Reverse Shoulder Arthroplasty or Nothing for Patients with Displaced Proximal Humeral Fractures. A Randomized Controlled Trial.

BACKGROUND: The benefits of reverse shoulder arthroplasty compared to nonoperative treatment for patients presenting with complex proximal fractures have been rarely explored. The aim of this prospective study was to compare the functional results of reverse shoulder arthroplasty with those of nonsurgical treatment in patients with displaced proximal humeral fractures. METHODS: A multicentric prospective randomized control trial of patients older than 70 years who sustained an acute proximal humeral fracture (3 or 4 parts), with less than 3 weeks of evolution, and had no previous condition or surgery on the affected shoulder was conducted. Patients were randomly assigned to the intervention group (implantation of a reverse shoulder arthroplasty and tuberosities reattachment) or the control group (nonoperative treatment). Functional outcome was assessed using the Constant-Murley score (CMS) at the 1-year follow-up. Complications and reinterventions were considered secondary outcomes. The power of the study relied on the inclusion of 81 patients to recognize a statistically significant difference of 10 points between CMS scores in the groups. Analysis was performed based on the intention to treat principle. RESULTS: Eighty-one patients were randomized to surgical treatment or nonoperative treatment, while 66 patients completed the 1-year follow-up evaluation. There was no significant difference between the groups in terms of age (76.1 yo vs 77.43 yo, p=0.43), sex (81.08% women in the surgical group vs 84.09% in the nonoperative group, p=0.72), or type of fracture according to Neer's classification system (p=0.06). At the 1-year follow-up, the group assigned to undergo the intervention had better functional outcomes than the nonoperative treatment group (mean CMS; 61.24, SD: 13.33 versus mean CMS: 52.44, SD: 16.22, p0.02), with a mean difference of 8.84 points, 95% CI [1.57, 16.11]. Two patients in the intervention group (6.5%) suffered major complications (periprosthetic joint infection and axillary nerve palsy). No major complications were observed in the nonoperative group. One patient in the intervention group underwent secondary surgery for a periprosthetic joint infection. CONCLUSIONS: Treatment with reverse shoulder arthroplasty provides superior functional outcomes compared with conservative treatment for patients presenting with an acute proximal humeral fracture. The difference in CMS is close to the clinically significant thresholds, and some harms are associated with the operative treatment.

Morphochromatic spectrum through gonad development stages of the razor surgeonfish, Prionurus laticlavius (Valenciennes, 1846) (Actinopterygii: Acanthuriformes).

Gonad development stages (GDS) are a critical tool that can be easily applied in fisheries to visually discriminate mature from immature organisms and assess their reproductive condition. This study proposes a morphochromatic scale to define gonad development stages for razor surgeonfish (Prionurus laticlavius) based on morphological and structural assessments of the gonad, histologically validated using multivariate dummy matrices modeled through multiple linear regression analyses. Gonads of 271 specimens were photographed prior to preservation to describe their shape, size, color, and turgor for morphochromatic analysis. Later, gonads were processed using standard histological methods. An oocyte growth scale was designed based on oocyte diameter and follicular wall thickness for each stage. In addition, five morphochromatic gonad development stages were histologically validated: immature, developing, spawning capable, regressing, and regenerating. Morphochromatic variations were observed in the last three stages in both sexes. Results show that gonad morphology and structure of P. laticlavius are similar to those of other acanthurids, albeit with some asymmetric and morphological differences, as well as gonad morphochromatic in both sexes. These findings confirm that maturation is species-specific. Also, although not a critical character, gonad colouration was found to play a major role in distinguishing between gonad development stages along with shape, size, vascularity (females), and folds (males). Therefore, gonad colouration should not be entirely overlooked because doing so may lead to errors in determining sexual maturity stages.

Are Cutibacterium acnes delivered from skin to deep tissues in primary reverse shoulder arthroplasty? A prospective study.

INTRODUCTION: The objective of this study is to determine whether the deep tissues are inoculated during surgery with the Cutibacterium acnes still present in the skin after the surgical preparation in reverse shoulder arthroplasties. MATERIALS AND METHODS: Prospective study including patients undergoing surgery with reverse shoulder arthroplasty. All the patients received preoperative antibiotic prophylaxis with cefazolin (2 g IV) and the skin was prepared with 2% chlorhexidine gluconate and 70% isopropyl alcohol. From all the patients, 9 cultures were obtained after the antibiotic was administrated and the skin surgically prepared. The cultures were sent to isolate C. acnes. DNA was extracted from the C. acnes isolated colonies. Isolate nucleotide distances were calculated using the Genome-based distance matrix calculator from the Enveomics collection toolbox. RESULTS: The study included 90 patients. C. acnes was isolated in 24 patients (26.6%) with a total of 61 positive cultures. There were 12 phylotype II, 27 IB and 22 IA. In 9 patients, C. acnes was present in both skin and deep tissues, and they constituted the sample to be studied by means of genomic analysis. In 7 out of the 9 patients, deep tissue samples clustered closer to at least one of its corresponding skin isolates when compared to the other independent bacterial ones. CONCLUSIONS: The C. acnes present in the skin at the beginning of the surgery are the same as those found in the deep tissues at the end of the surgery. This result strengthens the possibility that the C. acnes is delivered from the skin to the deep tissues.

Functional outcomes and complications of patients contaminated with Cutibacterium acnes during primary reverse shoulder arthroplasty: study at two- and five-years of follow-up.

PURPOSE: The objective of the study was to compare the functional outcomes and the complication rate of the patients with C. acnes contamination at the end of the primary reverse shoulder arthroplasty (RSA) surgery to those patients without C. acnes contamination. METHOD: A total of 162 patients were included. In all cases, skin and deep tissue cultures were obtained. A molecular typing characterization of the C. acnes strains was performed. Functional outcomes were assessed with the Constant score at the two and five year follow-up and all complications were also recorded. RESULTS: A total of 1380 cultures were obtained from the 162 primary RSA surgeries. Of those, 96 turned out to be positive for C. acnes. There were 25 patients with positive cultures for C. acnes. The overall postoperative Constant score was not significantly different between those patients having C. acnes-positive cultures and those with negative cultures at the two and five year follow-up (59.2 vs. 59.6 at two years, p 0.870, and 59.5 vs. 62.4 at five years, p 0.360). Patients with positive cultures presented a higher complication rate (p 0.001) with two infections, one revision surgery, and one dislocation. CONCLUSION: Patients ending up with C. acnes-positive cultures after primary shoulder arthroplasty surgery do not have worse clinical outcomes when compared to patients having negative cultures, but a greater number of complications were found in those patients with C. acnes-positive cultures.

Scratching the surface: a new species of Bent-toed gecko (Squamata, Gekkonidae, Cyrtodactylus) from Timor-Leste of the darmandvillei group marks the potential for future discoveries.

A new species of limestone-dwelling Bent-toed gecko (genus Cyrtodactylus) is described from Nino Konis Santana National Park in the far-east region of Timor-Leste. Both genetic and morphological data strongly support the evolutionary distinctness of the new species, which we describe herein as Cyrtodactylussantana sp. nov. Phylogenetic analysis based on the ND2 mitochondrial gene inferred the new species as part of the C.darmandvillei group with close genetic affinities to C.batucolus, C.seribuatensis, C.petani, C.sadleiri, and two undescribed lineages from the Moluccas in Indonesia. The new species represents the first species of Cyrtodactylus identified at the species level from Timor-Leste and fills an important gap in our understanding of the biogeography and evolutionary history of Cyrtodactylus especially in the Wallacean region. Our results strongly suggest that the diversity of Cyrtodactylus in Wallacea is still underestimated and many more unnamed species remain to be described.

Minimal number of cultures needed to detect Cutibacterium acnes in primary reverse shoulder arthroplasty: a prospective study.

BACKGROUND: The objective of this study was to determine the minimum number of cultures needed to detect Cutibacterium acnes in primary reverse shoulder arthroplasties (RSAs). METHODS: It is a prospective study including 160 primary RSAs. Exclusion criteria included an active infection, an invasive shoulder treatment in the last 6 months before surgery, an Arthro-SCAN or Arthro-MRI in the last 6 months before surgery, previous shoulder surgeries and revision cases. In 90 cases, 11 cultures were obtained. Another 10 cultures were obtained in the other 70 cases (culture 10 was a sterile sponge to detect false positives). To determine the minimum number of cultures needed to detect C acnes, the prevalence of C acnes contamination of the 160 patients included was determined. RESULTS: There were 128 females and 32 males, with a mean age of 74 years. There were 1690 cultures obtained from the 160 primary RSA surgeries, and 132 of them turned out to be positive for C acnes. There were 42 patients with positive cultures. Twenty of them were males and 22 females. When considering the skin and the deep tissue cultures altogether, the prevalence of positive cultures for C acnes was of 26.25%. If only deep tissues cultures were considered, the prevalence of positive cultures for C acnes was of 23.13%. When considering the skin and the deep tissue cultures together, the sensitivity to detect the C acnes is 19% if only 1 culture is obtained, 31% if 2 cultures are obtained, 50% if 3 cultures are obtained, 59.5% if 4 cultures are obtained, 66.7% if 5 cultures are obtained, 73.8% if 6 cultures are obtained, 85.7% if 7 cultures are obtained, and 92.9% if 8 cultures are obtained. When considering only the deep tissue cultures, if only 1 culture is obtained, the sensitivity to detect the C acnes is 24.3%, 40.5% if 2 cultures are obtained, 54.1% if 3 cultures are obtained, 73% if 4 cultures are obtained, 89.2% if 5 cultures are obtained, and 97.3% if 6 or 7 cultures are obtained. DISCUSSION: A minimum number of 8 cultures are needed to detect C acnes in skin. Moreover, a minimum of 6 cultures are needed to detect it in deep tissues when performing an RSA.

Population trends of seabirds in Mexican Islands at the California Current System.

The Baja California Pacific Islands (BCPI) is a seabird hotspot in the southern California Current System supporting 129 seabird breeding populations of 23 species and over one million birds annually. These islands had a history of environmental degradation because of invasive alien species, human disturbance, and contaminants that caused the extirpation of 27 seabird populations. Most of the invasive mammals have been eradicated and colonies have been restored with social attraction techniques. We have recorded the number of breeding pairs annually for most of the colonies since 2008. To assess population trends, we analyzed these data and show results for 19 seabird species on ten island groups. The maximum number of breeding pairs for each nesting season was used to estimate the population growth rate (λ) for each species at every island colony. We performed a moving block bootstrap analysis to assess whether seabird breeding populations are increasing or decreasing. San Benito, Natividad, and San Jerónimo are the top three islands in terms of abundance of breeding pairs. The most widespread species is Cassin's Auklet (Ptychoramphus aleuticus) with 14 colonies. Thirty-one populations of 14 species are significantly increasing while eleven populations of seven species are decreasing. We did not find statistical significance for 19 populations, however, 15 have λ>1 which suggest they are growing. Twelve of the 18 species for which we estimated a regional population trend are significantly increasing, including seven surface-nesting species: Brandt's Cormorant (Phalacrocorax penicillatus), Brown Pelican (Pelecanus occidentalis), Caspian Tern (Hydroprogne caspia), Double-crested Cormorant (P. auritus), Elegant Tern (Thalasseus elegans), Laysan Albatross (Phoebastria immutabilis) and Western Gull (Larus occidentalis), and five burrow-nesting species: Ainley's (Hydrobates cheimomnestes), Ashy (H. homochroa) and Townsend's (H. socorroensis) Storm-Petrels, and Craveri's (Synthliboramphus craveri) and Guadalupe (S. hypoleucus) Murrelets. The BCPI support between 400,000 and 1.4 million breeding individuals annually. Our results suggest that these islands support healthy and growing populations of seabirds that have shown to be resilient to extreme environmental conditions such as the "Blob", and that such resilience has been strengthen from conservation and restoration actions such as the eradication of invasive mammals, social attraction techniques and island biosecurity.

Patients Lost to Follow-up in Shoulder Arthroplasty: Descriptive Characteristics and Reasons.

BACKGROUND: The purpose of this study was to determine the number of patients lost to follow-up yearly in shoulder arthroplasty and investigate the characteristics of the patients lost to follow-up that may differ from those not lost to follow-up. METHODS: All shoulder arthroplasties performed from January 2008 to December 2014 were retrospectively reviewed. The number of patients lost to follow-up was determined yearly. Independent variables included age, sex, body mass index (BMI), diagnosis, type of prostheses, living condition, smoking, alcohol intake, American Society of Anesthesiologists (ASA) score, in-hospital length, surgery length, living area, preoperative Constant score, last Constant score available, and complications. Number of deaths was recorded. RESULTS: This study included 251 patients. There was an accumulation of 86 patients (34.3%) lost to follow-up after a maximum of 8 years. During the first year, 9.9% of the patients were lost to follow-up, 18.3% in the second year, 25.1% in the third year, 28.7% in the fourth year, 31.5% in the fifth year, 33.9% in the sixth year, and 34.3% in the seventh year. Patients with severe obesity had 2.44 times greater risk of being lost to follow-up (hazard ratio [HR], 2.44; p < 0.001). Elderly patients were also at higher risk (HR, 1.05; p < 0.001). Increases in the ASA score raised the risk of being lost (HR, 1.93; p < 0.001). Patients with complications had a lower risk (43%) of being lost (HR, 0.57; p = 0.018) at the 8-year follow-up. At the 2-year follow-up, the patients with acute fractures and fracture sequelae had a higher risk of being lost to follow-up (HR, 2.44; p = 0.002), and the patients with complications were not significantly different from those without complications (HR, 0.54; p = 0.12). CONCLUSIONS: The longer the follow-up in shoulder arthroplasty, the greater the number of patients lost to follow-up, reaching 34.3% by the seventh year. Patients lost to follow-up were not random in shoulder arthroplasty: older patients, severely obese patients, and those with higher ASA scores were at higher risk of being lost to follow-up, but reasons for being lost to follow-up changed through time and depending on when they were assessed.

Efectos de la actividad física y hábitos alimenticios en los niveles de obesidad de niños entre 6 y 12 años: revisión sistemática / The effects of physical activity and eating habits on obesity levels among children aged between 6 and 12 years old: systematic review

Introducción: La actividad física y los hábitos alimentarios son variables a tener en cuenta para el análisis y corrección de los problemas de obesidad. El objetivo de esta revisión fue evaluar los efectos que tiene la actividad física y los hábitos alimentarios en los niveles de obesidad en niños entre 6 a 12 años de edad. Material y método: Se realizó una búsqueda bibliográfica en las bases de datos WOS y SCOPUS. Los criterios de elegibilidad fueron establecidos en base al acrónimo PICOS: (P) niños de educación básica de entre 6 y 12 años de edad, (I) estudios que llevaran a cabo intervenciones del componente alimenticio, del componente de actividad física o una combinación de ambos. Esto en el ámbito escolar, deportivo y/o familiar, (C) ser sometidos a evaluación mediante la escala de PEDRO y obtener en esta un puntaje igual o superior a 7, (O) evaluar el efecto de los programas alimenticios y/o de actividad física sobre la obesidad infantil, (S) estudios controlados aleatorios, publicados entre los años 2015 y 2020. Resultados: Se identificaron 6.388 artículos, pero solo se incluyeron los que cumplieron con los criterios de inclusión. pero solamente se incluyeron los que cumplieron con los criterios de inclusión (34 estudios). Se encontró que las intervenciones más efectivas fueron las combinadas con una duración de intervención media, y la participación de los padres y el sexo pueden influir en la efectividad de estas intervenciones. Conclusión: Las intervenciones que consideran el componente de actividad física y hábitos alimenticios en conjunto son las más efectivas para logar una disminución de los niveles de obesidad en niños de 6 a 12 años de edad.(AU)

Introduction: Physical activity and eating habits are variables to take into account for the analysis and correction of obesity problems. The objective of this review was to evaluate the effects of physical activity and eating habits on obesity levels in children between 6 and 12 years of age. Material and method: A bibliographic search was carried out in the WOS and SCOPUS databases. The eligibility criteria were established based on the acronym PICOS: (P) basic education children between 6 and 12 years of age, (I) studies that carried out interventions of the nutritional component, the physical activity component or a combination of both of them. This in the school, sports and / or family environment, (C) be subjected to evaluation using the PEDRO scale and obtain a score equal to or greater than 7, (O) evaluate the effect of food programs and / or physical activity on childhood obesity, (S) randomized controlled studies, published between 2015 and 2020. Results: 6,388 articles were identified, but only those that met the inclusion criteria were included. but only those that met the inclusion criteria (34 studies) were included. The most effective interventions were found to be those combined with a medium duration of intervention, and parental involvement and gender may influence the effectiveness of these interventions. Conclusion: Interventions that consider the component of physical activity and eating habits together are the most effective in achieving a decrease in obesity levels in children 6 to 12 years of age.(AU)

Are Cutibacterium acnes present at the end of primary shoulder prosthetic surgeries responsible for infection? Prospective study.

The purpose of this study was to investigate if the C. acnes present at the end of a primary shoulder arthroplasty could be responsible for shoulder arthroplasty infection. Prospective study includes patients undergoing primary shoulder arthroplasty from January 2015 until December 2018. From all the patients included, 5 to 12 tissue samples were obtained and were specifically cultured to detect the presence of C. acnes. DNA was extracted from the C acnes isolated colonies and Whole Genome Sequencing (WGS) analysis was done. A cohort of 156 patients was finally included. In twenty-seven patients, the C. acnes was present at the end of the primary surgery. Two of these patients developed a C. acnes periprosthetic shoulder infection at 6 and 4 months after the primary surgery. WGS of C. acnes isolated colonies showed that all the revision-surgery isolates clustered near to the corresponding primary-surgery isolates compared to the other independent bacterial colonies. (99.89% of similarity). C. acnes present at the end of the primary surgery can be the cause of early or delayed periprosthetic joint infections in shoulder arthroplasty.

Frecuencia y caracterización de foramen mental accesorio en una población chilena mediante tomografía computarizada de haz cónico / Frequency and characterization of accessory mental foramen in a Chilean population using cone beam computed tomography

RESUMEN: En la práctica clínica odontológica, reconocer estructuras anatómicas es determinante en la planificación de distintos tratamientos que involucren algún riesgo. Uno de los exámenes complementarios recomendados para la planificación de diferentes tratamientos en odontología es la Tomografía Computarizada de Haz Cónico (CBCT). Con este examen, se pueden pesquisar variantes anatómicas como el Foramen Mental Accesorio (FMA), el cual es importante identificar para prevenir complicaciones. El objetivo de este trabajo fue determinar la frecuencia y caracterización de FMA en una población chilena adulta, de la ciudad de Valdivia, Chile. Este estudio es de tipo observacional descriptivo. Se revisaron 247 exploraciones de diferentes centros radiológicos de la ciudad de Valdivia, cumpliendo 143 con los criterios de selección. Este estudio fue aprobado por el Comité ético científico del Servicio de Salud de Valdivia. Se encontró presencia de FMA en el 17,48 % que corresponde a 25 pacientes de un total de 143, correspondiendo un 80 % al sexo femenino. El rango etario en que se encontró con mayor frecuencia correspondió a 18-39 años. La distancia promedio entre FMA y FM (Foramen Mental) fue de 5,76 mm, correspondiendo a 2 mm la distancia mínima y 11,5 mm la distancia máxima. La distancia promedio entre FMA y ápice dentario más cercano fue de 5,36 mm. La distancia mínima y máxima fueron de 0,8 mm y 10,2 mm respectivamente. El ápice radicular mayormente asociado al FMA correspondió al segundo premolar con una frecuencia de 60 % (n=15). Este estudio confirma la importancia de la correcta evaluación de la región mental ante procedimientos en la zona, la cual es vital para prevenir lesiones en relación a esta variante anatómica.

SUMMARY: The recognition of key anatomical structures is decisive to avoid complications in the dental clinical practice. Cone Beam Computed Tomography (CBCT) is a complementary exam recommended for the planning of different procedures in dentistry. With this exam, anatomical variants can be identified, such as the Accessory Mental Foramen (AMF). The objective of this work was to determine the frequency and characteristics of AMF in an adult Chilean population from the city of Valdivia, Chile. This is an observational study that included 247 CBCT exams from different radiological centers in Valdivia. According to the selection criteria, 143 CBCT exams were included. This study was approved by the Scientific Ethics Committee of the Valdivia Health Services. AMF was identified in 25 patients representing 17.48 %. From this result, 80 % were found in females. AMF was most frequently identified in patients from 18 to 39 years old. The average distance between AMF and Mental Foramen (MF) was 5.76 mm, which corresponds to 2 mm the minimum distance and 11.5 mm the maximum distance. The average distance between AMF and the nearest dental apex was 5.36 mm, and the minimum and maximum distance were 0.8 mm and 10.2 mm, respectively. The root apex of the second premolar was most frequently associated with the AMF, representing 60 % (n=15). This study confirms the importance of the correct evaluation of the mental region before initiating procedures in the area, which is vital to prevent injuries associated with this anatomical variant.

Positioning of the metaglene in reverse shoulder arthroplasty: deltopectoral versus anterosuperior approach: a prospective randomized trial.

BACKGROUND: The primary objective of this study was to determine whether there are differences in metaglene positioning related to the approach used (deltopectoral vs. anterosuperior) in primary reverse shoulder prosthesis (reverse shoulder arthroplasty) implantation. The hypothesis was that there would be no differences in metaglene positioning between the 2 approaches. METHODS: A prospective randomized trial was designed to evaluate metaglene positioning in primary reverse shoulder arthroplasty. The patients included were allocated to either the deltopectoral approach (group I) or the anterosuperior approach (group II). Glenosphere overhang and glenosphere tilt were assessed using the methods described by Lévigne et al, Simovitch et al, and Kempton et al, and the beta angle was assessed as described by Maurer et al. The functional outcome was assessed with the Constant score at 2 years' follow-up. Scapular notch development and complication rates were also recorded. RESULTS: A total of 98 patients (77 women and 21 men) were randomized and allocated to group I (49 patients) or group II (49 patients). The mean age of the patients was 74.4 years (standard deviation, 6.3 years). Glenosphere overhang did not show significant differences between groups (6.5 mm in group I vs. 6.1 mm in group II by the Lévigne method, P = .482; 2.2 mm in group I vs. 2.1 mm in group II by the Simovitch method, P = .08). Glenosphere tilt was significantly different between groups (94.6° in group I vs. 86.8° in group II by the Lévigne method, P < .001; 125.9° in group I vs. 119.4° in group II by the Kempton method, P = .002). This was also the case for the prosthesis-scapular neck angle (94.6° in group I vs. 86.8° in group II, P < .001). Moreover, the postoperative beta angle was significantly different between groups (78.6° in group I vs. 73.8° in group II, P = .001). No significant differences were noted in terms of functional outcomes as measured with the Constant score (P = .16). No significant differences between groups were noted relative to scapular notch development and the overall complication rate. DISCUSSION: The deltopectoral and anterosuperior approaches do not differ relative to the craniocaudal positioning of the metaglene, but a slight superior tilt can be expected when using the anterosuperior approach. Both approaches yield comparable functional outcomes, scapular notch development, and complication rates at 2 years' follow-up.

One Versus 3-Week Immobilization Period for Nonoperatively Treated Proximal Humeral Fractures: A Prospective Randomized Trial.

BACKGROUND: There is no consensus on the duration of immobilization for nonoperatively treated proximal humeral fractures (PHFs). The main objective of the study was to determine the differences in pain between PHFs that were treated nonoperatively with 3-week immobilization and those treated with 1-week immobilization. METHODS: A prospective randomized trial was designed to evaluate whether the immobilization time frame (1-week immobilization [group I] versus 3-week immobilization [group II]) for nonoperatively treated PHFs had any influence on pain and functional outcomes. Pain was assessed using a 10-cm visual analog scale (VAS) that was administrated 1 week after the fracture, at 3 weeks, and then at the 3, 6, 12, and 24-month follow-up. The functional outcome was evaluated using the Constant score. To assess the functional disability of the shoulder, a self-reported shoulder-specific questionnaire, the Simple Shoulder Test (SST), was used. The Constant score and the SST were recorded at the 3, 6, 12, and 24-month follow-up. Complications and secondary displacement were also recorded. RESULTS: One hundred and forty-three patients were randomized, and 111 (88 females and 23 males) who had been allocated to group I (55 patients) or group II (56 patients) were included in the final analysis. The mean age of the patients was 70.4 years (range, 42 to 94 years). No significant differences were found between the 2 groups in terms of pain as measured with the VAS at any time point (1 week [5.9 versus 5.6; p = 0.648], 3 weeks [4.8 versus 4.1; p = 0.059], 3 months [1.9 versus 2.4; p = 0.372], 6 months [1.0 versus 1.2; p = 0.605], 1 year [0.65 versus 0.66; p = 0.718], and 2 years [0.63 versus 0.31; p = 0.381]). No significant differences were found in the Constant score or SST score at any time point. No significant differences were noted in the complication rate. CONCLUSIONS: Short and long periods of immobilization yield similar results for nonoperatively treated PHFs, independent of the fracture pattern. These fractures can be successfully managed with a short immobilization period of 1 week in order to not compromise patients' independence for an overly extended period. LEVEL OF EVIDENCE: Randomized controlled trial Level II. See Instructions for Authors for a complete description of levels of evidence.

Development of membranes based on carboxymethyl cellulose/acetylated arrowroot starch containing bromelain extract carried on nanoparticles and liposomes.

Polymeric membranes have been used in several applications, including their use as curatives in cutaneous wounds. Bromelain has long been used for anti-inflammatory purposes, so the objective of this work was to produce carboxymethylcellulose-acetylated blends, incorporate bromelain, characterize the systems, compare the blends with bromelain loaded in nanoparticles and liposomes and, finally, to evaluate their healing potential. Four membrane formulations were produced by solvent evaporation: the control, membranes containing free bromelain, bromelain-loaded nanoparticles (NPs) and bromelain-loaded liposomes (LIPs). The enzyme concentration was the same for all formulations. Transparent, flexible and intact films were obtained. The membranes containing free bromelain, bromelain-loaded NPs and bromelain-loaded LIPs had higher water content, lower water vapor permeability and maximum tensile strength, and greater elongation at rupture. The capacity to absorb simulated exudate was higher in samples containing free bromelain, and bioadhesion was reduced in the presence of free bromelain compared to the control. An in vivo assay was performed to verify the membranes' healing potential. Histological analysis revealed no edema on the 14th day in animals treated with membranes containing bromelain-loaded NPs and LIPs.

Opinion leaders in the medical community attract more attention than randomized controlled trials in shoulder surgery.

PURPOSE: The objective of this study was to determine whether opinion leaders in the medical community attract more attention than randomized controlled trials (RCT) in shoulder surgery. METHODS: A PubMed search to retrieve all therapeutic and diagnosis RCT shoulder studies was carried out. Three opinion leaders were chosen from among the last ten presidents of the European Shoulder and Elbow Society based on the number of publications. Their studies were also retrieved from PubMed. The metrics of the studies were determined through ResearchGate and Web of Science. The year of publication, impact factor of the journal, level of evidence, number of citations, number of reads, research interest, and reported conflicts of interest were recorded for every study. RESULTS: Two-hundred forty-five shoulder RCTs and 236 opinion leader studies met the inclusion criteria. The opinion leader studies were read significantly more times than the RCTs (p = 0.04). The mean impact factor for RCT studies was 2.84 (SD 3.9) while it was of 1.99 (SD1.14) in the opinion leader group (p < 0.001). Most of the studies of the opinion leaders were level IV (73.3%), while only 6.3% of their papers were categorized as levels I-II. Conflict of interest was present in 19.6% of the RCTs and in 32.2% of the opinion leader studies (p < 0.001). CONCLUSION: The medical community pays more attention to opinion leader studies in shoulder surgery than to RCT studies even though RCTs are published in higher impact factor journals and opinion leader studies are mainly level IV evidence studies.

A green analytical method for the analysis of polycyclic aromatic hydrocarbons in oral fluids from crack smokers.

Aim: Develop and validate a method of solid-phase microextraction (SPME) and liquid chromatography to investigate three major polycyclic aromatic hydrocarbons (PAHs) in oral fluid. Results/Methodology: The extraction phase was exposed to 1.5 ml of diluted oral fluid under stirring at 1000 rpm for 60 min, at 70°C. Then, it was immersed in 200 µl of acetonitrile for 10 min at 25°C for desorption of the analytes. Linearity, absolute recovery, and inter- and intra-assay relative standard deviations and relative errors were 50-300 ng.ml-1, ≥24% and ≤15% for all analytes, respectively. A full factorial design was used to SPME optimization. Discussion/Conclusion: The method is suitable for the exploratory analysis of some PAHs in the oral fluid of crack smokers.

Sonication in shoulder surgery: is it necessary?

PURPOSE: The objective of the present study was to determine whether sonication yields greater sensitivity when compared with the traditional tissue culture in detecting peri-implant infections in shoulder surgery. METHODS: It is a retrospective study that includes 99 shoulder surgeries with implants explanted. The inclusion criteria required at least four tissue cultures, sonication of the material explanted, and a minimum follow-up of two years. Patients were classified according to the definition of periprosthetic shoulder infection of the 2018 International Consensus Meeting on Orthopedic Infections. The classifications are definitive infection, probable infection, possible infection, and unlikely infection. RESULTS: Among the 99 surgical procedures, 31 were considered definitive infections, 11 possible/probable infections, and 57 unlikely infections. Considering the cases with a definitive infection, the sensitivity of the tissue culture was 87.09% and the sensitivity of sonication stood at 80.64% (p = 0.406). Analyzing the cases with a definitive infection and those having a possible/probable infection together and comparing them with those with unlikely infection, the sensitivity of sonication was 80.4% and the sensitivity of the tissue culture came to 91.4%. The specificity of the sonication was 98.1% and the specificity of the tissue culture was 99.6%. CONCLUSION: The sensitivity of sonication in shoulder surgery (80.64%) is not superior to the sensitivity of the tissue culture (87.09%). Specificity remains high with both methods, being 98.1% in the sonication group and 99.6% in the tissue culture. Sonication brings no benefit to the detection of shoulder per-implant infections.

Can small glenospheres with eccentricity reduce scapular notching as effectively as large glenospheres without eccentricity? A prospective randomized study.

BACKGROUND: The objective of this study was to analyze whether small glenospheres with eccentricity were comparable to large glenospheres in scapular notch development. METHODS: This prospective randomized study included 82 patients who had undergone a reverse shoulder arthroplasty with a 2-year follow-up period. After randomization, 43 patients were allocated to receive a 42-mm glenosphere and 39 patients were allocated to receive a 38-mm glenosphere with 2 mm of eccentricity. Scapular notch development was defined after examination of an anteroposterior radiograph at the end of follow-up. Functional outcomes were recorded using the Constant score before surgery and at the end of follow-up. RESULTS: Scapular notch development was present in 16.6% of patients who received a 42-mm glenosphere and 34.2% of patients who received a 38-mm eccentric glenosphere. No significant difference was found between the groups with the number of cases available (P = .07). Functional outcomes significantly increased from preoperatively to postoperatively in both groups, with no significant difference found between them (P = .77). The mean glenosphere overhang measure was 6.3 mm in patients with a 42-mm glenosphere and 6.0 mm in those with a 38-mm eccentric glenosphere (P = .68). No significant differences were noted between patients with a scapular notch and patients without a scapular notch in terms of functional outcomes. DISCUSSION: Small glenospheres with eccentricity fared slightly worse than large glenospheres regarding scapular notch development, even though no significant differences were noted. Functional outcomes were comparable between the 2 designs.

Diabetes as a risk factor of acute kidney injury in vancomycin users: an observational and prospective study

Diabetes was investigated as a risk factor for nephrotoxicity induced by vancomycin. In the present study, the drug's nephrotoxic effect was indirectly evaluated by Glomerular Filtration Rate, albuminuria and serum levels of creatinine and urea on the 1st, 7th and 14th days of vancomicyn therapy in a group of diabetic and non-diabetic patients, with and without previous nephropathy. The correlations between investigated variables (including the population's epidemiological profile and hospital care) were measured by the Spearman test. The sample consisted of 132 patients, predominantly male diabetic patients with previous nephropathy, over 40 years, receiving ≥ 10 grams of vancomycin for the treatment of infectious diseases and showing satisfactory clinical outcomes. A risk of vancomycin drug interaction with potential nephrotoxic outcome was observed in 36.4% of patients who used multiple drugs. Furthermore, 80% of patients had an increase of at least 0.5 mg.dL-1 in baseline serum levels of creatinine and urea at the end of the study. This was more common among the diabetic patients with previous nephropathy, showing higher albuminuria and a reduction in the Glomerular Filtration Rate. Therefore, it has been recommended that the use of vancomycin in diabetic patients should be in careful dosages and that kidney functioning be monitored.

Optimistic bias: the more you do, the better you think it goes. Survey analysis of reverse shoulder arthroplasty.

OBJECTIVE: Even though heuristics are very helpful, several biases have been described related to their use. The aim of this study is to analyze the influence of surgery volume on the surgeon's perception of pain improvement in patients after having received a reverse total shoulder arthroplasty. DESIGN: Successive independent samples study. SETTING: Shoulder surgeons attending four shoulder meetings. PARTICIPANTS: 149 Shoulder surgeons were included. INTERVENTION: Physicians were asked to postulate the preoperative and postoperative pain of patients receiving a reverse shoulder arthroplasty and respond by putting a mark on two visual pain scales. MAIN OUTCOME MEASURES: Pain improvement, years of shoulder practice, number of shoulder studies read over 6 months and the number of reverse shoulder arthroplasties performed per year. To compare the answers of the survey-study, a cohort of 95 patients who had undergone reverse shoulder Arthroplasty because of a rotator cuff arthropathy were prospectively followed. RESULTS: Regarding the pain score before and after surgery, the patient cohort showed a mean improvement of 6.84 points. In terms of the doctors, the more years of surgical practice, led them to have a greater expectation of improvement (p=0.004). Moreover, the greater the number of prostheses they implanted, the greater the expectation of improvement (p=0.0005). It was the same in terms of the number of studies read by them (p=0.001). CONCLUSIONS: Years of practice, hospital position and the number of shoulder arthroplasties done per year all favor the surgeon's perception that their patients obtain a greater pain relief after receiving a shoulder arthroplasty than the real improvement in pain relief the patients experience.