An evaluation of the usability and durability of 3D printed versus standard suture materials.

The capability to produce suture material using three-dimensional (3D) printing technology may have applications in remote health facilities where rapid restocking of supplies is not an option. This is a feasibility study evaluating the usability of 3D-printed sutures in the repair of a laceration wound when compared with standard suture material. The 3D-printed suture material was manufactured using a fused deposition modelling 3D printer and nylon 3D printing filament. Study participants were tasked with performing laceration repairs on the pigs' feet, first with 3-0 WeGo nylon suture material, followed by the 3D-printed nylon suture material. Twenty-six participants were enrolled in the study. Survey data demonstrated statistical significance with how well the 3D suture material performed with knot tying, 8.9 versus 7.5 (p = 0.0018). Statistical significance was observed in the 3D-printed suture's ultimate tensile strength when compared to the 3-0 Novafil suture (274.8 vs. 199.8 MPa, p = 0.0096). The 3D-printed suture also demonstrated statistical significance in ultimate extension when compared to commercial 3-0 WeGo nylon suture (49% vs. 37%, p = 0.0215). This study was successful in using 3D printing technology to manufacture suture material and provided insight into its usability when compared to standard suture material.

A Total Knee Arthroplasty Preoperative Optimization Program Managed by an Advanced Practice Provider (Physician Assistant) Decreases Complications and Cost: A Pilot Study.

BACKGROUND: Studies have shown that optimizing modifiable risk factors leads to improved outcomes, with decreased lengths of stay (LOS), readmissions, complications, and hospital costs. Our goal was to demonstrate that use of an advanced practice provider, physician assistant (PA), within an orthopaedic practice would support these outcomes. METHODS: A preoperative optimization program managed by a PA was instituted at an academic medical center. From November 2019 to December 2022, a pilot group of fifteen (15) consecutive primary total knee arthroplasty (TKA) patients who were successfully optimized with the PA-managed program prior to TKA were matched 2:1 to a cohort of thirty (30) TKA patients who did not undergo optimization. Demographics and the modified readmission risk assessment tool score were used to match patients. Variables evaluated included LOS, emergency department visits, and hospital readmissions within 30 and 90 days after surgery, complications, and hospital costs of care. RESULTS: Optimized patients had less complications (P = .004) and significantly shorter (P < .001) mean LOS (1.27 days vs 2.97 days) compared to nonoptimized patients. The difference of hospital cost between cohorts for the primary admission was significant (P = .049). When readmission costs were included, the average hospital cost for the nonoptimized group was significantly higher than the optimized group (P = .018). CONCLUSIONS: Preoperative optimization led by a PA demonstrated significant reductions in LOS and the costs of care between optimized and non-optimized patients, along with decreased complications.

Bromo-spiroisoxazoline Alkaloids, Including an Isoserine Peptide, from the Caribbean Marine Sponge Aplysina lacunosa.

Three new bromotyrosine spiroisoxazoline alkaloids, lacunosins A and B (1 and 2) and desaminopurealin (3), were isolated from a MeOH extract of the marine sponge Aplysina lacunosa that showed modest α-chymotrypsin inhibitory activity. The structures of 1-3 share the spirocyclohexadienyl-isoxazoline ring system found in purealidin-R and several other Verongid sponge secondary metabolites. Compounds 1 and 2 are coupled to a glycine and an isoserine methyl ester, respectively. Alkaloid 3 is linked, contiguously, to an O-1-aminopropyl 3,5-dibromotyrosyl ether and, finally, to histamine through an amide bond. The planar structures of all three compounds were obtained from analysis of MS and 1D and 2D NMR data. The absolute configuration of the SIO unit of 1-3 was assigned by electronic circular dichroism (ECD). The isoserine amino acid residue in 2 was found to be a 1:1 mixture of epimers using a new Marfey's type reagent, derived from Trp-NH2. Allylic O-naphthoylation of the SIO subunit enhances the ECD spectrum of SIOs and improves discrimination of enantiomorphs. A unifying hypothesis is proposed that links the biosynthesis of several of the new compounds with previously reported analogues.

Synergistic Anti-Candida Activity of Bengazole A in the Presence of Bengamide A †.

Bengazoles A⁻G from the marine sponge Jaspis sp. exhibit potent in vitro antifungal activity against Candida spp. and other pathogenic fungi. The mechanism of action (MOA) of bengazole A was explored in Candida albicans under both liquid culture and surface culture on Mueller-Hinton agar. Pronounced dose-dependent synergistic antifungal activity was observed with bengazole A in the presence of bengamide A, which is also a natural product from Jaspis sp. The MOA of bengazole A was further explored by monitoring the sterol composition of C. albicans in the presence of sub-lethal concentrations of bengazole A. The GCMS of solvent extracts prepared from liquid cultures of C. albicans in the presence of clotrimazole-a clinically approved azole antifungal drug that suppresses ergosterol biosynthesis by the inhibition of 14α-demethylase-showed reduced cellular ergosterol content and increased concentrations of lanosterol and 24-methylenedihydrolanosterol (a shunt metabolite of ergosterol biosynthesis). No change in relative sterol composition was observed when C. albicans was cultured with bengazole A. These results eliminate an azole-like MOA for the bengazoles, and suggest that another as-yet unidentified mechanism is operative.

Structure-activity of antifungal compounds inspired by aminobisabolenes from the sponge Halichondria sp.

Structure-activity relationships of the antifungal aminobisabolene natural product, 1 isolated from Halichondria sp., and synthetic analogs were explored, in parallel with the antidermatophytic allylamine, Terbinafine®, against a panel of pathogenic fungi: Candida spp., Cryptococcus spp. and Trichophyton rubrum. Interpretation of the results suggest different modes of action in antifungal activity for the two classes of compounds.

Jamaicensamide A, a Peptide Containing ß-Amino-α-keto and Thiazole-Homologated η-Amino Acid Residues from the Sponge Plakina jamaicensis.

A new cyclic peptide, jamaicensamide A, composed of six amino acids, including a thiazole-homologated amino acid, was isolated from the Bahamian sponge Plakina jamaicensis, along with known compounds bitungolide A and franklinolide A. The structure of the title peptide was solved by integrated analysis of MS, 1D and 2D NMR data, oxidation-hydrolyses to α-amino acids, and their stereodetermination by Marfey's method. The close structural resemblance of Western Atlantic-derived jamaicensamide A to known Western Pacific-derived peptides of lithistid sponges in the genus Theonella and Discodermia suggests a common origin: the symbiotic bacterium Entotheonella sp., a so-called "talented producer" responsible for biosynthesis of most Theonella-associated peptides. Similar natural products from sponges of disparate genera evince the likelihood that these invertebrates harbor the same or a very similar symbiont.

Peroxide Natural Products from Plakortis zyggompha and the Sponge Association Plakortis halichondrioides-Xestospongia deweerdtae: Antifungal Activity against Cryptococcus gattii.

Cryptococcus gattii is a human pathogen and causative agent of a pernicious, sometimes fatal, disseminated fungal disease. Investigation of antifungal extracts of the marine sponge association Plakortis halichondrioides-Xestospongia deweerdtae and the sponge Plakortis zyggompha from the Bahamas led to the discovery and isolation of 6-epi-7,8-dihydroplakortide K (1), plakortide AA (2), and three new plakinic acids, N-P (4-6; unstable 1,2-dioxolanes bearing benzyl-substituted conjugated dienes), along with known plakinic acids L, K, and M.5 Chiroptical comparisons and DFT calculations of (13)C NMR chemical shifts were used to assign the absolute stereostructure of 4. The stereospecific base-promoted rearrangement-saponification of 1 to 10 was briefly investigated and showed tight kinetic control and stereospecific formation of the new C-2 stereocenter with inversion at C-3. Plakinic acid M and plakortides 9 and 11 exhibited antifungal activity against C. gattii (MIC90 = 2.4 to 36 µM), but plakinic acids N-P were inactive under the same conditions.

Antipodal crambescin A2 homologues from the marine sponge Pseudaxinella reticulata. Antifungal structure-activity relationships.

Investigation of antifungal natural products from the marine sponge Pseudaxinella reticulata from the Bahamas led to the discovery of new crambescin homologues (1, 2) and enantiomers (3, 4) of known natural products. The cyclic-guanidine structures were solved through analysis of 2D NMR, MS-MS, and CD data. The absolute configurations of 1-4 were established as 13R-opposite of known homologues reported from Crambe crambe obtained from the Mediterranean Sea-by comparison of their CD spectra with predicted Cotton effects obtained from DFT calculations. Antifungal activities of 1-4 against the pathogenic strains Candida albicans and Cryptococcus sp. were observed to correlate potency (MIC50 and MIC90) with the length of the alkyl side chain.

Salvadenosine, a 5'-deoxy-5'-(methylthio) nucleoside from the Bahamian tunicate Didemnum sp.

Salvadenosine, (1) a rare 5'-deoxy-5'-(methylthio) nucleoside, was isolated from the deep-water Bahaman tunicate Didemnum sp. The structure was solved by integrated analysis of MS and 1D and 2D NMR data. We revise the structure of the known natural product, hamiguanosinol, which is a constitutional isomer of 1, to 5 by interpretation of the spectroscopic data and comparison with synthesized nucleosides.

Vitamin D Supplementation May Prevent or Treat Deficiency After Total Knee Arthroplasty: A Retrospective Cohort Analysis.

BACKGROUND: Vitamin D deficiency is associated with poorer functional outcomes and increased complication rates after total knee arthroplasty (TKA). Yet, there is no longer term study evaluating vitamin D levels and supplementation after TKA. Our study aimed to compare quantitative vitamin D levels and supplementation regimens after TKA stratified by patient sex and race. METHODS: A retrospective cohort study of primary TKA patients at a single hospital from 2015 to 2022 was conducted. We analyzed vitamin D preoperatively and postoperatively up to 2 years. Vitamin D deficiency was defined as <30 ng/mL. A subgroup analysis was conducted in patients with vitamin D <21 ng/mL. Supplementation categories included none, low (<1,001 IU), medium (1,001 to 5,000 IU), and high (>5,000 IU). RESULTS: A total of 400 (66.0% female) patients who underwent 430 primary TKA procedures were included, and 65.3% received supplementation. Patients who were vitamin D sufficient preoperatively demonstrated higher vitamin D levels and ability to maintain sufficiency postoperatively using low-dose supplementation compared with no supplementation (P = 0.004). Those who were vitamin D deficient preoperatively demonstrated higher vitamin D levels postoperatively using medium to high doses (P = 0.02). For patients who became deficient postoperatively, supplementation was associated with achieving repletion at an average of 10.2 months (P < 0.001). Black patients demonstrated 2.8 times higher odds of having a vitamin D level less than 30 ng/mL (P = 0.03). CONCLUSION: Our study demonstrated that low-dose vitamin D supplementation (<1,001 IU) was beneficial for vitamin D-sufficient TKA patients to achieve higher levels and maintain vitamin D sufficiency. Vitamin D-deficient TKA patients benefitted from medium-to-high dose supplementation (1,001 to 5,000+), but only 33.7% achieved vitamin D repletion. This work highlights the need to continue vitamin D surveillance postoperatively and the need to continue vitamin D repletion.

Bone Cement Fumes Generated in Laminar Airflow Versus Conventionally Ventilated Operating Rooms: Does the Mixing System Matter?

BACKGROUND: Bone cement is commonly utilized in a variety of orthopaedic procedures and contains methylmethacrylate (MMA) monomer. MMA is a colorless, clear, flammable liquid of intense odor. Its vapor concentration in the immediate breathing zone can vary considerably in the operative setting and, in higher concentrations, can become an occupational health hazard. Therefore, reducing MMA vapor is desirable. The aim of this study was to compare the MMA vapor levels emitted during mixing among 5 commercially available cement-mixing systems across 2 operative settings: an operating room (OR) with conventional ventilation (CV) and an OR with laminar airflow (LAF). METHODS: A prospective, in vitro study was conducted at a single hospital in an OR with LAF and in an OR with CV. MMA vapor release during the cement preparation of a SAWBONES femoral canal was measured with use of a calibrated MiniRAE 3000. A total of 5 different vacuum cement-mixing systems were utilized to mix the same cement type according to the manufacturer instructions of each system. MMA vapor concentrations were measured during 5 phases of mixing, and each mixing system was randomly utilized 10 times in each OR. RESULTS: When comparing the MMA concentration levels of each system between the 2 settings, emissions remained generally higher in the CV setting for every system and in nearly every phase. Among the 5 systems analyzed, System #5, the only entirely closed system, had the lowest overall emissions for each of the 5 phases in the CV setting. CONCLUSIONS: This study demonstrated that an operative environment with LAF is conducive to clearing the fumes of MMA during mixing as well as limiting the amount of time that residual fumes linger after mixing. Additionally, the entirely closed cement-mixing system was the most effective in minimizing fume levels within the CV setting. Utilizing this closed system, especially in an OR with CV, may reduce exposure to MMA fumes from bone cement, potentially creating a more favorable working environment. CLINICAL RELEVANCE: This study provides evidence that a closed cement-mixing system utilized under vacuum in both an OR with CV and an OR with LAF is effective in keeping MMA fume levels below those considered harmful by the U.S. Occupational Safety and Health Administration.

Age, Sex, and Education Level Predict Telehealth Engagement in Total Joint Arthroplasty Patients.

Background: Racial and other demographic predictors of total joint arthroplasty (TJA) telehealth engagement since the onset of the COVID-19 pandemic remain unclear. The purpose of the current study was to elucidate this relationship. Methods: A retrospective, cross-sectional study on 732 primary TJA patients was conducted within a single hospital system from March 2020-December 2021 (during the pandemic). Patients were excluded if their race or education level could not be determined. Patient demographics (age, sex, body mass index, language) and TJA information were obtained. The number of telehealth visits and telehealth engagement were assessed. Engagement (yes/no) and engagement frequency across all demographics and each measure of telehealth (telemedicine, patient-reported outcome measurements [PROMs], and electronic patient portal [EPP] messaging) were analyzed using multivariate logistic and linear regression, respectively. Results: Our results demonstrated that non-White race was not a significant predictor of binomial engagement or engagement frequency across all telehealth measures. Older age was a negative predictor of binomial engagement and engagement frequency with telemedicine and EPPs. Male sex was shown to be a negative predictor of binomial engagement with EPPs as well as PROM engagement frequency. Educational attainment of less than a college degree was a negative predictor of binomial engagement and engagement frequency with PROMs and EPPs. Conclusions: This study demonstrates that older age, male sex, and lower education level were negative predictors of various measures of telehealth engagement. Non-White race was not a significant predictor. This data informs providers on how to improve access to virtual orthopaedic care.

Racial Disparities in Periprosthetic Joint Infections after Primary Total Joint Arthroplasty: A Retrospective Study.

In the United States, racial disparities have been observed in complications following total joint arthroplasty (TJA), including readmissions and mortality. It is unclear whether such disparities also exist for periprosthetic joint infection (PJI). The clinical data registry of a large New England hospital system was used to identify patients who underwent TJA between January 2018 and December 2021. The comorbidities were evaluated using the Elixhauser Comorbidity Index (ECI). We used Poisson regression to assess the relationship between PJI and race by estimating cumulative incidence ratios (cIRs) and 95% confidence intervals (CIs). We adjusted for age and sex and examined whether ECI was a mediator using structural equation modeling. The final analytic dataset included 10,018 TJAs in 9681 individuals [mean age (SD) 69 (10)]. The majority (96.5%) of the TJAs were performed in non-Hispanic (NH) White individuals. The incidence of PJI was higher among NH Black individuals (3.1%) compared with NH White individuals (1.6%) [adjusted cIR = 2.12, 95%CI = 1.16-3.89; p = 0.015]. Comorbidities significantly mediated the association between race and PJI, accounting for 26% of the total effect of race on PJI incidence. Interventions that increase access to high-quality treatments for comorbidities before and after TJA may reduce racial disparities in PJI.

Lumbopelvic postural differences in adolescent idiopathic scoliosis: A pilot study.

BACKGROUND: A primary etiology of adolescent idiopathic scoliosis (AIS) is currently unknown, but poor postural control of the spinal extensor musculature has been identified as an AIS risk factor. Identifiable postural differences would aid in advancing the precise postural behaviors that should be modified during Physiotherapy Scoliosis Specific Exercise (PSSE) to help limit the progression of AIS. RESEARCH QUESTION: Are there any determinable differences in lumbopelvic posture or range of motion between subjects with AIS and controls? METHODS: This prospective cohort pilot study consisted of 53 subjects (27 AIS and 26 control) aged 11-17 years. Subjects had their lumbopelvic posture assessed and monitored using the ViMove DorsaVi sensor package. All subjects underwent a live assessment to obtain initial lumbopelvic (LP) range of motion (ROM) measurements. Subjects were then monitored while continuing with normal activities of daily living (ADLs) for 12 h. With an alpha level of 0.05, nonparametric analyses were performed for each variable via a Mann-Whitney U-test. RESULTS: During the live assessment, controls exhibited a significantly greater anterior pelvic tilt ROM in the sitting position than the AIS group (p = 0.0433). When compared to female controls, females with AIS had a sitting pelvic tilt ROM that was significantly more retroverted (p = 0.0232) and less anteverted (p = 0.0010). During ADLs, female controls exhibited a higher total number of extension events than their female with AIS (p = 0.0263). These associations did not strengthen with greater spinal deformity. SIGNIFICANCE: This work demonstrates postural differences between patients with AIS and controls. Further study is necessary to determine why patients with AIS adopt these postures, and if PSSEs can be utilized to limit the progression of AIS.

Inducamides A-C, chlorinated alkaloids from an RNA polymerase mutant strain of Streptomyces sp.

Inducamides A-C (1-3), three new chlorinated alkaloids featuring an amide skeleton generated by a tryptophan fragment and a 6-methylsalicylic acid unit, were isolated from a chemically induced mutant strain of Streptomyces sp. with the inducamides only being produced in the mutant strain. Their structures, including stereochemistry, were determined by spectroscopic analysis, Marfey's method, and CD spectroscopy.

Ammosamide D, an oxidatively ring opened ammosamide analog from a marine-derived Streptomyces variabilis.

Ammosamide D (1), an oxidized analog of the ammosamide family, was isolated from a marine-derived Streptomyces variabilis. Pyrroloquinoline containing alkaloids are a growing class of natural products, with 1 being the first example of an oxidized analog resulting in a 5,6-dioxo-5,6-dihydroquinoline ring system. Attempts at chemical conversion of ammosamide B to ammosamide D revealed that a strong chemical oxidant is required. Ammosamide D has modest cytotoxicity to the MIA PaCa-2 pancreatic cancer cell line.