Notes

Calming your cytokine storm regarding COVID-19 via hang-up associated with JAK2/STAT3 signaling.
Mean SMFA scores at 2 years for all groups were 13 DN, 12 DO, 17 NN, 17 NO.

All groups (operative/nonoperative and displaced/non-displaced) reported worst function 3 months following injury and all but (DN) continued to recover for 2 years following injury, with peak recovery for DN seen at 1 year. No functional benefit was seen with operative intervention for either displaced or non-displaced injuries at any time point.

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
To evaluate whether the implementation of a geriatrics-focused orthopedic and hospitalist comanagement program can improve perioperative outcomes and decrease resource utilization.

A retrospective chart review study was conducted before and after the implementation of a geriatrics-focused orthopedic and hospitalist comanagement program, based on the American Geriatrics Society (AGS) AGS CoCareOrtho®.

A large urban, academic tertiary center, located in the greater New York metropolitan area.

Patients 65 years and older hospitalized for operative hip fracture. Selleckchem VX-11e Those with pathologic or periprosthetic fractures, and chronic substance use were excluded.

Outcome measures included time to operating room (TtOR), length of stay (LOS), daily and total morphine milligram equivalents (MME), use of preoperative transthoracic echocardiogram (TTE) and blood transfusions, perioperative complications (e.g., urinary tract infections), and six-month mortality.

Our study included 290 patients hospitalized with hip frce.
To determine if preoperative administration of venous thromboembolism (VTE) chemoprophylaxis (PPx) prior to pelvic and acetabular fracture surgery affects estimated blood loss (EBL), perioperative change in hemoglobin (ΔHgb), or transfusion rates.

Retrospective cohort study.

Level 1 trauma center, southeastern United States.Patients/Participants" All pelvic and acetabular surgeries performed between 4/2014 and 2/2020.

EBL, immediate and 24h post-op ΔHgb, and intra-/post-op transfusion.

In all 267 surgeries were included; 97 pre- and 170 post-change. Median ISS was 17 before vs 14 after the change. One surgeon retired and two started during the study, producing differences in acetabular approaches. Median surgical duration was longer post-change. Cohorts were otherwise similar. No differences were observed in EBL, ΔHgb, or transfusion rates. link2 Rates of VTE and surgical site complications were unchanged. No VTE-related deaths occurred. In the as-treated analysis (63 patients given LMWH <12h pre-op vs 190 patients not given PPx), no differences were observed.

Administration of VTE PPx within 12h of pelvic and acetabular surgery had no effect on perioperative blood loss. This study is limited by changes in faculty, but it suggests that traumatologists need not advocate for holding VTE PPx before pelvic and acetabular trauma surgery.

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Prognostic Level III. link3 See Instructions for Authors for a complete description of levels of evidence.
Compare blood loss and transfusion rates among reamer irrigator aspirator (RIA), iliac crest bone graft (ICBG), and proximal tibial curettage (PTC) for autograft harvest.

Retrospective Comparative Study.

Level 1 Trauma CenterPatients/Participants The study included 139 adult patients treated between 2011 and 2018.

Non-union repair of the femur or tibia utilizing either RIA (n=64), ICBG (n=59), or PTC (n=16) for autograft.

Estimated Blood Loss and Transfusion Rates.

Patient demographics, surgical indications, and medical comorbidities that affect bleeding did not differ among the groups. Estimated blood loss (mL) was significantly higher in the RIA group (RIA 388 ±368 [50-2000], ICBG 286 ±344 [10-2000], PTC 196mL ±219 [10-700], p<0.01). The transfusion rate was also significantly higher in the RIA group (RIA 14%, ICBG 0%, PTC 0%, p<0.01). The amount of graft obtained was higher in the RIA group (RIA=48.3cc, ICBG=31.0cc, PTC=18.8cc, p < 0.01), and the operative time (hours) was longer in the RIA group (RIA=2.8, ICBG=2.6, PTC=1.9, p=0.04).

Estimated blood loss and transfusion rates were significantly higher in patients undergoing RIA compared to ICBG and PTC; however, the incidence of transfusion following RIA (14%) was considerably lower than previous reports. These findings suggest that the risk of transfusion following RIA is present and clinically significant but lower than previously thought, and it is likely affected by the amount of graft obtained and complexity of the nonunion repair. The risk of transfusion should be discussed with patients and the choice of RIA carefully evaluated in patients who have anemia or risk factors for bleeding.

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
To compare the cost and utility of scleral buckle (SB), pars plana vitrectomy (PPV) and PPV with SB (PPV/SB) for moderately complex rhegmatogenous retinal detachment (RRD) repair.

Cost-utility analysis utilizing data from the Primary Retinal Detachment Outcomes Study (PRO Study). The model estimated costs, lifetime utility, and lifetime cost per quality-adjusted life year (QALY) for treatment of moderately complex RRD with SB, PPV or PPV/SB. Data from the Centers for Medicare and Medicaid Services were used to calculate costs in hospital and ASC settings.

Total costs (2020 United States dollars) for repair of a moderately complex RRD in hospital (ASC) settings were $5975 ($3774) for the SB group, $8125 ($5082) for the PPV group, and $7551 ($4713) for the PPV/SB group. The estimated lifetime QALYs gained were 5.4, 4.7, and 4.7 in the SB, PPV and PPV/SB groups, respectively. The cost per QALY for hospital and ASC settings was $1106 a ($699) for the SB group, $1729 ($1081) for the PPV group, and $1607 ($1003) for the PPV/SB group.

SB, PPV and PPV/SB yielded very favorable cost-utility results for the repair of moderately complex RRD, with slightly better results for SB, compared to current willingness to pay standards.
SB, PPV and PPV/SB yielded very favorable cost-utility results for the repair of moderately complex RRD, with slightly better results for SB, compared to current willingness to pay standards.
To describe the ophthalmic manifestations of familial transthyretin amyloidosis (FTA) mutations, including Asp38Ala and Thr59Lys, which have not been previously reported to have ocular involvement.

This is an observational case series of prospectively collected data of 16 FTA patients who were taking tafamidis for mild peripheral neuropathy and underwent a comprehensive ophthalmic examination at a single tertiary center, between January 2013 and March 2020. The ocular involvement of each FTA mutation type and the specific manifestations were the main outcome measures.

Six of 16 FTA patients manifested ocular involvement. Ocular involvement was noted in two of three patients with Glu89Lys mutations having retinal deposits, retinal hemorrhages, and corneal opacity. Three of nine patients with Asp38Ala mutations and one of two patients with Thr59Lys mutations showed ocular involvement that had not been previously described. The ophthalmic findings included glaucoma, anterior lens capsule opacity, vitreous opacity, and retinal deposits. The decrease in vascular flow due to perivascular cuffing of the amyloid deposits was detected by optical coherence tomography angiography.

The current study newly described that two transthyretin mutation types of FTA, Asp38Ala and Thr59Lys, may manifest with ocular findings such as anterior lens capsule opacity and retinal deposits.
The current study newly described that two transthyretin mutation types of FTA, Asp38Ala and Thr59Lys, may manifest with ocular findings such as anterior lens capsule opacity and retinal deposits.
To increase insight into the myopic presentation of central serous chorioretinopathy (CSC) by comparing a large group of myopic patients with CSC to reference groups with only one of the diagnoses.

Myopic cases with CSC (spherical equivalent (SE) ≤-3D, n=46), emmetropic patients with CSC (SE -0.5 to 0.5D, n=83) and myopic, non CSC, patients (n=50) were included in this multicentre cross-sectional study. Disease characteristics and imaging parameters, like subfoveal choroidal thickness (SFCT) and ICGA patterns, were compared between cases and reference groups.

In myopic CSC cases, median SFCT (286 μm (IQR 226-372μm) was significantly thicker than SFCT in myopic, non CSC patients (200 μm (IQR 152-228μm), p<0.001), but thinner than emmetropic CSC patients (452 μm (IQR 342-538 μm), p<0.001). They also had pachyvessels in 70% of the eyes, comparable to emmetropic CSC (76%, p=0.70). Choroidal hyperpermeability was frequently present on ICGA in both myopic and emmetropic CSC eyes. Need for treatment, treatment success or recurrence rate were not significantly different between CSC groups.

Myopic CSC presents with similar imaging and clinical characteristics as emmetropic CSC, apart from their thinner choroids. Keeping in mind the structural changes of myopia, other imaging characteristics could aid the diagnostic process.
Myopic CSC presents with similar imaging and clinical characteristics as emmetropic CSC, apart from their thinner choroids. Keeping in mind the structural changes of myopia, other imaging characteristics could aid the diagnostic process.
To describe the presentation, microbiology, management, and prognosis of eyes with endophthalmitis following Boston keratoprosthesis (KPro) implantation.

Retrospective case series with history, diagnostics, management, and outcomes data in endophthalmitis following KPro implantation presenting to a tertiary center between 2009 and 2020.

Of 137 KPro-implanted eyes, 7 eyes of 7 patients (5%) developed endophthalmitis. On presentation, 6 (86%) reported decreased visual acuity (VA), and only 1 (14%) reported pain. Peripheral corneal ulcers were present in 2 eyes (29%). Seidel testing was negative in all cases. Six eyes (86%) had retroprosthetic membranes. One (14%) underwent initial pars plana vitrectomy (PPV) with mechanical vitreous biopsy, whereas 6 (86%) received a needle vitreous tap-half of which were dry. Organisms were isolated following vitreous tap in 2 eyes Streptococcus intermedius and Mycobacterium abscessus. Mean VA pre-endophthalmitis, at presentation, and at 6 months were 20/267, 20/5944, and 20/734, respectively. VA improved 9.08 ± 11.78 ETDRS lines from presentation to 6 months. Six-month VA was correlated with pre-endophthalmitis VA (r=0.92, p=0.003) but not presenting VA (p=0.838).

Visual acuity at 6 months is correlated with pre-endophthalmitis VA, not presenting VA. Endophthalmitis should be considered in the differential diagnosis of painless intraocular inflammation any time after KPro implantation, even if Seidel negative.
Visual acuity at 6 months is correlated with pre-endophthalmitis VA, not presenting VA. Endophthalmitis should be considered in the differential diagnosis of painless intraocular inflammation any time after KPro implantation, even if Seidel negative.
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