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Clinically significant outcome (CSO) benchmarks have been previously established for shoulder arthroplasty by assimilating preoperative diagnoses and arthroplasty types. The purpose of this study was to establish unique CSO thresholds and compare the time-to-achievement of these for reverse shoulder arthroplasty (RSA) for osteoarthritis (GHOA), RSA for rotator cuff arthropathy (RCA), and total shoulder arthroplasty (TSA) for GHOA. Consecutive patients who underwent elective RSA for GHOA, TSA for GHOA, or RSA for RCA between February 2015 and May 2020, with 2-year minimum follow-up, were retrospectively identified from a prospectively maintained single surgeon registry. The American Shoulder and Elbow Surgeons (ASES) score was administered preoperatively and postoperatively at 2-week, 6-week, 3-month, 6-month, 1-year, and 2-year timepoints. Satisfaction and subjective overall improvement anchor questionnaires were administered at the time of final follow-up. Distribution-based methods were used to calculate the Minimal Clinically Important Difference (MCID), and anchor-based methods were used to calculate the Substantial Clinical Benefit (SCB) and the Patient Acceptable Symptom State (PASS) for each patient group. Median time to achievement, individual incidence of achievement at each time point, and cumulative incidence of achievement calculated using Kaplan–Meier survival curve analysis with interval censoring were compared between groups for each CSO. Cox-regression analyses were also performed to determine which patient factors were significantly associated with early or delayed achievement of CSOs. There were 471 patients eligible for study analysis: 276 RSA for GHOA, 107 TSA for GHOA, and 88 RSA for RCA. The calculated MCID, SCB, and PASS scores differed for each group. There were no significant differences in median time to achievement of any CSO between groups. Log-rank testing revealed that cumulative achievements significantly differed between groups for MCID (P =.014) but not for SCB (P =.053) or PASS (P =.620). On cox regression analysis, TSA patients had earlier achievement of SCB, whereas TSA and RSA for GHOA patients had earlier achievement of MCID. At 2-years, a significantly higher percentage of RSA for GHOA patients achieved MCID and SCB compared to RSA for RCA (MCID:100%, 95.5%, P =.003, SCB:94.6%, 86.4%, P =.036). Calculated CSO thresholds differ according to preoperative diagnosis and shoulder arthroplasty type. Patients undergoing TSA and RSA for GHOA achieve CSOs earlier than RSA for RCA patients, and a significantly higher percentage of RSA for GHOA patients achieve CSOs by 2 years compared to RSA for RCA patients. [ABSTRACT FROM AUTHOR]

The first 2 years of life is a period of rapid learning and growth when humans acquire notable motor, perceptual, linguistic, and social capabilities. Because of challenges in measuring brain activity in human infants, many of the neural mechanisms underlying these capabilities have not been identified. Advances in neuroimaging technologies, task designs, and data analyses from studies of older children and adults are starting to be translated into studies of infants. These new methods include frequency tagging designs in electroencephalography (EEG), task-based functional magnetic resonance imaging (fMRI) studies in awake and behaving infants, multivariate analyses of EEG and functional near-infrared spectroscopy (fNIRS), and the emergence of infant-friendly optically pumped magnetometry (OPM). The resulting neural data provide rich new measures of infant cognition, supplementing the limited behavioral data that can be obtained from preverbal infants. The functional properties of the infant brain are poorly understood. Recent advances in cognitive neuroscience are opening new avenues for measuring brain activity in human infants. These include novel uses of existing technologies such as electroencephalography (EEG) and magnetoencephalography (MEG), the availability of newer technologies including functional near-infrared spectroscopy (fNIRS) and optically pumped magnetometry (OPM), and innovative applications of functional magnetic resonance imaging (fMRI) in awake infants during cognitive tasks. In this review article we catalog these available non-invasive methods, discuss the challenges and opportunities encountered when applying them to human infants, and highlight the potential they may ultimately hold for advancing our understanding of the youngest minds. [ABSTRACT FROM AUTHOR]

Monoblock ceramic cups are designed to accommodate large-diameter femoral heads. This has the potential to offer the advantages of an increased range of motion and enhanced joint stability. These features could benefit younger and high-demand patients in need of total hip arthroplasty. The aim of this study was to assess the survival rate and the reasons for revision of the DeltaMotion cup. Data from the AOANJRR were analyzed for all patients who had undergone a primary conventional THA performed between January 1, 2001 and December 31, 2021. Only prostheses with ceramic/ceramic, ceramic/XLPE, metal/XLPE, or CM/XLPE bearing surfaces were included. The primary outcome measure was the cumulative percent revision for all causes. Secondary outcome measures were revision for dislocation/instability, ceramic breakage, or noise. A subanalysis for cup size was also performed. There were 486,946 primary conventional THA procedures undertaken for any reason. Of these, 4,033 used the DeltaMotion cup and 482,913 were modular designs. The DeltaMotion cup had the lowest CPR for all diagnoses compared to the modular bearings at all time points, had a significantly lower revision rate for prosthesis dislocation and no revisions for squeaking compared to other modular bearings. There were 175 ceramic breakages recorded in the modular bearing group and 1 ceramic breakage in the DeltaMotion group. The DeltaMotion cup had a low rate of all-cause revision, and for dislocation, ceramic breakage, and noise. Although this cup is no longer manufactured, ongoing follow-up of newer monoblock ceramic cups will determine their suitability for younger and more active patients. [ABSTRACT FROM AUTHOR]

Lumbar interbody instrumentation techniques are common and effective surgical options for a variety of lumbar degenerative pathologies. Anterior lumbar interbody fusion (ALIF) has become a versatile and powerful means of decompression, stabilization, and reconstruction. As an anterior only technique, the integrity of the posterior muscle and ligaments remain intact. Adding posterior instrumentation to ALIF is common and may confer benefits in terms of higher fusion rate but could contribute to adjacent segment degeneration due to additional rigidity. Large clinical studies comparing stand-alone ALIF with and without posterior supplementary fixation (ALIF+PSF) are lacking. To compare rates of operative nonunion and adjacent segment disease (ASD) in ALIF with or without posterior instrumentation. Retrospective cohort study. Adult patients (≥18 years old) who underwent primary ALIF for lumbar degenerative pathology between levels L4 to S1 over a 12-year period. Exclusion criteria included trauma, cancer, infection, supplemental decompression, noncontiguous fusions, prior lumbar fusions, and other interbody devices. Reoperation for nonunion and ASD compared between ALIF only and ALIF+PSF. Reoperations were modeled as time-to-events where the follow-up time was defined as the difference between the primary ALIF procedure and the date of the outcome of interest. Crude cumulative reoperation probabilities were reported at 5-years follow-up. Multivariable Cox proportional hazard regression was used to evaluate risk of operative nonunion and for ASD adjusting for patient characteristics. The study consisted of 1,377 cases; 307 ALIF only and 1070 ALIF+PSF. Mean follow-up time was 5.6 years. The 5-year crude nonunion incidence was 2.4% for ALIF only and 0.5% for ALIF+PSF; after adjustment for covariates, a lower operative nonunion risk was observed for ALIF+PSF (HR=0.22, 95% CI=0.06–0.76). Of the patients who are deemed potentially suitable for ALIF alone, one would need to add posterior instrumentation in 53 patients to prevent one case of operative nonunion at a 5-year follow-up (number needed to treat). Five-year operative ASD incidence was 4.3% for ALIF only and 6.2% for ALIF+PSF; with adjustments, no difference was observed between the cohorts (HR=0.96, 95% CI=0.54–1.71). While the addition of posterior instrumentation in ALIFs is associated with lower risk of operative nonunion compared with ALIF alone, operative nonunion is rare in both techniques (<5%). Accordingly, surgeons should evaluate the added risks associated with the addition of posterior instrumentation and reserve the supplemental posterior fixation for patients that might be at higher risk for operative nonunion. Rates of operative ASD were not statistically higher with the addition of posterior instrumentation suggesting concern regarding future risk of ASD perhaps should not play a role in considering supplemental posterior instrumentation in ALIF. [ABSTRACT FROM AUTHOR]

To compare complication rates, reoperation rates, and subjective outcomes after arthroscopic and open irrigation and debridement for treatment of native knee septic arthritis. Following The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review of the Embase, Cochrane, and PubMed databases was performed. Comparative studies reporting clinical outcomes after arthroscopic versus open treatment for septic arthritis of the native knee in human adults were included. Excluded were case series with <10 patients, inclusion of patients <18 years old, studies on non-native joints, abstract-only publications, and studies without stratification of the involved joint. Two reviewers in duplicate independently performed search and data extraction. The quality of the included studies was assessed with the Methodological Index for Non-Randomized Studies instrument. The mean score among the included studies was 18.2 (range 16-23). Eleven studies were included, comprising 2,343 knees treated arthroscopically, and 1,595 treated with arthrotomy. Studies reported no differences in erythrocyte sedimentation rate, C-reactive protein, peripheral white blood cells, or symptom chronicity between groups. Nine studies (81.8%) attempted to control for potentially confounding variables in their analyses, and 4 studies (36.4%) reported significant differences in patient characteristics. Reoperation rates ranged from 0% to 50% for arthroscopy and 6% to 71% for arthrotomy. Complication rates ranged from 0% to 39.4% arthroscopically and 0% to 49% for arthrotomy. Superior patient-reported outcomes were achieved after arthroscopy in 2 studies that analyzed subjective outcomes. Arthroscopic management of native knee septic arthritis is a safe and effective alternative to open treatment and is associated with comparable complication rates, reoperation rates, hospitalization lengths, readmission rates, and superior patient-reported outcomes compared with open irrigation and debridement. Level IV, systematic review of Level I, III, and IV studies. [ABSTRACT FROM AUTHOR]

Pyoderma gangrenosum est une dermatose neutrophilique rare, se présentant par des ulcérations cutanées inflammatoires et douloureuses, riches en infiltrat à PNN, souvent prises pour des lésions infectieuses ou ischémiques, et le plus souvent localisées au niveau du tronc et des membres inférieurs. Dans la moitié des cas, il est associé à des pathologies inflammatoires ou onco-hématologiques. On note une forte association avec les pathologies inflammatoires digestives notamment. Pyoderma gangrenosum peut s'étendre à des tissus extra-cutanés, avec des atteinte pulmonaires ou articulaires. Nous rapportons ici le cas d'une patiente de 56 ans, prise en charge pour un Pyoderma gangrenosum pulmonaire. Elle avait pour principale antécédent une maladie de Crohn colique, non sténosante et non fibrosante, initialement traitée par infliximab, en combothérapie avec du méthotrexate. Les principales complications de ce traitement ont été, en 2020, une infection pulmonaire à mycobactérie atypique de type Xenopi traitée par quadrithérapie (azithromycine, éthambutol, clofazimine et isoniazide) et une aspergillose pulmonaire cavitaire apicale droite, traitée par voriconazole. Un relai de la combothérapie a également été réalisé, par du védolizumab, sans un contrôle entièrement satisfaisant de l'activité de la maladie de Crohn. Dans le cadre du suivi pneumologique, malgré une évolution scanographique initiale favorable et la poursuite du voriconazole, un PET-scanner avait mis en évidence la persistance d'un épaississement de la paroi avec un hypermétabolisme de la cavité apicale droite. Par la suite, du fait d'une évolution défavorable avec un nouveau contrôle scanographique en faveur d'un comblement cavitaire et d'une extension de l'atteinte en sous-pleural, une bronchoscopie a été réalisée. Des sécrétions purulentes ont été retrouvées, avec des prélèvements bactériologiques, mycologiques et mycobactériologiques négatifs. L'anatomopathologie éliminait une lésion néoplasique bronchique et concluait à un matériel de lavage légèrement inflammatoire à polynucléaires neutrophiles. Le diagnostic de Pyoderma gangrenosum a été posé, et après discussion entre les pneumologues et les gastro-entérologues, l'introduction d'un traitement commun à l'atteinte digestive et pulmonaire par upadacitinib 30 mg a été décidée. Le contrôle scanographique à un mois était en faveur d'une diminution du comblement et de l'épaisseur de la paroi de la cavité pulmonaire. On notait également un contrôle satisfaisant de l'inflammation digestive. Les anti-JAK sont de plus en plus présents dans notre pratique et dans l'arsenal thérapeutique de différentes spécialités, avec une efficacité plus ou moins démontrée dans les atteintes inflammatoires dermatologiques, rhumatologiques et gastro-entérologiques notamment. Favoriser les discussions collégiales pluridisciplinaires permettrait un meilleur contrôle d'atteintes inflammatoires multiples, avec un traitement unique. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy is a microvascular disease that causes blindness. Using acid sphingomyelinase knockout mice, we reported that ceramide generation is critical for diabetic retinopathy development. Here, in patients with proliferative diabetic retinopathy, we identify vitreous ceramide imbalance with pathologic long-chain C16-ceramides increasing and protective very long-chain C26-ceramides decreasing. C16-ceramides generate pro-inflammatory/pro-apoptotic ceramide-rich platforms on endothelial surfaces. To geo-localize ceramide-rich platforms, we invented a three-dimensional confocal assay and showed that retinopathy-producing cytokines TNFα and IL-1β induce ceramide-rich platform formation on retinal endothelial cells within seconds, with volumes increasing 2-logs, yielding apoptotic death. Anti-ceramide antibodies abolish these events. Furthermore, intravitreal and systemic anti-ceramide antibodies protect from diabetic retinopathy in standardized rodent ischemia reperfusion and streptozotocin models. These data support (1) retinal endothelial ceramide as a diabetic retinopathy treatment target, (2) early-stage therapy of non-proliferative diabetic retinopathy to prevent progression, and (3) systemic diabetic retinopathy treatment; and they characterize diabetic retinopathy as a "ceramidopathy" reversible by anti-ceramide immunotherapy. [Display omitted] • Vitreous C16:0/26:0 ceramide ratio is increased in proliferative diabetic retinopathy • C16-ceramide forms pro-inflammatory and pro-apoptotic ceramide-rich platforms • Cytokines induce ceramide-rich platform formation on retinal endothelial cells • Retinal microvascular injury in diabetes is reversed by anti-ceramide immunotherapy Diabetic metabolic abnormalities cause retinal "ceramidopathy," with sphingolipid imbalance leading to pathological ceramide-rich platform formation on the surface of retinal endothelial cells. Anti-ceramide antibodies targeting ceramide-rich platforms inhibit diabetes-induced endothelial cell apoptosis, dysfunction, and increased permeability. Intravitreal and systemic anti-ceramide immunotherapy reverse retinal microvascular injury in diabetic retinopathy. [ABSTRACT FROM AUTHOR]

To reach balance and harmony, current demand, growth, and sustainability, there is a need to include economic, social, cultural, and biological principles for a holistic approach in fisheries management. However, despite the combined efforts, severe challenges still threaten the sustainability of small-scale fisheries in the Philippines. This study carried out a systematic review of the literature published from 1998 to 2021 in the Philippines. This timeframe was selected to align with the implementation of the Philippines Fisheries Code of 1998 (Republic Act 8550) and its subsequent amendment as Republic Act 10654 in 2015, which legally recognized sustainable fisheries by local governments from 1998 onwards. The literature search came out with a total of 775 articles from Web of Science and 345 from SCOPUS, after duplicates were removed, 207 literature were included in the synthesis. The main issues that came out are on fishing, reef, livelihood, catch and protected areas. In the Philippines, the reliance of fishers on their livelihood remains a limiting factor in the effectiveness of management plans as pressure from the increasing population of highly fishery-dependent coastal communities, food insecurity, and catch demand can render tactics ineffective. The root issues are larger and systemic, but stem from a lack of sustainable financing to support the viability of established fishery management schemes. Marine conservation programs require consideration of the economic impacts and creating alternatives to diversify income sources so that other larger drivers of unsustainable fisheries can be addressed. [ABSTRACT FROM AUTHOR]

Sardines are a crucial component of Philippine capture fisheries, providing economic benefits and contributing to food security. This study aimed to provide an overview of the status, trends and challenges in the sardine fishery in the Sulu Archipelago, a major fishing ground for sardines, focusing on the traditional but less-documented small-scale commercial ringnets or locally called kulibu. The modern kulibu has an average size of about 10 gross tons and is operated by 7–15 crew members. We estimated about 500 kulibu vessels operating in the entire Sulu Archipelago, with Sulu having the most, followed by Basilan and Tawi-Tawi, respectively. The normal catch rates of a kulibu ranged from 10 to 20 tubs or banggera per night, with each banggera containing about 40 kg of fish. While some fishers reported that catches are still abundant and did not change much over the past three decades, we have identified some signs of overfishing. These include using of advanced technology and bigger boats/nets, expansion of fishing to more distant areas, the increasing frequency of low to zero catches, and a change in species composition indicative of fishing down marine foodwebs. Fishers have identified major issues and challenges confronting the fishery, such as intrusion of larger purse seiners into their fishing grounds, lack or inefficiency of post-harvest facilities, absence of a reliable market for their catches, and security risks at sea. To provide a comprehensive perspective, we adopted the Sustainable Livelihood Approach (SLA) framework, highlighting the broader implications of our findings for fishery management. Bottom of Form [ABSTRACT FROM AUTHOR]

There is significant variability in postoperative neurological injury rates in patients with congenital heart disease, with early injuries impacting long-term neurodevelopmental outcomes; therefore, there is an urgent need for identifying effective strategies to mitigate such injuries. This study aims to assess the association between nadir intraoperative temperature (NIT) and early neurological outcomes in neonates undergoing congenital heart surgery. Analyzing data from 24,345 neonatal cardiac operations from the Society for Thoracic Surgeons Congenital Heart Surgery Database between 2010 and 2019, NIT was assessed using a mixed-effect logistic regression model, targeting major neurological injury (stroke, seizure, or deficit at discharge) as a primary endpoint. The study observed a shift from hypothermic circulatory arrest to cerebral perfusion with an increase in mean nadir temperature from 23.9 °C to 25.6 °C (P < 0.0001). Major neurological injury was noted in 4.9% of the cohort, with variations based on surgical procedure. After adjusting for risk, NIT was not significantly associated with major neurological injuries overall, but a lower NIT showed protective effects in the Norwood subgroup. Factors increasing the risk of major neurological injury included younger age at surgery, the Norwood procedure, longer cardiopulmonary bypass times, younger gestational age, presence of noncardiac abnormalities, and chromosomal anomalies. Whereas neurological injuries are prevalent after neonatal cardiac surgery, current practices lean towards higher core temperatures. This trend is supported by the nonsignificant impact of NIT on neurological outcomes. However, lower NIT in the Norwood subgroup indicates that reduced temperatures may be beneficial amidst specific risk factors. [ABSTRACT FROM AUTHOR]

Healthy aging is typically accompanied by cognitive decline. Previous work has shown that engaging in multiple, non-work activities during midlife can have a protective effect on cognition several decades later, rendering it less dependent on brain structural health; the definition of "cognitive reserve". Other work has shown that increasing age is associated with reduced segregation of large-scale brain functional networks. Here we tested the hypothesis that functional segregation (SyS) mediates this effect of middle-aged lifestyle on late-life cognition. We used fMRI data from three tasks in the CamCAN dataset, together with cognitive data on fluid intelligence, episodic memory, and retrospective lifestyle data from the Lifetime of Experiences Questionnaire (LEQ). In all three tasks, we showed that SyS related to fluid intelligence even after adjusting for the (nonlinear) age effects. However, we found no evidence that SyS in late-life mediated the relationship between non-specific (non-occupation) midlife activities and either measure of cognition in late-life. Thus, the brain correlates of cognitive reserve arising from mid-life activities remain to be discovered. • System segregation (SyS) is stable across different brain states. • SyS is negatively associated with age. • Fluid intelligence, but not episodic memory, was robustly predicted by SyS. • Late life SyS was not associated with midlife outside of work activities. [ABSTRACT FROM AUTHOR]