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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]

• 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]

Long-term changes in exercise capacity and cardiopulmonary hemodynamics after pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) have been poorly described. We analyzed the data from 2 prospective surgical CTEPH cohorts in Hammersmith Hospital, London, and Amsterdam UMC. A structured multimodal follow-up was adopted, consisting of right heart catheterization, cardiac magnetic resonance imaging, and cardiopulmonary exercise testing before and after PEA. Preoperative predictors of residual pulmonary hypertension (PH; mean pulmonary artery pressure >20 mm Hg and pulmonary vascular resistance ≥2 WU) and long-term exercise intolerance (VO 2 max <80%) at 18 months were analyzed. A total of 118 patients (61 from London and 57 from Amsterdam) were included in the analysis. Both cohorts displayed a significant improvement of pulmonary hemodynamics, right ventricular (RV) function, and exercise capacity 6 months after PEA. Between 6 and 18 months after PEA, there were no further improvements in hemodynamics and RV function, but the proportion of patients with impaired exercise capacity was high and slightly increased over time (52%-59% from 6 to 18 months). Long-term exercise intolerance was common and associated with preoperative diffusion capacity for carbon monoxide (DLCO), preoperative mixed venous oxygen saturation, and postoperative PH and right ventricular ejection fraction (RVEF). Clinically significant RV deterioration (RVEF decline >3%; 5 [9%] of 57 patients) and recurrent PH (5 [14%] of 36 patients) rarely occurred beyond 6 months after PEA. Age and preoperative DLCO were predictors of residual PH post-PEA. Restoration in exercise tolerance, cardiopulmonary hemodynamics, and RV function occurs within 6 months. No substantial changes occurred between 6 and 18 months after PEA in the Amsterdam cohort. Nevertheless, long-term exercise intolerance is common and associated with postoperative RV function. [Display omitted] [ABSTRACT FROM AUTHOR]

The emerging pathogen, Batrachochytrium dendrobatidis (Bd), causes a fatal amphibian disease called chytridiomycosis, and has impacted amphibian biodiversity. Amphibian declines were first noticed in the 1970s and 1980s, decades before Bd was discovered (1998). In the Sierra Nevada mountains (California, USA), mass die-offs of Yosemite toads (Anaxyrus canorus) occurred in the late 1970s. In this study, we investigated the historical and contemporary Bd presence on A. canorus. We used a retrospective analysis to determine Bd presence/absence on 719 museum specimens collected between 1915 and 2005, and on an additional 1678 samples collected from live animals in the wild (2004–2012). For the 1678 contemporary dataset, we developed a statistical model to identify biotic and abiotic drivers of Bd infection likelihood. We found that: 1) Bd emerged coincident with historical declines; 2) Bd is currently widely distributed throughout the species range; 3) life stage, elevation, and precipitation regime were associated with Bd infection likelihood; and, 4) the juvenile life stage was the most highly infected, with some having Bd infection loads surpassing a mortality threshold identified in other species. In combination, our results suggest that Bd may have played a significant yet unrecognized role in the decline of A. canorus. Additionally, we find evidence that Bd may continue to affect survival and recruitment, depressing population growth and increasing extinction risk in remaining populations. These represent key insights for efforts to recover this species across its historical range and may also be important in hundreds of other species that declined before Bd was discovered. [ABSTRACT FROM AUTHOR]

[Display omitted] The dual-specificity protein kinase MKK3 has been implicated in tumor cell proliferation and survival, yet its precise role in cancer remains inconclusive. A critical step in elucidating the kinase's involvement in disease biology is the identification of potent, cell-permeable kinase inhibitors. Presently, MKK3 lacks a dedicated tool compound for these purposes, along with validated methods for the facile screening, identification, and optimization of inhibitors. In this study, we have developed a TR-FRET-based enzymatic assay for the detection of MKK3 activity in vitro and a BRET-based assay to assess ligand binding to this enzyme within intact human cells. These assays were instrumental in identifying hit compounds against MKK3 that share a common chemical scaffold, sourced from a library of bioactive kinase inhibitors. Initial hits were subsequently expanded through the synthesis of novel analogs. The resulting structure–activity relationship (SAR) was rationalized using molecular dynamics simulations against a homology model of MKK3. We expect our findings to expedite the development of novel, potent, selective, and bioactive inhibitors, thus facilitating investigations into MKK3′s role in various cancers. [ABSTRACT FROM AUTHOR]