Application Repetition and Electrode-Tissue-Contact Results in Deeper Lesions Using a Pulsed-Field Ablation Circular Variable Loop Catheter.

BACKGROUND: Pulsed field ablation (PFA) is a novel, myocardial-selective, non-thermal ablation modality used to target cardiac arrhythmias. Although prompt EGM signal disappearance is observed immediately after PFA application in the pulmonary veins, whether this finding results in adequate transmural lesions is unknown. STUDY AIM: If application repetition and catheter-tissue contact impact on lesion formation during PFA. METHODS: A circular loop PFA catheter was used to deliver repeated energy applications with various levels of contact-force. A benchtop vegetal potato model and a beating heart ventricular myocardial model were utilized to evaluate the impact of application repetition, contact force, and catheter repositioning on contiguity and lesion depth. Lesion development occurred over 18 hours in the vegetal model and over 6 hours in the porcine model. RESULTS: Lesion formation was found to be dependent on application repetition and contact. In porcine ventricles, single and multiple stacked applications led to a lesion depth of 3.5 ± 0.7 mm and 4.4 ± 1.3 mm, respectively (p =0.002). Furthermore, the greater the catheter-tissue contact, the more contiguous and deeper the lesions in the vegetal model (1.0±0.9 mm with no contact Vs. 5.4±1.4 mm with 30 g of force; p=.0001). CONCLUSION: PFA delivered via a circular catheter showed that both repetition and catheter contact led independently to deeper lesion formation. These findings indicate that endpoints for effective PFA ablation are more related to PFA biophysics than mere EGM attenuation.

Socioeconomic Factors Including Patient Income, Education Level, and Health Insurance Influence Postoperative Secondary Surgery and Hospitalization Rates Following Hip Arthroscopy.

PURPOSE: To evaluate a large cross-sectional sample of patients utilizing administrative database records and analyze the effects of income, insurance type, and education level on outcomes after hip arthroscopy, including 2-year revision surgery, conversion to total hip arthroplasty (THA), and 90-day hospitalizations. METHODS: Current Procedural Terminology codes were used to query the PearlDiver Mariner database from October 2015 to January 2020 for patients undergoing hip arthroscopy with a minimum 2-year follow-up. Patients were categorized by mean family income in their zip code of residence (MFIR), health insurance type, and educational attainment in their zip code of residence (EAR). Two-year revision arthroscopy, conversion to THA, and 90-day hospital readmissions or emergency department (ED) visits were analyzed along socioeconomic strata. RESULTS: Multivariate analysis of 33,326 patients revealed that patients with MFIR between $30,000 and $70,000 had lower odds of 2-year revision arthroscopy (odds ratio [OR], 0.63; P < .001), THA conversion (OR, 0.76; P = .050), and 90-day readmission (OR, 0.53; P = .007) compared to MFIR >$100,000. Compared to patients with commercial insurance, patients with Medicare had lower odds of revision arthroscopy (OR, 0.60; P = .035) and THA conversion (OR, 0.46, P < .001) but greater odds of 90-day readmission (OR, 1.74; P = .007). Patients with Medicaid had higher odds of 90-day ED visits (OR, 1.84; P < .001). Patients with low EAR had higher odds of revision arthroscopy (OR, 1.42; P = .005) and THA conversion (OR, 1.58; P = .002) compared to those with high EAR. CONCLUSIONS: Following hip arthroscopy, patients residing in areas with lower mean family income were less likely to undergo reoperations and readmissions. Medicare patients showed lower reoperation but higher readmission odds, while Medicaid patients showed higher odds of ED visits. Additionally, higher educational attainment in the zip code of residence is protective against future reoperation. LEVEL OF EVIDENCE: Level III, retrospective case series.

Movement Velocity as a Determinant of Actual Intensity in Resistance Exercise.

This study aimed to analyze the acute mechanical, metabolic and EMG response to five resistance exercise protocols (REP) in the full squat (SQ) exercise performed with two velocity conditions: maximal intended velocity (MaxV) vs. half-maximal velocity (HalfV). Eleven resistance-trained men performed 10 REP (5 with each velocity conditions) in random order (72-96 h apart). The REP consisted of three sets of 8-3 repetitions against 45-65% 1RM. The percent change in countermovement jump (CMJ) height, velocity attained with the load that elicited a ~1.00 m·s-1 (V1-load), surface EMG variables and blood lactate concentration were assessed pre- vs. post-exercise protocols. MaxV resulted in greater percent changes (Δ: 12-25%) and intra-condition effect sizes (ES: 0.76-4.84) in loss of V1-load and CMJ height compared to HalfV (Δ: 10-16%; ES: 0.65-3.90) following all REP. In addition, MaxV showed higher post-exercise lactate concentration than HalfV (ES: 0.46-0.83; p<0.05). For EMG variables, only the Dimitrov index resulted in relevant changes after each REP, with MaxV showing greater magnitude of changes (23-38%) than HalfV (12-25%) across all REP. These results suggest that voluntary movement velocity is a key aspect to consider since it clearly determines the overall training intensity during resistance exercise.

Down's syndrome and COVID-19: risk or protection factor against infection? A molecular and genetic approach.

Down syndrome (DS) is the most common genetic cause of learning difficulties and intellectual disabilities. DS patients often present with several congenital defects and chronic diseases, including immunity disorders. Elevated levels of pro-inflammatory cytokines such as interleukin (IL)-6 and tumor necrosis factor alpha (TNF-α) have been seen, which appear to vary with age. At birth, patients present with combined immunodeficiency, with frequent infections that decrease with age. Furthermore, high levels of IL-4 and IL-10 with anti-inflammatory properties and low levels of IL-6 and TNF-α are described in children. The immune system is believed to play an essential role in SARS-CoV-2 pathogenesis, and it has been associated with elevated levels of pro-inflammatory cytokines and an exaggerated cytokine release syndrome (CRS) that may eventually trigger a severe situation called cytokine storm. On the other hand, genetic features seem to be involved in the predisposition to illness and its severity. Overexpression of DSCR1 and ZAKI-4 inhibits the translocation of activated T lymphocyte nuclear factor (NF-AT) to the nucleus, a main step in the inflammatory responsiveness. We discuss here the possible role of immunology and genetic features of DS in the infection and prognosis in COVID-19.

Effect of velocity loss during squat training on neuromuscular performance.

This study aimed to compare the effects of three resistance training (RT) programs differing in the magnitude of velocity loss (VL) allowed in each exercise set: 10%, 30%, or 45% on changes in strength, vertical jump, sprint performance, and EMG variables. Thirty-three young men were randomly assigned into three experimental groups (VL10%, VL30%, and VL45%; n = 11 each) that performed a velocity-based RT program for 8 weeks using only the full squat exercise (SQ). Training load (55-70% 1RM), frequency (2 sessions/week), number of sets (3), and inter-set recovery (4 min) were identical for all groups. Running sprint (20 m), countermovement jump (CMJ), 1RM, muscle endurance, and EMG during SQ were assessed pre- and post-training. All groups showed significant (VL10%: 6.4-58.6%; VL30%: 4.5-66.2%; VL45%: 1.8-52.1%; p < 0.05-0.001) improvements in muscle strength and muscle endurance. However, a significant group × time interaction (p < 0.05) was observed in CMJ, with VL10% showing greater increments (11.9%) than VL30% and VL45%. In addition, VL10% resulted in greater percent change in sprint performance than the other two groups (VL10%: -2.4%; VL30%: -1.8%; and VL45%: -0.5%). No significant changes in EMG variables were observed for any group. RT with loads of 55-70% 1RM characterized by a low-velocity loss (VL10%) provides a very effective and efficient training stimulus since it yields similar strength gains and greater improvements in sports-related neuromuscular performance (jump and sprint) compared to training with higher velocity losses (VL30%, VL45%). These findings indicate that the magnitude of VL reached in each exercise set considerably influences the observed training adaptations.

Health-related quality of life in renal stone formers: are we improving?

PURPOSE OF REVIEW: Health-related quality of life (HRQOL) is a multidimensional construct measuring how disease impacts one's life. In the context of nephrolithiasis this is particularly relevant given the active and quiescent phases of the disease which may not correlate with the traditional index of stone free status. Several instruments are now available to objectively measure HRQOL in this population, including the first disease-specific instrument. Therefore, an overview of emerging data on HRQOL is provided that reviews the availability of these tools/instruments and emphasizes patient-centered care and research. RECENT FINDINGS: The common generic instruments used to measure HRQOL in any population (36-Item Short Form health survey and Patient-Reported Outcomes Measurement Information System) and the only disease-specific instrument developed to measure HRQOL in nephrolithiasis (Wisconsin Stone Quality of Life Questionnaire) are described. Emerging evidence suggests that age and sex influence renal stone formers perception of their HRQOL across a range of dimensions. Several other factors also appear to play a role, such as socioeconomic status, but these have yet to be validated in more than one study or population, and postoperative outcomes measured in terms of HRQOL are almost absent from the literature. SUMMARY: Physician-centric outcomes, such as stone status, are no longer the only objective and acceptable measures by which to understand the natural history of nephrolithiasis. Patient-centered approaches through the use of HRQOL are slowly emerging in research and clinical care alike. However, they remain largely in their infancy in these spheres.

Influence of Acromial Morphologic Characteristics and Acromioclavicular Arthrosis on the Effect of Platelet-Rich Plasma on Partial Tears of the Supraspinatus Tendon.

OBJECTIVE. The purposes of this study were to determine the medium-term effect of ultrasound-guided infiltration of platelet-rich plasma (PRP) on partial tears of the supraspinatus tendon (SST) and to identify prognostic indicators of an unfavorable outcome. SUBJECTS AND METHODS. Over a period of 4 years, patients with a partial SST tear smaller than 1.5 cm referred for ultrasound-guided PRP infiltration (1 mL) for shoulder pain lasting more than 3 months were recruited consecutively. MRI was used to analyze the type of acromion and presence of acromioclavicular (AC) arthrosis. Primary (size of the tear and associated bursitis) and secondary (mobility and pain) results were collected at 3 months. RESULTS. The study included 128 patients (66 men, 62 women; mean age, 48.3 years; range, 20-59 years). At 3 months, favorable evolution of the tear repair was recorded in 71.1% (91/128) of patients and resolution of bursitis in 66.7% (42/63). Changes in tear size had large effect sizes (Cohen d ≥ 1.16), as did pain and shoulder mobility (Cohen d ≥ 0.95). The strongest predictors of unfavorable evolution of tear and bursitis were type 3 acromion and types 1 and 2 acromion with AC arthrosis (p < 0.001; ß = 20.412). CONCLUSION. Ultrasound-guided PRP infiltration of partial tears of the SST relieves pain and improves shoulder mobility, but its effect on the size of the tear is influenced by the morphologic characteristics of the acromion and the presence of AC arthrosis. The effect of PRP is insufficient in patients with a type 3 acromion or severe AC arthrosis.

Reducing Opioid Use After Endourologic Procedures.

PURPOSE OF REVIEW: Surgeons have played a significant role in the current opioid epidemic through overprescribing practices in the postoperative setting. However, contemporary efforts have helped to decrease opioid excess, particularly in the field of urology. Minimally invasive surgery offers a unique avenue to address overuse of narcotics in the postoperative period given its emphasis on enhanced recovery. RECENT FINDINGS: Historically, the majority of the literature characterizing postoperative opioid use and its reduction has focused on non-urological surgery. However, recent studies have shown that patients undergoing urologic procedures are prescribed opioids in a similar manner as patients in other surgical specialties. Reduction strategies have been implemented through the use of regional anesthesia, enhanced recovery after surgery pathways, and the development of procedure-specific opioid prescription recommendations. Patients undergoing urologic surgery experience the same risk of opioid misuse and abuse as patients undergoing other types of surgery. However, the wide use of minimally invasive urological surgeries including robotic surgery offers a unique opportunity to reduce postoperative opioid use through multimodal and interdisciplinary protocols and standardizing guidelines.

Chemical compounds causing severe acute toxicity in heavy liquids used for intraocular surgery.

Perfluorocarbon liquids (PFCLs) have been considered safe for intraocular manipulation of the retina, but since 2013 many cases of acute eye toxicity cousing blindness have been reported in various countries when using various commercial PFCLs. All these PFCLs were CE marked (Conformité Européenne), which meant they had been subjected to evaluation complying with the International Organization for Standardization (ISO) guidelines. These dramatic events raised questions about the safety of PFCLs and the validity of some cytotoxicity tests performed under ISO guidelines. Samples from toxic batches were analyzed by gas chromatography-mass spectrometry combined with Raman and infrared spectrometry. Perfluorooctanoic acid, dodecafluoro-1-heptanol, ethylbenzene and tributyltin bromide were identified and evaluated by a direct contact cytotoxicity test using ARPE-19 cell line, patented by our group (EP 3467118 A1). Perfluorooctanoic acid at a concentration of >0.06 mM and tributyltin bromide at a concentration of ≥0.016 mM were shown to be toxic, whereas the concentration found in the toxic samples reached 0.48 mM, and 0.111 mM, respectively. These finding emphasized the idea that determination of partially fluorinated compounds are not enough to guarantee the safety of these medical devices.

Role of the Effort Index in Predicting Neuromuscular Fatigue During Resistance Exercises.

Rodríguez-Rosell, D, Yáñez-García, JM, Mora-Custodio, R, Torres-Torrelo, J, Ribas-Serna, J, and González-Badillo, JJ. Role of the effort index in predicting neuromuscular fatigue during resistance exercises. J Strength Cond Res XX(X): 000-000, 2020-This study aimed: (a) to analyze the acute mechanical, metabolic, and electromyographic (EMG) response to 16 resistance exercise protocols (REPs) defined by the first repetition's mean velocity and the percentage of velocity loss (%VL) over the set in the full-squat (SQ) exercise; and (b) to assess whether the effort index (EI, the product of the first repetition's mean velocity and the %VL in the set) could be used as an objective indicator of neuromuscular fatigue. Eleven resistance-trained men performed 16 REPs in the SQ exercise. For the configuration of the 16 REPs, 4 relative intensities (50, 60, 70, and 80% 1 repetition maximum) and 4 magnitudes of %VL (∼10, ∼20, ∼30, and ∼45%) were used. The induced fatigue after each REP was quantified using the percentage of change in (a) countermovement jump (CMJ) height, (b) mean propulsive velocity attained with the load that elicited an ∼1.00 m·s (V1 m·s load), and (c) changes in surface EMG variables. Blood lactate concentration was also collected. The EI presented very strong relationships with the %VL with the V1 m·s load, CMJ height, and post-exercise lactate concentration (r = 0.92, 0.93, and 0.91, respectively; p < 0.001). Moderate to strong relationships were found between the EI and the changes in amplitude (r = 054-0.58; p < 0.05), frequency (r = -0.55 to -0.83; p < 0.05-0.001), and time-frequency (r = 0.52-0.77; p < 0.05-0.001) EMG variables. In addition, the moderate to strong relationships found between the relative changes in mechanical, metabolic, and EMG variables after each REP reinforce the validity of the EI as an objective indicator of muscle fatigue, metabolic stress, and neural effect induced by typical resistance training sessions. Thus, by adjusting the EI in each session, it is possible to quantifying the actual level of effort experienced by each individual during resistance exercises.

Time Course of Recovery From Resistance Exercise With Different Set Configurations.

Pareja-Blanco, F, Rodríguez-Rosell, D, Aagaard, P, Sánchez-Medina, L, Ribas-Serna, J, Mora-Custodio, R, Otero-Esquina, C, Yáñez-García, JM, and González-Badillo, JJ. Time course of recovery from resistance exercise with different set configurations. J Strength Cond Res 34(10): 2867-2876, 2020-This study analyzed the response to 10 resistance exercise protocols differing in the number of repetitions performed in each set (R) with respect to the maximum predicted number (P). Ten males performed 10 protocols (R(P): 6(12), 12(12), 5(10), 10(10), 4(8), 8(8), 3(6), 6(6), 2(4), and 4(4)). Three sets with 5-minute interset rests were performed in each protocol in bench press and squat. Mechanical muscle function (countermovement jump height and velocity against a 1 m·s load, V1-load) and biochemical plasma profile (testosterone, cortisol, growth hormone, prolactin, IGF-1, and creatine kinase) were assessed at several time points from 24-hour pre-exercise to 48-hour post-exercise. Protocols to failure, especially those in which the number of repetitions performed was high, resulted in larger reductions in mechanical muscle function, which remained reduced up to 48-hour post-exercise. Protocols to failure also showed greater increments in plasma growth hormone, IGF-1, prolactin, and creatine kinase concentrations. In conclusion, resistance exercise to failure resulted in greater fatigue accumulation and slower rates of neuromuscular recovery, as well as higher hormonal responses and greater muscle damage, especially when the maximal number of repetitions in the set was high.

Red blood cell transfusion after a global strategy for early detection and treatment of iron deficiency anemia: three-year results of a prospective observational study.

BACKGROUND: Anemia is the main indication for red blood cell (RBC) transfusion and iron deficiency is the most prevalent, preventable, and treatable cause of anemia worldwide. We aimed to assess the impact of iron deficiency anemia (IDA) on RBC transfusion by means of a program for prevention, early detection, and treatment. STUDY DESIGN AND METHODS: A prospective observational study was conducted starting in 2014 after an intervention in clinical practice in Melilla, a peripheral city isolated by 207 km sea distance to nearest continental Spain. Recommendations were proposed for first-step diagnosis of iron deficiency in the laboratory, oral iron prevention and treatment in primary care, and intravenous iron complexes and RBC transfusion for hospital management. Reduction in RBC use for years 2014 to 2016 was the primary outcome, with the period 2010 to 2013 considered as baseline performance for statistical analysis. RESULTS: Compared to baseline, there was a significant (p < 0.05) increase in mean (±SD) yearly reference population (79,748 ± 3265 vs. 85,376 ± 781), ferritin assays (6980 ± 997 vs. 11,794 ± 1567), admissions (6768 ± 239 vs. 7629 ± 191), and subjects exposed to iron therapy (3975 ± 0.0 vs. 4667 ± 21 for oral, 54 ± 7 vs. 257 ± 109 for sucrose, and 128 ± 9 vs.176 ± 15 for carboxymaltose iron). Mean yearly number of RBC units transfused decreased (1622 ± 112 vs. 1434 ± 44; p = 0.043), with a mean reduction of 11.6% from baseline, or 21.4% when estimated by units transfused per 1000 admissions. CONCLUSIONS: Management of IDA is a target to avoid RBC transfusion, and awareness of this health problem should be among the first pillars for any patient blood management program.

Optimisation of sonourethrography: the clamp method.

PURPOSE: To describe the clamp method for performing retrograde sonourethrography (RSUG) and contrast-enhanced voiding sonourethrography (CE-VSUG) via the transperineal approach in male adults. MATERIALS AND METHODS: Prospective study of 113 males (14-86 years) with urethral strictures confirmed by urethrography who received sonourethrography via the clamp method between 2011 and 2015. The characteristic parameters of the quantitative variables were calculated and a comparative analysis of the qualitative variables was conducted using the McNemar test. RESULTS: RSUG was performed successfully in all the cases (n = 113) and detected 49 cases with anterior urethral strictures; the strictures in the proximal bulbar cone in five of them (10.2%) were not visualised on retrograde urethrography (RUG) (p < 0.05). CE-VSUG was performed successfully in 97 cases and observed posterior urethral strictures in 82; the bladder neck strictures in 6 of them (7.3%) were not observed on voiding cystourethrography (VCUG) (p < 0.05). Retrograde bladder filling was achieved in approximately 6 min. CONCLUSION: The clamp method enables RSUG and CE-VSUG to be performed simply, effectively and painlessly by a single operator. It also allows the evaluation of cases with urethromeatal alterations (stricture, hypospadias and meatotomy). KEY POINTS: • The clamp method enables RSUG to be performed simply and painlessly. • The clamp method requires only one operator and allows assessing urethromeatal alterations. • RSUG shows greater capacity for detecting anterior urethral strictures than RUG. • The clamp method achieves retrograde bladder filling in approximately 6 min. • CE-VSUG shows greater capacity for detecting strictures than VCUG.

Acoustic radiation force impulse imaging for detection of liver fibrosis in overweight and obese children.

Background Acoustic radiation force impulse (ARFI) is a non-invasive alternative to a liver biopsy for the evaluation of liver fibrosis (LF). Purpose To investigate the potential usefulness of acoustic radiation force impulse ARFI for detecting LF in overweight and obese children Material and Methods A cross-sectional study was conducted in 148 schoolchildren. A diagnosis of non-alcoholic fatty liver disease (NAFLD) and LF was based on ultrasound (US) and ARFI shear wave velocity (SWV). Results The laboratory parameters were normal in all the children. NAFLD was observed in 50 children (33.8%). The median SWV was 1.18 ± 0.28 m/s. Differences between ARFI categories and hepatic steatosis grades were observed (χ2 = 43.38, P = 0.0005). No fibrosis or insignificant fibrosis (SWV ≤ 1.60 m/s) was detected in 137 children (92.5%), and significant fibrosis (SWV > 1.60 m/s) in 11 children (7.5%), nine of whom had normal US or mild steatosis. Conclusion The present study is the first to evaluate the utility of the ARFI technique for detecting LF in overweight and obese children. The results of the study suggest that children with normal laboratory parameters such as normal liver ultrasound or mild steatosis may present with significant LF.

openBIS ELN-LIMS: an open-source database for academic laboratories.

UNLABELLED: The open-source platform openBIS (open Biology Information System) offers an Electronic Laboratory Notebook and a Laboratory Information Management System (ELN-LIMS) solution suitable for the academic life science laboratories. openBIS ELN-LIMS allows researchers to efficiently document their work, to describe materials and methods and to collect raw and analyzed data. The system comes with a user-friendly web interface where data can be added, edited, browsed and searched. AVAILABILITY AND IMPLEMENTATION: The openBIS software, a user guide and a demo instance are available at https://openbis-eln-lims.ethz.ch. The demo instance contains some data from our laboratory as an example to demonstrate the possibilities of the ELN-LIMS (Ottoz et al., 2014). For rapid local testing, a VirtualBox image of the ELN-LIMS is also available.

The Use of Combined Hip Arthroscopy and Periacetabular Osteotomy for Hip Dysplasia Is Increasing and Has Low Complication Rates.

Purpose: To analyze the annual use of hip arthroscopy (HA) and Bernese periacetabular osteotomy (PAO) for the treatment of hip dysplasia (HD), as well as postoperative outcomes, including ipsilateral reoperations. Methods: International Classification of Diseases, Ninth and Tenth Revision, codes were used to query the PearlDiver Mariner database from January 2010 through January 2022 to identify patients aged 10 to 59 years who had a presenting diagnosis of HD and subsequently underwent (1) HA; (2) PAO; or (3) combined HA and PAO (HA-PAO, defined as PAO on the same day or within 28 days after HA). We analyzed annual rates for each treatment, as well as rates of postoperative emergency visits, readmissions, and 5-year ipsilateral secondary operations (determined via Kaplan-Meier analysis). Results: There were 32,068 patients who underwent surgical treatment of HD. For HA, PAO, and HA-PAO, there were 29,700, 2,083, and 285 patients, respectively. All operations had the greatest percent-increase from 2015 to 2016. HA and HA-PAO peaked in 2021, whereas PAO peaked in 2019. For HA, PAO, and HA-PAO, most cases were performed in female patients and patients aged 30 to 49 years, 10 to 19 years, and 10 to 29 years, respectively. The 5-year incidence of ipsilateral secondary operations, which include revision HA, PAO, or conversion to total hip arthroplasty, was 9.2% (95% confidence interval 8.6%-9.8%) in the HA group and 6.5% (95% confidence interval 4.1%-8.8%) in the PAO group. Combining HA with PAO resulted in so few secondary operations that Kaplan-Meier analysis was infeasible. The PAO cohort had the greatest 30-day emergency visit and 90-day readmission rates, with infection as the most common cause for readmission. Conclusions: HA is more frequently performed than PAO for hip dysplasia. HA-PAO is increasing at the greatest rate, demonstrating fewer complications and reoperations. Level of Evidence: Level III, retrospective comparative trial.

Total shoulder arthroplasty in patients with dementia or mild cognitive impairment.

Background: Anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA) reliably alleviate pain and restore shoulder function for a variety of indications. However, these procedures are not well-studied in patients with neurocognitive impairment. Therefore, the purpose of this study was to investigate whether patients with dementia or mild cognitive impairment (MCI) have increased odds of surgical or medical complications following arthroplasty. Methods: The PearlDiver database was queried from 2010 through October 2021 to identify a cohort of patients who underwent either ATSA or RTSA and had a minimum 2-year follow-up. Current Procedural Terminology and International Classification of Diseases codes were used to stratify this cohort into three groups: (1) patients with dementia, (2) patients with MCI, and (3) patients with neither condition. Surgical and medical complication rates were compared among these three groups. Results: The overall prevalence of neurocognitive impairment among patients undergoing total shoulder arthroplasty was 3.0% in a cohort of 92,022 patients. Patients with dementia had increased odds of sustaining a periprosthetic humerus fracture (odds ratio [OR] = 1.46, P < .001), developing prosthesis instability (OR = 1.72, P < .001), and undergoing revision arthroplasty (OR = 1.55, P = .003) after RTSA compared to patients with normal cognition. ATSA patients with dementia did not have an elevated risk of surgical complications or revision. Conversely, RTSA patients with MCI did not have an elevated risk of complications or revision, although ATSA patients with MCI had greater odds of prosthesis instability (OR = 2.51, P = .008). Additionally, patients with neurocognitive impairment had elevated odds of medical complications compared to patients with normal cognition, including acute myocardial infarction and cerebrovascular accident. Conclusion: Compared to patients with normal cognition, RTSA patients with preoperative dementia and ATSA patients with preoperative MCI are at increased risk for surgical complications. Moreover, both ATSA and RTSA patients with either preoperative MCI or dementia are at increased risk for medical complications. As the mean age in the U.S. continues to rise, special attention should be directed towards patients with neurocognitive impairment to minimize postoperative complications aftertotal shoulder arthroplasty, and the risks of this surgery more carefully discussed with patients and their families and caretakers.

Efficacy of intralesional triamcinolone injection in the treatment of mammillary fistula: a prospective study.

BACKGROUND: Recurring mammillary fistula (MF) is often difficult to manage. PURPOSE: To evaluate the efficacy of intralesional triamcinolone (ILT) injection versus irrigation with saline solution in the management of MF. MATERIAL AND METHODS: A prospective study was conducted including 10 patients with MF. The patients were distributed non-randomly into two groups: saline group (n = 5) and triamcinolone group (n = 5). Ultrasound guidance was used for ILT injection. The injection was repeated in the case of no response or recurrence. RESULTS: No statistically significant differences were observed between the saline and triamcinolone groups for clinical parameters and ultrasonographic characteristics of the MF and for the outcomes of the two methods of treatment. However, a statistically significant difference was observed between the two groups for recurrence of MF (P < 0.046). Success of the treatment with ILT injection was observed in 90% of the patients (9/10), and a failure in one case (10%) after three ILT injections, who was referred for surgery. CONCLUSION: ILT injection is an effective, simple, and safe treatment for the management of MF.

Regrowth of the psoas tendon after arthroscopic tenotomy: a magnetic resonance imaging study.

PURPOSE: The purpose of this study was to evaluate whether the psoas tendon regenerates after arthroscopic tenotomy through the central compartment of the hip in patients with internal snapping hip. METHODS: Twenty-seven patients with a snapping hip, aged 18 to 54 years (mean, 37.47 years), underwent arthroscopic tenotomy through the central compartment of the hip; all patients had symptomatic femoroacetabular impingement as well. The degree of regeneration was evaluated by preoperative and postoperative measurements of the tendon perimeter with a magnetic resonance imaging protocol in patients with more than 6 months' follow-up. In addition, function was assessed preoperatively and postoperatively with the Western Ontario and McMaster Universities Osteoarthritis Index score. Postoperative active flexion force was graded clinically between 1 and 5 with the Medical Research Council score. RESULTS: Eight patients had less than 6 months' follow-up, and they were excluded. The remaining 19 patients were evaluated after a mean follow-up period of 23.16 months (SD, 12.95 months). Tendon regeneration occurred in all patients. Compared with preoperative measurement, the psoas tendon circumference had recovered by 84.3% on average (55.44 ± 5.68 mm v 46.71 ± 6.05 mm, P < .001). Pain improved in all patients, and the mean Western Ontario and McMaster Universities Osteoarthritis Index score fell from 49 ± 15.9 points to 10.74 ± 11.35 points (P < .001). Muscle force recovered completely in all cases. CONCLUSIONS: There is a process of tissular repair after psoas tenotomy, and the findings on magnetic resonance imaging suggest that tendon tissue regrowth occurs. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Algae from Cr-containing infiltrate bioremediation for valorised chemical production - Seasonal availability, composition, and screening studies on hydrothermal conversion.

Integrating bioremediation of toxic wastewater with value-added production is increasing interest, but - due to some essential problems - it is hardly applied in industrial practice. The aim of the study was an annual observation of the taxonomic and biochemical composition of various Cr-resistant algal communities grown in the existing Cr-containing infiltrate treatment system, selection of the most suitable algal biomass for infiltrates bioremediation and chromium-loaded algae conversion under mild subcritical conditions. Considering continuous availability and relatively constant chemical composition, Cladophora sp. was selected for utilisation in the chromium bioremediation system, simultaneously as a waste biomass source suitable for hydrothermal conversion. Screening studies conducted in a continuous pilot plant confirmed the possibility of selective extraction of saccharides and their separation from the metals remaining in the solid residual. The negligible concentration of metals in the obtained sugar-rich aqueous phase is essential for its further use in biotechnological processes.