Are Short Stems Associated With Higher Fracture Rates and Early Revision Rates in Primary Total Hip Arthroplasty? A Noninferiority Analysis.

BACKGROUND: This study aimed to determine if "short" femoral stems were noninferior to (at least as good as) standard-length stems in regards to 90-day periprosthetic fracture and 1-year revision rates. METHODS: Using the MARCQI implant registry, a retrospective study of statewide data was carried out on 64,084 total hip arthroplasties (THAs) between 2012 and 2017. We noticed an increase in the use of "short" uncemented femoral hip stems during THA. Chi-square tests were used to test homogeneity of categorical variables. The covariates included in the analyses were identified using modern epidemiological methods. A Type I probability of 0.05 was used as the level of statistical significance. Inverse probability of treatment weighting (IPTW) was used to mitigate confounding variables. RESULTS: One hundred and seven stems were implanted by surgeons in the state of Michigan. They were classified according to the Khanuja Classification System as Type 2A (trapezoidal, double-tapered calcar loading, n = 3,281), Type 3 (calcar loading with lateral flare, n = 1,898), and Type 4 (shortened, tapered, conventional, n = 19,580), and were compared to standard-length, type 5, stems (n = 33,322) in regards to the 2 outcomes (periprosthetic fractures and 1-year revision rates). Overall, 1-year revision and the 90-day fracture rates were 1.3% (791/57,853) and 1.1% (631/57,968), respectively. Noninferiority was established for all short stems at the clinical threshold of an odds ratio (OR) of 1.5 with P-values <0.05 for 90-day fractures. In regards to 1-year revision rates, noninferiority was also established for Type 3 and 4 stems (P < .05). CONCLUSION: The increased use of "short stems" in Michigan did not lead to increased 1-year revision or 90-day fracture rates.

Light regulates xylem cell differentiation via PIF in Arabidopsis.

The balance between cell proliferation and differentiation in the cambium defines the formation of plant vascular tissues. As cambium cells proliferate, subsets of daughter cells differentiate into xylem or phloem. TDIF-PXY/TDR signaling is central to this process. TDIF, encoded by CLE41 and CLE44, activates PXY/TDR receptors to maintain proliferative cambium. Light and water are necessary for photosynthesis; thus, vascular differentiation must occur upon light perception to facilitate the transport of water and minerals to the photosynthetic tissues. However, the molecular mechanism controlling vascular differentiation in response to light remains elusive. In this study we show that the accumulation of PIF transcription factors in the dark promotes TDIF signaling and inhibits vascular cell differentiation. On the contrary, PIF inactivation by light leads to a decay in TDIF activity, which induces vascular cell differentiation. Our study connects light to vascular differentiation and highlights the importance of this crosstalk to fine-tune water transport.

Analysis of the Effect of the Size and Grade of Soft Tissue Sarcoma on Rates of Unplanned Resection, Metastatic Disease, Mortality, and Morbid Re-Resection Over 20 Years.

Soft tissue sarcomas are rare malignancies that are often presumed to be benign and are resected without the typical preoperative workup, such as imaging or biopsy. These unplanned resections occur in approximately 30% of all cases and frequently require further morbid treatments, resulting in worse oncologic outcomes. A retrospective review was performed of all patients who presented to a tertiary sarcoma center with a diagnosis of sarcoma between 1996 and 2017. In-depth chart reviews were performed for the 2600 patients who were identified, with 836 having a primary diagnosis of soft tissue sarcoma in an upper or lower extremity. Data collected included histologic features, grade, size, resection status, demographic features, referral information, metastatic disease, morbid procedures, and mortality rate. Patients were divided into 2 groups based on whether the tumor size was greater or less than 5 cm. This classification was in keeping with the guideline of referring patients to a tertiary sarcoma center for workup for tumors "larger than a golf ball." The difference in the rate of unplanned resection for tumors measuring less than 5 cm (41.6%) and those measuring 5 cm or greater (18.8%) was statistically significant (P<.001), with smaller tumors more likely to undergo unplanned resection, in keeping with the success of the "golf ball rule." The rate of metastatic disease for unplanned resection for tumors measuring 5 cm or greater (50.7%) was significantly greater than that for tumors measuring less than 5 cm (19.7%) (P<.001). The authors found a great deal of morbidity associated with unplanned resection, regardless of tumor size. Before resection is planned, delineation is required beyond tumor size. [Orthopedics. 2021;44(3):166-171.].

Sodiation and Desodiation via Helical Phosphorus Intermediates in High-Capacity Anodes for Sodium-Ion Batteries.

Na-ion batteries are promising alternatives to Li-ion systems for electrochemical energy storage because of the higher natural abundance and widespread distribution of Na compared to Li. High capacity anode materials, such as phosphorus, have been explored to realize Na-ion battery technologies that offer comparable performances to their Li-ion counterparts. While P anodes provide unparalleled capacities, the mechanism of sodiation and desodiation is not well-understood, limiting further optimization. Here, we use a combined experimental and theoretical approach to provide molecular-level insight into the (de)sodiation pathways in black P anodes for sodium-ion batteries. A determination of the P binding in these materials was achieved by comparing to structure models created via species swapping, ab initio random structure searching, and a genetic algorithm. During sodiation, analysis of 31P chemical shift anisotropies in NMR data reveals P helices and P at the end of chains as the primary structural components in amorphous Na xP phases. X-ray diffraction data in conjunction with variable field 23Na magic-angle spinning NMR support the formation of a new Na3P crystal structure (predicted using density-functional theory) on sodiation. During desodiation, P helices are re-formed in the amorphous intermediates, albeit with increased disorder, yet emphasizing the pervasive nature of this motif. The pristine material is not re-formed at the end of desodiation and may be linked to the irreversibility observed in the Na-P system.

Veterans Health Information Exchange: Successes and Challenges of Nationwide Interoperability.

Health Information Exchange (HIE) between organizations is necessary to have more complete information and coordinate care. Given its nationwide footprint, the Department of Veterans Affairs (VA) connects and exchanges health information with a large number of organizations and consequently has a unique opportunity to experience most issues affecting clinical interoperability. The Veterans HIE Program manages these exchanges by focusing on patient engagement, provider adoption, partner relationship, technology platform, and performance. This paper analyzes the success and challenges of this program over the last five years, and offers valuable metrics and insights. Although significant progress has been made, nationwide interoperability remains fragmented and laborious, requiring multiple agreements and exchange methods. A future nationwide interoperability would embrace a single "on-ramp" to connect to everyone.

Digital plasmonic holography.

We demonstrate digital plasmonic holography for direct in-plane imaging with propagating surface-plasmon waves. Imaging with surface plasmons suffers from the lack of simple in-plane lenses and mirrors. Lens-less digital holography techniques, however, rely on digitally decoding an interference pattern between a reference wave and an object wave. With far-field diffractive optics, this decoding scheme provides a full recording, i.e., a hologram, of the amplitude and phase of the object wave, giving three-dimensional information from a two-dimensional recording. For plasmonics, only a one-dimensional recording is needed, and both the phase and amplitude of the propagating plasmons can be extracted for high-resolution in-plane imaging. Here, we demonstrate lens-less, point-source digital plasmonic holography using two methods to record the plasmonic holograms: a dual-probe near-field scanning optical microscope and lithographically defined circular fluorescent screens. The point-source geometry gives in-plane magnification, allowing for high-resolution imaging with relatively lower-resolution microscope objectives. These results pave the way for a new form of in-plane plasmonic imaging, gathering the full complex wave, without the need for plasmonic mirrors or lenses.

Mindful Eating: The Art of Presence While You Eat.

IN BRIEF Mindfulness, a practice based on Zen Buddhism, has become popular as a way of self-calming and as a method of changing eating behaviors. Mindful eating is being incorporated into behavior change programs along with recommended dietary behavior changes. This article describes mindful eating and offers ideas for how to teach the basics of this practice.

Cadaver-based abscess model for medical training.

Ultrasound imaging is a rapid and noninvasive tool ideal for the imaging of soft tissue infections and is associated with a change of clinician management plans in 50% of cases. We developed a realistic skin abscess diagnostic and therapeutic training model using fresh frozen cadavers and common, affordable materials. Details for construction of the model and suggested variations are presented. This cadaver-based abscess model produces high-quality sonographic images with internal echogenicity similar to a true clinical abscess, and is ideal for teaching sonographic diagnostic skills in addition to the technical skills of incision and drainage or needle aspiration.

A novel fresh cadaver model for education and assessment of joint aspiration.

OBJECTIVES: The objective of this study was to describe a novel cadaver model and to determine the utility of this model for teaching and assessing students in performing knee, elbow, and wrist arthrocentesis. METHODS: Third year medical students were evaluated while performing arthrocentesis during a fresh cadaver training sessions. RESULTS: Sixty-three participants were included in this analysis. There was statistically significant improvement between the pre- and post-test analysis in all aspects assessed in our study of elbow, knee and wrist arthrocentesis. CONCLUSIONS: The use of fresh cadavers for the education and assessment of arthrocenteses is an effective training model.

Quantum hydrogen-bond symmetrization in the superconducting hydrogen sulfide system.

The quantum nature of the proton can crucially affect the structural and physical properties of hydrogen compounds. For example, in the high-pressure phases of H2O, quantum proton fluctuations lead to symmetrization of the hydrogen bond and reduce the boundary between asymmetric and symmetric structures in the phase diagram by 30 gigapascals (ref. 3). Here we show that an analogous quantum symmetrization occurs in the recently discovered sulfur hydride superconductor with a superconducting transition temperature Tc of 203 kelvin at 155 gigapascals--the highest Tc reported for any superconductor so far. Superconductivity occurs via the formation of a compound with chemical formula H3S (sulfur trihydride) with sulfur atoms arranged on a body-centred cubic lattice. If the hydrogen atoms are treated as classical particles, then for pressures greater than about 175 gigapascals they are predicted to sit exactly halfway between two sulfur atoms in a structure with Im3m symmetry. At lower pressures, the hydrogen atoms move to an off-centre position, forming a short H-S covalent bond and a longer H···S hydrogen bond in a structure with R3m symmetry. X-ray diffraction experiments confirm the H3S stoichiometry and the sulfur lattice sites, but were unable to discriminate between the two phases. Ab initio density-functional-theory calculations show that quantum nuclear motion lowers the symmetrization pressure by 72 gigapascals for H3S and by 60 gigapascals for D3S. Consequently, we predict that the Im3m phase dominates the pressure range within which the high Tc was measured. The observed pressure dependence of Tc is accurately reproduced in our calculations for the phase, but not for the R3m phase. Therefore, the quantum nature of the proton fundamentally changes the superconducting phase diagram of H3S.

Disc Golf, a Growing Sport: Description and Epidemiology of Injuries.

BACKGROUND: Disc golf is a sport played much like traditional golf, but rather than using a ball and club, players throw flying discs with various throwing motions. It has been played by an estimated 8 to 12 million people in the United States. Like all sports, injuries sustained while playing disc golf are not uncommon. Although formalized in the 1970s, it has grown at a rapid pace; however, disc golf-related injuries have yet to be described in the medical literature. PURPOSE: To describe the most common injuries incurred by disc golf players while comparing the different types of throwing styles. STUDY DESIGN: Descriptive epidemiology study. METHODS: The data in this study were collected from 883 disc golf players who responded to an online survey collected over a 1-month period. Respondents answered 49 questions related to demographics, experience, style of play, and injury details. Using a chi-square analysis, common injuries sustained in players using backhand and forehand throwing styles were compared. RESULTS: More than 81% of respondents stated that they had sustained an injury playing disc golf, including injuries to the elbow (n = 325), shoulder (n = 305), back (n = 218), and knee (n = 199). The injuries were most commonly described as a muscle strain (n = 241), sprain (n = 162), and tendinitis (n = 145). The type of throw primarily used by players varied, with 86.2% using backhand, 12.7% using forehand, and 1.1% using an overhead throw. Players using a forehand throw were more likely to sustain an elbow injury (P = .014). Many players (n = 115) stated they had undergone surgery due to a disc golf-related injury, with the most common surgeries including meniscal, shoulder, spine, and foot/ankle surgeries. CONCLUSION: The majority of surveyed disc golfers sustained at least 1 injury while playing disc golf, with many requiring surgery. The types of injuries sustained by players varied by the types of throw primarily used. As the sport of disc golf continues to expand, health professionals should be aware of injuries sustained, with future studies focusing on injury prevention and education strategies.

Retrospective Analysis of the Effectiveness of Platelet-Rich Plasma in the Treatment of Achilles Tendinopathy: Pretreatment and Posttreatment Correlation of Magnetic Resonance Imaging and Clinical Assessment.

UNLABELLED: Platelet-rich plasma (PRP) has been presented as a means of treating Achilles tendinopathy. Over the past dozen years, a plethora of medical articles have advocated this treatment, yet little evidentiary-based research exists in support of this approach. Treatment protocols with PRP have been performed in 2 ways during this time: administered adjunctively during tendon surgery and as a stand-alone injection. The senior author has utilized PRP by both methods to treat Achilles tendinopathy over the past 7 years; 26 patients so treated were able to be recalled, half having undergone Achilles tendon surgery in combination with PRP administration and the other half PRP alone. In this retrospective study, qualified patients had pretreatment and posttreatment magnetic imaging studies and completed a Victorian Institute of Sports Assessment-Achilles questionnaire. In this limited study, PRP showed promise in the treatment of Achilles tendinopathy. Both the stand-alone injection group and surgical/injection groups had statistically significant degrees of improvement in pre-MRI and post-MRI imaging studies. There was no statistically significant difference between the 2 treatment groups. Of interest, it appears that the difference between the MRI scoring correlates with the survey score. LEVEL OF EVIDENCE: Therapeutic, Level, IV: Case series.

High-pressure hydrogen sulfide from first principles: a strongly anharmonic phonon-mediated superconductor.

We use first-principles calculations to study structural, vibrational, and superconducting properties of H_{2}S at pressures P≥200 GPa. The inclusion of zero-point energy leads to two different possible dissociations of H2S, namely 3H2S→2H3S+S and 5H2S→3H3S+HS2, where both H3S and HS2 are metallic. For H3S, we perform nonperturbative calculations of anharmonic effects within the self-consistent harmonic approximation and show that the harmonic approximation strongly overestimates the electron-phonon interaction (λ≈2.64 at 200 GPa) and Tc. Anharmonicity hardens H─S bond-stretching modes and softens H─S bond-bending modes. As a result, the electron-phonon coupling is suppressed by 30% (λ≈1.84 at 200 GPa). Moreover, while at the harmonic level Tc decreases with increasing pressure, the inclusion of anharmonicity leads to a Tc that is almost independent of pressure. High-pressure hydrogen sulfide is a strongly anharmonic superconductor.

Calcium peroxide from ambient to high pressures.

Structures of calcium peroxide (CaO2) are investigated in the pressure range 0-200 GPa using the ab initio random structure searching (AIRSS) method and density functional theory (DFT) calculations. At 0 GPa, there are several CaO2 structures very close in enthalpy, with the ground-state structure dependent on the choice of exchange-correlation functional. Further stable structures for CaO2 with C2/c, I4/mcm and P21/c symmetries emerge at pressures below 40 GPa. These phases are thermodynamically stable against decomposition into CaO and O2. The stability of CaO2 with respect to decomposition increases with pressure, with peak stability occurring at the CaO B1-B2 phase transition at 65 GPa. Phonon calculations using the quasiharmonic approximation show that CaO2 is a stable oxide of calcium at mantle temperatures and pressures, highlighting a possible role for CaO2 in planetary geochemistry. We sketch the phase diagram for CaO2, and find at least five new stable phases in the pressure-temperature ranges 0 ≤ P ≤ 60 GPa, 0 ≤ T ≤ 600 K, including two new candidates for the zero-pressure ground state structure.

Differences in relative hippocampus volume and number of hippocampus neurons among five corvid species.

The relative size of the avian hippocampus (Hp) has been shown to be related to spatial memory and food storing in two avian families, the parids and corvids. Basil et al. [Brain Behav Evol 1996;47:156-164] examined North American food-storing birds in the corvid family and found that Clark's nutcrackers had a larger relative Hp than pinyon jays and Western scrub jays. These results correlated with the nutcracker's better performance on most spatial memory tasks and their strong reliance on stored food in the wild. However, Pravosudov and de Kort [Brain Behav Evol 2006;67:1-9] raised questions about the methodology used in the 1996 study, specifically the use of paraffin as an embedding material and recalculation for shrinkage. Therefore, we measured relative Hp volume using gelatin as the embedding material in four North American species of food-storing corvids (Clark's nutcrackers, pinyon jays, Western scrub jays and blue jays) and one Eurasian corvid that stores little to no food (azure-winged magpies). Although there was a significant overall effect of species on relative Hp volume among the five species, subsequent tests found only one pairwise difference, blue jays having a larger Hp than the azure-winged magpies. We also examined the relative size of the septum in the five species. Although Shiflett et al. [J Neurobiol 2002;51:215-222] found a difference in relative septum volume amongst three species of parids that correlated with storing food, we did not find significant differences amongst the five species in relative septum. Finally, we calculated the number of neurons in the Hp relative to body mass in the five species and found statistically significant differences, some of which are in accord with the adaptive specialization hypothesis and some are not.

Prevalence of plantar verrucae in patients with human immunodeficiency virus infection during the post-highly active antiretroviral therapy era.

BACKGROUND: since the implementation of highly active antiretroviral therapy (HAART), the life expectancy of patients with human immunodeficiency virus (HIV) has significantly increased. This is likely to cause changes in podiatric medical manifestations, such as plantar verrucae, in this population. METHODS: attendees at a San Francisco street fair in 2008 provided information about HIV status and the presence of verrucae via a survey. A total of 504 surveys were analyzed and compared with 1995 data, before HAART implementation. We examined if there was a statistically significant change in the increased likelihood of plantar verrucae in HIV-positive patients from 1995 to 2008. Then we examined the likelihood of HIV-positive patients (compared to HIV-negative patients) presenting with plantar verrucae in 2008, by using logistic regression, and controlling for age, sex, and race/ethnicity. RESULTS: patients with HIV infection were 5.2 times more likely to present with plantar verrucae compared to patients without HIV infection in 2008 (95% confidence interval, 2.5-11.0, P < .0001) and 10.0 times more likely in 1995 (95% confidence interval, 3.4-29.0, P < .0001). This decrease in likelihood over time was not statistically significantly different (P = .33). Logistic regression analysis controlling for the covariates of age, race, and sex showed that patients with HIV in 2008 were 4.5 times more likely to present with verrucae compared to patients without HIV (95% confidence interval, 2.1-9.9, P = .0002). CONCLUSIONS: patients with HIV infection in 2008 are still significantly more likely to present with plantar verrucae after controlling for age, race, and sex. This increased likelihood has not changed significantly across time. Because HAART has increased the life expectancy of patients with HIV, this group of patients with plantar verrucae will continue to represent a significant population in the practice of podiatric medicine.

Men's health, low testosterone, and diabetes: individualized treatment and a multidisciplinary approach.

Testosterone plays a critical role in male reproductive and metabolic functioning. Serum testosterone levels decrease with age, and low testosterone is associated with a variety of comorbidities, including insulin resistance, type 2 diabetes, obesity, metabolic syndrome, and cardiovascular disease. Men with type 2 diabetes have been shown to have significantly lower testosterone levels than men without diabetes. Several forms of testosterone replacement therapy (eg, oral, injectable, buccal, transdermal preparations) are available for use in the United States. The primary goals of testosterone therapy are to restore physiologic testosterone levels and reduce the symptoms of hypogonadism. Testosterone therapy may be a viable option in some men with diabetes and low testosterone; however, clinicians must be aware of contraindications to therapy (eg, prostate cancer and male breast cancer), implement appropriate monitoring procedures, and ensure that patient expectations are realistic regarding treatment outcome. Data suggest that testosterone therapy may have a positive effect on bones, muscles, erythropoiesis and anemia, libido, mood and cognition, penile erection, cholesterol, fasting blood glucose, glycated hemoglobin, insulin resistance, visceral adiposity, and quality of life. Sexual health may be a window into men's health; thus, more effective communication strategies are needed between clinicians and men with diabetes to ensure that sexual health topics are adequately addressed. Diabetes educators can play a key role in screening for low testosterone, providing relevant information to patients, and increasing clinician awareness of the need to address men's sexual health and implement appropriate strategies. Multidisciplinary care and individualized treatment are needed to optimize outcome.

Insights and trends in diabetes education: results of the 2008 AADE National Diabetes Education Practice Survey.

PURPOSE: The purpose of this study is to describe current diabetes education practice and specific interventions and responsibilities of diabetes educators in the United States. METHODS: The 2008 National Practice Survey (NPS) instrument consisted of 53 items addressing diabetes education program structure, processes and interventions, outcomes and quality improvement activities, and the chronic care model. The survey was hosted online for American Association of Diabetes Educators (AADE) members. Participants totaled 2447 members, constituting a 25% return rate. Data from the 2008 NPS were analyzed and compared with results from previous surveys. RESULTS: Nearly two-thirds of respondents in 2008 provided diabetes education in a single location, most commonly in a clinical outpatient/managed care setting (39%). Most programs provided comprehensive services. Managers noted that 42% of their programs were either cost/revenue neutral or profitable. Programs varied in types of services, number of patient visits, team member functions, time spent on services, and instructional methods used. At least 50% of managers said their programs report outcome data, and 88% participate in quality/performance improvement activities. Nearly two-thirds of respondents were unfamiliar with the AADE-adopted chronic care model. CONCLUSIONS: Many 2008 NPS results concur with those obtained in 2005 through 2007. Areas of variability among programs suggest a need for standardized interventions and practice guidelines. Educators are encouraged to report outcomes to elucidate the contributions of their programs to patient care. AADE can use the results and comparative data obtained from the 2008 survey when developing practice, research, and advocacy activities.