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Temporomandibular joint replacement (TJR) with an alloplastic (metal/ultra-high-molecular-weight polyethylene) device has proven to be a successful and predictable procedure. This paper describes a novel technique for performing TJR with an endaural incision alone. The technique we are describing uses only an endaural incision with supplemental trocar incision(s), to perform a TJR. There were 4 patients for a total of 8 temporomandibular joints that were selected. All 4 patients were assessed immediately following surgery, on postoperative days 1 and 7 and at 6 months following surgery. Maximal interincisal opening and subjective variables were assessed at each of the time points. Additionally, the total operative time was measured and compared to a previous age and diagnosis matched control group using the traditional 2 incisions TJR.There were 3 females and 1 male (ages 19-67) who underwent TJR with an endaural incision alone. There were 4 females (ages 19-68) who underwent traditional TJR surgery. None of the patients in either group had major complications and all patients were discharged on postoperative day 1. All patients in the endaural incision alone group had increased maximal interincisal opening and reported a quicker subjective decrease in pain and disability following surgery with less average time in the operating room. However, all patients in the endaural incision alone group had CN VII weakness that lasted longer than those in the traditional TJR group.The minimally invasive approach for TJR was successful in the present pilot study and could be used in specific situations to decrease the morbidity associated with additional incisions for this procedure. Ultimately, the endaural only incision approach offers promising outcomes for future patients undergoing temporomandibular joints TJR in the right patient population.

In this study we asked whether nonwords created by transposing two phonemes (/biksɔt/) are perceived as being more similar to their base words (/biskɔt/) than nonwords created by substituting two phonemes (/bipfɔt/). Using the short-term phonological priming and a lexical-decision task, Experiment 1 showed that transposed-phoneme nonword primes lead to shorter RTs on the target base words than substituted-phoneme nonword primes. Using a single-presentation lexical-decision task, Experiment 2 showed that transposed-phoneme nonwords lead to longer "no" decision responses than substituted-phoneme nonwords. In both Experiments 1 and 2, the transposed-phoneme effect was observed when the transposed phonemes were adjacent (/biksɔt/-/biskɔt/) but not when they were distant (/ʃoloka/-/ʃokola/). Our findings suggest that nonwords created by transposing adjacent phonemes in real words generate more activation of the lexical representations associated with the base words than do matched control nonwords. More generally, our findings present a challenge for models of spoken word recognition that code for the precise order of speech segments. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Background The objective of this study was to evaluate the short-term and long-term effects of tooth-anchored and bone-anchored maxillary expansion appliances on the condyle–fossa relationship, compared to those in a matched control group. Another objective of the study was to evaluate whether the amount of dental and skeletal expansion is correlated with the condyle–fossa relationship. Methods A total of 180 cone-beam computed tomography scans (CBCTs) for 60 subjects were analyzed for 3 groups: 1) bone-anchored maxillary expansion (BA; n = 20); 2) tooth-anchored maxillary expansion (TA; n = 21); and 3) controls (n = 19) at pretreatment, post-expansion (T2), and post-treatment (T3). The posterior joint space (PJS), superior joint space (SJS), anterior joint space, angle of mandibular condyle, distance of the condyle to the mid-sagittal plane, the inter-molar cuspal width, and the skeletal maxillary width (SMW) were measured for all 3 groups. Results Both BA and TA led to a significant increase in inter-molar cuspal width, SMW, and TA led to a significant increase in PJS as compared to controls at T2. However, there was no significant difference in the joint spaces between the BA, TA, and control groups in the long term. Both the BA and TA groups showed a significant increase in SMW at T3 compared to the control group. Molar extrusion showed a weak correlation with PJS at T2 (r = 0.46) and T3 (r = 0.51), and a moderate correlation with SJS at T2 (r = 0.61) and T3 (r = 0.69). Conclusions TA led to a significant increase in PJS, compared to a control group, at T2, but there was no long-term difference in the condyle–fossa relationship among the BA, TA, and control groups. Molar extrusion showed moderate correlation with SJS and PJS.

Concussion is associated with acute disturbances in brain function and behavior, with potential long‐term effects on brain health. However, it is presently unclear whether there are sex differences in acute and long‐term brain recovery. In this study, magnetic resonance imaging (MRI) was used to scan 61 participants with sport‐related concussion (30 male, 31 female) longitudinally at acute injury, medical clearance to return to play (RTP), and 1‐year post‐RTP. A large cohort of 167 controls (80 male, 87 female) was also imaged. Each MRI session assessed cerebral blood flow (CBF), along with white matter fractional anisotropy (FA) and mean diffusivity (MD). For concussed athletes, the parameters were converted to difference scores relative to matched control subgroups, and partial least squares modeled the main and sex‐specific effects of concussion. Although male and female athletes did not differ in acute symptoms or time to RTP , all MRI measures showed significant sex differences during recovery. Males had greater reductions in occipital‐parietal CBF (mean difference and 95%CI: 9.97 ml/100 g/min, [4.84, 15.12] ml/100 g/min, z = 3.73) and increases in callosal MD (9.07 × 10−5, [−14.14, −3.60] × 10−5, z = −3.46), with greatest effects at 1‐year post‐RTP. In contrast, females had greater reductions in FA of the corona radiata (16.50 × 10−3, [−22.38, −11.08] × 10−3, z = −5.60), with greatest effects at RTP. These findings provide new insights into how the brain recovers after a concussion, showing sex differences in both the acute and chronic phases of injury., This study examined whether there are sex differences in acute and long‐term brain changes after concussion. Male athletes showed greater declines in cerebral blood flow, whereas both sexes showed unique alterations in white matter microstructure. These sex differences were present at acute injury and remained up to 1 year after medical clearance.

Purpose To assess the effects of surgical treatment of athletic pubalgia (AP) on game use and performance metrics in National Basketball Association (NBA) players. Methods A retrospective review of all NBA players who underwent surgical management for AP from 1996 to 2018 was performed. A matched control group was created for comparison. The index period was defined as the entire NBA season in which surgery occurred, including the corresponding offseason. Player demographics, use (games played, games started, and minutes per game) and performance (player efficiency rating) metrics were collected for all players. Statistical analysis was performed to compare data before and after return to play. Results Thirty players with a history of surgical management for AP were included in the final analysis. Following surgery for AP, NBA players were found to have a return to play (RTP) rate of 90.91% (30/33). The average RTP following surgery was 4.73 ± 2.62 months. Compared with control athletes, athletes in the AP group played significantly fewer seasons postinjury (4.17 ± 2.70 vs 5.49 ± 3.04 seasons, respectively; P = .02). During the first year following RTP, NBA players experienced significant reductions in game use and performance, both when compared with the year prior and matched control athletes (P < .05). At 3-year follow-up, players continued to demonstrate significant reductions in game use (minutes per game, P < .05) but not performance. Conclusions Following surgical treatment of AP, NBA players demonstrated a high RTP rate, but shortened career. A short-term reduction in game use and performance metrics was found the year of return following surgery. However, 3-year follow-up performance metrics normalized when compared with healthy controls. Study Design Level III; retrospective case-control study.

BACKGROUND Limited data describe poisoning exposures in pregnant women. Previous studies are limited to inpatient populations, those seen only by toxicologists, or single poison centers. This study aimed to describe poison exposures reported to U.S. poison control centers in pregnant patients compared to non-pregnant controls. METHODS This was a retrospective observational study of exposures reported to the American Association of Poison Control Centers National Poison Data System from 2000 through 2019. Pregnant patients were included from 15-44 years along with a random sampling of 5:1 age and year matched control group of non-pregnant exposures. Demographics, primary substance, and known medical outcomes were described. Chi square analysis was performed for comparisons. RESULTS From 2000 to 2019, a total of 131,619 pregnant cases and 658,095 non-pregnant controls were identified. The median age was 27 years (IQR: 22, 31) for the matched groups. For known trimester of pregnancy: 29.8, 37.0, and 28.2% were in the first, second, and third trimester, respectively. Most common exposures were analgesics and cleaning products. Intentional exposures were more common in non-pregnant compared to pregnant cases (41.2 vs 21.9%; OR 2.71, 95% CI 2.67-2.75), mostly self-harm attempts (31.5 vs. 15.8%). Notably, there was a large discrepancy in the proportion of environmental exposures, with fewer in non-pregnant controls compared with pregnant cases (3.8 vs. 12.1%; OR 0.29, 95% CI 0.28-0.29). More non-pregnant cases had multiple substance exposures compared with pregnant cases (22.2 vs. 10.9%; OR 2.34, 95% CI 2.29-2.38). There were more moderate effect outcomes in non-pregnant compared with pregnant cases (13.2 vs. 6.3%; OR 2.25, 95% CI 2.20-2.30). CONCLUSIONS Outcomes of poisoning exposures in pregnant patients reported to U.S. poison centers are less serious compared to non-pregnant controls, likely due to the lower rates of intentional abuse and self-harm exposures and greater number of minimally toxic environmental exposures.

The World Health Organization (WHO) postulates that depressive disorders (DD) will be the leading cause of morbidity and mortality by 2030. Studies evaluating the association of DD following open reduction and internal fixation (ORIF) for the treatment of acetabular fractures are limited. Therefore, the purpose of this matched-control study was to determine whether DD patients undergoing ORIF for acetabular fractures have higher rates of: (1) in-hospital lengths of stay (LOS); (2) readmissions; (3) medical complications; and (4) costs of care. A retrospective query from the 100% Medicare Standard Analytical Files (SAF) was performed to identify patients who underwent ORIF for acetabular fractures. The study group consisted of those patients with DD, whereas patients without the condition served as controls. Primary endpoints of the study were to compare in-hospital LOS, readmission rates, ninety-day medical complications, and costs of care. A p-value less than 0.01 was considered statistically significant. The query yielded 7084 patients within the study (ORIF = 1187, control = 5897). DD patients were found to have significantly longer in-hospital LOS (11 days vs. 10 days, p

Burn injury and reconstructive operations often result in severe pain, particularly at skin graft donor sites. Traditional local anesthetics administered intraoperatively control pain at donor sites, but the duration of action is short. Liposomal bupivacaine, a novel local anesthetic, can provide sustained-release analgesia for 72h. The primary aim of this study was to describe the efficacy of liposomal bupivacaine for postoperative donor site pain control for patients undergoing skin graft procedures.A retrospective cohort study was performed on patients who received a donor site liposomal bupivacaine field block and was compared to a matched control. Patients rated donor site pain on post-operative day 0 and 1, and stated whether the donor or graft site was more painful.Fifty-eight patients were included. Twenty-nine patients received liposomal bupivacaine. Eighty-six percent of patients in the treatment group rated donor site pain as three or less on postoperative day 0 and 1, compared to 3.4% in the control (p0.0001). Also, 76% of patients in the treatment group stated donor site pain was less than graft site pain, compared to 3.4% in the control (p0.0001).Patients who received liposomal bupivacaine reported less postoperative donor site pain and found the donor site to be less bothersome without major complications. Liposomal bupivacaine may be a safe and promising agent for prolonging postoperative analgesia and minimizing donor site pain.

As the prevalence of peripheral vascular disease (PVD) continues to increase nationwide, studies demonstrating its effects following primary total knee arthroplasty (TKA) are limited. Therefore, the purpose of this study was to evaluate whether patients with PVD have higher rates of: 1) in-hospital lengths of stay (LOS); 2) readmissions; 3) medical complications; 4) implant-related complications; and 5) costs of care.Using a nationwide database, patients with PVD undergoing primary TKA were identified and matched to controls in a 1:5 ratio by age, sex, and medical comorbidities. The query yielded 1,547,092 between the cohorts. Outcomes analyzed included: in-hospital LOS, readmission rates, complications, and costs of care. A p-value less than 0.004 was considered statistically significant.PVD patients had significantly longer in-hospital LOS (4-days vs. 3-days, p 0.0001). Additionally, the study cohort had a higher incidence and odds (OR) of readmissions (20.5 vs. 15.2%; OR: 1.43, 95% CI: 1.42-1.45, p 0.0001), medical complications (2.46 vs. 1.32%; OR: 1.88, CI: 1.83-1.94, p 0.0001), and implant-related complications (3.82 vs. 2.18%; OR: 1.78, CI: 1.26-1.58, p 0.0001). Additionally, the study found patients with PVD had higher day of surgery (p 0.0001) and 90-day costs of care (p 0.0001).After adjusting for confounding variables the results of the study show patients with PVD undergoing primary TKA have longer in-hospital LOS; in addition to higher rates of complications, readmissions, and costs of care. The study can be utilized by orthopaedists to adequately counsel patients of the potential complications following their procedure.

Cross-sectional studies have demonstrated that the prevalence of sleep apnea (SA) to be increasing within the United States. While studies have shown the association of SA and its association on complications following elective orthopedic procedures, well-powered studies investigating its impact in a traumatic setting are limited. The purpose of this study was to determine whether SA patients undergoing primary total hip arthroplasty (THA) for femoral neck fractures have higher rates of: (1) hospital lengths of stay (LOS); (2) readmissions; (3) complications; and (4) healthcare expenditures. The 100% Medicare Standard Analytical Files was queried from 2005 to 2014 for patients who sustained femoral neck fractures and were treated with primary THA. The study group consisted of patients with concomitant diagnoses of SA, whereas patients without SA served as controls. Study group patients were matched to controls in a 1:5 ratio by age, sex, and various comorbid conditions. Demographics of the cohorts were compared using Pearson’s chi-squared analyses, and multivariate logistic regression analyses were used to calculate the odds (OR) of the effects of SA on postoperative outcomes. A p value less than 0.006 was considered to be statistically significant. The final query yielded 24,936 patients within the study (n = 4166) and control (n = 20,770) cohorts. SA patients had significantly longer in-hospital LOS (6 vs. 5 days, p

RNA modifications, such as N6-methyladenosine (m6A), modulate functions of cellular RNA species. However, quantifying differences in RNA modifications has been challenging. Here we develop a computational method, xPore, to identify differential RNA modifications from nanopore direct RNA sequencing (RNA-seq) data. We evaluate our method on transcriptome-wide m6A profiling data, demonstrating that xPore identifies positions of m6A sites at single-base resolution, estimates the fraction of modified RNA species in the cell and quantifies the differential modification rate across conditions. We apply xPore to direct RNA-seq data from six cell lines and multiple myeloma patient samples without a matched control sample and find that many m6A sites are preserved across cell types, whereas a subset exhibit significant differences in their modification rates. Our results show that RNA modifications can be identified from direct RNA-seq data with high accuracy, enabling analysis of differential modifications and expression from a single high-throughput experiment.

Aim: To compare the screw accuracy and clinical outcomes between robot-assisted minimally invasive transforaminal lumbar interbody fusion (RA MIS-TLIF) and open TLIF in the treatment of one-level lumbar degenerative disease. Materials & methods: From May 2018 to December 2019, a consecutive series of patients undergoing robot-assisted minimally invasive one-level lumbar fusion procedures were retrospectively compared with matched controls who underwent one-level open TLIF procedures for clinical and quality-of-life outcomes. Results: A total of 52 patients underwent RA MIS-TLIF procedures (robot-assisted [RA] group) and 52 matched controls received freehand open TLIF procedures (open [OP] group). The RA group had more grade A screws with 96.2% one-time success rate of screw placement (p < 0.05). Besides, the RA group experienced less intraoperative blood loss and shorter length of hospital stay, while the OP group had shorter operative duration and cumulative radiation time (p < 0.001). What is more, the average VAS score for low back pain and ODI score in the RA group were lower than that in the OP group 1 month after operation (p < 0.05). Conclusion: The use of real-time, image-guided robot system may further expand the advantages of MIS-TLIF technique in terms of accuracy and safety.

Introduction This study aims to determine whether musculoskeletal corticosteroid injections increase the risk for COVID-19. Method 734 patients who received a corticosteroid injection during the COVID-19 pandemic were followed and their COVID status within 30 days after the injection checked. The results were then compared with an age and sex matched control group. Results No statistically significant difference in the frequency of COVID-19 cases between the two groups was found. Conclusion It appears that the use of musculoskeletal corticosteroid injections during the COVID-19 pandemic does not confer increased risk of contracting the virus.

Background Fecal microbiota transfer (FMT) has become a standard of care in the prevention of multiple recurrent Clostridioides difficile (rCDI) infection. Aim While primary cure rates range from 70–80% following a single treatment using monodirectional approaches, cure rates of combination treatment remain largely unknown. Methods In a retrospective case-control study, outcomes following simultaneous bidirectional FMT (bFMT) with combined endoscopic application into the upper and lower gastrointestinal tract, compared to standard routes of application (endoscopy via upper or lower gastrointestinal tract and oral capsules; abbreviated UGIT, LGIT and CAP) on day 30 and 90 after FMT were assessed. Statistical matching partners were identified using number of recurrences ( Results Primary cure rates at D30 and D90 for bFMT were 100% (p=.001). The matched control groups showed cure rates of 81.3% for LGIT (p=.010), 62.5% for UGIT (p=.000) and 78.1% for CAP (p=.005) on D30 and 81.3% for LGIT (p=.010), 59.4% for UGIT (p=.000) and 71.9% for CAP (p=.001) on D90. Conclusion In our analysis, bFMT on the same day significantly increased primary cure rate at D30 and D90. These data require prospective confirmation but suggest that route of application may play a significant role in optimizing patient outcomes. ClinicalTrials.gov no: NCT02681068

Background: Girls who are victims of commercial sexual exploitation (CSEC) have high rates of substance use and childhood sexual abuse. We compared girls who are victims of CSEC and matched control...

Background: There is a paucity of midterm outcome data on hip revision arthroscopic surgery. Purpose: (1) To report minimum 5-year patient-reported outcome measurement scores (PROMSs) in patients who underwent revision hip arthroscopy, (2) to compare minimum 5-year PROMSs with a propensity-matched control group that underwent primary hip arthroscopy, and (3) to compare the rate of achieving the minimal clinically important difference (MCID) at minimum 5-year follow-up between the revision group and the propensity-matched control primary group. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected between June 2008 and April 2014. Patients were included who underwent revision hip arthroscopy with preoperative and minimum 5-year follow-up scores for the modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Patients with Tönnis grade >1 or with hip conditions such as avascular necrosis, Legg-Calve-Perthes disease, Ehlers-Danlos syndrome, and pigmented villonodular synovitis were excluded. A subanalysis was performed against a propensity-matched control group that underwent primary surgery. Groups were propensity matched in a 1:2 ratio for sex, age, body mass index, and follow-up time. Results: A total of 127 revision arthroscopies (113 patients) were included, and the mean ± SD follow-up time was 72.8 ± 23.3 months. The revision group was 74.0% female, and the average age and body mass index were 34.9 ± 12.4 years and 24.8 ± 4.2, respectively. The revision group demonstrated improvement for all PROMSs and reached the MCID for the mHHS (66.1%), HOS-SSS (68.4%), NAHS (66.9%), and VAS (80.0%). All revision cases were propensity matched to 254 primary arthroscopy cases. PROMSs in the revision group were lower than those of the control group before and after surgery. Delta values were similar between groups for all PROMSs. There were no differences in rates of achieving the MCID. The relative risk of arthroplasty conversion was 2.6 (95% CI, 1.5-4.6) for the revision group as compared with the primary group. Conclusion: Significant improvement in all PROMSs, including the VAS, and high patient satisfaction at minimum 5-year follow-up were reported after revision hip arthroscopy. A high proportion of patients in the revision cohort reached the MCID for the mHHS, HOS-SSS, NAHS, and VAS, with similar rates and magnitudes of improvement relative to the control group. As expected, these data indicate that patients undergoing primary hip arthroscopy have higher PROMSs before and after surgery and lower rates of conversion to arthroplasty.

Összefoglaló. Bevezetés: Az EKG-n megjelenő korai repolarizációs mintázat diagnosztikai kritériumai és klinikai jelentősége elsősorban az elmúlt évtizedben került tisztázásra, ugyanakkor viszonylag kevés vizsgálat foglalkozott mind ez idáig a korai repolarizációs mintázathoz köthető esetleges strukturális szívelváltozások felderítésével. Módszer: Egy prospektív vizsgálat során azonosított 30, korai repolarizációs mintázatot mutató fiatal férfi (átlagéletkor: 22,5 ± 1,5 év) echokardiográfiás paramétereit hasonlítottuk össze egy 32 főből álló (átlagéletkor: 22,3 ± 1,9 év) megfeleltetett kontrollcsoport azonos jellemzőivel. A hagyományos paraméterek mérésén túlmenően, szöveti Doppler- és ’strain’ (deformáció – speckle tracking módszerrel) vizsgálatot is végeztünk, összesen 35 jellemzőt követve. A paraméterek összehasonlítása kétmintás t-próba, illetve khi-négyzet-próba segítségével történt (szignifikancia: pEredmények: Nem találtunk patológiás elváltozásokat egyik személy esetében sem, és a két csoport között csupán két paraméter tekintetében fedeztünk fel szignifikáns eltérést. A korai repolarizációs mintázatot mutató csoportban kisebbnek bizonyult a bal kamra végsystolés térfogata (37,6 ± 15,2 ml vs. 45,5 ± 13,4 ml; p = 0,037), illetve gyakoribbnak találtuk az enyhe mitralis regurgitatio előfordulását (41,4% vs. 6,5%; pKövetkeztetés: A korai repolarizációs mintázatot mutató fiatal férfiak esetén kimutathatók bizonyos echokardiográfiás jellegzetességek. Ezek időbeli alakulásának, illetve prognosztikai, aritmológiai jelentőségének megítélése további, longitudinális követést igényel. Orv Hetil. 2021; 162(19): 741–745. Summary. Introduction: The diagnostic criteria and clinical significance of early repolarization pattern on ECG were clarified mainly in the last decade. However, there are only a few studies published on the exploration of cardiac structural changes underlying early repolarization pattern. Method: We compared the echocardiographic parameters of 30 young males with early repolarization pattern (mean age: 22.5 ± 1.5 years), who were identified during a prospective survey, with the same parameters of a matched control group consisting of 32 young males (mean age: 22.3 ± 1.9 years). Beyond measuring the conventional parameters, tissue Doppler and strain measures (speckle tracking) were obtained. Comparison of parameters was performed using t-test and chi-square test (significancy: pResults: There were no pathological changes in any person, and we found significant difference between the two groups only in the case of two parameters. In the early repolarization pattern group, the left ventricular end-systolic volume was smaller (37.6 ± 15.2 ml vs. 45.5 ± 13.4 ml; p = 0.037) and the presence of mild mitral regurgitation was more frequent (41.4% vs. 6.5%; pConclusion: In young males with early repolarization pattern, we managed to demonstrate the existence of certain echocardiographic features. The assessment of their time course, prognostic and arrhythmological significance requires a longer follow-up. Orv Hetil. 2021; 162(19): 741–745.

Background and Purpose: A recent randomized controlled trial DIRECT-MT (Direct Intra-Arterial Thrombectomy to Revascularize AIS Patients With Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals) compared the safety and efficacy of mechanical thrombectomy (MT) versus combined intravenous thrombolysis (IVT) and MT for acute large vessel occlusion. The current study utilized a prospective, nationwide registry to validate the results of the DIRECT-MT trial in a real-world practice setting. Methods: Subjects were selected from a prospective cohort of acute large vessel occlusion patients undergoing endovascular treatment at 111 hospitals from 26 provinces in China (ANGEL-ACT registry [Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke]) between November 2017 and March 2019. All patients eligible for IVT and receiving MT were reviewed and then grouped according to whether prior IVT or not (MT and combined IVT+MT). After a 1:1 propensity score matching, the outcome measures including the 90-day modified Rankin Scale, successful recanalization, door-to-puncture time, symptomatic intracranial hemorrhage, and intraprocedural embolization were compared. Results: A total of 1026 patients, 600 in the MT group and 426 in the combined group, were included. Among 788 patients identified after matching, there were no significant differences in the 90-day modified Rankin Scale (median, 3 versus 3 points; P =0.82) and successful recanalization (86.6% versus 89.3%; P =0.23) between the two groups; however, patients of the MT group had a shorter door-to-puncture time (median, 112 versus 136 minutes; β=−45.02 [95% CI, −68.31 to −21.74]), lower rates of symptomatic intracranial hemorrhage (5.5% versus 10.1%; odds ratio, 0.52 [95% CI, 0.30–0.91]), and embolization (4.6% versus 8.1%; odds ratio, 0.54 [95% CI, 0.30–0.98]) than those of the combined group. Conclusions: This matched-control study largely confirmed the findings of the DIRECT-MT trial in a real-world practice setting, suggesting that MT may carry similar effectiveness to combined IVT+MT for acute large vessel occlusion patients, despite MT alone seems to be associated with a shorter in-hospital delay until procedure, lower risks of symptomatic intracranial hemorrhage, and embolization. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03370939.

Amino acid (AA) metabolism is severely disturbed in critically ill ICU patients. To be able to make a more scientifically based decision on the type of protein or AA nutrition to deliver in ICU patients, comprehensive AA phenotyping with measurements of plasma concentrations and whole body production (WBP) is needed. Therefore, we studied ICU patients and matched control subjects using a novel pulse isotope method to obtain in-depth metabolic analysis. In 51 critically ill ICU patients (SOFA~6.6) and 49 healthy controls, we measured REE and body composition/phase-angle using BIA. In the postabsorptive state, we collected arterial (ized) blood for CRP and AA. Then, we administered an 8 mL solution containing 18 stable AA tracers as a pulse and calculated WBP. Enrichments: LC-MS/MS and statistics: t-test, ANCOVA. Compared to healthy, critically ill ICU patients had lower phase-angle (p 0.00001), and higher CRP (p 0.0001). Most AA concentrations were lower in ICU patients (p 0.0001), except tau-methylhistidine and phenylalanine. WBP of most AA were significantly (p 0.0001) higher with increases in glutamate (160%), glutamine (46%), and essential AA. Remarkably, net protein breakdown was lower. There were only weak relationships between AA concentrations and WBP. Critically ill ICU patients (SOFA 8-16) had lower values for phase angle (p = 0.0005) and small reductions of most plasma AA concentrations, but higher tau-methylhistidine (p = 0.0223) and hydroxyproline (p = 0.0028). Remarkably, the WBP of glutamate and glutamine were lower (p 0.05), as was their clearance, but WBP of tau-methylhistidine (p = 0.0215) and hydroxyproline (p = 0.0028) were higher. Our study in critically ill ICU patients shows that comprehensive metabolic phenotyping was able to reveal severe disturbances in specific AA pathways, in a disease severity dependent way. This information may guide improving nutritional compositions to improve the health of the critically ill patient. CLINICAL TRIAL REGISTRY: Data are from the baseline measurements of study NCT02770092 (URL: https://clinicaltrials.gov/ct2/show/NCT02770092) and NCT03628365 (URL: https://clinicaltrials.gov/ct2/show/NCT03628365).

This paper investigates whether private equity (PE)-backed acquirers have a “parenting advantage” in the mergers & acquisitions (M&A) market. We employ a sample of 788 PE-backed firms and a carefully matched control group of 6,652 non-PE-backed peers, for which we observe the entire acquisition history over a 19-year time span. Difference-in-differences estimates suggest that PE backing induces a sizeable but short-lived boost to acquisition activity, while the type and complexity of acquisitions are similar to those of non-PE-backed peers. These results are consistent with the idea that PE backing enhances execution and speed in the M&A market. We find that portfolio firms benefit from this boost through improved valuations and margins. The extent to which this is true, however, depends on the institutional setting of the PE owner. Our results indicate that add-on acquisitions are detrimental if PE owners are late buyers or suffer from limited attention problems.

Purpose: To identify the time to return to play (RTP) and evaluate the performance level in wide receivers in the National Football League following anterior cruciate ligament (ACL) reconstruction. Methods: A total of 29 wide receivers in the National Football League who underwent ACL reconstruction between 2013 and 2017 who met inclusion criteria were retrospectively identified and reviewed. For each player, a matched control with similar demographics was identified to compare various in-game performance measurements and seasons played. Results: Of the wide receivers that met the inclusion criteria, 9 of 29 (31%) did not RTP in a regular season game following ACL reconstruction. For players who did RTP, 20 of 29 (69%), the average time was 10.9 months (331.4 ± 41.6 days). When we compared the tear group with the matched control cohort, players with ACL tears ended their careers on an average of 1.9 seasons earlier (2.2 vs 4.1 seasons, P < .001) and also played less than half the number of games (25.5 vs 56.6 games, P = .001), respectively. Those that RTP also saw decreased performance statistics in targets (353.6 vs 125.2 P < .001), receptions (208.0 vs 74.4, P = .001), receiving yards (2691.0 vs 987.9, P = .001), and touchdowns (17.4 vs 6.2, P = .002). Conclusions: Sixty-nine percent of wide receivers who underwent ACL reconstruction were able to RTP at an average of 10.9 months, or 331.4 days. Despite the majority of players being able to RTP, there was a significant decrease in both statistical performance and career duration. Level of Evidence: Level III, case-control study.

Juvenile recidivism is a serious public health concern. Using statewide administrative data, this study examined the independent predictive value of childhood maltreatment on repeat offending and compared risk factors for recidivism between 698 first-time juvenile offenders with maltreatment and their propensity score matched sample of 698 without maltreatment. For 3 years, 65.2% of maltreated offenders and 61.5% of their matched sample recidivated after their initial offense. The effect of childhood maltreatment on recidivism remained statistically significant beyond the inclusion of control variables. In both groups, being a youth of color and having a diagnosed emotional/behavioral disability increased risk for recidivism. Additional risk factors included being a male for maltreated offenders and out-of-school suspension, entry into the juvenile justice system at younger ages, and out-of-home placement only after their first offense or continuing placement for their matched sample without maltreatment. Preventive interventions must be responsive to such different risks.

INTRODUCTION: The purpose of this study was to determine whether alcohol use disorder (AUD) patients undergoing reverse shoulder arthroplasty (RSA) have increased: 1) lengths of stay (LOS); 2) complications; and 3) costs. METHODS: The study identified 19,168 patients in the study (n = 3198) and control (n = 15,970) cohort. In-hospital LOS, 90-day complications, and costs were assessed. RESULTS: AUD patients had significantly longer LOS (3- vs. 2-days, p

Summary Convalescent plasma can provide passive immunity during viral outbreaks, but the benefit is uncertain for the treatment of novel coronavirus disease 2019 (COVID‐19). Our goal is to assess the efficacy of COVID‐19 convalescent plasma (CCP). In all, 526 hospitalized patients with laboratory‐confirmed SARS‐CoV‐2 at an academic health system were analyzed. Among them, 263 patients received CCP and were compared to 263 matched controls with standard treatment. The primary outcome was 28‐day mortality with a subanalysis at 7 and 14 days. No statistical difference in 28‐day mortality was seen in CCP cases (25·5%) compared to controls (27%, P = 0·06). Seven‐day mortality was statistically better for CCP cases (9·1%) than controls (19·8%, P

To explore if electrographic status epilepticus (ESE) after cardiac arrest causes additional secondary brain injury reflected by serum levels of two novel biomarkers of brain injury: neurofilament light chain (NfL) originating from neurons and glial fibrillary acidic protein (GFAP) from glial cells.Simplified continuous EEG (cEEG) and serum levels of NfL and GFAP, sampled at 24, 48 and 72 h after cardiac arrest, were collected during the Target Temperature Management (TTM)-trial. Two statistical methods were used: multivariable regresssion analysis; and a matched control group of patients without ESE matched for early predictors of poor neurological outcome.128 patients had available biomarkers and cEEG. Twenty-six (20%) patients developed ESE, the majority (69%) within 24 h. ESE was an independent predictor of elevated serum NfL (p 0.001) but not of serum GFAP (p = 0.16) at 72 h after cardiac arrest. Compared to a control group matched for early predictors of poor neurological outcome, patients who developed ESE had higher levels of serum NfL (p = 0.03) and GFAP (p = 0.04) at 72 h after cardiac arrest.ESE after cardiac arrest is associated with higher levels of serum NfL which may suggest increased secondary neuronal injury compared to matched patients without ESE but similar initial brain injury. Associations with GFAP reflecting glial injury are less clear. The study design cannot exclude imperfect matching or other mechanisms of secondary brain injury contributing to the higher levels of biomarkers of brain injury seen in the patients with ESE.

Introduction This meta-analysis study assessed the effects of Berberis vulgaris L. and Berberis aristata L. in patients with metabolic syndrome. Methods Data were analysed through "random-effects meta-regression" performance. Results The findings indicated that LDL was 0.68 and 2.92 lower in the B. vulgaris L. and B. aristata L.-treated groups versus the controls. The HDL was 0.71-fold higher in the B. aristata L.-treated group versus the controls. The total-cholesterol levels were 1.02 and 2.25 folds lower in the B. vulgaris L. and B. aristata L.-treated groups versus the matched control groups. The triglyceride levels were 1.35 and 1.16-fold lower in the B. vulgaris L. and B. aristata L.-treated groups versus the controls. Glucose was 0.96 and 0.54 folds lower in the B. vulgaris L. and B. aristata L.-treated groups versus the control groups, respectively. Conclusion B. vulgaris L. and B. aristata L. have beneficial effects in patients with metabolic syndrome.

The exposure-driven olfactory compensation associated with sensory loss is likely to be observed in assessment of food-related dangers. Therefore, in the current study we tested the hypothesis that olfactory compensation occurs in the case of protection from food-related hazards. We compared thresholds for detection of an unpleasant rotten food odor (fermented fish sauce) in four groups of subjects: blind subjects (n = 100), sighted controls (n = 100), deaf subjects (n = 74) and hearing controls (n = 99). Overall, we observed no significant differences in smell acuity between the blind and deaf groups and their matched control samples. However, the sensory deprived subjects assessed their sensitivity as higher than did control groups. The present study is yet another example of research among large samples of sensory deprived individuals that shows no evidence of olfactory compensation. This result is consistent with a growing number of studies suggesting no sensory compensation in simple, absolute sensitivity tasks.

Background Cochrane recently amended its exercise review for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in response to an official complaint. Objective To determine if the amended review has addressed the concerns raised about the previous review and if exercise is an effective treatment that restores the ability to work in ME/CFS. Method The authors reviewed the amended Cochrane exercise review and the eight trials in it by paying particular interest to the objective outcomes. We also summarised the recently published review of work rehabilitation and medical retirement for ME/CFS. Results The Cochrane review concluded that graded exercise therapy (GET) improves fatigue at the end of treatment compared to no-treatment. However, the review did not consider the unreliability of subjective outcomes in non-blinded trials, the objective outcomes which showed that GET is not effective, or the serious flaws of the studies included in the review. These flaws included badly matched control groups, relying on an unreliable fatigue instrument as primary outcome, outcome switching, p-hacking, ignoring evidence of harms, etc. The review did also not take into account that GET does not restore the ability to work. Conclusion GET not only fails to objectively improve function significantly or to restore the ability to work, but it's also detrimental to the health of≥50% of patients, according to a multitude of patient surveys. Consequently, it should not be recommended.

BACKGROUND Recent evidence support that netrin-1 involves in colorectal carcinogenesis. OBJECTIVE This study was to evaluate the performance of serum netrin-1 for detection of colorectal cancer (CRC) in both clinical/screening sets. METHODS A total of 115 consecutive patients with CRC and matched healthy controls were included in Clinical Set. Fifty subjects with CRC, 50 subjects with advanced adenoma (AA), and 150 matched control participants free of neoplasia were included in Screening Set. RESULTS In Clinical set, subjects with CRC presented higher levels of serum netrin-1 (513.9 ± 22.6 pg/mL) than controls (347.8 ± 20.3 pg/mL, p< 0.0001). Similar in Screening set, serum netrin-1 was higher in CRC (644.5 ± 37.0 pg/mL, both p< 0.0001), compared with controls (407.7 ± 14.8 pg/mL) and AA (416.5 ± 18.5 pg/mL). However, there was no difference between controls and AA (p= 0.752). Compared with the low netrin-1 group, the high group presented increased risk of CRC (Clinical set: OR = 4.300, p< 0.001; Screening set: OR = 7.731, p< 0.001). ROC curve of netrin-1 was developed to detect CRC (Clinical set: AUC 0.703; Screening set: AUC 0.759). CONCLUSIONS It suggests netrin-1 as a potential biomarker for CRC detection.

An initial public offering (IPO) is a critical event in a firm’s life cycle which can reshape its innovation strategy. Research suggests that after going public firms experience an increase in patent productivity. Our paper explores perceived litigation risks as a determinant of this outcome by examining US semiconductor firms. Results show that perceived patent litigation risks are positively associated with patent productivity after the IPO. Interestingly, we also find that the amount of capital raised during the IPO is positively associated with patent productivity after the IPO, successfully replicating previous findings on this relationship. These results are robust to model specifications where we attempt to account for the dynamics of self-selection of firms into IPO by considering matched control firms with similar pre-IPO characteristics, but that never went public.

We examined the organization of past and future affective autobiographical knowledge in sexual-trauma survivors compared with control participants. Participants ( N = 113) divided their past (and future) life into chapters (e.g., “college,” “marriage”), then characterized each chapter using positive or negative attributes. Sexual-trauma survivors ( n = 27) endorsed a greater proportion of negative attributes, demonstrated greater affective compartmentalization (separation of positive and negative attributes into different chapters), and showed reduced redundancy (consistent endorsement across chapters) of positive attributes relative to control participants ( n = 23). Groups did not differ on negative redundancy for past life structure or any metrics for future life structure. In a secondary analysis, we compared life structures for the sexual-trauma group and for individuals with chronic depression but no sexual-trauma history ( n = 30) and matched control participants ( n = 56), which revealed significantly greater negative redundancy in the depressed group. The distinct life structure presented by sexual-trauma survivors may reflect efforts to constrain the impact of trauma on an individual’s self-identity.

For anterior cruciate ligament (ACL)-deficient patients, using a single bone-patellar tendon-bone (BPTB) graft for the double-bundle concept is one of the suitable approaches for acquiring better stability and reducing bone tunnel enlargement compared with the use of hamstring grafts. At least 10-mm width of BPTB autograft is needed to achieve this concept; however, it is larger than one-third of the patellar tendon width for small or middle physique patients. This study aimed to assess the clinical and radiographic outcomes of BPTB and gracilis (G) composite autografts for primary double-bundle ACL reconstruction in Asian athletes. Thirty-two Asian patients undergoing double-bundle ACL reconstruction with 7.0 to 7.5 mm of BPTB and 5.0 to 5.5 mm of G composite grafts were compared with 43 double-bundle ACL reconstruction with hamstring graft cases. The BPTB graft was used for the anteromedial bundle (AMB), with the G graft for the posterolateral bundle (PLB). Percentage of femoral bone tunnel enlargement compared with the original size was determined by computed digital radiographs on the first postoperative day and at 12 months in the anteroposterior (AP) and lateral views. Standard clinical evaluations, including the limb symmetry index (LSI), were also performed. Less PLB tunnel enlargement was found in the BPTB + G group than in the hamstring group in the AP (101.9 ± 22.9 vs.113.7 ± 20.6%, p = 0.031) and lateral views (104.4 ± 18.1 vs. 120.6 ± 23.4%, p

Background: Different options, from reverse (anteverting) periacetabular osteotomy to hip arthroscopy, have been proposed for surgical treatment of femoroacetabular impingement syndrome (FAIS) in the setting of acetabular retroversion. Purpose: (1) To report and analyze midterm patient-reported outcome scores (PROs) in patients with FAIS and labral tears in the setting of acetabular retroversion after isolated hip arthroscopy and (2) to compare these PROs with those of a propensity-matched control group without acetabular retroversion. Study Design: Cohort study; Level of evidence, 3. Methods: Prospectively collected data were retrospectively reviewed for patients who underwent hip arthroscopy for FAIS and labral tear treatment between June 2008 and March 2014. Inclusion criteria were as follows: acetabular retroversion, pre- and postoperative PROs for modified Harris Hip Score (mHHS), Non-arthritic Hip Score, Hip Outcome Score–Sports Specific Scale (HOS-SSS), and visual analog scale (VAS). Propensity score matching was utilized to identify a control group without acetabular retroversion matched 1:1 with similar age, sex, body mass index, acetabular and femoral head Outerbridge grade, preoperative lateral center-edge angle, and labral treatment. Patient acceptable symptomatic state (PASS) and/or minimal clinically important difference (MCID) for the mHHS, HOS-SSS, International Hip Outcome Tool–12, and VAS was calculated. Results: A total of 205 hips with acetabular retroversion were matched to a control group. The groups showed no difference in demographic variables. The retroversion group was composed of 139 female and 66 male hips, with a mean ± SD age of 23.81 ± 7.28 years and follow-up time of 65.24 ± 20.31 months. Intraoperative diagnostic data and procedures performed were similar between groups, except more femoroplasties were performed in the retroversion group. Significant improvements for the mHHS, Non-arthritic Hip Score, HOS-SSS, and VAS were seen for both groups at a mean 5-year follow-up. The proportion of patients who reached the PASS and MCID were similar. Conclusion: In the setting of FAIS and labral tears, patients with acetabular retroversion can be safely treated with advanced hip arthroscopic techniques without reverse (anteverting) periacetabular osteotomy in a high-volume surgeon’s hands. Patients with acetabular retroversion demonstrated favorable PROs at midterm follow-up. Furthermore, the proportion of patients reaching the MCID and PASS for several PROs were comparable with those of a propensity-matched control group without acetabular retroversion.

Studies evaluating the effects of depressive disorders in patients undergoing primary total knee arthroplasty (TKA) are sparse. Therefore, the purpose of this study is to investigate whether patients who have depressive disorders undergoing primary TKA have higher rates of (1) in-hospital lengths of stay (LOS), (2) readmission rates, (3) medical complications, (4) implant-related complications, and (5) costs of care.Patients with depressive disorders undergoing primary TKA were identified and matched to controls in a 1:5 ratio by age, sex, and comorbidities. The query yielded 138,076 patients who had (n = 23,061) or did not have (n = 115,015) depressive disorders. Primary outcomes analyzed included in-hospital LOS, 90-day readmission rates, 90-day medical complications, 2-year implant-related complications, and costs of care. A P value less than .003 was considered statistically significant.Patients who have depressive disorders had significantly longer in-hospital LOS (6.2 days vs 3.1 days; P.0001). Additionally, study group patients had a higher incidence and odds of readmissions (15.5% vs 12.1%; odds ratio [OR], 1.33; P001), medical complications (5.0% vs 1.6%; OR, 3.34; P.0001), and implant-related complications (3.3% vs 1.7%; OR; 1.97; P.0001) Study group patients also incurred significantly higher day of surgery ($12,356.59 vs $10,487.71; P.0001) and 90-day costs ($23,386.17 vs $22,201.43; P.0001).After adjusting for age, sex, and comorbidities, this study demonstrated that patients who have depressive disorders have increased rates of in-hospital LOS, readmissions, complications, and cost. The study is useful in allowing orthopedists to adequately educate patients of potential complications which may occur.

BackgroundRidesharing services (eg, Uber, Lyft) have facilitated over 11 billion trips worldwide since operations began in 2010, but the impacts of ridesharing on motor vehicle injury crashes are largely unknown.—MethodsThis spatial ecological case-cross over used highly spatially and temporally resolved trip-level rideshare data and incident-level injury crash data for New York City (NYC) for 2017 and 2018. The space-time units of analysis were NYC taxi zone polygons partitioned into hours. For each taxi zone-hour we calculated counts of rideshare trip origins and rideshare trip destinations. Case units were taxi zone-hours in which any motor vehicle injury crash occurred, and matched control units were the same taxi zone from 1 week before (−168 hours) and 1 week after (+168 hours) the case unit. Conditional logistic regression models estimated the odds of observing a crash (separated into all injury crashes, motorist injury crashes, pedestrian injury crashes, cyclist injury crashes) relative to rideshare trip counts. Models controlled for taxi trips and other theoretically relevant covariates (eg, precipitation, holidays).ResultsEach additional 100 rideshare trips originating within a taxi zone-hour was associated with 4.6% increased odds of observing any injury crash compared with the control taxi zone-hours (OR=1.046; 95% CI 1.032 to 1.060). Associations were detected for motorist injury and pedestrian injury crashes, but not cyclist injury crashes. Findings were substantively similar for analyses conducted using trip destinations as the exposure of interest.ConclusionsRidesharing contributes to increased injury burden due to motor vehicle crashes, particularly for motorist and pedestrian injury crashes at trip nodes.

Background Baseball pitchers frequently develop varying levels of posterior shoulder tightness (PST) and often present with characteristics associated with subacromial impingement. Purpose To determine if a group of baseball pitchers with excessive PST (bilateral internal rotation ROM difference >18 ° and bilateral total arc of motion difference >5 °) have differences in subacromial joint space, forward scapular posture, or glenohumeral elevation range of motion (ROM) when compared to a control group. Study Design Descriptive, cross-sectional study. Methods Thirty-five asymptomatic professional baseball pitchers with excessive PST were matched with 35 pitchers with acceptable levels of PST. The investigators measured subacromial space using diagnostic ultrasound, glenohumeral elevation ROM using a digital goniometer, and scapular posture using a double square, and were blinded to the group of each participant. Separate t-tests were used to determine significant differences between groups (p

We show evidence of localized knowledge spillovers using a new database of US patent interferences terminated between 1998 and 2014. Interferences resulted when two or more independent parties submitted identical claims of invention nearly simultaneously. Following the idea that inventors of identical inventions share common knowledge inputs, interferences provide a new method for measuring knowledge spillovers. Interfering inventors are 1.4 to 4.0 times more likely to live in the same local area than matched control pairs of inventors. They are also more geographically concentrated than citation-linked inventors. Our results emphasize geographic distance as a barrier to tacit knowledge flows. (JEL D83, O31, O33, O34)

Schizophrenia is a disorder of altered neural connections resulting in impaired information integration. Whole brain assessment of within- and between-network connections may determine how information processing is disrupted in schizophrenia. Patients with early-stage schizophrenia (n = 56) and a matched control sample (n = 32) underwent resting-state fMRI scans. Gray matter regions were organized into nine distinct functional networks. Functional connectivity was calculated between 278 gray matter regions for each subject. Network connectivity properties were defined by the mean and variance of correlations of all regions. Whole-brain network measures of global efficiency (reflecting overall interconnectedness) and locations of hubs (key regions for communication) were also determined. The control sample had greater connectivity between the following network pairs: somatomotor-limbic, somatomotor-default mode, dorsal attention-default mode, ventral attention-limbic, and ventral attention-default mode. The patient sample had greater variance in interactions between ventral attention network and other functional networks. Illness duration was associated with overall increases in the variability of network connections. The control group had higher global efficiency and more hubs in the cerebellum network, while patient group hubs were more common in visual, frontoparietal, or subcortical networks. Thus, reduced functional connectivity in patients was largely present between distinct networks, rather than within-networks. The implications of these findings for the pathophysiology of schizophrenia are discussed.

The objective of the study was to identify the main personal, familial and social factors associated with the academic failure of Iranian students. This was a case-control study conducted in Semnan University. The case group consisted of the students who had failed academically and the matched control group was selected randomly from among the classmates of the students in the case group. The conditional logistic regression model was used for analysis at the 5% significance level. In the present study, 34 women (42.5%) and 46 men (57.5%) were interviewed as the case group and the same number of people were interviewed as the control group. Working part-time as a student (OR=6.78, P

IntroductionThis study assessed whether initiating e-cigarette use increases the uptake of cigarette smoking in US adolescents compared with behavioural and synthetic controls.MethodsData come from 78 265 adolescents in the National Youth Tobacco Survey (2014–2017) of whom 38 630 provided information about the first tobacco product they had used in 2014/15. Ever, past 30 day and established (30 day use and 100+ lifetime cigarettes) cigarette smoking was compared in adolescents who first used an e-cigarette (exposure group), a non-cigarette combustible (CT) or other non-combustible tobacco (NT) product (behavioural controls), and propensity score matched adolescents without initial e-cigarette use (synthetic controls).ResultsRelative to behavioural controls, adolescents who tried e-cigarettes first were less likely to have ever smoked cigarettes (26% vs CT (42.4%; OR 0.48, 95% CI 0.40 to 0.57), or NT initiators (52.7%; OR 0.32, 95% CI 0.26 to 0.39)), to be past 30 day (6% vs CT (11.9%; OR 0.48, 95% CI 0.36 to 0.62), or NT initiators (20.0%; OR 0.26, 95% CI 0.19 to 0.35)) or be established cigarette smokers (0.7% vs CT (3.9%; OR 0.17, 95% CI 0.10 to 0.30), or NT initiators (8.4%; OR 0.08, 95% CI 0.04 to 0.13)). E-cigarette initiators were also less likely than synthetic controls (without initial e-cigarette use) to have ever smoked cigarettes (OR 0.76, 95% CI 0.62 to 0.93), be past 30 day (OR 0.71, 95% CI 0.55 to 0.91) or be established cigarette smokers (OR 0.26, 95% CI 0.13 to 0.51).ConclusionLess than 1% of US adolescents who use e-cigarettes first were established cigarette smokers. They were less likely to be smokers than adolescents who tried other combustible or non-combustible tobacco products first and propensity score matched adolescents without initial e-cigarette use.

Background Abnormalities in gait kinetics in patients with Parkinson’s disease (PD) who have suffer from gait impairment have been noted using a conventional inverse dynamic analysis derived by marker-based motion capture system and force plate, which are typically mounted in the laboratory floor. Despite the high accuracy of this approach in tracking markers’ trajectories and acquiring ground reaction forces (GRFs), its dependence on laboratory-mounted equipment restricts its potential use in wider variety of clinical applications. Research question Would a full-body musculoskeletal model driven by a single depth sensor data only produce comparable gait kinetic parameters, including GRFs and lower extremity joints moments, for elderly participants, both healthy and those diagnosed with PD? Methods Nine patients diagnosed with PD and 11 healthy age-matched control participants performed three over-ground gait trials. Full-body kinematic data were collected using a depth sensor and a musculoskeletal model have been constructed using AnyBody musculoskeletal modeling system to predict the three-dimensional GRFs and lower extremity joint moments. Predicted kinetic parameters for both PD and control groups were compared during the braking and propulsive phases of the gait cycle. In addition, ensemble curve analysis with 90% confidence intervals were constructed to compare between group differences across the stance phase of the gait cycle. Results The findings of this study showed that the PD exhibited a significantly lower braking peak vertical GRF and propulsion peak horizontal GRF while no significant between-group differences were found in peak lower extremity joint moments. However, the PD showed significant alterations in lower extremity joint moments during the early and late phases of stance, which indicate a difference in ambulation strategy. Significance The proposed method adopting full-body musculoskeletal model driven by a depth sensor data proves that it has the potential to be a portable and cost-effective gait analysis tool in the clinical setting.

Echocardiographic determination of the right ventricular end-systolic remodeling index (RVES RI) has clinical value for the assessment of pulmonary hypertension (PH) in adults. We aim to determine RVES RI values in pediatric PH and to correlate RVES RI data with echocardiographic variables and NYHA functional class (FC). Prospective echocardiography study in 49 children with PH. The 49 matched control subjects were chosen from 123 healthy children used to construct pediatric normal reference values. The associations with invasive hemodynamic variables were also investigated in a validation cohort of 12 PH children and matched controls. RVES RI was increased in children with PH vs. healthy controls (1.45 ± 0.16 vs. 1.16 ± 0.06; p

Introduction: The effect of long-lasting immune-modulating therapy was studied in patients with chronic inflammatory demyelinating polyneuropathy (CIDP). Methods: A population-based, cross-sectional study of treated patients referred to the Danish health-care system between 1985 and 2006. Results: The 51 participating patients had a median disease duration of 16 (interquartile range, 14–21) years. Twenty-seven patients (53%) had discontinued therapy and 46 walked independently. Disability and isokinetic strength were impaired by 17% and 20%, respectively, as compared with matched control subjects. For a few patients long-term CIDP was associated with severe morbidity (6%) and even mortality (1%). Prolongation of time until start of therapy was associated with an increased burden of long-term disability. Discussion: Long-term prognosis in treated CIDP is characterized by limited disability in the majority of patients. Disability is related to delay of therapy. Therefore, more attention should be given to early treatment start in CIDP.

Introduction: It’s well known that exposure to polycyclic aromatic hydrocarbons (PAHs) increasesthe risk of cancer; however less is known about their adverse effects on male reproductive health. Aim of work: To assess the effects of occupational exposure to PAHs on male reproductive health in a company for coke production. Materials and methods: A cross sectional comparative study was performed on an exposed group of coal tar workers (No=45) and a matched control group (No=45). Personal interview with specially designed questionnaire and standardized self-completed questionnaire was done to assess the erectile dysfunction. Urinary 1-hydroxypyrene (1-OH Pyrene) and serum malondialdehyde (MDA) in addition to reproductive hormones and semen analysis were assessed. Results: The study revealed a statistically significant increase in the level of 1-OHpyrene,MDA and estradiol ratio among the exposed group with Mean ±SD 8.42±3.61, 11.95±7.29, 7.89±3.45 vs 3.14±3.51, 2.44±1.61, 6.59±2.21 respectively among the controls with p 0.05). Conclusion and recommendations: The adversehealth effect on the male reproductive system in the current study might be one of the hazards that can be attributed to occupational exposure to PAHs in coal tar workers. Regular wearing of good quality personal protective equipment, especially masks and gloves is highly recommended to decreaseexposure to PAH in addition to screening with urinary 1-OH pyrene and serum MDA levels.

BACKGROUND: Residential respite is an important support for many community-dwelling older Australians and their caregivers. Respite clients are often very frail with high or specific care needs. Little is known about the comparative outcomes of hospital admission between permanent residential aged care facility (RACF) residents and residential respite residents. AIM: To determine the number of residential respite clients admitted to an acute tertiary hospital, and compare characteristics and in-hospital outcomes with those of permanent residential care residents. METHODS: Retrospective study of residential respite patients admitted to an Australian tertiary hospital between November 2014 and September 2017. Comparison groups: all RACF patients admitted during same period (general RACF group), and control group matched (2:1) for aged, gender and diagnosis. MAIN OUTCOME MEASURES: in-hospital mortality, hospital length of stay (LOS), in-hospital complications (including fall, delirium, pressure injury, Medical Emergency Team (MET) call). Comparisons adjusted for age, gender, presenting symptom and matching variable. RESULTS: A total of 166 admissions from residential respite and 332 matched RACF controls identified from 4575 admissions for permanent RACF residents. Mortality was significantly higher in respite group versus general RACF group (15.1 vs 8.2%, P < 0.001) but not matched control group (15.1 vs 16.3%, P = 0.795). LOS was significantly higher in respite patients than either control group. Respite patients had significantly higher prevalence of in-hospital fall (10.8 vs 1.5%, P < 0.0001) and delirium (35.5 vs 17.7%, P < 0.001) than matched RACF controls. No significant differences were seen in in MET-call and pressure injury rates. CONCLUSION: Although residential respite recipients represent a minority of total residential aged care admissions, they are at high risk of poor outcomes. Prospective identification and timely intervention may improve quality of care for this vulnerable cohort.

IntroductionAcute physiological deterioration is a major contributor to in-hospital morbidity and mortality. Early detection and intervention of deteriorating patients is key to improving patient outcomes. Prior research has demonstrated the effectiveness of Early Warning Systems and other algorithmic approaches in automatically identifying these patients from passively monitoring vital signs.MethodsIn this work, we conduct a prospective pilot study of clinical deployment of the Mayo Clinic Bedside Patient Rescue (BPR) system using an escalating alerting logic enabled by machine learning. Among four units where the BPR system was deployed, time to response and time to intervention for deteriorating patients were significantly reduced relative to matched control units.ResultsIn pilot units, time to response decreased by 35.4% (from 63.2 minutes to 40.8 minutes) and time to intervention decreased by 48.5% (from 106.3 minutes to 55.9 minutes). No significant differences were observed in counterbalance metrics of mortality, ICU transfer rate, and Rapid Response Team activation rate. Furthermore, the automated alerting system was well-received by clinicians participating in the pilot study, as assessed by survey.DiscussionThese results demonstrate a successful clinical deployment of a practice-changing machine learning alert system with demonstrable impact on improving patient care.

Background: The purpose of this study was to determine the return-to-play (RTP) rate and postinjury performance after Achilles tendon (AT) ruptures in National Football League (NFL) skill position players. Methods: The study included NFL skill positions with an AT rupture between the 2009-2010 and 2015-2016 seasons. Performance data were collected and compared against a matched control group. RTP was defined as playing in at least 1 game after repair. Results: RTP rate was 57% for the study cohort. The tight ends (TEs) had the highest RTP rate at 71% while the wide receivers (WRs) had the lowest RTP rate at 38%. Compared with the control group, WRs with successful RTP had significantly less receptions per game ( P = .01). For defensive players with RTP there were significant decreases in postrepair performance in tackles, passes defended, and fumbles forced/recovered compared with the control group. Conclusion: A total of 57% of players achieved RTP with WRs and running backs (RBs) having the lowest RTP rates and TEs and linebackers (LBs) having the highest RTP rates. RBs, defensive backs (DBs), and LBs with successful RTP had decreased performance in all categories. This updated information may be helpful for athletes, physicians, scouts, and coaches in evaluating players with a history of AT rupture. Levels of Evidence: Analytic, level 3, retrospective cohort study, Epidemiologic study

Introduction Evidence from randomized trials suggests that, in patients with sinus-node dysfunction (SND), physiologic pacing (dual-chamber, DDD) may be superior to single-chamber (ventricular, VVI) pacing because it is associated with lower risks of atrial fibrillation and stroke, better exercise capacity and lower risk of pacemaker syndrome. However, benefits on mortality and risk of heart failure have not been demonstrated and these issues have not been fully evaluated in large “real life” analyses. The aim of our study was to assess and compare clinical outcomes within the first 30 days and during a longer-term follow-up with the two types of pacing at a nationwide level for patients with SND. Methods Using the administrative hospital database in France 2010–2020, 52,974 patients with SND were included in the analysis: 4,069 patients had VVI pacing and 48,905 had DDD pacing. Patients with leadless VVI pacemakers were excluded of the analysis. After propensity score matching 2,213 patients with VVI pacemaker were matched 1:1 with 2,213 patients treated with DDD pacemaker. Results In the matched analysis, patients with DDD pacemakers had a lower rate of all-cause (hazard ratio HR 0.711, 95% CI 0.61–0.828) and cardiovascular death (HR 0.628, 95% CI 0.48–0.818) within the 30 days after implantation. There were no significant differences for incidence of tamponade (HR 0.666, 95% CI 0.11–3.992), pneumothorax (HR 1.000, 95% CI 0.32–3.105), hemothorax (HR 0.800, 95% CI 0.21–2.982), major bleeding (HR 0.824, 95% CI 0.68–1.005) and transfusion (HR 1.016, 95% CI 0.83–1.243). During subsequent follow-up (mean: 3.0±2.8 years), risk of all-cause death in the matched population was significantly lower in the DDD group than in the VVI pacemaker group (HR 0.683, 95% CI 0.60–0.784). Patients with SND treated DDD pacemakers also had a lower risk of cardiovascular death (HR 0.569, 95% CI 0.44–0.732), new-onset atrial fibrillation (HR 0.638, 95% CI 0.58–0.706), ischemic stroke (HR 0.685, 95% CI 0.53–0.887) and hospitalization for heart failure (HR 0.758, 95% CI 0.68–0.850) than those treated VVI pacemakers, whilst risk of endocarditis was not significantly different (HR 0.986, 95% CI 0.50–1.951). Conclusion Patients with SND treated with DDD pacemakers had better clinical outcomes compared to those treated with VVI pacemakers. DDD pacing was associated with lower risks of death, cardiovascular death, new-onset atrial fibrillation, ischemic stroke, hospitalization for heart failure. DDD pacing was neither associated with a higher risk of complication on the short-term nor of endocarditis on the longer-term. Funding Acknowledgement Type of funding sources: None.

Purpose: Many studies report a high primary success rate of ACL reconstruction (ACLR), with an increased risk of decline in knee performance correlating with the time passed since surgery. Only one study has compared male soccer players after ACLR to a matched control group of uninjured players in terms of their return to sport and performance. The purpose of this cross-sectional case-control study was to determine the knee performance between soccer players after ACLR and control group matched by age, sex, and professional experience. Methods: All the male professional soccer players aged 18–36 years at the time of injury, who sustained an ACL tear while playing league soccer in Poland between January 2008 and December 2011 were contacted and compared with age and experience-matched healthy control group selected from professional football players. KOOS, IKDC-2000, Lysholm and SF-36 scales were used for comparison. Results: The average follow-up was 7.9 years (range 6–9 years). The ACL-injured soccer players scored significantly lower in IKDC and Lysholm scores compared with the reference group but still were classified as normal knee function in both scales. In all five dimensions of the KOOS and subscales of SF-36 no apparent differences were noted. In all scales in the study group, no correlation was observed between the player’s age and follow-up time after ACLR. Conclusion: After ACL reconstruction and successful return to professional sport, knee function is as good as uninjured team members in the midterm follow-up. Level of evidence: III

OBJECTIVES Hip and core injuries are common in National Football League (NFL) athletes; however, the impact following injury remains unclear. The goal of this manuscript was to determine the impact of nonoperative hip and core injuries on return to play and performance. METHODS NFL athletes who sustained a hip or core injury treated nonoperatively between 2010 and 2016 were identified. Offensive and defensive power ratings were calculated for each player's injury season and two seasons before and after to assess longitudinal impact. A matched control group without an identified hip and/or core injury was assembled for comparison. RESULTS A total of 41 offensive and 71 defensive players with nonoperative hip or core injury were analyzed. All athletes returned to play; offensive and defensive players missed 4.0 ± 5.2 and 3.1 ± 2.6 games after injury, respectively. Offensive players played fewer cumulative career games returning from core injury versus hip (23.5 ± 20.6 vs 41.0 ± 26.4). Defensive players played fewer games (58.1 ± 41.1 versus 37.4 ± 27.1, p