Constraining the Nuclear Symmetry Energy with Multimessenger Resonant Shattering Flares.

Much effort is devoted to measuring the nuclear symmetry energy through neutron star (NS) and nuclear observables. Since matter in the NS core may be nonhadronic, observables like radii and tidal deformability may not provide reliable constraints on properties of nucleonic matter. By performing the first consistent inference using ensembles of core and crust equations of state from astrophysical and nuclear data, we demonstrate that coincident timing of a resonant shattering flare (RSF) and gravitational wave signal during binary NS inspiral probes the crust-core transition region and provides constraints on the symmetry energy comparable to terrestrial nuclear experiments. We show that nuclear masses, RSFs, and measurements of NS radii and tidal deformabilities constrain different density ranges of the equation of state, providing complementary probes.

Global mapping of herpesvirus-host protein complexes reveals a transcription strategy for late genes.

Mapping host-pathogen interactions has proven instrumental for understanding how viruses manipulate host machinery and how numerous cellular processes are regulated. DNA viruses such as herpesviruses have relatively large coding capacity and thus can target an extensive network of cellular proteins. To identify the host proteins hijacked by this pathogen, we systematically affinity tagged and purified all 89 proteins of Kaposi's sarcoma-associated herpesvirus (KSHV) from human cells. Mass spectrometry of this material identified over 500 virus-host interactions. KSHV causes AIDS-associated cancers, and its interaction network is enriched for proteins linked to cancer and overlaps with proteins that are also targeted by HIV-1. We found that the conserved KSHV protein ORF24 binds to RNA polymerase II and brings it to viral late promoters by mimicking and replacing cellular TATA-box-binding protein (TBP). This is required for herpesviral late gene expression, a complex and poorly understood phase of the viral lifecycle.

Nitrogenase Chemistry at 10 Kelvin─Phototautomerization and Recombination of CO-Inhibited α-H195Q Enzyme.

CO-bound forms of nitrogenase are N2-reduction inhibited and likely intermediates in Fischer-Tropsch chemistry. Visible-light photolysis at 7 K was used to interrogate all three known CO-related EPR-active forms as exhibited by the α-H195Q variant of Azotobacter vinelandii nitrogenase MoFe protein. The hi(5)-CO EPR signal converted to the hi-CO EPR signal, which reverted at 10 K. FT-IR monitoring revealed an exquisitely light-sensitive "Hi-2" species with bands at 1932 and 1866 cm-1 that yielded "Hi-1" with bands at 1969 and 1692 cm-1, which reverted to "Hi-2". The similarities of photochemical behavior and recombination kinetics showed, for the first time, that hi-CO EPR and "Hi-1" IR signals arise from one chemical species. hi(5)-CO EPR and "Hi-2" IR signals are from a second species, and lo-CO EPR and "Lo-2" IR signals, formed after prolonged illumination, are from a third species. Comparing FT-IR data with CO-inhibited MoFe-protein crystal structures allowed assignment of CO-bonding geometries in these species.

Pumpkin carving knife injuries: National incidence and trends of hand injury.

INTRODUCTION: Seasonal media reports often describe the dangers of pumpkin carving, yet little data exists regarding the actual incidence of hand injuries resulting from pumpkin carving. The purpose of this study is to describe, quantify, and trend ED encounters associated with pumpkin-related knife injuries. METHODS: The National Electronic Injury Surveillance System (NEISS) was queried for pumpkin-related knife injuries from 2012 to 2021. Patient demographic and injury data was collected and analyzed to describe trends in incidence, patient demographics, and injury patterns associated with an ED encounter for a pumpkin-related knife injury. RESULTS: There were an estimated 20,579 (95% CI: 17,738-23,420) pumpkin-related knife injuries from 2012 to 2021. The incidence of pumpkin-related knife injuries remained stable over time (R2 = 0.195, P = 0.201). Hand injuries comprised 87.6% of all injuries, with the thumb (33.5%) and index finger (25.0%) most commonly affected. Men and women were injured at similar rates (51.6% vs 48.4%). The most common demographic injured were 10 to 19-year olds (31.5%) followed by children <10-years old (19.5%). Women ages 10 to 19-years old were the most commonly injured subgroup (10.0% of all injuries). Most ED presentations occurred on Saturdays (16.5%) or Sundays (23.3%). The large majority occurred during the months of October (83.5%) followed by November (11.2%), with almost half of all cases (45.6%) occurring in the last week of October. Peak incidence of injury occurred on October 30th. CONCLUSION: Pumpkin-related knife injuries are a preventable cause of hand injury with predictably high-incidence in fall months. Additionally, our data suggests further precautions should be taken to prevent injury in pediatric patients. Understanding at-risk populations in addition to implementing public safety initiatives and education on safe pumpkin-carving techniques could prevent serious injuries in the future.

No effect of preoperative ulceration on outcomes of tibiotalocalcaneal arthrodesis.

BACKGROUND: Tibiotalocalcaneal (TTC) arthrodesis is a commonly performed operation for complex hindfoot pathology, but the effect of preoperative ulceration on TTC outcomes has been debated. This study aims to examine infection rates in patients undergoing TTC arthrodesis with internal fixation with and without concomitant hindfoot ulceration. METHODS: We conducted a retrospective review of 31 patients who underwent a TTC arthrodesis between June 2016 and February 2021 with a fellowship-trained foot and ankle surgeon at an academic medical center. Nine (29.0%) patients had preoperative ulceration. Mean follow-up duration was 1.49 (range, 0.51-4.28) years. Other data collected included demographics, comorbidities, surgical approach, fixation method, and complication and reoperation rates. RESULTS: There was no difference in overall complication (ulcer [U]=66.7%, no ulcer [NU]=50.0%; p = .397), infection (U=33.3%, NU=31.8%; p = .935), or reoperation (U=55.6%, NU=27.3%; p = .135) rates between groups. CONCLUSIONS: TTC arthrodesis with internal fixation appears to be a reasonable treatment method for patients with a preoperative ulcer.

DdlR, an essential transcriptional regulator of peptidoglycan biosynthesis in Clostridioides difficile.

D-Ala-D-Ala ligase, encoded by ddl genes, is responsible for the synthesis of a dipeptide, D-Ala-D-Ala, an essential precursor of bacterial peptidoglycan. In Clostridioides difficile, the single ddl gene is located upstream of the ddlR gene, which encodes a putative transcriptional regulator. Using mutational and transcriptional analysis and DNA-binding assays, DdlR was found to be a direct activator of the ddl ddlR operon. DdlR is a member of the MocR/GabR-type proteins that have aminotransferase-like, pyridoxal 5'-phosphate-binding domains. A DdlR mutation that prevented covalent binding of pyridoxal 5'-phosphate abolished the ability of DdlR to activate transcription. Addition of D-Ala-D-Ala to the medium inactivated DdlR, reducing dipeptide biosynthesis. In contrast, D-Ala-D-Ala limitation caused a dramatic increase in expression from the ddl promoter. Though uncommon for transcription regulators, C. difficile DdlR is essential, as the ddlR null mutant cells could not grow even in complex laboratory media in the absence of D-Ala-D-Ala. A dyad symmetry sequence, which is located immediately upstream of the -35 region of the ddl promoter, serves as an important element of the DdlR-binding site. This sequence is conserved upstream of putative DdlR targets in other bacteria of classes Clostridia and Bacilli, indicating a similar mode of regulation of these genes.

Why Aquinas's Metaphysics of Gender Is Fundamentally Correct: A Response to John Finley.

In an important article, John Finley suggests a correction to Aquinas's understanding of gender distinction. Disagreeing with Aquinas, Finley proposes that gender distinction (male and female) stems from the soul rather than from the body. In this essay, I will show that this is not a tenable position because it does not fit with either what we know about the physical development of sex differences or the unity of man and woman as a single human species. I will defend Aquinas's fundamental insights into the root of gender distinction without defending his biological understanding of the process itself. I will argue that there is a single generic generative power in the soul that is determined by the matter to which the soul is united, to be expressed as either male or female. This paradigm, I believe, copes better than the one offered by Finley with phenomena such as intersexed persons and sex reassignment surgery. While I do not accept the idea of a feminine or masculine soul, the paradigm offered here does lead to the notion of the soul being feminized or masculinized on account of the matter that it informs.

Preliminary Assignment of Protonated and Deprotonated Homocitrates in Extracted FeMo-Cofactors by Comparisons with Molybdenum(IV) Lactates and Oxidovanadium Glycolates.

A similar pair of protonated and deprotonated mononuclear oxidovanadium glycolates [VO(Hglyc)(phen)(H2O)]Cl·2H2O (1) and [VO(glyc)(bpy)(H2O)] (2) and a mixed-(de)protonated oxidovanadium triglycolate (NH4)2[VO(Hglyc)2(glyc)]·H2O (3) were isolated and examined. The ≡C-O(H) (≡C-OH or ≡C-O) groups coordinated to vanadium were spectroscopically and structurally identified. The glycolate in 1 features a bidentate chelation through protonated α-hydroxy and α-carboxy groups, whereas the glycolate in 2 coordinates through deprotonated α-alkoxy and α-carboxy groups. The glycolates in 3 coordinate to vanadium through α-alkoxy or α-hydroxy and α-carboxy groups and thus have both protonated ≡C-OH and deprotonated ≡C-O bonds simultaneously. Structural investigations revealed that the longer protonated V-Oα-hydroxy bonds [2.234(2) Å and 2.244(2) Å] in 1 and 3 are close to those of FeV-cofactor (FeV-co) 2.17 Å1 (FeMo-co 2.17 Å2), while deprotonated V-Oα-alkoxy bonds [2, 1.930(2); 3, 1.927(2) Å] were obviously shorter. This shows a similar elongated trend as the Mo-O distances in the previously reported deprotonated vs protonated molybdenum lactates (Wang, S. Y. et al. Dalton Trans. 2018, 47, 7412-7421) and these vanadium and molybdenum complexes have the same local V/Mo-homocitrate structures as those of FeV/Mo-cos of nitrogenases. The IR spectra of these oxidovanadium and the previously synthesized molybdenum complexes including different substituted ≡C-O(H) model compounds show red-shifts for ≡C-OH vs ≡C-O alternation, which further assign the two IR bands of extracted FeMo-co at 1084 and 1031 cm-1 to ≡C-O and ≡C-OH vibrations, respectively. Although the structural data or IR spectra for some of the previously synthesized Mo/V complexes and extracted FeMo-co were measured earlier, this is the first time that the ≡C-O(H) coordinated peaks are assigned. The overall structural and IR results well suggest the coexistence of homocitrates coordinated with α-alkoxy (deprotonated) and α-hydroxy (protonated) groups in the extracted FeMo-co.

Is Trehalose an Effective Quenching Agent of Azotobacter vinelandii Mo-Nitrogenase Turnover?

H2-evolution assays, plus EPR and FTIR spectroscopies, using CO-inhibited Azotobacter vinelandii Mo-nitrogenase have shown that the disaccharide trehalose is an effective quenching agent of enzymatic turnover and also stabilizes the reaction intermediates formed. Complete inhibition of H2-evolution activity was achieved at 1.5 M trehalose, which compares favorably to the requirement for 10 M ethylene glycol to achieve similar inhibition. Reaction-intermediate stabilization was demonstrated by monitoring the EPR spectrum of the 'hi-CO' form of CO-inhibited N2ase, which did not change during 1 hr after trehalose quenching. Similarly, in situ photolysis with FTIR monitoring of 'hi-CO' resulted in the same 1973 and 1681 cm-1 signals as observed previously in ethylene glycol-quenched systems. [a] These results clearly show that 1.5 M trehalose is an effective quench and stabilization agent for Mo-N2ase studies. Possible applications are discussed.

Contraception and abortion: Fruits of the same rotten tree?

This article seeks to show how contraception, when generally accepted in a society, helps to bring about a radical change in social perceptions of sexual intercourse, human life, the human person, science, and morality in general. On account of this, contraception helps to ingrain abortion and other anti-life practices into the culture that accepts it and, therefore, in no sense can be considered as a panacea for abortion. Particular attention is given to the thought of John Paul II on this matter who noted that "despite their differences of nature and moral gravity, contraception and abortion are often closely connected, as fruits of the same tree" (Evangelium vitae, n. 13). Lay summary: The article considers the connection between contraception and abortion and defends Pope John Paul II's claim that "despite their differences of nature and moral gravity, contraception and abortion are often closely connected, as fruits of the same tree." The thesis is that contraception is a "game-changer" in the sense that it changes the way we think about some very fundamental realities such as attitudes to sex, to life, to science, to the human person, and to morality. Any one of these changes would have a significant impact on a society in terms of promoting a culture of death: together they are devastating.

Another role for CO with nitrogenase? CO stimulates hydrogen evolution catalyzed by variant Azotobacter vinelandii Mo-nitrogenases.

A likely entry/exit path for nitrogenase substrates, products, and/or protons involves residues α277(Arg), α192(Ser), and α356(Gly), all of which are highly conserved among MoFe proteins from different organisms. The α192(Ser) and α277(Arg) residues form part of a hydrogen-bonded network that also involves α195(His), which interacts with a FeMo cofactor-based sulfide. The terminal amino groups of α277(Arg) are also hydrogen-bonded directly to α281(Tyr), which resides at the surface of the MoFe protein. Individual amino acid substitutions placed at position α277 or α192 resulted in a variety of effects on the catalytic and/or spectroscopic properties of the resulting variant MoFe protein. Of particular interest was the effect of CO on H2 evolution catalyzed by three MoFe protein variants, α277(Cys), α192(Asp), and α192(Glu). All three variants exhibited CO stimulation of H2 evolution under high-electron flux conditions but not under low-electron flux conditions. This observation is best explained by these variants being redox-compromised but only at the most reduced redox states of the MoFe protein. Normally, these states are accessed and operational only under high-electron flux conditions, and the effect of added CO is to prevent access to these most reduced redox states, resulting in a normal rate of catalysis. Furthermore, via correlation of the effect of pH changes on H2 evolution activity for both the wild type and the α277(Cys) MoFe protein variant under argon, with or without 10% CO present, likely pathways for the delivery of a proton to the FeMo cofactor were identified.

Structural characterization of CO-inhibited Mo-nitrogenase by combined application of nuclear resonance vibrational spectroscopy, extended X-ray absorption fine structure, and density functional theory: new insights into the effects of CO binding and the role of the interstitial atom.

The properties of CO-inhibited Azotobacter vinelandii (Av) Mo-nitrogenase (N2ase) have been examined by the combined application of nuclear resonance vibrational spectroscopy (NRVS), extended X-ray absorption fine structure (EXAFS), and density functional theory (DFT). Dramatic changes in the NRVS are seen under high-CO conditions, especially in a 188 cm(-1) mode associated with symmetric breathing of the central cage of the FeMo-cofactor. Similar changes are reproduced with the α-H195Q N2ase variant. In the frequency region above 450 cm(-1), additional features are seen that are assigned to Fe-CO bending and stretching modes (confirmed by (13)CO isotope shifts). The EXAFS for wild-type N2ase shows evidence for a significant cluster distortion under high-CO conditions, most dramatically in the splitting of the interaction between Mo and the shell of Fe atoms originally at 5.08 Å in the resting enzyme. A DFT model with both a terminal -CO and a partially reduced -CHO ligand bound to adjacent Fe sites is consistent with both earlier FT-IR experiments, and the present EXAFS and NRVS observations for the wild-type enzyme. Another DFT model with two terminal CO ligands on the adjacent Fe atoms yields Fe-CO bands consistent with the α-H195Q variant NRVS. The calculations also shed light on the vibrational "shake" modes of the interstitial atom inside the central cage, and their interaction with the Fe-CO modes. Implications for the CO and N2 reactivity of N2ase are discussed.

Two-Year Survivorship and Patient-Reported Outcomes of a Prospectively Enrolled Cohort of INFINITY Total Ankle Arthroplasties.

BACKGROUND: The INFINITY total ankle implant is a widely and successfully used option for total ankle arthroplasty. The purpose of this study is to assess the 2-year survivorship, complication rates, patient-reported outcomes, and radiologic findings of prospectively enrolled patients undergoing a fixed-bearing total ankle arthroplasty (TAA). This study sought to determine if factors such as traditional vs patient-specific instrumentation, preoperative degree of arthritis, deformity, or etiology of arthritis impact surgical or clinical outcomes. METHODS: A total of 143 prospectively enrolled patients (148 ankles) underwent TAA with a fixed-bearing total ankle implant between 2017 and 2019 at 9 different institutions by 9 different surgeons. A total of 116 completed 2-year follow-up. Patients were stratified by instrumentation used, degree of preoperative deformity, the Canadian Orthopaedic Foot and Ankle Society (COFAS) grading system, and etiology of arthritis. Outcomes used included implant survivorship and adverse events within 2 years of surgery. Additionally, patient-reported outcomes and radiographs were collected at 6-month, 1-year, and 2-year postoperatively. PROMs used included Ankle Osteoarthritis Score (AOS), Patient-Reported Outcomes Measurement Information System (PROMIS) global health score, the Foot and Ankle Outcome Score (FAOS), and patient satisfaction (rated from excellent to poor). RESULTS: Implant survivorship at 2 years was 97.79%. There were 17 reoperations (11.5%), with 4 of the implants requiring revision (2.7%). Significant improvements in all PROMs were observed among all subgroups at all postoperative time points without significant variation between subgroups. Patients classified as COFAS type 2 arthritis preoperatively demonstrated significantly more improvement in FAOS Total Symptom Score at the 1- and 2-year measurements than COFAS type 3 patients at both time points. CONCLUSION: Total ankle arthroplasty with a fixed-bearing implant system is a safe and reliable treatment option for patients with end-stage arthritis regardless of degree of deformity or COFAS grading. LEVEL OF EVIDENCE: Level II, prospective cohort study.

Cannabidiol prevents LPS-induced inflammation by inhibiting the NLRP3 inflammasome and iNOS activity in BV2 microglia cells via CB2 receptors and PPARγ.

Neuroinflammation stands as a critical player in the pathogenesis of diverse neurological disorders, with microglial cells playing a central role in orchestrating the inflammatory landscape within the central nervous system. Cannabidiol (CBD) has gained attention for its potential to elicit anti-inflammatory responses in microglia, offering promising perspectives for conditions associated with neuroinflammation. Here we investigated whether the NLRP3 inflammasome and inducible nitric oxide synthase (iNOS) are involved in the protective effects of CBD, and if their modulation is dependent on cannabinoid receptor 2 (CB2) and PPARγ signalling pathways. We found that treatment with CBD attenuated pro-inflammatory markers in lipopolysaccharide (LPS)-challenged BV2 microglia in a CB2- and PPARγ-dependent manner. At a molecular level, CBD inhibited the LPS-induced pro-inflammatory responses by suppressing iNOS and NLRP3/Caspase-1-dependent signalling cascades, resulting in reduced nitric oxide (NO), interleukin-1ß (IL-1ß), and tumour necrosis factor-alpha (TNF-α) concentrations. Notably, the protective effects of CBD on NLRP3 expression, Caspase-1 activity, and IL-1ß concentration were partially hindered by the antagonism of both CB2 receptors and PPARγ, while iNOS expression and NO secretion were dependent exclusively on PPARγ activation, with no CB2 involvement. Interestingly, CBD exhibited a protective effect against TNF-α increase, regardless of CB2 or PPARγ activation. Altogether, these findings indicate that CB2 receptors and PPARγ mediate the anti-inflammatory effects of CBD on the NLRP3 inflammasome complex, iNOS activity and, ultimately, on microglial phenotype. Our results highlight the specific components responsible for the potential therapeutic applications of CBD on neuroinflammatory conditions.

Stent effects on duplex velocity estimates.

BACKGROUND: Doppler-derived velocity criteria used to define the presence and severity of in-stent restenosis after percutaneous angioplasty and endoluminal stenting have been called into question. This study uses an in vitro flow model to examine Doppler-derived velocities after placement of balloon-expandable and self-expanding endoluminal stents (BES and SES). METHODS: An in vitro vascular circuit model consisting of a pulsatile pump, tubing, and a conduit was created. The pump was programmed to replicate the Doppler spectral waveform pattern of the renal and carotid arteries. Peak systolic velocity (PSV) and end diastolic velocity (EDV) were estimated at five distinct conduit locations. Three replicate velocity measurements were made at each location. After initial velocity estimates, a BES or an SES was deployed within the conduit. RESULTS: Mean ± standard error PSV was 95.8 ± 2.6 cm/s, 97.0 ± 2.7 cm/s, and 101.4 ± 2.7 cm/s for unstented, BES and SES, respectively. PSV estimates were increased between unstented and stented conduits when SESs were present. The increase in mean systolic velocity of 6.4% observed with SES was statistically significant (P < 0.05). EDV values did not differ significantly across conditions. Mean ± standard error EDV was 36.2 ± 1.0 cm/s, 37.3 ± 1.1 cm/s, and 37.2 ± 1.1 cm/s for unstented, BES, and SES, respectively. CONCLUSION: The presence of an SES was associated with a less than 7% change in estimated PSV. These results suggest that Doppler velocity estimates for renal and carotid arteries are not materially affected by either BES or SES.

Perilunate Dislocations: Reduction and Stabilization.

Background: The all-dorsal scapholunate reconstruction technique is indicated for the treatment of scapholunate injuries in cases in which the carpus is reducible and there is no arthrosis present. The goal of this procedure is to reconstruct the torn dorsal portion of the scapholunate ligament in order to stabilize the scaphoid and lunate. Description: A standard dorsal approach to the wrist, extending from the third metacarpal distally to the distal radioulnar joint, is utilized. The extensor pollicis longus is transposed and retracted radially, and the second and fourth extensor compartments are retracted ulnarly. A Berger ligament-sparing capsulotomy is utilized to visualize the carpus. Volarly, an extended open carpal tunnel release is also utilized to relieve any median nerve compression and to aid in reduction. The contents of the carpal tunnel can be retracted radially, allowing for visualization of the carpal bones. Joystick pins are placed in order to reduce the scaphoid and lunate. Reduction is held provisionally by clamping the pins until 4 pins can be placed across the carpal bones. For scapholunate reconstruction, 3 holes are made: in the lunate, proximal scaphoid, and distal scaphoid. Suture tape is then utilized to hold the scaphoid and lunate in their proper position. The dorsal wrist capsule and extensor retinaculum are repaired during closure. The pins are cut near the skin and are removed in 8 to 12 weeks. Alternatives: Several other methods of scapholunate reconstruction have been described, including capsulodesis, tenodesis, and bone-tissue-bone repairs. Additionally, in patients who are poor candidates for scapholunate reconstruction, wrist-salvage procedures can be utilized as the primary treatment. Rationale: Scapholunate reconstruction has the advantage of preserving the native physiologic motion of the wrist, in contrast to the many different wrist-salvage procedures that include arthrodesis or arthroplasty. Avoiding arthrodesis is specifically advantageous in patients who have not yet developed arthrosis of the wrist bones. Expected Outcomes: Outcomes of scapholunate reconstruction vary widely; however, there is a nearly universal decrease in range of motion and strength of the wrist. Wrist range of motion is typically 55% to 75% of the contralateral side, and grip strength is typically approximately 65% of the contralateral side. In a prior study, 50% to 60% of patients whose work involved physical labor were able to return to their same level of full-time work. Disabilities of the Arm, Shoulder and Hand scores average between 24 and 30. Specific patients at risk for inferior outcomes are those with delayed surgical treatment, poor carpal alignment following reduction, or open injuries. Important Tips: Patients are counseled preoperatively regarding the likelihood of permanent wrist stiffness and the possibility of scapholunate diastasis even in the setting of technically successful repair.Traction and dorsally directed pressure on the lunate through an extended carpal tunnel incision can aid in reduction of the lunate.The joystick pin position in the dorsal scaphoid is angulated from distal to proximal and that in the lunate is angulated from proximal to distal in order to help correct flexion of the scaphoid and extension of the lunate by clamping together the Kirschner wires. Modifying the distance of the clamp from the carpus can allow precision in the degree of scapholunate angle fixation.Intercarpal Kirschner wire fixation of the scapholunate, lunotriquetral, and midcarpal joints (scaphocapitate and triquetrohamate) is best performed with 0.062-in (1.6-mm) Kirschner wires. The insertion angle is best visualized when the Kirschner wire is introduced from inside the incision through the skin, "inside out," in order to best envision the trajectory on the dorsal carpus and define the starting point on the bone. The Kirschner wire is then advanced through the carpus from outside-in at a slightly more volarly translated (but not angulated) position. The Kirschner wires are then cut beneath the skin at a depth that will allow them to be retrieved but will not cause them to become exposed once swelling decreases.The wrist is generally immobilized until the pins are removed at 3 months postoperatively. Acronyms and Abbreviations: ROM = range of motionK-wire = Kirschner wireDASH = Disabilities of the Arm, Shoulder and HandDISI = dorsal intercarpal ligament instability.

Preoperative Opioid Use Predicts Poorer Outcomes of Total Ankle Arthroplasty and Hindfoot Fusions.

BACKGROUND: This study aimed to determine the impact of preoperative opioid use on outcomes of patients undergoing ankle or hindfoot arthrodesis, or total ankle arthroplasty (TAA). METHODS: We conducted a retrospective review of 190 patients undergoing an ankle or hindfoot arthrodesis (n=122) or TAA (n=68) between December 2015 and September 2020 with a single fellowship-trained orthopaedic foot and ankle surgeon at an academic medical center. Data collected included demographics, medical comorbidities, treatment history, complications and reoperation rates, patient-reported outcome measures (PROMs) (eg, Foot and Ankle Outcome Score [FAOS]), and opioid use. RESULTS: Patients with preoperative opioid use were more likely to continue usage at 90 (r = 0.931, P < .001) and 180 (r = 0.940, P < .001) days postoperatively. For the entire cohort, complication and reoperation rates were 48.9% and 13.2%, respectively. While preoperative opioid use groups did not differ in the overall complication rate, users had significantly more infections (user = 12.5%, nonuser = 3.3%; P = .036) and reoperations (user = 22.5%, nonuser = 10.7%; P = .049). When analyzing postoperative opioid prescriptions, there were many significant correlations with preoperative PROMs, mainly FAOS, such that increased postoperative opioid use was associated with worse subjective outcomes. CONCLUSION: Preoperative opioid users are more likely to continue postoperative opioid use, experience infections, and undergo reoperations. LEVEL OF EVIDENCE: Level III: Retrospective cohort study.

Long-Term Oral Steroid Use: A Unique Risk Factor in 4-Corner Fusion Compared With Other Wrist Salvage Operations.

INTRODUCTION: Salvage procedures such as proximal row carpectomy, 4-corner fusion, total wrist arthroplasty, and total wrist arthrodesis are commonly used at the end stages of wrist arthritis. These operations have high complication rates, and significant controversy exists regarding the selection of procedure. Long-term oral glucocorticoid therapy has previously been identified as a risk factor for complications in multiple orthopedic procedures. The purpose of this study is to investigate the effect long-term oral preoperative corticosteroid use has on complications after different salvage operations for wrist arthritis. METHODS: The National Surgical Quality Improvement Program database was queried to identify patients who underwent proximal row carpectomy, 4-corner fusion, total wrist arthroplasty, or total wrist fusion between 2005 and 2020. Patients were classified by steroid use. Univariate analysis and multivariate logistic regression were used to assess the risk of complications. RESULTS: A total of 1298 patients were identified. Overall, steroid use was found to be independently associated with a higher complication rate. On multivariate analysis of patients who underwent 4-corner fusion, steroid use was found to be associated with higher complication rate and surgical site infection rate. Steroid use was not associated with increased complications in patients who underwent proximal row carpectomy, total wrist arthroplasty, or total wrist fusion when examined individually. CONCLUSION: Long-term oral corticosteroid therapy was associated with an increased risk of postoperative infections in patients who underwent 4-corner fusion, which was not found in other wrist salvage operations.

National incidence and trends of bicycle injury.

Bicycle utilization continues to increase annually, and this trend was recently accelerated by the coronavirus disease of 2019 pandemic. There is limited epidemiologic data, however, regarding the prevalence and nature of bicycle-related injuries. Therefore, the purpose of this study is to characterize trends in bicycle-related injuries. The National Electronic Injury Surveillance System was queried for bicycle-related injuries from 2012 to 2021. Patient demographic and injury data were collected and analyzed to describe trends in incidence, patient demographics, and injury patterns associated with an emergency department encounter for a bicycle-related injury. There were an estimated 4,666,491 (95% confidence interval: 4,661,472-4,671,510) bicycle-related injuries from 2012 to 2021. The incidence of these injuries has significantly decreased over time (R = -0.983, R2 = 0.967, p < 0.001). However, the rate of injury in elderly patients increased over time. Injuries occurred most often during summer months (36%) and on weekend days (31.9%). Males and younger patients were more commonly injured. Head injuries were the most commonly affected body part among all age groups. Fractures were the most common injury type overall. Upper extremity injuries were more common than the lower extremity. Despite increased public bicycle utilization, there is a significant downtrend in bicycle-related injuries over the last decade. Injuries among elderly patients are becoming more common, who demonstrate a high rate of fracture and head injury. Fractures and head injuries were the most common injuries among all age groups, highlighting the importance of bicycle safety initiatives and helmet-wearing regardless of age.

Risks of Chronic Preoperative Opioid Use on Distal Radius Surgery Outcomes.

BACKGROUND: The purpose of this study was to determine the influence of chronic preoperative opioid use on complications, reoperation rates, and postoperative opioid use among patients undergoing open reduction and internal fixation (ORIF) of distal radius fractures. METHODS: A retrospective review of 111 patients who underwent ORIF of a distal radius fracture from 2019 to 2021 at an academic medical center by the same fellowship-trained orthopedic hand surgeon was conducted. Patient demographics, medical comorbidities, perioperative details, surgical complications, and patient-reported outcome measures were analyzed. The SCRIPTS database was used to obtain opioid prescription data. RESULTS: A total of 10 patients (9.01%) were identified as preoperative chronic opioid users. This group was not associated with risk of increased complication. However, they were more likely to continue using narcotics at 90 and 180 days postoperatively. Patients with a history of substance use were at an increased risk of hardware complications and prolonged postoperative pain. In addition, these patients were more likely to receive narcotics at 90 and 180 days, and to have more refills postoperatively. CONCLUSION: Patients with preoperative opioid use are not at an increased risk of surgical complication following ORIF of distal radius fractures. However, they are at an increased risk of prolonged postoperative opioid use. Patients with a known history of substance use were at an increased risk of hardware complications, prolonged pain, and increased postoperative opioid use. Surgeons should consider these associations to better manage individual patients in the postoperative period.