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As the demand for primary reverse total shoulder arthroplasty (RTSA) increases due to an aging population and expanding indications, it is crucial to understand the effects of the age on outcomes, particularly in patients 80 years or older. The purpose of this study was to determine postoperative patient-reported outcomes and evaluate postoperative imaging of octogenarian patients (≥80 year old) who underwent primary RTSA with a minimum 12-month follow-up. In this retrospective case series, all consecutive patients aged 80 years or older who underwent primary RTSA at a tertiary health-care system were included from April 2012 to January 2022. Patient demographic and preoperative comorbidity data were collected, and the corresponding standard comorbidity indices were determined for each patient. Primary outcomes included postoperative patient-reported functional outcomes, while the secondary outcomes were adverse radiographic findings, mortality, and 90-day postoperative complications. Statistical analysis included descriptive analyses and a Wilcoxon Signed-Rank test for comparisons. A P <.05 was considered to be statistically significant. A total of 59 patients were included in the analysis, with a mean age of 84.21 ± 3.24 years and 39 (66.1%) female patients. All patient-reported outcome measures significantly improved postoperatively, including the Single Assessment Numeric Evaluation and American Shoulder and Elbow Surgeons scores, the Visual Analog Scale, and range of motion. The most common adverse radiographic outcome was scapular notching (27.1%), followed by acromial stress fractures (5.1%). Eight (13.6%) complications were observed, requiring four revision surgeries. In conclusion, RTSA leads to significant improvements in patient-reported outcomes with an acceptable rate of adverse radiographic outcomes in patients aged 80 years or older. Despite the potential for increased risk of adverse events in the elderly population, our study did not find an increase in complications within this age group when compared to rates previously reported in literature. Our findings suggest that RTSA is a safe and effective option in octogenarian patients. [ABSTRACT FROM AUTHOR]

Mesh has been the acceptable standard for incisional hernia repair regardless of hernia size. It is not clear whether there is a size of incisional hernias in whom repair would be best performed without mesh. This study aims to compare outcomes of mesh versus suture repairs for incisional hernias <2 cm in size. Incisional hernia repairs from 2012 to 2021 for hernias ≤2 cm in width were queried from the Abdominal Core Health Quality Collaborative. Those with 1-year follow up were considered. Hernia recurrence was defined using composite hernia recurrence, which combines both clinical and patient reported outcomes. Propensity score matching was performed between mesh and non-mesh using body mass index, smoking, diabetes, and drains as covariates. A total of 352 patients met inclusion criteria. After propensity score matching, there were 132 repairs with mesh and 71 without. There was no difference in recurrence rates at 1 year between mesh and non-mesh repairs (15% vs 24%, P =.12). Mesh was associated with a higher rate of 30-day postoperative complications (11% vs 1%, P =.017). There were no differences in 1-year quality of life scores. The repair of incisional hernias ≤2 cm without mesh results in similar recurrence rates, similar quality of life scores, and lower postoperative early complications compared with repairs with mesh. Our findings suggest that there may be select patients with small incisional hernias that could reasonably undergo incisional hernia repair without mesh. Longer-term follow-up is needed to confirm ideal candidates and durability of these repairs. [ABSTRACT FROM AUTHOR]

Copyright of Reumatología Clínica is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To evaluate if the addition of cone-beam computed tomography (CT) to digital subtraction angiography (DSA) improves the identification of the genicular arteries during genicular artery embolization (GAE) for knee pain secondary to osteoarthritis (OA). This single-center study retrospectively analyzed 222 patients who underwent GAE for painful knee OA between May 2018 and April 2022. Intraprocedural cone-beam CT and DSA images were reviewed independently by 2 sets of interventional radiologists. DSA was performed for all patients. Technically adequate cone-beam CT was available for 205 patients (92.3%). The presence of the genicular arteries identified by cone-beam CT and DSA was compared using Φ coefficients. Embolization targets identified by both cone-beam CT and DSA were evaluated against those identified by DSA alone. Genicular arteries with the highest concordance between cone-beam CT and DSA were the inferior lateral (196 vs 198; Φ = 0.3530; P <.0001), superior lateral (197 vs 200; Φ = 0.3060; P <.0001), and superior medial genicular (186 vs 161; Φ = 0.2836; P <.0001) arteries. Cone-beam CT demonstrated higher rates of detection of the inferior medial (195 vs 178; Φ = 0.04573; P =.5150) and median genicular arteries (200 vs 192; Φ = 0.04573; P =.5150). Meanwhile, genicular arteries less frequently identified by cone-beam CT were the descending genicular (197 vs 200; Φ = −0.03186; P =.6502), superior patellar (175 vs 184; Φ = 0.1332; P =.0569), and recurrent anterior tibial (156 vs 186; Φ = 0.01809; P =.7969) arteries. Cone-beam CT in combination with DSA identified 13.4% (372 vs 328) more targets compared to DSA alone. Based on the results of the current study, cone-beam CT serves as a valuable adjunct for visualizing the genicular arteries during GAE, and together with DSA, it identifies more potential embolization targets. [Display omitted] [ABSTRACT FROM AUTHOR]

The rising incidence of primary total shoulder arthroplasty (TSA) predicts a $4 billion increase in cost associated with this procedure by 2030. Studies have evaluated sources of cost containment, including inpatient services, namely routine perioperative laboratory tests. This study evaluates the utility of routine perioperative complete blood count (CBC) and basic metabolic panel (BMP) in TSA and identifies predictors of abnormal postoperative laboratory results and the need for medical intervention (NMI). All patients undergoing primary TSA from 2013 to 2020 at a single institution were included. Demographics, comorbidities, procedural details, and preoperative and postoperative CBC and BMP values were recorded. Abnormal values were identified for each laboratory parameter. NMI was defined as postoperative blood transfusion, electrolyte repletion, fluid resuscitation, and inpatient medical consultation. Univariate and multivariate analyses were performed to determine independent predictors for abnormal postoperative CBC and BMP (AbBMP) results and NMI. A P value <.05 was considered statistically significant. A total of 328 patients were included in the study, with 202 (61.6%) female patients and a median age of 70.5 years. Medical intervention was required in 115 (35.1%). There were no differences in rates of NMI based on patient demographics, comorbidities, and preoperative CBC and BMP results, although there was a significant difference in rates of NMI when comparing postoperative serum potassium (4.1 mmol/L in no NMI group; 3.9 mmol/L in NMI group; P =.039). Ultimately, there were no demographic, surgical, or laboratory factors associated with postoperative NMI on predictive modeling. Increasing body mass index (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.01-1.15, P <.03), preoperative serum glucose (OR 1.05, 95% CI 1.02-1.08, P =.003), and preoperative serum blood urea nitrogen (OR 1.12, 95% CI 1.05-1.12, P =.01) are associated with an 8.0%, 5.0%, and 12% increase in odds of an AbBMP, respectively. Preoperative potassium is inversely correlated with odds of AbBMP (OR 0.19, 95% CI 0.05-0.67, P =.01). Although postoperative laboratory tests were routinely obtained following primary shoulder arthroplasty, abnormal postoperative CBC and BMP were not associated with NMI. Postoperative BMP tests should be considered in patients with elevated body mass index, elevated preoperative serum glucose, elevated preoperative serum blood urea nitrogen, and those with preoperative serum hypokalemia. Postoperative CBC tests are likely not necessary after primary shoulder arthroplasty. [ABSTRACT FROM AUTHOR]

Copyright of Reumatología Clínica is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To compare the performance of a prototype high-flow catheter connector, the Lamprey Lock, with that of a conventional Luer connector. The Lamprey Lock was created to eliminate the choke point resulting from Luer connections by achieving a cross-sectional area approximately 2.5 times larger than that achieved by a conventional Luer connector. A Lamprey Lock 3-way connector was also created by expanding the inner channels of a traditional Luer 3-way connector and exchanging the male Luer connection with a Lamprey Lock connection. These were tested against unaltered Luer and Luer 3-way connectors to compare flow rates using in vitro models of serous and purulent fluid. Each experimental condition was repeated 5 times. In the serous model, the mean drainage rate was 4.4 mL/s (95% CI, 4.3–4.6) and 3.3 mL/s (95% CI, 3.3–3.5) for the Lamprey Lock and Luer connector, respectively (P <.001). The mean drainage rate was 4.2 mL/s (95% CI, 3.9–4.5) and 2.7 mL/s (95% CI, 2.5–2.8) for the Lamprey Lock 3-way and Luer 3-way connector, respectively (P <.001). In the purulent model, the mean drainage rate was 1.4 mL/min (95% CI, 1.3–1.6) and 0.75 mL/min (95% CI, 0.68–0.82) for the Lamprey Lock and Luer connector, respectively (P <.001). The mean drainage rate was 1.5 mL/min (95% CI, 1.3–1.7) and 0.74 mL/min (95% CI, 0.70–0.78) for the Lamprey Lock 3-way and Luer 3-way connector, respectively (P <.001). The proposed high-flow catheter connector, the Lamprey Lock, demonstrated higher flow rates than those demonstrated by a conventional Luer connector in vitro. [Display omitted] [ABSTRACT FROM AUTHOR]

Preeclampsia (PE) is a pregnancy-related disorder associated with maternal hypertension and placental dysfunction. A significant micronutrient during pregnancy is iron, which is important in cellular functions. While iron absorption increases in pregnancy, little is known about the exact mechanisms regulating maternal iron levels and transfer through the placenta in normal and complicated pregnancies. In this retrospective study, we investigated the regulation of maternal and placental iron availability and storage, in normotensive and pregnancies complicated by early- or late-onset PE. Methods used were analysis of clinical records, ELISA analysis on plasma samples, immunofluorescent and Prussian Blue analysis on placenta biopsies. Focusing on erythroferrone (ERFE) as a new marker and hormonal regulator of iron, our results demonstrated altered maternal ERFE levels in PE. We are the first to report the expression of ERFE in trophoblasts and indicate its lower levels in early-onset PE placentas. These changes were associated with lower placental transferrin receptor 1 (TfR1) in syncytiotrophoblasts in both early- and late-onset PE. In addition, maternal plasma ERFE levels were elevated in both early- and late-onset PE and hepcidin levels reduced in early-onset PE. Unaltered maternal plasma IL-6 levels suggest mechanism other than inflammation being involved in altered iron regulation in PE pregnancy. Our data supports a deregulation in maternal iron bioavailability in early- and late-onset PE vs normotensive pregnancies. The exact role of placental ERFE in regulating maternal-placental-fetal iron transport axis requires further investigation. • ERFE is expressed by trophoblasts in the placenta. • Placental ERFE is lower in early-onset PE. • Higher ERFE and lower hepcidin in maternal plasma in early-onset PE. • Higher iron stores found in the placenta in early-onset PE. • Placental TfR1 lower in early- and late-onset PE, and FPN higher in early-onset PE. [ABSTRACT FROM AUTHOR]

The therapeutic efficacy of mesenchymal stromal cells (MSCs) for tissue regeneration is critically linked to the potency of the complex mixture of growth factors, cytokines, exosomes, and other biological cues that they secrete. The duration of cell-based approaches is limited by rapid loss of cells upon implantation, motivating the need to prolong cell viability and extend the therapeutic influence of the secretome. We and others demonstrated that the secretome is upregulated when MSCs are formed into spheroids. Although the efficacy of the MSC secretome has been characterized in the literature, no studies have reported the therapeutic benefit of in situ sequestration of the secretome within a wound site using engineered biomaterials. We previously demonstrated the capacity of sulfated alginate hydrogels to sequester components of the MSC secretome for prolonged presentation in vitro , yet the efficacy of this platform has not been evaluated in vivo. In this study, we used sulfated alginate hydrogels loaded with MSC spheroids to aid in the regeneration of a rat muscle crush injury. We hypothesized that the use of sulfated alginate to bind therapeutically relevant growth factors from the MSC spheroid secretome would enhance muscle regeneration by recruiting host cells into the tissue site. The combination of sulfated alginate and MSC spheroids resulted in decreased collagen deposition, improved myogenic marker expression, and increased neuromuscular junctions 2 weeks after injury. These data indicate that MSC spheroids delivered in sulfated alginate represent a promising approach for decreased fibrosis and increased functional regeneration of muscle. The therapeutic efficacy of mesenchymal stromal cells (MSCs) for tissue regeneration is attributed to the complex diversity of the secretome. Cell-based approaches are limited by rapid cell death, motivating the need to extend the availability of the secretome. We previously demonstrated that sulfated alginate hydrogels sequester components of the MSC secretome for prolonged presentation in vitro , yet no studies have reported the in situ sequestration of the secretome. Herein, we transplanted MSC spheroids in sulfated alginate hydrogels to promote muscle regeneration. MSC spheroids in sulfated alginate decreased collagen deposition, improved myogenic marker expression, and increased neuromuscular junctions. These data indicate that MSC spheroids delivered in sulfated alginate represent a promising approach for decreasing fibrosis and increasing functional muscle regeneration. [Display omitted] [ABSTRACT FROM AUTHOR]

This study evaluated the precision of a simplified workflow using only preoperative cone-beam computed tomographic (CBCT) scans to gain guided access to root canals of extracted mandibular molars. A workflow using CBCT scanning associated with 3-dimensional oral scanning was used as a reference for comparison. The influence of the presence of coronal restoration in the simplified workflow was also evaluated. Forty-five mandibular molars were randomized into 3 groups: a control group in which digital planning was performed with CBCT and oral scanning and 2 experimental groups in which digital planning was performed only with CBCT examination. In experimental group 1, teeth had no coronal restorations, whereas in group 2 teeth presented with coronal composite restorations. After digital planning, the teeth were accessed using the guides, and a new CBCT scan was made to overlap the pre- and postoperative examinations. Precision was measured by calculating the deviation between the planned and prepared cavities in millimeters and angle. Data were compared using 1-way analysis of variance (P <.05). All root canals were accessible after access preparation in all tested groups. Deviations of the planned and prepared access cavities were low, with a mean value of 0.55, 0.58, and 0.47 mm and 1.98°, 2.45°, and 1.43° for the control group, group 1, and group 2, respectively. No significant differences in millimeters or angle were observed among the 3 tested groups (P >.05). The simplified digital workflow using only CBCT examination allowed a high level of precision in obtaining access in extracted molars with and without coronal restoration, presenting similar results compared with the digital workflow using CBCT and 3-dimensional oral scanning. [ABSTRACT FROM AUTHOR]

A robust current control approach with disturbance cross-coupling compensation for permanent magnet synchronous motor drives (PMSM) is proposed in this paper. The proposed approach can enhance the reference tracking and provides a robust option for current control of PMSM drives. A discrete-time sliding mode current controller is proposed. The PMSM model includes the digital implementation delay, present due to the discrete-time algorithm execution. A discrete-time backstepping disturbance observer is developed, being combined to the sliding mode controller as a means to improve the robustness and tracking capability. The effects of coupling, parametric uncertainties and load disturbances are compensated by the backstepping disturbance observer. The stability analysis of the combined system is presented and the limits for overall system stability are discussed. Simulations and experimental results validate the combined scheme and demonstrate the good performance of the proposal. • The proposal includes the digital implementation delay in the problem formulation. • The proposed system is analyzed in the discrete-time domain. • Mitigation of the coupling effect in dq axes via the disturbance observer. • The proposed switching functions cross the sliding surface at each sampling period. • A simple structure suitable to nonlinear plants with mismatched uncertainties [ABSTRACT FROM AUTHOR]

• Professional practices are not guided primarily by theoretical knowledge, but by practical experience. • While cultural competencies and specific technical knowledge on the part of professionals are essential for supporting LGBTIQ adolescents, professionals also need skills to redirect adult-centric relationships that concentrate power exclusively in the adults. • Professionals with a higher level of training or stronger commitment to sexual and gender diversity were found to be better equipped with the tools and skills necessary to provide support to LGBTIQ adolescents. • Professional practices are heterogeneous and tend to develop in an unmethodological way. • Adults must listen to adolescents to understand their needs, experiences, expectations, and perceptions regarding sexuality and gender. Since the 2010s, LGBTIQ children have become increasingly visible in Spain, a visibility reflected in their inclusion in public policies at both national and regional levels. Regions such as Catalonia and Madrid have passed legislation that creates specific services and protocols to protect these children. However, the actual impact of these laws and services has not yet been assessed. This article analyses the results of 35 interviews with stakeholders in addition to four focus groups containing 24 adolescents, focusing on the knowledge, practices, experiences and needs of the two groups. Despite the differences between the regions, the results are similar: although professionals can be supportive, they need both more knowledge and clearer directions regarding how to focus their interventions with LGBTIQ children, while adolescents need adults to listen to them and confront and combat their adultist biases. [ABSTRACT FROM AUTHOR]