Notes

Overall Emergency of Hepatocellular Carcinoma Individuals Have Radiofrequency Ablation (RFA) Treatment method: any Retrospective Cohort Study on 2 Recommendation Hospitals in Indonesia.
The performed studies revealed that cathelicidin did not cause any negative changes in lung morphology/structure, immune cell composition or cytokines production. At the same time, CRAMP attenuated the immune reaction induced by mice chronic exposure to P. agglomerans and inhibited hydroxyproline and collagen deposition in the lung tissue of mice treated with bacteria extract. The beneficial effect of CRAMP on HP treatment was associated with restoring the balance in quantity of immune cells, cytokines production and synthesis of extracellular matrix components. The presented study suggests the usefulness of cathelicidin in preventing lung fibrosis; however, cathelicidin was not able to reverse pathological changes completely.Suicide is the 10th leading cause of death in the U.S (1999-2019). However, predicting when someone will attempt suicide has been nearly impossible. In the modern world, many individuals suffering from mental illness seek emotional support and advice on well-known and easily-accessible social media platforms such as Reddit. While prior artificial intelligence research has demonstrated the ability to extract valuable information from social media on suicidal thoughts and behaviors, these efforts have not considered both severity and temporality of risk. The insights made possible by access to such data have enormous clinical potential-most dramatically envisioned as a trigger to employ timely and targeted interventions (i.e., voluntary and involuntary psychiatric hospitalization) to save lives. In this work, we address this knowledge gap by developing deep learning algorithms to assess suicide risk in terms of severity and temporality from Reddit data based on the Columbia Suicide Severity Rating Scale (C-SSRS). In particular, we employ two deep learning approaches time-variant and time-invariant modeling, for user-level suicide risk assessment, and evaluate their performance against a clinician-adjudicated gold standard Reddit corpus annotated based on the C-SSRS. Our results suggest that the time-variant approach outperforms the time-invariant method in the assessment of suicide-related ideations and supportive behaviors (AUC0.78), while the time-invariant model performed better in predicting suicide-related behaviors and suicide attempt (AUC0.64). The proposed approach can be integrated with clinical diagnostic interviews for improving suicide risk assessments.In the highly eusocial wasp, Vespula vulgaris, queens produce honest signals to alert their subordinate workers of their fertility status, and therefore they are reproductively suppressed and help in the colony. The honesty of the queen signals is likely maintained due to hormonal regulation, which affects fertility and fertility cue expression. Here, we tested if hormonal pleiotropy could support the hypothesis that juvenile hormone controls fertility and fertility signaling in workers. In addition, we aimed to check oocyte size as a proxy of fertility. To do that, we treated V. vulgaris workers with synthetic versions of juvenile hormone (JH) analogue and a JH inhibitor, methoprene and precocene, respectively. We dissected the treated females to check ovary activation and analyzed their chemical profile. Our results showed that juvenile hormone has an influence on the abundance of fertility linked compounds produced by workers, and it also showed to increase oocyte size in workers. Our results corroborate the hypothesis that juvenile hormone controls fertility and fertility signaling in workers, whereby workers are unable to reproduce without alerting other colony members of their fertility. This provides supports the hypothesis that hormonal pleiotropy contributes to keeping the queen fertility signals honest.
Coronavirus disease 2019 (COVID-19) is currently the critical health problem of the globe, including Ethiopia. Visitors of healthcare facilities are the high-risk groups due to the presence of suspected and confirmed cases of COVID-19 in the healthcare setting. Increasing the knowledge, attitude, and practices towards COVID-19 prevention among hospital visitors are very important to prevent transmissions of the pandemic despite the lack of evidence remains a challenge in Ethiopia. Therefore, this study was designed to investigate the status of knowledge, attitude, and preventive practice towards COVID-19 and associated factors among hospital visitors in South Gondar Zone Hospitals, Northwest Ethiopia.

A facility-based cross-sectional study design was employed during August 1 to 30, 2020 from randomly selected 404 adult hospital visitors in South Gondar Zone Hospitals, Northwest Ethiopia. The data was collected using interviewer-administered questionnaire. The outcome of this study was good or poor knowledighly encouraged to increase the good knowledge status of adult hospital visitors. Furthermore, providing training about COVID-19 prevention methods and using various sources of information about COVID-19 will help for improving positive attitude towards COVID-19 prevention, whereas for increasing the status of good preventive practices towards COVID-19, improving the good knowledge about COVID-19 of adult hospital visitors are essential.
The coronavirus disease 2019 (COVID-19) pandemic has affected the life and work of people worldwide. The present study aimed to evaluate the rhythm disruptions of life, work, and entertainment, and their associations with the psychological impacts during the initial phase of the COVID-19 pandemic.

A cross-sectional study was conducted from the 10th to 17th March 2020 in China. A structured e-questionnaire containing general information, the Chinese version of Brief Social Rhythm Scale, and Zung's self-rating scales of depression and anxiety (SDS and SAS) was posted and collected online through a public media (i.e. EQxiu online questionnaire platform). Scores in sleeping, getting up, and socializing (SGS) rhythm and eating, physical practice, and entertainment (EPE) rhythm were compared among and between participants with different sociodemographic backgrounds including gender, age, education, current occupation, annual income, health status, and chronic disease status. Correlations of SDS and SAS with SGSnxiety. Interventions should be applied to people vulnerable to the rhythm disruption during the COVID-19 pandemic.
Social rhythm disruption was independently associated with depression and anxiety. Interventions should be applied to people vulnerable to the rhythm disruption during the COVID-19 pandemic.TRIM32 is an E3 ligase implicated in diverse biological pathways and pathologies such as muscular dystrophy and cancer. TRIM32 are expressed both as full-length proteins, and as a truncated protein. The mechanisms for regulating these isoforms are poorly understood. Here we identify a PEST sequence in TRIM32 located in the unstructured region between the RING-BBox-CoiledCoil domains and the NHL repeats. The PEST sequence directs cleavage of TRIM32, generating a truncated protein similarly to the short isoform. We map three lysine residues that regulate PEST mediated cleavage and auto-ubiquitylation activity of TRIM32. Mimicking acetylation of lysine K247 completely inhibits TRIM32 cleavage, while the lysines K50 and K401 are implicated in auto-ubiquitylation activity. We show that the short isoform of TRIM32 is catalytic inactive, suggesting a dominant negative role. These findings uncover that TRIM32 is regulated by post-translational modifications of three lysine residues, and a conserved PEST sequence.The advance in microbiome and metabolome studies has generated rich omics data revealing the involvement of the microbial community in host disease pathogenesis through interactions with their host at a metabolic level. However, the computational tools to uncover these relationships are just emerging. Here, we present MiMeNet, a neural network framework for modeling microbe-metabolite relationships. Using ten iterations of 10-fold cross-validation on three paired microbiome-metabolome datasets, we show that MiMeNet more accurately predicts metabolite abundances (mean Spearman correlation coefficients increase from 0.108 to 0.309, 0.276 to 0.457, and -0.272 to 0.264) and identifies more well-predicted metabolites (increase in the number of well-predicted metabolites from 198 to 366, 104 to 143, and 4 to 29) compared to state-of-art linear models for individual metabolite predictions. Additionally, we demonstrate that MiMeNet can group microbes and metabolites with similar interaction patterns and functions to illuminate the underlying structure of the microbe-metabolite interaction network, which could potentially shed light on uncharacterized metabolites through "Guilt by Association". Our results demonstrated that MiMeNet is a powerful tool to provide insights into the causes of metabolic dysregulation in disease, facilitating future hypothesis generation at the interface of the microbiome and metabolomics.We analyzed prosocial behaviors in a field experiment (N = 307) conducted in an urban context (Timisoara, Banat region, Romania), starting from a classical Cross-Cultural Psychology research organized in UK and Iran by Collet & O'Shea in 1976. If the evoked study is focused on comparing prosocial behaviors in two very different national cultures (UK vs. Iran), we compared helping strangers strategies within the same national culture in relation to the regional identities of the help-seeking subjects. A behavioral scenario was created by asking naïve participants to offer support and give directions to a place even if they did not know its whereabouts. Drawing on social identity theory, it was tested whether regional belonging of the help-seeker (in-group vs. out-group) predicts the availability of help-givers for offering help, their availability for giving wrong directions, as well as their emotional expressiveness. Results are interpreted within the perspective of social distance between groups and show that the more distant regional identities are perceived to be, the less generous help-givers are, both in terms of their decision to help and to give wrong directions, as well as in their expressed emotions.Delirium is the most common postsurgical neurological complication and has a variable incidence rate. Laparoscopic surgery, when associated with the Trendelenburg position, can cause innumerable physiological changes and increase the risk of neurocognitive changes. The association of general anesthesia with a spinal block allows the use of lower doses of anesthetic agents for anesthesia maintenance and facilitates better control over postoperative pain. Our primary outcome was to assess whether a spinal block influences the incidence of delirium in oncologic patients following laparoscopic surgery in the Trendelenburg position. Our secondary outcome was to analyze whether there were other associated factors. A total of 150 oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position were included in this randomized controlled trial. The patients were randomized into 2 groups the general anesthesia group and the general anesthesia plus spinal block group. Patients were immediately evaluated during the postoperative period and monitored until they were discharged, to rule out the presence of delirium. Delirium occurred in 29 patients in total (22.3%) (general anesthesia group 30.8%; general anesthesia plus spinal block 13.8% p = 0.035). Patients who received general anesthesia had a higher risk of delirium than patients who received general anesthesia associated with a spinal block (odds ratio = 3.4; 95% confidence interval 1.2-9.6; p = 0.020). Spinal block was associated with reduced delirium incidence in oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position.Due to an increasing number of cardiovascular diseases, artificial heart valves and blood vessels have been developed. Although cardiovascular applications using decellularized tissue have been studied, the mechanisms of their functionality remain unknown. To determine the important factors for preparing decellularized cardiovascular prostheses that show good in vivo performance, the effects of the luminal surface structure of the decellularized aorta on thrombus formation and cell behavior were investigated. Various luminal surface structures of a decellularized aorta were prepared by heating, drying, and peeling. The luminal surface structure and collagen denaturation were evaluated by immunohistological staining, collagen hybridizing peptide (CHP) staining, and scanning electron microscopy (SEM) analysis. To evaluate the effects of luminal surface structure of decellularized aorta on thrombus formation and cell behavior, blood clotting tests and recellularization of endothelial cells and smooth muscle cells were performed. The results of the blood clotting test showed that the closer the luminal surface structure is to the native aorta, the higher the anti-coagulant property. The results of the cell seeding test suggest that vascular cells recognize the luminal surface structure and regulate adhesion, proliferation, and functional expression accordingly. These results provide important factors for preparing decellularized cardiovascular prostheses and will lead to future developments in decellularized cardiovascular applications.Durum wheat is an important cereal grown in Ethiopia, a country which is also its center for genetic diversity. Yellow (stripe) rust caused by Puccinia striiformis fsp tritici is one of the most devastating diseases threatening Ethiopian wheat production. To identify sources of genetic resistance and combat this pathogen, we conducted a genome wide association study of yellow rust resistance on 300 durum wheat accessions comprising 261 landraces and 39 cultivars. The accessions were evaluated for their field resistance using a modified Cobb scale at Meraro, Kulumsa and Chefe Donsa in the 2015 and 2016 main growing seasons. Analysis of the 35K Axiom Array genotyping data of the panel resulted in a total of 8,797 polymorphic SNPs of which 7,093 were used in subsequent analyses. Population structure analysis suggested two groups in which the cultivars clearly stood out separately from the landraces. Eleven SNPs significantly associated with yellow rust resistance were identified on four chromosomes (1A, 1B, 2B, and 5A) which defined at least five genomic loci. Six of the SNPs were consistently identified on chromosome 1B singly at each and combined overall environments which explained 62.6-64.0% of the phenotypic variation (R2). Resistant allele frequency ranged from 14.0-71.0%; Zooming in to the identified resistance loci revealed the presence of disease resistance related genes involved in the plant defense system such as the ABC transporter gene family, disease resistance protein RPM1 (NBS-LRR class), Receptor kinases and Protein kinases. This study has provided SNPs for tracking the loci associated with yellow rust resistance and a diversity panel which can be used for association study of other agriculturally important traits in durum wheat.The heart develops from 2 sources of mesoderm progenitors, the first and second heart field (FHF and SHF). Using a single-cell transcriptomic assay combined with genetic lineage tracing and live imaging, we find the FHF and SHF are subdivided into distinct pools of progenitors in gastrulating mouse embryos at earlier stages than previously thought. Each subpopulation has a distinct origin in the primitive streak. The first progenitors to leave the primitive streak contribute to the left ventricle, shortly after right ventricle progenitor emigrate, followed by the outflow tract and atrial progenitors. Moreover, a subset of atrial progenitors are gradually incorporated in posterior locations of the FHF. Although cells allocated to the outflow tract and atrium leave the primitive streak at a similar stage, they arise from different regions. Outflow tract cells originate from distal locations in the primitive streak while atrial progenitors are positioned more proximally. Moreover, single-cell RNA sequencing demonstrates that the primitive streak cells contributing to the ventricles have a distinct molecular signature from those forming the outflow tract and atrium. We conclude that cardiac progenitors are prepatterned within the primitive streak and this prefigures their allocation to distinct anatomical structures of the heart. Together, our data provide a new molecular and spatial map of mammalian cardiac progenitors that will support future studies of heart development, function, and disease.Tularemia is a highly dangerous zoonotic infection due to the bacteria Francisella tularensis. Low genetic diversity promoted the use of polymorphic tandem repeats (MLVA) as first-line assay for genetic description. Whole genome sequencing (WGS) is becoming increasingly accessible, opening the perspective of a time when WGS might become the universal genotyping assay. The main goal of this study was to describe F. tularensis strains circulating in Kazakhstan based on WGS data and develop a MLVA assay compatible with in vitro and in silico analysis. In vitro MLVA genotyping and WGS were performed for the vaccine strain and for 38 strains isolated in Kazakhstan from natural water bodies, ticks, rodents, carnivores, and from one migratory bird, an Isabellina wheatear captured in a rodent burrow. The two genotyping approaches were congruent and allowed to attribute all strains to two F. tularensis holarctica lineages, B.4 and B.12. The seven tandem repeats polymorphic in the investigated strain collection could be typed in a single multiplex PCR assay. Identical MLVA genotypes were produced by in vitro and in silico analysis, demonstrating full compatibility between the two approaches. The strains from Kazakhstan were compared to all publicly available WGS data of worldwide origin by whole genome SNP (wgSNP) analysis. Genotypes differing at a single SNP position were collected within a time interval of more than fifty years, from locations separated from each other by more than one thousand kilometers, supporting a role for migratory birds in the worldwide spread of the bacteria.
Tuberculosis represents a public health problem, with extrapulmonary disease occurring in 15% of incident cases annually. Early diagnosis is a challenge due to its paucibacillary nature. Recently, a molecular real-time semi-quantitative assay (GeneXpert Ultra) was developed to overcome limitations of the previous assay version (Xpert MTB/RF).

The objective of the study was to assess the usefulness of the novel next-generation GeneXpert assay in extrapulmonary samples from different anatomic sites under routine diagnostic conditions at a university medical center.

A total of 519 samples from patients with presumptive diagnosis of extrapulmonary TB were subjected to smear microscopy, culture, and molecular assay. Univariate analyses for demographic and microbiological characteristics were performed. The sensitivity, specificity, and Kappa index with a 95% confidence interval were determined.

Molecular assay was positive in 53 samples (10.2%), of which 38 (71.6%) belonged to the "low" and "trace" semi-quantitative categories. The overall sensitivity and specificity were 86.4% (95% confidence intervals [CI] 74.1-98.8) and 95.6% (95% CI 93.7-97.6), respectively. Phenotypic drug susceptibility testing for rifampin was 100% concordant.

Molecular assay showed significant results when compared to other standard tests, making it a useful tool that could lead in the improvement to a rapid diagnosis of extrapulmonary disease.
Molecular assay showed significant results when compared to other standard tests, making it a useful tool that could lead in the improvement to a rapid diagnosis of extrapulmonary disease.BACKGROUND The aim of this study was to investigate the association of oral behaviors (OBs) with anxiety, depression, and jaw function in patients with temporomandibular disorders (TMDs) in China. MATERIAL AND METHODS A total of 537 patients diagnosed with TMD were included in this study (average age, 31.55±12.08 years; 86 men [16.0%] and 451 women [84.0%]). There were 31 cases of masticatory muscle pain, 459 cases of disc displacement, and 13 cases of arthralgia/arthrosis, and 34 cases were uncategorized. Patients were assessed using the Oral Behaviors Checklist (OBC), Jaw Functional Limitation Scale (JFLS), Generalized Anxiety Disorder-7 (GAD-7) scale, and Patient Health Questionnaire-9 (PHQ-9). The relationships between OBC scores and mouth opening, pain scores, JFLS, PHQ-9, and GAD-7 were evaluated with Spearman's correlation analysis. The median TMD symptom duration was 3 (0.5-154) months; men and women did not differ significantly in symptom duration or in the number of episodes of depression and anxiety. RESULTS The following OBs were common in patients with TMDs "putting pressure on the jaw (52.9%)", "chewing food on 1 side (47.5%)", and "holding teeth together during activities other than eating (33.3%)". The OBC scores were significantly correlated with the JFLS, PHQ-9, and GAD-7 scores (P less then 0.01). CONCLUSIONS Patients with TMDs exhibit specific OBs, which are associated with depression, anxiety, and jaw function. It is necessary to further investigate the interaction of OBs with depression and anxiety in the development of TMDs.BACKGROUND Anti-N methyl D-aspartate receptor encephalitis (anti-NMDArE) is a disorder in which triggers such as infectious agents or neoplastic disease can lead to an autoimmune response against the nervous system, although this disorder is usually idiopathic. Some patients with anti-NMDArE have evidence of other autoimmune alterations. Here, we present a case of non-paraneoplastic anti-NMDArE with elevation of serum anti-thyroid antibodies and a literature review of this association. CASE REPORT A 16-year-old girl was admitted in the University Hospital of Bari for a new onset of tonic-clonic seizures. Progressively, the patient manifested also psychomotor agitation, language difficulties, memory impairment, psychotic symptoms, autonomic dysfunction, and psychomotor retardation. Blood evaluation revealed the presence of anti-thyroglobulin, anti-thyroperoxidase, and anti-NMDAr antibodies. Cerebrospinal fluid analysis confirmed the diagnosis of anti-NMDArE. No tumors were found. Treatment with intravenous immunoglobulin, steroids, and plasma exchange relieved symptoms and decreased levels of serum anti-NMDAr antibodies. After 12 months, the patient had full recovery of communicative capacity, with the persistence of slight difficulty of memory and mild tendency to irritability. Blood exams shown persistence of anti-NMDAr positivity and absence of anti-thyroid antibodies. CONCLUSIONS We report a rare case in which an autoimmune involvement of thyroid gland was concurrent with an anti-NMDArE. It would be useful for clinical practice to clarify whether the presence of anti-thyroid antibody an characterize the clinical course, prognosis, and response to treatment of the idiopathic type of anti-NMDArE.
A substantial proportion of patients undergoing orthopaedic care are prescribed some form of anticoagulant medication, whether for perioperative venous thromboembolism prophylaxis or chronic anticoagulation in the setting of a cardiac or other condition.

An abundance of preclinical data suggests that many commonly used anticoagulant medications may have a harmful effect on bone-healing.

The orthopaedic surgeon should be informed and mindful of the added variable that anticoagulation may play in the outcomes of fracture treatment and bone-healing.

Heparin and warfarin appear to have a greater detrimental impact than low-molecular-weight heparin. Factor Xa inhibitors may confer the least risk, with some studies even suggesting the potential for enhancement of bone-healing.
Heparin and warfarin appear to have a greater detrimental impact than low-molecular-weight heparin. Factor Xa inhibitors may confer the least risk, with some studies even suggesting the potential for enhancement of bone-healing.
The potential benefits of computer-assisted surgical (CAS) navigation and robotic total knee arthroplasty (TKA) systems, such as increased reliability of restoring the mechanical axis, fewer outliers, more rapid hospital discharge, less physical therapy requirements, decreased blood loss, and decreased revision rates, have led to their application not only in primary cases but also in complex cases such as preoperative deformity and revision.

Early evidence demonstrates that CAS navigation may help to improve alignment in complex cases of femoral and tibial deformity and in cases of femoral bowing.

Data regarding deformity correction with robotic systems are similar to CAS navigation with regard to alignment, but are more limited. There are also scant data regarding revision cases and cases of previous intramedullary canal instrumentation.

Concerns remain regarding cost, learning curves, and operative times. There are potential long-term cost savings associated with a decrease in revisions and readmissions that require additional investigation.

Early evidence for the use of these emerging technologies for deformity correction and revision cases is promising, but their impact on long-term functional outcomes remains to be demonstrated. Additional well-designed comparative studies are warranted.
Early evidence for the use of these emerging technologies for deformity correction and revision cases is promising, but their impact on long-term functional outcomes remains to be demonstrated. Additional well-designed comparative studies are warranted.Increased intra-abdominal pressure (IAP) following large abdominal surgeries can lead to postoperative complications, including wound dehiscence and surgical reoperation. Numerous factors can contribute to increased postoperative IAP, and intractable hiccups have been implicated as a culprit. Different treatment modalities have been widely used with variable success in addressing intractable hiccups. Here, we present a case in which postoperative hiccups leading to wound dehiscence and reoperation were successfully treated with an indwelling phrenic nerve catheter. Following placement, a significant reduction in hiccup severity and frequency was noted, improving the patient's quality of postoperative course and preventing further surgical intervention.
Patient dissatisfaction after primary reverse total shoulder arthroplasty (rTSA) has been reported as high as 9%. In patients with excessive thoracic kyphosis, the scapula protracts and tilts anteriorly, which may lead to early impingement with the acromion and loss of forward elevation. The primary purpose of this study was to evaluate the effect of thoracic kyphosis on overhead ROM after rTSA.

A prospectively collected shoulder registry was retrospectively reviewed for all patients undergoing primary rTSA with a minimum of 2-year follow-up. Preoperative and latest follow-up ROM (forward elevation, abduction, internal rotation, and external rotation), patient-reported outcome measures (SPADI, SST-12, ASES, UCLA, SF-12, and the visual analog scale), and the Constant score were collected. Postoperative radiographs were evaluated for implant loosening and notching. Patients were separated into three groups according to the thoracic kyphosis angle (<25°, 25 to 45°, and >45°) and also analyzed as a cont III.
III.June 2021' In this issue of JNO, Drs. M. Tariq Bhatti and Mark L. Moster discuss the following 6 articles Vynckier J, Demeestere J, Lambert J. Black-blood MRI in Giant Cell Arteritis. J Rheumatol. 2021;48301-302.Hwang CJ, Nichols EE, Chon BH, Perry JD. Bilateral dysthyroid compressive optic neuropathy responsive to teprotumumab. Eur J Ophthalmol. 20211120672121991042. doi 10.1177/1120672121991042. Epub ahead of print. PMID 33525898.Narayanaswami P, Sanders DB, Wolfe G, Benatar M, Cea G, Evoli A, Gilhus NE, Illa I, Kuntz NL, Massey J, Melms A, Murai H, Nicolle M, Palace J, Richman D, Verschuuren J. International Consensus Guidance for Management of Myasthenia Gravis 2020 Update. Neurology. 2021;96114-122.Mastrangelo V, Merli E, Rucker JC, Eggenberger ER, Zee DS, Cortelli P. Neuro-Ophthalmological Findings in Early Fatal Familial Insomnia. Ann Neurol. 2021. doi 10.1002/ana.26008. Epub ahead of print. PMID 33386648.D'Antona L, Jaime Merchan MA, Vassiliou A, et al. Clinical Presentation, Investigation Findings, and Treatment Outcomes of Spontaneous Intracranial Hypotension Syndrome A Systematic Review and Meta-analysis. JAMA Neurol. Published online January 04, 2021. doi10.1001/jamaneurol.2020.4799.Simonett JM, Skalet AH, Lujan BJ, Neuwelt EA, Ambady P, Lin P. Risk Factors and Disease Course for Blood-Brain Barrier Disruption-Associated Maculopathy. JAMA Ophthalmol. 2021;139143-149. doi 10.1001/jamaophthalmol.2020.5329. PMID 33270081; PMCID PMC7716256.
This review of disorders of the fourth cranial nerve includes discussion on anatomy, examination techniques, congenital and acquired etiologies, differential diagnosis, and management options. The findings of the superior oblique muscle on orbital MRI in patients with fourth nerve palsy have had a major impact on our understanding of this cranial neuropathy. In addition, briefly reviewed are rare disorders of the fourth nerve superior oblique myokymia, Brown syndrome, and ocular neuromyotonia. It behooves the clinician to have a clear understanding of the role that the fourth cranial nerve plays in a variety of neuro-ophthalmic conditions.
This review of disorders of the fourth cranial nerve includes discussion on anatomy, examination techniques, congenital and acquired etiologies, differential diagnosis, and management options. The findings of the superior oblique muscle on orbital MRI in patients with fourth nerve palsy have had a major impact on our understanding of this cranial neuropathy. In addition, briefly reviewed are rare disorders of the fourth nerve superior oblique myokymia, Brown syndrome, and ocular neuromyotonia. It behooves the clinician to have a clear understanding of the role that the fourth cranial nerve plays in a variety of neuro-ophthalmic conditions.
Over the past 2 decades, a growing number of large-scale clinical trials have helped expand the toolkit for emergency management of acute ischemic stroke. This article is intended to be an up-to-date resource to aid nonstroke specialist neurology providers and ophthalmologists in identifying situations and patient populations in which urgent stroke evaluation should be completed with options for emergent reperfusion therapy considered.

The literature forming the foundation of the guidelines for early management of patients with acute ischemic stroke was reviewed, annotated, and summarized.

Data from both initial and follow-up trials investigating the benefits and indications for use of intravenous thrombolysis and endovascular intervention for stroke are reviewed systematically, with an emphasis on new updates to qualifying patient populations and time periods for treatment.

Recent studies underscore the conclusion that timely reperfusion in acute ischemic stroke is the most effective available treatment and that there are a growing number of new scenarios and patients for which interventions maybe applied.
Recent studies underscore the conclusion that timely reperfusion in acute ischemic stroke is the most effective available treatment and that there are a growing number of new scenarios and patients for which interventions maybe applied.
Affection of the central nervous system and the eyes is increasingly recognized as manifestations of a SARS-CoV-2 infection (COVID-19). This review aims at summarizing and discussing recent advances concerning causes and locations of impaired vision because of an infection with SARS-CoV-2.

On a literature search through PubMed and ScholarOne, all available publications about COVID-19 patients with impaired vision were retrieved.

Visual impairment in SARS-CoV-2-infected patients may be due to infection of lacrimal glands (dacryoadenitis), conjunctivitis, tonic pupils, vitritis, central retinal artery/venous occlusion, retinitis, retinal bleeding, panuveitis, anterior ischemic optic neuropathy, optic nerve stroke, optic neuritis, optic perineuritis, or occipital ischemic stroke. Visual impairment may be the initial manifestation of SARS-CoV-2.

This mini review shows that impaired vision may be the initial manifestation of COVID-19, that all sections of the visual tract may be affected and causative for visual impairment in COVID-19 patients, and that SARS-CoV-2 manifests along the visual tract with ischemia, focal infection, and immunological reactions.
This mini review shows that impaired vision may be the initial manifestation of COVID-19, that all sections of the visual tract may be affected and causative for visual impairment in COVID-19 patients, and that SARS-CoV-2 manifests along the visual tract with ischemia, focal infection, and immunological reactions.This article describes lessons from the feasibility testing of a parent-focused, life skills-based intervention to promote healthy weight in 58 low-income children aged 2 to 5 years. This intervention was feasible and acceptable, with a potential to impact child weight and diet (calories) and parental quality of life (QOL). The group delivery approach through a partnering organization (Head Start) was a more efficient way to reach/engage parents. Compared with one-on-one sessions, the group could provide an avenue to enhance parental psychosocial well-being, given QOL improvements among parents in group sessions. Lessons will inform future research to test the effectiveness of life skills interventions.
Intertrochanteric (IT) fractures are estimated to burden the healthcare system six billion dollars annually. Previous studies have documented a trend of early-career orthopaedic surgeons favoring intramedullary nails (IMNs) for these fractures, despite multiple randomized controlled trials demonstrating no evidence for improved patient outcomes when compared with sliding hip screws (SHSs). The purpose of this study was to report the trend of implant utilization for IT fracture fixation from 2007 to 2017.

The American Board of Orthopaedic Surgery (ABOS) Part II (oral) database was used to identify IT fractures (International Classification of Diseases, 9th revision, code 820.21 or 820.31, and 10th revision, code S72.14) over a 10-year period (2007 to 2017). The cases were categorized by IMN or SHS fixation by surgeon-reported Current Procedural Terminology codes. Utilization of the devices was analyzed according to year, and the implants were compared for outcomes, complications, and cost.

As of 2017, 92
Symptoms of stress, depression, and burnout are prevalent in medicine, adversely affecting physician performance. We investigated real-time measurements of physiological strain in orthopaedic resident and faculty surgeon volunteers and identified potential daily stressors.

We performed a prospective blinded cohort pilot study in our academic orthopaedic department. Physicians used a wearable fitness device for 12 weeks to objectively measure heart rate variability (HRV), a documented parameter of overall well-being. Baseline burnout levels were assessed using the Maslach Burnout Inventory questionnaire. Daily surveys inquiring on work responsibilities (clinic, operating room [OR], or "other") were correlated with physiological parameters of strain. Descriptive statistics and linear mixed effects modeling were used to evaluate bivariate relationships.

Of the 21 participating surgeons, 9 faculty and 12 residents, there was a response rate of 95.2% for the initial burnout survey. Daily surveys were completidentify those at risk of burnout and in need of well-being interventions.

Level III.
Level III.
Acetaminophen is an effective addition to a multimodal pain regimen; however, evidence to support intravenous versus oral administration requires further evaluation.

While nonsteroidal anti-inflammatory drugs are a valuable addition to a multimodal pain strategy, concerns regarding their effect on healing after certain procedures (i.e., rotator cuff repair) in select patients may preclude their use.

The use of perioperative gabapentinoids have varied results for pain control, and additional research is warranted to support their use after certain shoulder procedures.

Opioid-prescribing should be limited and reserved for severe postoperative pain. When prescribed, opioids should be taken at the lowest possible dose and for the shortest period.

Centrally acting analgesics such as tramadol have been shown to be as effective as opioids and have a lower risk of complications.

Nerve blocks are an excellent addition to multimodal pain management strategies. Longer-lasting formulations of perioperative single-shot injections and indwelling catheters may reduce rebound pain.
Nerve blocks are an excellent addition to multimodal pain management strategies. Longer-lasting formulations of perioperative single-shot injections and indwelling catheters may reduce rebound pain.
Frailty is a strong predictor of adverse outcomes in the perioperative period. Given the increasing availability of electronic medical data, we performed a systematic review and meta-analysis with primary objectives of describing available frailty instruments applied to electronic data and synthesizing their prognostic value. Our secondary objectives were to assess the construct validity of frailty instruments that have been applied to perioperative electronic data and the feasibility of electronic frailty assessment.

Following protocol registration, a peer-reviewed search strategy was applied to Medline, Excerpta Medica dataBASE (EMBASE), Cochrane databases, and the Comprehensive Index to Nursing and Allied Health literature from inception to December 31, 2019. All stages of the review were completed in duplicate. The primary outcome was mortality; secondary outcomes included nonhome discharge, health care costs, and length of stay. Effect estimates adjusted for baseline illness, sex, age, procedure, andd performance and to assess their feasibility and clinical impact.
Frailty status derived from electronic data provides prognostic value as it is associated with adverse outcomes, even after adjustment for typical risk factors. However, future research is required to evaluate multidimensional instruments and their head-to-head performance and to assess their feasibility and clinical impact.
Post-total joint arthroplasty (TJA) discharge to a skilled nursing facility (SNF) is associated with higher costs and more complications than home discharge; however, some patients still require postoperative SNF care. To improve outcomes for patients requiring postoperative SNF care, this article analyzed the effect of SNF-surgeon partnerships on TJA postoperative costs and patient outcomes.

This was a retrospective study of primary TJA patients who were part of Medicare's Comprehensive Care for Joint Replacement (CJR) pilot program at our urban, academic medical center. We identified all patients discharged to SNF and designated SNFs as "preferred" if they maintained a partnership with our surgical team. SNF costs, total 90-day postoperative costs, average length of stay in SNF, 90-day readmission rates, and readmission diagnoses were recorded. Data were compared using Student t-tests. Readmission rates and the presence of a readmission diagnosis were analyzed using z-scores.

Our search identified 189 patients (22.9%) discharged to SNFs, with 128 (67.8%) discharged to preferred and 61 (32.2%) discharged to nonpreferred facilities. Over the 4-year CJR pilot program, SNF costs ($10,981.23 versus $7,343.34; P < 0.005) and overall postdischarge costs ($23,952.52 versus $18,339.26; P = 0.07) were higher for patients discharged to nonpreferred SNFs versus preferred SNFs. Patients discharged to nonpreferred SNFs also had increased length of stay (14.8 versus 10.1 days; P < 0.005) and increased readmission rates (19.7% versus 3.9%; P < 0.005). These differences became more pronounced across the study period.

For patients undergoing primary TJA, hospital partnership with SNFs can improve CJR performance by cost reduction and overall outcomes for TJA patients.
For patients undergoing primary TJA, hospital partnership with SNFs can improve CJR performance by cost reduction and overall outcomes for TJA patients.
Anterior cruciate ligament (ACL) injuries can be treated with or without ACL reconstruction (ACLR), and more high-quality studies evaluating outcomes after the different treatment courses are needed. The purpose of the present study was to describe and compare 5-year clinical, functional, and physical activity outcomes for patients who followed our decision-making and treatment algorithm and chose (1) early ACLR with preoperative and postoperative rehabilitation, (2) delayed ACLR with preoperative and postoperative rehabilitation, or (3) progressive rehabilitation alone. Early ACLR was defined as that performed ≤6 months after the preoperative rehabilitation program, and late ACLR was defined as that performed >6 months after the preoperative rehabilitation program.

We included 276 patients from a prospective cohort study. The patients had been active in jumping, pivoting, and cutting sports before the injury and sustained a unilateral ACL injury without substantial concomitant knee injuries. The patie acceptable symptom state.

Patients with ACL injury who were active in jumping, pivoting, and cutting sports prior to injury; who had no substantial concomitant knee injuries; and who followed our decision-making and treatment algorithm had good 5-year knee function and high sport participation rates. Three of 4 patients had undergone ACLR within 5 years. There were no significant differences in any outcomes among patients treated with early ACLR, delayed ACLR, or progressive rehabilitation alone.

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.Cubital tunnel syndrome is a common upper extremity compressive neuropathy. Recalcitrant cubital tunnel syndrome poses diagnostic and treatment challenges. Potential etiologies of persistent or recurrent symptoms after surgical treatment include an inaccurate preoperative diagnosis, incomplete nerve decompression, iatrogenic injury, postsurgical perineural adhesions, irreversible nerve pathology, or conditions associated with secondary nerve compression. Confirmation of recalcitrant ulnar nerve pathology relies on a thorough history to consider symptoms and chronology, careful examination to quantify nerve function and to assess for focal nerve provocation, and objective testing to highlight a possible nerve lesion such as ultrasonography and electrodiagnostic testing. Conservative treatment may provide symptomatic relief; however, surgical management such as revision neuroplasty, neurolysis, nerve reconstruction, and/or anterior transposition may be indicated. Optimizing the biology of the local nerve environment is critical. No surgical treatment procedure has shown superiority over another; however, individualized treatment is emphasized to improve symptoms and maximize nerve recovery potential.
The BIRMINGHAM HIP Resurfacing (BHR) system is a metal-on-metal hip implant system approved by the U.S. Food and Drug Administration in 2006. The approval required a multicenter, prospective, post-market-approval study. Our purpose is to report the current results at 10 years of follow-up.

Between October 2006 and December 2009, 280 primary BHR procedures were performed at 5 sites. Outcome measures included Kaplan-Meier survivorship, reasons for revision, radiographic component stability and osteolysis, Harris hip scores, and metal levels including cobalt and chromium. The mean age at the time of the procedure was 51.3 ± 7.1 years, 74% (206) of 280 BHRs were implanted in male patients, the mean body mass index was 27.8 ± 4.4 kg/m2, and 95% (265) of 280 hips had a primary diagnosis of osteoarthritis. The mean follow-up among all 280 hips was 9.0 ± 2.5 years. Prior to 10-year follow-up, 20 hips were revised and 5 patients representing 5 hips had died. Among the remaining 255 hips, 218 (85%) met the minimum hen remained stable through 5 years before slightly decreasing at 10 years postoperatively (cobalt 1.3 ppb, p < 0.001; chromium 1.4 ppb, p < 0.001).

This prospective, multicenter, post-market-approval study demonstrated that the BHR implant system is safe and effective through 10 years of follow-up, particularly among young male patients.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Olecranon fractures are common in the elderly. Articular impaction is encountered occasionally, but the incidence and outcomes after treatment of this injury pattern have not been well characterized.

We evaluated a cohort of geriatric olecranon fractures to determine the incidence of articular impaction and describe a technique for open reduction and internal fixation.

Of the 63 patients in our series, 31 had associated intraarticular impaction (49.2%). Patients with articular impaction did not have significantly different rates of postoperative complications (11/31, 35.5% versus 10/31, 32.3%; P = 1.00) or revision surgery (10/31, 32.3% versus 8/31, 25.8%; P = 0.780) compared with those without articular impaction.

Articular impaction is a common feature of geriatric olecranon fractures. Surgeons must maintain a high index of suspicion and have a surgical plan in place for managing this component of the injury.
Articular impaction is a common feature of geriatric olecranon fractures. Surgeons must maintain a high index of suspicion and have a surgical plan in place for managing this component of the injury.
Diversity has increased within youth sports. It is unknown whether these demographic or socioeconomic factors affect adolescent patients' and their guardians' preferences of sports medicine physicians and involvement in medial decision making. Demographic and socioeconomic factors may affect adolescent patient and guardian preferences for sports medicine physicians.

Patients, age 10 to 18 years, and their guardians presenting to two sports medicine offices were asked to complete matched, anonymous surveys assessing their preferences for medical decision making, sports medicine physician gender, and personality characteristics. Analysis of demographic and socioeconomic effects on preferences was completed.

Matched survey responses were collected from 353 patients and 325 corresponding guardians. Patient average age was 14.6 years (SD 2.1), with 43% female. Guardian average age was 43.4 years (SD 8.3), with 79% female. For both patients and guardians, the highest valued physician characteristic was being cohort study.
This is a prospective, cohort study.
A 15-year-old boy with chondroblastoma of the right hemipelvis presented with significant periacetabular bone destruction. Neoadjuvant denosumab treatment facilitated initial joint preserving surgery. Unfortunately, he experienced 2 local recurrences and underwent wide surgical resection 2 years after his initial diagnosis.

Inhibition of the receptor activator of NF-κB (RANK)/RANK ligand (RANK-L) pathway with denosumab has been used neoadjuvantly for the treatment of giant cell tumor of bone, but its role in the treatment of chondroblastoma is less understood. This patient's clinical response and effect on cellular RANK/RANK-L activity support the consideration of denosumab in the treatment algorithm for other osteolytic bone tumors such as chondroblastoma.
Inhibition of the receptor activator of NF-κB (RANK)/RANK ligand (RANK-L) pathway with denosumab has been used neoadjuvantly for the treatment of giant cell tumor of bone, but its role in the treatment of chondroblastoma is less understood. This patient's clinical response and effect on cellular RANK/RANK-L activity support the consideration of denosumab in the treatment algorithm for other osteolytic bone tumors such as chondroblastoma.
Age 65 years or older is considered a risk factor for worse outcomes after transforaminal lumbar interbody fusion (TLIF). However, few studies have differentiated this cohort from younger patients. This study compares postoperative outcomes among patients 65 years or older of age with a younger cohort after minimally invasive (MIS) TLIF.

A database was reviewed for adults undergoing primary, elective, single-level MIS TLIF procedures for degenerative pathology from 2008 to 2019. Outcomes included visual analogue scale (VAS) for back and leg, Oswestry Disability Index (ODI), Short Form 12-Item physical component score (SF-12 PCS), and Patient-Reported Outcome Measurement Information System physical function. Outcomes were collected preoperatively and at 6 weeks, 12 weeks, 6 months, and 1 year postoperatively. Patients were categorized as ≥75 years, 65 to 74 years, or <65 years of age. Propensity score matching was performed, and outcome improvement and minimum clinically important difference (MCID) achimepoints. With appropriate selection criteria, patient age may not act as a notable risk factor for successful MIS TLIF procedures.
Patients 65 years or older of age markedly improved from baseline, similarly to younger patients. Postoperative outcome scores and MCID achievement demonstrated differences between groups at intermittent timepoints. With appropriate selection criteria, patient age may not act as a notable risk factor for successful MIS TLIF procedures.Practicing orthopaedic surgeons are subject to both the requirement and the opportunity to participate in individual or group quality assessment, quality-based payment programs, and clinical data registries. An important limitation to participating in and receiving the benefits of quality measuring activities and programs is the lack of a current resource outlining quality assessment models, current quality metrics, and the presence and function of current quality programs, payment models, and active orthopaedic registries. This article is intended as a primer for the practicing orthopaedic surgeon and orthopaedic groups. We provide a detailed overview of current quality metric databases, their categorization and use, and orthopaedic surgeon's role in creating and shaping the definition of quality care and outcomes assessment in the future.
Physical function evaluated by Patient-Reported Outcomes Measurement Information System (PROMIS PF) instrument has been validated through the short-term postsurgical period in spine surgery patients. Evidence for long-term efficacy of PROMIS PF is lacking in lumbar decompression (LD) patients. The objective of this study was to evaluate correlations between PROMIS PF and legacy patient-reported outcome measures for patients undergoing LD.

Consecutive primary or revision, single-level or multilevel LD surgeries were retrospectively reviewed from May 2015 to September 2017. Patients lacking preoperative or 2-year PROMIS PF scores were excluded. Demographics, baseline pathology, and perioperative characteristics were collected, and descriptive statistics performed. Visual Analogue Scale (VAS) back and leg, Oswestry Disability Index (ODI), 12-Item Short Form (SF-12) Physical Composite Score (PCS), and PROMIS PF were collected at preoperative and postoperative timepoints and evaluated for improvement from baseline values.
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