI, type of surgery, and tranexamic acid (TXA) treatment on the fibrinolytic system in TJA patients. METHODS: Ninety-nine patients undergoing TJA (32 total hip arthroplasty [THA] and 67 total knee arthroplasty [TKA]) were included in this study. Blood samples were drawn at preoperative clinic appointments and on postoperative day 1. Antigenic levels of d-dimer, plasminogen activator inhibitor 1 (PAI-1), and tissue plasminogen activator (tPA) were measured using a commercially available enzyme-linked immunosorbent assay kit. Antiplasmin activity was measured using functional method. Age, gender, hemoglobin (Hb) levels, and BMI were collected from the records. RESULTS: Preoperative d-dimer and tPA levels were positively correlated with age, whereas preoperative antiplasmin was negatively correlated with age. Body mass index was only associated with preoperative tPA levels. There was no significant difference in postoperative levels of d-dimer, PAI-1, tPA, or antiplasmin between patients treated with TXA or without TXA. Percentage change in d-dimer and tPA showed significantly lower values in patients treated with TXA compared to the nontreated group. Type of surgery did not affect the fibrinolytic markers. CONCLUSION: These results confirm that advanced age and elevated BMI positively contribute to fibrinolytic dysregulation in TJA patients, whereas TXA seems to decrease the fibrinolytic activity.