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Background Context: Cervical spondylotic myelopathy (CSM) is a progressive condition characterized by spinal cord compression secondary to disc degeneration. While anterior cervical discectomy and fusion (ACDF) has long been considered the standard surgical treatment for CSM, loss of motion segments after this procedure may lead to sequelae, including adjacent segment disease (ASD), further propagating loss of function and the potential requirement for revision procedures. More recently, cervical disc arthroplasty (CDA) has been introduced as a motion-preserving alternative to ACDF in CSM., Purpose: This study compares ACDF to CDA in patients with preoperative CSM., Study Design/setting: A matched cohort retrospective study., Patient Sample: About 110 patients were included in the final analysis; 55 underwent ACDF, and 55 underwent CDA., Outcome Measures: Complication rates, myelopathic severity measured by the Nurick scale, and patient-reported outcomes measured by VAS-neck, VAS-arm, and NDI scores METHODS: We examined patients who underwent either one or two-level ACDF or CDA with a minimum follow-up of 2 years. Patients were matched for age, sex, comorbid conditions, preoperative myelopathy severity, and the number of indicated operative levels. Demographics, perioperative data, and complication rates were compared between the two cohorts of patients. Patient-reported outcome measures were assessed at multiple follow-up intervals., Results: No significant differences were observed in demographics or perioperative data. Overall complication rates were similar between the two cohorts (p=.167). Rates of dysphagia (p=1.00), dysphonia (p=.157), infection (p=1.00), construct failure (p=.154), heterotopic ossification (p= .132), and ASD (p=.315) were similar between the two groups. Furthermore, revision rates were similar between the two groups (p=.315). No significant differences were observed in median postoperative Nurick scores between the two cohorts (p=1.00). NDI improvements were greater in the CDA cohort (p=.040)., Conclusions: ACDF and CDA had statistically similar complication rates and improvements in myelopathic symptoms. However, patients who underwent CDA had superior PROMs to those who had undergone ACDF., Competing Interests: Declaration of Competing Interest One or more of the authors declare financial or professional relationships on ICMJE-TSJ disclosure forms., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background & Aims: Because transmural healing (TH) could be the best therapeutic target in Crohn's disease (CD), we aimed to build and validate a score to assess TH and transmural response (TR), and to confirm their association with favorable CD outcomes., Methods: DEVISE-CD project encompassed 2 retrospective cohorts (274 and 224 patients with CD for development and validation phase, retrospectively) and 1 multicenter prospective validation cohort (N = 46 patients). A step-by-step process was used to build the modified Clermont score (C-score). The primary end points were time to bowel damage progression, and steroid-free clinical remission with fecal calprotectin <250 at 1 year for retrospective and prospective validation cohorts, respectively., Results: Edema, ulcer, contrast enhancement, diffusion-weighted hyperintensity, fat wrapping, bowel thickening (>3 mm), and enlarged lymph nodes were associated to higher risk of bowel damage progression (P < .01). Edema, diffusion-weighted hyperintensity, post-gadolinium contrast enhancement, and bowel thickening were highly coexistent (>95%) and collinear (P < .0001). Bowel thickness had the highest sensitivity to change after treatment (standardized mean difference = 0.30 ± 1.0; P = .001). C-score was calculated as 0.2x(bowel thickness-3mm) + 1.5x enlarged lymph nodes + 2x ulcer. TH (C-score <0.5; hazard ratio [HR], 0.28 [0.13-0.63]; P = .002; adjusted HR [aHR], 0.15 [0.04-0.53]; P = .003), TR50 (50% decrease of C-score; HR, 0.30 [0.15-0.63]; P = .001; aHR, 0.36 [0.14-0.88]; P = .025), or TR25 (25% decrease of C-score; HR, 0.37 [0.19-0.71]; P = .003; aHR, 0.46 [0.23-0.94]; P = .034) prevented bowel damage progression in development and validation cohorts, respectively. In the prospective validation cohort, achieving TH (OR, 4.6 [1.3-15.6]; P = .016), TR50 (OR, 6.9 [1.8-26.0]; P = .008), or TR25 (OR, 6.0 [1.6-22.3]; P = .008) after 12 weeks of anti-tumor necrosis factor therapy led to higher rate of corticosteroid-free remission at 1 year., Conclusions: C-score is a validated, reliable, and easy-to-use tool to assess TH and TR in patients with CD., (Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Study Design: Retrospective cohort analysis., Objective: To compare clinical outcomes of outpatient anterior cervical disk replacements (ACDR) performed in free-standing private ambulatory surgery centers versus tertiary hospital centers., Summary of Background Data: ACDR is an increasingly popular technique for treating various degenerative pathologies of the cervical spine. There has been an increase in the utilization of ambulatory surgery centers (ASCs) for outpatient cervical procedures due to economic and convenience benefits; however, a paucity of literature exists in evaluating long-term safety and efficacy of ACDRs performed in ASCs versus outpatient hospital centers., Methods: A retrospective cohort review of all patients undergoing 1- or 2-level ACDRs at 2 outpatient ASCs and 4 tertiary care medical centers from 2012 to 2020, with a minimum follow-up of 24 months, was performed. Approval by each patient's insurance and patient preference determined distribution into an ASC or non-ASC. Demographics, perioperative data, length of follow-up, complications, and revision rates were analyzed. Functional outcomes were assessed using VAS and NDI at follow-up visits., Results: One hundred seventeen patients were included (65 non-ASC and 52 ASC). There were no significant differences in demographics or length of follow-up between the cohorts. ASC patients had significantly lower operative times (ASC: 89.5 minutes vs. non-ASC: 110.5 minutes, P <0.001) and mean blood loss (ASC: 17.5 mL vs. non-ASC: 25.3 mL, P <0.001). No significant differences were observed in rates of dysphagia (ASC: 21.2% vs. non-ASC: 15.6%, P <0.001), infection (ASC: 0.0% vs. non-ASC: 1.6%, P =0.202), ASD (ASC: 1.9% vs. non-ASC: 1.6%, P =0.202), or revision (ASC: 1.9% vs. non-ASC: 0.0%, P =0.262). Both groups demonstrated significant improvements in VAS and NDI scores ( P <0.001), but no significant differences in the degree of improvement were observed., Conclusions: Our 2-year results demonstrate that ACDRs performed in ASCs may offer the advantages of reduced operative time and blood loss without an increased risk of postoperative complications., Competing Interests: A.E. receives grants/research support from NuVasive and Stryker Spine. K.H. is a consultant for Stryker Spine. The remaining authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: Cross-sectional radioanatomic study., Objective: To introduce a classification system using MRI to describe psoas morphology and examine the position of nearby neurovascular structures., Summary of Background Data: Oblique lumbar interbody fusion (OLIF) and lateral lumbar interbody fusion (LLIF) offer sagittal malignment correction and reduced morbidity. LLIF has a higher incidence of nerve injuries, while OLIF has a higher incidence of vascular injuries., Methods: Measurements were completed on the left psoas at the inferior L4 endplate. Class A was designated if the ventral border of the psoas muscle was >2 mm anterior; B if it was ≤ 2 mm anterior or posterior to the vertebral body, and C if >2 mm posterior to the vertebral body ventral border. Modified oblique corridor, measured as the distance between two lines, one at the medial border of the psoas muscle and the other at the lateral border of the nearest vascular structure, and a preferred LLIF trajectory was projected onto an axial image of the left psoas. If the trajectory violated the posterior third of the psoas, it was considered a dangerous approach due to potential iatrogenic nerve injury., Results: 100 patient MRIs (Class A: 44; Class B: 27; Class C: 29) were analyzed. Average modified oblique corridor was 7.49 mm. Modified oblique corridor varied amongst the three types of psoas morphologies (A: 8.99 mm vs. B: 8.10 mm vs. C: 4.66 mm, P=0.040). LLIF trajectory intersected the 'danger zone' in 34.1%, 3.7%, and 0.0% of patients, (P<0.001) respectively., Conclusion: Class A psoas had the largest modified oblique corridor but highest proportion of those with a dangerous LLIF trajectory. Class C psoas had the narrowest modified oblique corridor, but no dangerous LLIF trajectories were identified., Competing Interests: Conflict of Interest declaration: The authors declare that they have NO affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: While fecal calprotectin (Fcal) is now recommended, the positioning of intestinal ultrasonography (IUS) is still unknown to monitor patients with CD., Aims: To assess the agreement between IUS performed by a novice sonographer and Fcal to detect active CD and to compare these two monitoring tools to determine the need for therapeutic escalation., Methods: In this cross-sectional prospective study, we consecutively included CD patients ≥ 18 years-old with concomitant IUS and Fcal testing within 7 days. IUS was performed by a novice sonographer. The endpoints were the agreement between IUS and Fcal (> 150 µg/g) to detect active CD and the need for therapeutic escalation., Results: Among 66 patients undergoing IUS, 56 patients had also Fcal testing. The agreement between IUS and Fcal to detect an active CD was 80.4% (κ-coefficient = 0.536 ± 0.127). Fcal, IUS or both had respectively the following positive (76.9%[54.0-99.8], 70.0%[49.9-90.1], and 81.8%[59.0-100.0]) and negative (81.4%[69.8-93.0], 88.9%[78.6-99.2], and 80.0%[68.3-91.7]) predictive values to detect active CD requiring therapeutic escalation. Using a 10 points-acceptability numerical scale, IUS presented with a better acceptability than Fcal (9.5 ± 1.2 vs 8.0 ± 2.3, p < 0.0001). Contrary to the agreement with Fcal and the performances of IUS to identify the need for therapeutic escalation, the duration of IUS procedure decreased over time (correlation coefficient = - 0.54, p = 0.001) and plateaued between 15 and 20 min-long from the 24th procedure., Conclusion: IUS and fecal calprotectin do not give the same information and could be complementary to monitor patients with CD., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Microplastic pollution and the urgent need for sustainable agriculture have raised interest in developing degradable carriers for controlled agrochemical release. Porous polymeric particles are particularly promising due to their unique release profiles compared to solid or core-shell carriers. However, creating degradable, mesoporous (2-50 nm) microparticles is challenging, and their potential for agrochemical delivery is largely unexplored. A straightforward self-assembly method is demonstrated for fully degradable porous polymer cubosomes (PCs), showcasing their ability to load and release agrochemicals. Using fully degradable block copolymers (BCPs), poly(ethyl ethylene phosphate)-b-polylactide (PEEP-b-PLA), PCs are synthesized in water with high inner order and open pores averaging 19 ± 3 nm in diameter. During the self-assembly process in the presence of the hydrophobic fungicide tebuconazole, polymersomes transform into PCs by enriching the hydrophobic polymer domain and altering the BCP packing parameter. After self-assemby, highly porous and fungicide-loaded PCs are obtained. Fungicide-loaded PCs show high antimycotic activity against Botrytis cinerea (grey mold), adhere to Vitis vinifera Riesling leaves even after simulated rain, and release the fungicide continuously over several days with different release-kinetics compared to solid particles. PCs hydrolyze completely into lactic acid and phosphate derivatives, highlighting their potential as microplastic-free agrochemical delivery systems for sustainable agriculture., (© 2024 The Author(s). Advanced Materials published by Wiley‐VCH GmbH.)

Background: Data on infliximab efficacy in bio-exposed patients with ulcerative colitis (UC) are limited., Aims: To evaluate infliximab effectiveness and its predictors in UC patients with prior exposure to subcutaneous (SC) anti-TNF agent., Methods: In this multicenter retrospective study (8 centers), we included all consecutive UC patients with prior exposure to subcutaneous anti-TNF, starting infliximab for symptomatic UC, excluding acute severe colitis. Corticosteroid-free clinical remission (CFREM) was assessed at week 14 (W14) and W52 while endoscopic improvement (CFREM + endoscopic Mayo score≤1) was evaluated at W14., Results: Overall, 104 patients were included (pancolitis=54.8%, primary failure to subcutaneous anti-TNF=57.4%, concomitant immunosuppressant=53.8%, median partial Mayo score at baseline=7[5-8]). The rate of CFREM was 33.6% (35/104) at W14 and 40.4% (42/104) at W52. At W14, endoscopic improvement was achieved in 29.8%(31/104). In multivariable analysis, concomitant immunosuppressant was associated with higher rate of CFREM at W14(OR=2.83[1.06-7.54], p = 0.037) and W52(OR=2.68[1.16-6.22];p = 0.021), while primary failure to a previous subcutaneous anti-TNF agent led to lower rate of CFREM at W14 (OR=0.37[0.14-0.98], p = 0.046). After a median follow-up of 20.9 months[11.7-33.7]), 50.0%(52/104) patients had discontinued infliximab., Conclusion: Infliximab is an effective option in UC patients previously exposed to prior subcutaneous anti-TNF agent and should be used with concomitant immunosuppressant., (Copyright © 2024. Published by Elsevier Ltd.)

Background Context: Anterior cervical disc replacement (ACDR) and minimally invasive posterior cervical foraminotomy (MI-PCF) have emerged as two increasingly popular alternatives to anterior cervical discectomy and fusion (ACDF) for the management of cervical radiculopathy. Both techniques provide advantages of segmental motion preservation and lower rates of adjacent segment degeneration (ASD) compared to ACDF., Purpose: The purpose of this study was to analyze the clinical and functional outcomes of patients undergoing ACDR or MI-PCF for the treatment of unilateral cervical radiculopathy., Study Design/setting: Retrospective Cohort Review., Patient Sample: A total of 152 patients were included (86 ACDR and 66 MI-PCF)., Outcome Measures: (1) Patient demographics; (2) perioperative data; (3) rates of complications and revisions; (5) visual analogue scale (VAS) and Neck Disability Index (NDI) scores., Methods: A retrospective cohort review was performed to identify all patients at a single institution between 2012-2020 who underwent 1- or 2- level ACDR or MI-PCF from C3-C7 with a minimum follow-up of 24 months. Patient demographics, perioperative data, postoperative complications, and revisions were analyzed. Patient reported outcome measures including VAS and NDI scores were compared., Results: The ACDR group had a significantly greater mean operative time (99.8 minutes vs 79.2 minutes, p<.001), but comparable estimated blood loss and length of stay following surgical intervention (p=.899). The overall complication rate was significantly greater in the ACDR group than the MI-PCF group (24.4% vs 6.2%; p=.003) but was largely driven by approach-related dysphagia in 20.9% of ACDR patients. The MI-PCF group had significantly greater revision rates (13.6% vs 1.2%; p=.002) with an average time to revision of 20.7 months in the MI-PCF group compared to 40.3 months in the ACDR group. The ACDR cohort had significantly greater improvements in NDI scores at the final follow-up (25.0 vs 21.3, p<.001)., Conclusion: Our results suggest that ACDR offer clinically relevant advantages over MI-PCF in terms of long-term revision rates despite an increased approach-related risk of transient postoperative dysphagia. Additionally, patients in the ACDR cohort achieved greater mean improvements in NDI scores but these results may have limited clinical significance due to inability to reach minimally clinically important difference (MCID) thresholds., Competing Interests: Declaration of competing interest One or more of the authors declare financial or professional relationships on ICMJE-TSJ disclosure forms., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Anterior cervical discectomy and fusion (ACDF) is a reliable procedure commonly performed in older patients with degenerative diseases of the cervical spine. Over 130,000 procedures are performed every year with an annual increase of 5%, and overall morbidity rates can reach as high as 19.3%, indicating a need for surgeons to gauge their patients' risk for adverse outcomes. Frailty is an age-associated decline in functioning of multiple organ systems and has been shown to predict adverse outcomes following various spine procedures. There have been several proposed frailty indices of various factors including the 11-factor modified frailty index (mFI-11), which has been shown to be an effective tool for predicting complications in patients undergoing ACDF. However, there is a paucity of literature assessing the utility of the 5-factor modified frailty index (mFI-5) as a risk stratification tool for patients undergoing ACDF. The purpose of this study was to analyze the predictive capability of the mFI-5 score for 30-day postoperative adverse events following elective ACDF., Methods: A retrospective review was performed using the National Surgical Quality Improvement Program (NSQIP) database from 2010 through 2019. Patients older than 50 years of age who underwent elective ACDF were identified using Current Procedural Terminology ([CPT] codes 22554, 22551, 22552, and 63075). Exclusion criteria removed patients under the age of 51, as well as those with fractures, sepsis, disseminated cancer, a prior operation in the last 30 days, ascites, wound infection, or an emergency surgery. Patients were grouped using mFI scores of 1, 2, and 3+. Univariate analysis, using chi-squared and one-way analysis of variance (ANOVA) tests, was conducted to compare demographics, comorbidities, and postoperative complications across the varying cohorts based on mFI-5 scores. Multivariate logistic regression, including patient demographics and preoperative comorbidities as covariates, was performed to evaluate if mFI-5 scores were independent predictors of 30-day postoperative adverse events. Covariates including race, BMI, sex, ASA, and comorbidities were included in regression models., Results: The 45,991 patients were identified and allocated in cohorts based on mFI-5 score. Rates for superficial surgical site infection (SSI), organ/deep space SSI, pneumonia, progressive renal insufficiency, acute renal failure (ARF), urinary tract infection (UTI), stroke/cardiovascular accident (CVA), cardiac arrest requiring cardiopulmonary resuscitation (CPR), myocardial infarction, bleeding requiring transfusions, deep vein thrombosis/thrombophlebitis, sepsis, septic shock, readmissions, reoperation, and mortality incrementally increased with mFI-5 scores from 0 to 3+. Multivariate regression analysis revealed that mFI-5 scores 1 to 3+ increased the odds, in a stepwise manner, of total complications, cardiac arrest requiring CPR, pneumonia and mortality. MFI-5 scores of 2 and 3+ were independent predictors of readmission (2: OR=1.5, p<.001; 3+: OR=2.0, p<.001) and myocardial infarction (2: OR=3.4, p=.001; 3+: OR=6.9, p<.001). A score of 3+ increased the odds of ARF (OR=9.7, p=.022), septic shock (OR=3.6, p=.036), UTI (OR=2.1, p=.007), bleeding requiring transfusions (OR=2.1, p=.016), and reoperations (OR=1.7, p=.004)., Conclusion: mFI-5 score is a quick and viable option for surgeons to use as an assessment tool to stratify high risk patients undergoing elective ACDF, as increasing mFI-5 scores showed significantly higher rates of all adverse outcomes accounted for in this study, except for deep incisional SSI, wound disruption, and PE. Additionally, moderate to severe mFI-5 scores of 2 or 3+ were independent predictors for 30-day postoperative ARF, UTI, MI, bleeding requiring transfusions, septic shock, reoperation, and readmissions following elective ACDF surgery in adults over 50 years old., Competing Interests: The authors declare no conflicts of interest regarding our work, “The 5-Factor Modified Frailty Index (mFI-5) Predicts Adverse Outcomes After Elective Anterior Cervical Discectomy and Fusion (ACDF)” to be published in North American Spine Society Journal (NASSJ)., (© 2024 The Author(s).)

Study Design: Retrospective cohort study., Objectives: To compare the clinical and radiographic outcomes of Anterior Cervical Discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) in patients with preoperative segmental kyphosis., Methods: Patients with segmental cervical kyphosis at the operative levels undergoing 1- or 2-level ACDF or CDA from 2017 to 2020 with 2 years of follow were identified. Patient demographics, perioperative data, complication rates, radiographic findings and reported outcomes were analyzed., Results: A total of 48 patients met inclusion criteria and were included in our study (ACDF: n = 24, CDA: n = 24). Patient demographic data between the 2 cohorts was similar expect for proportion of males (ACDF: 62.5% vs CDA: 33.3%, P = .043). There was no statistical significance in the change of segmental lordosis (ACDF: +8.09° vs CDA: +5.88°, P = .075) between the preoperative and final postoperative period. Additionally, the change in cervical lordosis was similar between groups (ACDF:+ 9.86° vs CDA: +7.60°, P = .226). VAS scores were similar between the 2 groups at every follow-up interval. NDI scores were significantly different at the 6-month, 12 month and the final follow-up. Mean improvements between preoperative and final postoperative periods were statistically superior in the CDA cohort compared to the ACDF cohort (ACDF: 22.8 vs CDA: 24.1, P = .0375)., Conclusion: CDA was superior to ACDF in regards to NDI scores following index procedure in patients with preoperative segmental cervical kyphosis. Those in the CDA cohort had similar complication rates, revision rates and radiographic outcomes as those who underwent ACDF., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The long-term risk of relapse after switching from intravenous (IV) to subcutaneous (SC) infliximab remains unknown in inflammatory bowel disease (IBD)., Aims: To assess the long-term effectiveness and acceptability of switching from IV to SC infliximab in patients with IBD treated with or without an intensified IV regimen., Methods: We extended the follow-up of the REMSWITCH study including patients with IBD in clinical remission who were switched from IV to SC infliximab (120 mg/2 weeks). Relapse was defined as clinical relapse or faecal calprotectin increase ≥150 μg/g compared to baseline., Results: After median follow-up of 18 [15-20] months, among 128 patients, rates of relapse were 13.8% (8/58), 18.4% (7/38), 35.3% (6/17) and 86.7% (13/15) at last follow-up (p < 0.001), in those receiving 5 mg/kg/8 weeks, 10 mg/kg/8 weeks, 10 mg/kg/6 weeks and 10 mg/kg/4 weeks at baseline, respectively. Among relapsing patients, dose escalation led to clinical remission in 82.1% (23/28). In multivariable analyses, factors associated with higher risk of relapse were IV infliximab 10 mg/kg/4 weeks (OR = 61.0 [6.1-607.0], p < 0.001) or 10 mg/kg/6 weeks (OR = 4.7 [1.1-20.2], p = 0.017), and decreased (OR = 5.6 [1.5-20.3], p = 0.004) or stable (OR = 5.0 [1.6-15.0], p = 0.009) serum levels of infliximab between baseline and first post-switch visit. Acceptability was improved at 6 months and did not decrease over time (6.9 ± 1.6 before the switch vs. 8.8 ± 1.3 at 6 months and 8.8 ± 1.3 at last follow-up; p < 0.001). No severe adverse events were reported., Conclusions: Switching from IV to SC infliximab 120 mg every other week is safe and well accepted leading to low long-term risk of relapse. Tight monitoring and dose escalation should be recommended for patients receiving 10 mg/kg/6 weeks and 4 weeks, respectively., (© 2023 John Wiley & Sons Ltd.)

Background Context: Cervical disc arthroplasty (CDA) is a safe and effective alternative to anterior cervical discectomy and fusion (ACDF) in the treatment of various degenerative pathologies with advantages of motion preservation and lower rates of adjacent segment degeneration (ASD). Absolute contraindications for CDA have been well outlined in order to prevent adverse outcomes in patients. However, in cases of patients with relative contraindications (kyphotic deformity, prior cervical surgery, etc.), there remains controversy. There is minimal literature evaluating long-term outcomes in this patient population., Purpose: To compare long-term clinical and functional outcomes of CDA in typical patients versus those with relative contraindications., Design: Retrospective cohort review., Patient Sample: Eighty-nine patients were included in the study: 55 (no contraindications) in Group 1 and 34 (relatively contraindicated) in Group 2 and 26 (preoperative segmental kyphosis) in Group 3., Outcome Measures: (1) Patient demographics; (2) perioperative data; (3) rates of complications and revisions; (5) visual analogue scale (VAS), and neck disability index (NDI) scores., Methods: Patients were placed in the relatively contraindicated cohort if they possessed at least one of the following: (1) segmental kyphosis of 5° to 10°, (2) significant loss of disc height (between 50% and 75% of initial measurements or 1.5-3mm), (3) bridging osteophytes, and (4) prior cervical spine surgery based on preoperative cervical radiographs. The other cohort included patients without any relative contraindication who underwent CDA over the same time frame. Additionally, a subgroup analysis was used to compare those without any contraindications to those with only preoperative segmental kyphosis. Patients were included in this study if they met the following criteria: over 18 years of age, minimum follow-up of 24 months, and availability of complete medical records. Patient demographics, levels operated on, and perioperative outcomes were assessed between the two groups. Revision and complication rates were recorded. Functional outcomes scores were compared using VAS and NDI scores at 6-months, 12-months and final follow-up., Results: Mean follow-up was 40.8 months in Group 1 and 38.3 months in Group 2 (p=.569). Complication rates were 21.8% in Group 1 and 26.4% in Group 2 (p=.615). Complication rates in a comparison between Groups 1 and 3 were statistically insignificant (p=.383). The most common complication was transient approach-related postoperative dysphagia (Group 1: 20% vs Group 2: 23.5%, p=.693). No significant differences were observed in the rates of transient dysphonia (Group 1: 0.0% vs Group 2: 2.9%, p=.201), adjacent segment degeneration (ASD) (Group 1: 1.8% vs Group 2: 0.0%, p=.429), infection (Group 1: 1.8% vs Group 2: 2.9%, p=.712), heterotopic ossification (Group 1: 49.1% vs Group 2: 50.0%, p=.934) or spontaneous fusion (Group 1: 1.8% vs Group 2: 2.9%, p=.728). No revision surgeries were observed in either cohort. All three groups demonstrated significant improvements in their VAS and NDI scores compared with preoperative measurements (p<.001), but no significant differences were found in the degree of improvement between groups at any point in time., Conclusions: Our study found no significant differences in clinical and functional outcomes between patients undergoing 1- and 2-level CDA with relative contraindications versus typical patients. These findings suggest that patient eligibility criteria for CDA may warrant expansion. However, future prospective studies over a longer period of follow-up are necessary to corroborate our results., Competing Interests: Declaration of Competing Interest Dr Emami receives grants/research support from NuVasive. Dr Hwang is a consultant for Stryker Spine. None of these are applicable to the current study. For the remaining authors, none were declared., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: The aim of this study is to evaluate the knowledge and awareness levels of patients who have at least one impacted tooth and who had previously applied to the dentist., Study Design: This study was conducted in patients aged 15 years and older who applied to Ordu University Faculty of Dentistry for routine examination and agreed to fill out the questionnaire form. A total of 325 people participated in the survey conducted to determine the awareness of patients applying to the faculty of dentistry about their existing impacted teeth. A Pearson's chi-square test was used for hypothesis testing when expected frequencies exceeded 5., Results: It was determined that 56.9 % (185) of the participants were aware of their existing teeth, while 43.1 % (140) were not aware. When the patients were evaluated according to the institutions they had visited, it was seen that the group who were most aware of the presence of impacted tooth were those who apply to the faculty of dentistry (74.4 %). The rate of being informed by dentists in the institutions that they had previously visited was higher in patients with university or post-university graduates (p < 0.05). The most common information given by the dentists to the patients about their impacted dental problems was that the tooth should be followed up (40.4 %), while the removal of the tooth constituted 28.4 % of the information given., Conclusion: This study showed that although patients are aware of their existing impacted teeth, their level of knowledge about the risks it may pose is low. For a healthy oral care and health, patients should be adequately informed about impacted teeth., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

This study was conducted to assess the patient characteristics, types of treatment, and outcomes of patients who are surgically treated for vertebral osteomyelitis (VO) in the United States. VO can be treated with or without surgical intervention. Surgically treated cases of VO are associated with significant morbidity and mortality, and incur major healthcare costs. There are few studies assessing the characteristics and outcomes of patients with VO who are treated surgically, as well as the overall impact of surgically managed VO on the healthcare system of the United States. Utilizing the Nationwide Inpatient Sample (NIS) database, 44,401 patients were identified who underwent surgical treatment for VO over a fifteen year period. Severity of comorbidity burden was calculated using the Deyo Index (DI). Surgical approach and comorbidities were analyzed in regard to their impact on complications, mortality rate, LOS, and hospitalization charges. The incidence of surgical intervention for patients who had VO increased from 0.6 to 1.1 per U.S. persons over the study period. Surgically treated patients had a mean age of 56 years, were 75.8% white, were 54.5% male, 37.9% carried Medicare insurance, and they had a mean DI of 0.88. Anterior/posterior approach (OR: 3.53), thoracolumbar fusion (OR: 2.69), thoracolumbar fusion (OR: 19.94), and anterior/posterior approach (OR: 64.73) were the surgical factors that most significantly predicted any complication, mortality, increased LOS, and increased hospital charges, respectively (P < 0.001). The mean inflation-adjusted total hospital cost increased from $20,355 to $39,991 per patient over the study period. VO has been steadily increasing in the United States. Incidence and inflation-adjusted costs nearly doubled. Anterior/posterior approach and thoracolumbar fusion most significantly predicted negative outcomes. VO is associated with lengthy and expensive hospital stays resulting in a significant burden to patients and the healthcare system.

The synthesis and properties of Janus nanoparticles with spherical, cylindrical, and disk-like shapes are nowadays rather well understood. Other topologies such as nanorings and bowl-shaped Janus nanoparticles are believed to show distinctly different solution behavior and interaction with interfaces, but limitations in their synthesis currently prevents a proper investigation of these properties. Especially the combination of shape- and surface-anisotropy of bowl-shaped Janus nanoparticles could result in enhanced selectivity in uptake of cargo and enhanced directional diffusion. We here produce bowl-shaped Janus nanoparticles without noticeable side products through evaporation-induced confinement assembly (EICA) of triblock terpolymers blended with high molecular weight homopolymer. The triblock terpolymer phase separates from the homopolymer into spherical domes, where the terpolymer adopts a hemispherical lamella-lamella morphology ( ll ). Selective cross-linking, removal of the homopolymer, and disassembly of the microparticles releases the bowl-shaped Janus nanoparticles. The amount of blended homopolymer determines the size of the spherical dome, allowing to control particle curvature into flat Janus nanoplates, hemispherical Janus nanobowls, and deep Janus nanocups. The use of Shirasu Porous Glass (SPG) membranes with pore sizes in the range of d pore = 0.2-2.0 μm further provides control of particle diameter. Size and shape were analyzed with electron microscopy and the Janus character through selective surface decoration. The diffusion behavior of bowl-shaped Janus nanoparticles was investigated depending on particle curvature and anisotropy using angle-dependent dynamic light scattering.

Study Design: Retrospective Cohort Study., Objectives: To determine the predictive capability between the 5-factor modified frailty index (mFI-5) scores and adverse clinical and radiographic outcomes following single-level transforaminal lumbar interbody fusion (TLIF)., Methods: All patients over the age of 50 undergoing single-level open or minimally invasive TLIF from 2012 to 2021 with a minimum follow-up of 1 year were identified. Deformity, trauma, emergency, and tumor cases were excluded as were patients undergoing revision surgeries. An mFI-5 score was computed for each patient using a set of five factors which included hypertension requiring medication, chronic obstructive pulmonary disease, diabetes mellitus, congestive heart failure, and partially or fully dependent functional status. Univariate and multivariate logistic regression analysis were performed to evaluate the impact of mFI-5 scores on readmissions, reoperations, and postoperative complications., Results: 156 patients were included and grouped according to their level of frailty: no-frailty (mFI = 0, n = 67), mild frailty (mFI = 1, n = 59), and severe frailty (mFI = 2+, n = 30). Multivariate analysis found high levels of frailty (mFI = 2+) to be independent predictors of reoperation (OR: 16.9, CI: 2.7 - 106.9, P = .003) and related readmissions (OR = 16.5, CI: 2.6 - 102.7, P = .003) as compared to the no-frailty group. An mFI-5 score of 2+ was also predictive of any complication (OR = 4.5, CI: 1.4 - 14.3, P = .01) and adjacent segment disease (ASD) (OR = 12.5, CI: 1.2 - 134.0, P = .037)., Conclusion: High levels of frailty were predictive of related readmissions, reoperations, any complications, and ASD in older adult patients undergoing single-level TLIF., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Emami receives grants/research support from NuVasive. Dr. Hwang is a consultant for Stryker Spine. None of these are applicable to the current study. For the remaining authors, none were declared.

Background Context: Oblique lumbar interbody fusion (OLIF) and extreme lateral interbody fusion (XLIF) are 2 popular minimally invasive spinal fusion techniques with unique approach-related complication profiles. Accordingly, patient-specific anatomical factors, such as vascular anatomy or iliac crest height, greatly influence which technique to use. Previous studies comparing these approaches do not account for the inability of XLIF to access the L5-S1 disc space and therefore do not exclude this level in their analysis. The purpose of this study was to compare radiological and clinical outcomes of these techniques in the L1-L5 region., Methods: A query of 3 electronic databases (PubMed, CINAHL plus, and SCOPUS) was performed, without time restriction, to identify studies that evaluated outcomes of single-level OLIF and/or XLIF between L1 and L5. Based on heterogeneity, a random effects meta-analysis was performed to evaluate the pooled estimation of each variable between the groups. An overlap of 95% confidence intervals suggests no statistically significant difference at the p<.05 level., Results: A total of 1,010 patients (408 OLIF, 602 XLIF) were included from 24 published studies. Improvements in disc height (OLIF: 4.2 mm; XLIF: 5.3 mm), lumbar segmental (OLIF: 2.3°; XLIF: 3.1°), and lumbar lordotic angles (OLIF: 5.3°; XLIF: 3.3°) showed no significant difference. The rate of neuropraxia was significantly greater in the XLIF group at 21.2% versus 10.9% in the OLIF group (p<.05). However, the rate of vascular injury was higher in the OLIF cohort at 3.2% (95% CI:1.7-6.0) as compared to 0.0 (95% CI: 0.0-1.4) in the XLIF cohort. Improvements in VAS-b (OLIF: 5.6; XLIF: 4.5) and ODI (OLIF: 37.9; XLIF: 25.6) scores were not significantly different between the 2 groups., Conclusions: This meta-analysis demonstrates similar clinical and radiological outcomes between single-level OLIF and XLIF from L1 to L5. XLIF had significantly higher rates of neuropraxia, whereas OLIF had greater rates of vascular injury., Competing Interests: Dr. Emami receives grants/research support from NuVasive. Dr. Faloon receives grant and research support from Stryker Spine and Centinel Spine. Dr. Hwang is a consultant for Stryker Spine. None of these are applicable to the current study. For the remaining authors, none were declared.

Introduction: Orthopedic surgery is one of the most common subspecialties subject to medical malpractice claims. Although total shoulder arthroplasty (TSA) is associated with favorable patient outcomes and relatively low complication rates, surgeons performing this procedure may be subject to malpractice litigation leading to significant economic and psychological burden on the provider. The purpose of this study is to characterize and describe malpractice claims against orthopedic surgeons performing TSA using the Westlaw legal database., Methods: The Westlaw legal database was queried for all cases related to TSA using the terms "malpractice" AND "shoulder replacement" OR "shoulder arthroplasty." Cases were excluded if the defendant was not an orthopedic surgeon, the procedure involved was not a TSA, or if the patient was a minor. Patient demographics, causes cited for litigation, case outcomes, and indemnity payments were analyzed to determine common factors that lead plaintiffs to pursue legal action., Results: Thirty-five TSA cases were identified that met inclusion criteria. The mean plaintiff age was 55 years with 63.6% female. The most common category of negligence alleged was intraoperative error, which occurred in 25 claims (71%). The most common types of damages incurred were nerve injury (23%), functional limitation (20%), and infection (17%). Overall, 27 cases (77%) resulted in a defense verdict. Four cases (11%) resulted in settlements and 4 cases (11%) resulted in plaintiff verdicts. The average inflation-adjusted monetary award in these cases was $1,619,919 (standard deviation, $1,689,452)., Discussion: This study provides a comprehensive summary of malpractice claims and associated outcomes in TSA. Given the rapidly increasing rate of TSA in the United States and the burden of associated malpractice claims, understanding potential legal implications of TSA is of great value to orthopedic surgeons. Intraoperative error was the category of negligence cited most commonly in TSA malpractice claims. Nerve injury, functional limitation, and infection were the most commonly cited specific damages. These findings highlight the need for orthopedic surgeons to educate patients regarding potential postoperative complications while continuing to focus on minimizing their occurrence., (Copyright © 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: The 5-factor modified frailty index (mFI-5) has been shown to be a concise and effective tool for predicting adverse events following various spine procedures. However, there have been no studies assessing its utility in patients undergoing anterior lumbar interbody fusion (ALIF). Therefore, the aim of this study was to analyze the predictive capabilities of the mFI-5 for 30-day postoperative adverse events following elective ALIF., Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried from 2010 through 2019 to identify patients who underwent elective ALIF using Current Procedural Terminology (CPT) codes in patients over the age of 50. The mFI-5 score was calculated using variables for hypertension, congestive heart failure, comorbid diabetes, chronic obstructive pulmonary disease, and partially or fully dependent functional status which were each assigned 1 point. Univariate analysis and multivariate logistic regression models were utilized to identify the associations between mFI-5 scores, and 30-day rates of overall complications, readmissions, reoperations, and mortality., Results: 11,711 patients were included (mFI-5=0: 4,026 patients, mFI-5=1: 5,392, mFI-5=2: 2,102, mFI-5=3+: 187. Multivariate logistic regression revealed that mFI-5 scores of 1 (OR: 2.2, CI: 1.2-4.2, p=0.02), 2 (OR: 3.6, CI: 1.8-7.3, p<0.001), and 3+ (OR: 7.0, CI: 2.5-19.3, p<0.001) versus a score of 0 were significant predictors of pneumonia. An mFI-5 score of 2 (OR: 1.3; CI: 1.01-1.6, p=0.04), and 3+ (OR: 1.9; CI: 1.1-3.1; p=0.01) were both independent predictors of related readmissions. An mFI score of 3+ was an independent predictor of any complication (OR: 1.5, CI: 1.01-2.2, p=0.004), UTI (OR: 2.4, CI: 1.1-5.2, p=0.02), and unplanned intubation (OR: 4.5, CI: 1.3-16.1, p=0.02)., Conclusions: The mFI-5 is an independent predictor for 30-day postoperative complications, readmissions, UTI, pneumonia, and unplanned intubations following elective ALIF surgery in adults over the age of 50., Competing Interests: One or more of the authors declare financial or professional relationships on ICMJE-NASSJ disclosure forms. None of these are applicable to the current study. For the remaining authors, none were declared.

Background and Aims: The mechanism of action of anti-tumour necrosis factor [anti-TNF] agents could implicate macrophage modulation in Crohn's disease [CD]. As CD macrophages are defective in controlling CD-associated adherent-invasive Escherichia coli [AIEC], anti-TNF agents could limit AIEC replication within macrophages. We assessed the effect of anti-TNF agents on AIEC survival within monocyte-derived macrophages [MDMs] from CD patients and attempted to identify the proteins involved., Methods: Peripheral blood MDMs were obtained from 44 CD patients [22 with and 22 without anti-TNF agents]. MDMs were infected with reference strain AIEC-LF82. Proteomic analysis was performed before and 6 h after AIEC-LF82 infection., Results: AIEC-LF82 survival was lower in MDMs from CD patients receiving anti-TNF agents compared to those who did not [-73%, p = 0.006]. After AIEC-LF82 infection, the levels of CD82 [p = 0.007], ILF3 [Interleukin enhancer-binding factor 3; p = 0.001], FLOT-1 [Flotillin-1; p = 0.007] and CHI3L1 [Chitinase 3-like 1; p = 0.035] proteins were different within CD-MDMs depending on anti-TNF exposure. FLOT-1 [ϱ = -0.44; p = 0.038] and CHI3L1 [ϱ = 0.57, p = 0.006] levels were inversely and positively correlated with AIEC survival within MDMs from CD patients with or without anti-TNF, respectively. We observed a dose-dependent decrease of AIEC-LF82 survival after adjunction of anti-TNF within MDMs, inducing an increase of FLOT-1 and decrease of CHI3L1 mRNA levels. Neutralization of intra-macrophagic CHI3L1 protein using anti-CHI3L1 antibodies reduced AIEC survival within macrophages 6 h after infection [p < 0.05]., Conclusion: Anti-TNF agents are able to restrict replication of pathobionts, such as AIEC, within macrophages by modulating FLOT-1 and CHI3L1 expression in CD patients., (© The Author(s) 2022. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

While the confinement assembly of block copolymers into functional microparticles has been extensively studied, little is known about the behavior of Janus nanoparticles (JNPs) in spherical confinement. Here, the confinement self-assembly of JNPs in drying emulsion droplets is investigated and their behavior compared to their ABC triblock terpolymer precursors. Emulsions of both materials are prepared using Shirasu Porous Glass membranes leading to narrow size distributions of the microparticles with average hydrodynamic radii in the range of R h  = 250-500 nm (depending on the membrane pore radius, R pore ). The internal structure of the microparticles is verified with transmission electron microscopy (TEM) on ultrathin cross sections and compared to the corresponding bulk morphologies. While the confinement assembly of terpolymers results in microparticles with ordered inner morphologies, order for JNPs diminishes when the Janus balance deviates from parity., (© 2022 The Authors. Macromolecular Rapid Communications published by Wiley-VCH GmbH.)

Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is an established technique for the treatment of degenerative spine disease. The larger body habitus of obese patients increases the intraoperative complexity of MI-TLIF. Therefore, it is unclear whether this procedure is appropriate for this population. The goal of this study was to compare postoperative outcomes for obese patients vs nonobese patients undergoing MI-TLIF through a matched cohort analysis. A retrospective review was performed to identify patients who underwent MI-TLIF at a single institution with a minimum follow-up of 5 years. Patients were divided into 2 cohorts: nonobese (body mass index <30 kg/m 2 ) and obese (body mass index ≥30 kg/m 2 ). Each cohort was matched for age, sex, and levels operated. Perioperative data and patient-reported outcomes were compared. Radiographic outcomes were measured at final follow-up. Standard binomial and categorical comparative analyses were performed. A total of 148 patients were included. Of obese patients, 17.6% required revision surgery compared with 16.2% of nonobese patients ( P =.826). Both cohorts had a similar proportion of pelvic incidence-lumbar lordosis mismatch correction ( P =.780). Mean change in functional outcome scores for each cohort did not differ significantly. Obese patients had clinically minor but statistically significantly greater blood loss and longer operative times than nonobese patients ( P <.001). Obese and non-obese patients undergoing MI-TLIF showed no long-term differences in revision rate, radiologic outcome, or functional outcome after long-term follow-up. Obese patients had slightly greater blood loss and longer operative times. Our findings suggest that MI-TLIF is an appropriate alternative to traditional open lumbar fusion for obese patients. [ Orthopedics . 2022;45(4):203-208.].

Study Design: Retrospective cohort study., Objective: To compare minimally invasive posterior cervical foraminotomy (MI-PCF) and anterior cervical discectomy and fusion (ACDF) in the treatment of unilateral cervical radiculopathy., Summary of Background Data: MI-PCF has been shown to be equally effective as ACDF in treating cervical radiculopathy due to foraminal stenosis and similar pathologies. Additionally, it has been hypothesized that preserving motion and avoiding fusion reduces risk for adjacent segment disease, but potentially increases risk for subsequent revision to an ACDF. With similar short-term outcomes and substantial advantages, MI-PCF may be an effective alternative to ACDF for addressing appropriate cervical pathology., Methods: A retrospective review was performed to identify patients between 2009 and 2013 who underwent ACDF or MI-PCF with a minimum follow-up of 7 years. Demographic data was recorded. Revision rates and average time to revision between cohorts were compared. Clinical outcomes were assessed at each follow-up visit with Neck Disability Index and Visual Analog Scale for neck and Visual Analog Scale for arm pain scores. All complications were reviewed. Standard binomial and categorical comparative analysis were performed., Results: A total of 251 consecutive patients were included (205 ACDF, 46 MI-PCF). Mean follow-ups for the ACDF and MI-PCF groups were 98.3 and 95.9 months, respectively. Complication rates were 2.9% and 2.2% for the ACDF and MI-PCF cohorts, respectively (P = 0.779). Revision rates were 7.8% for the ACDF cohort and 8.7% for the MI-PCF cohort (P = 0.840). Both cohorts experienced significant improvements in their clinical scores compared with their preoperative values. Final Visual Analog Scale for neck pain (ACDF: 2.6; MI-PCF: 1.6) and Visual Analog Scale for arm pain (ACDF: 1.1; MI-PCF: 0.4) scores differed significantly at final follow-up (P =  < 0.001; P =  < 0.001)., Conclusion: MI-PCF is a safe and effective alternative to ACDF in the treatment of cervical radiculopathy, demonstrating substantial benefit. After final follow-up, MI-PCF demonstrated superior improvements in Visual Analog Scale scores, without increased complication or revision rates.Level of Evidence: 3., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Long posterior cervical decompression and fusion (PCF) is commonly performed to surgically treat patients with multilevel cervical pathology. In cases in which constructs may necessitate crossing the cervicothoracic junction (CTJ), recommendations for appropriate caudal fusion level vary in the literature. The aim of this study was to report the clinical and radiological outcomes of multilevel PCFs ending at C7 versus those crossing the CTJ., Methods: A systematic search of PubMed, CINAHL Plus, and Scopus was conducted to identify articles that evaluated clinical and radiological outcomes of long PCFs that ended at C7 (cervical group) or crossed the CTJ (thoracic group). Based on heterogeneity, random-effects models of a meta-analysis were used to estimate the pooled estimates and the 95% confidence intervals., Results: PCF outcome data of 1120 patients from 10 published studies were included. Compared with the cervical group, the thoracic group experienced greater mean blood loss (453.0 ml [95% CI 333.6-572.5 ml] vs 303.5 ml [95% CI 203.4-403.6 ml]), longer operative times (235.5 minutes [95% CI 187.7-283.3 minutes] vs 198.5 minutes [95% CI 157.9-239.0 minutes]), and a longer length of stay (6.7 days [95% CI 3.3-10.2 days] vs 6.2 days [95% CI 3.8-8.7 days]); however, these differences were not statistically significant. None of the included studies specifically investigated factors that led to the decision of whether to cross the CTJ. The cervical group had a mean fusion rate of 86% (95% CI 71%-94%) compared with the thoracic group with a rate of 90% (95% CI 81%-95%). Of patients in the cervical group, 17% (95% CI 10%-28%) required revision surgery compared with 7% (95% CI 4%-13%) of those in the thoracic group, but this difference was not statistically significant. The proportion of patients who experienced complications in the cervical group was found to be 28% (95% CI 12%-52%) versus 14% (95% CI 7%-26%) in the thoracic group; however, this difference was not statistically significant. There was no significant difference (no overlap of 95% CIs) in the incidence of adjacent-segment disease, pseudarthrosis, or wound-related complications between groups., Conclusions: This meta-analysis suggests similar clinical and radiographic outcomes in multilevel PCF, regardless of inclusion of the CTJ. The lowest instrumented level did not significantly affect revision rates or complications. The ideal stopping point must be tailored to each patient on an individualized basis.

Given the shift toward value-based healthcare, strategies that decrease risk in commonly performed procedures such as anterior cervical discectomy and fusion (ACDF) are of interest. The objective of this study was to analyze the effect of a two-attending surgeon team on the outcomes of patients undergoing single-level ACDF. A retrospective matched-cohort study of patients undergoing single-level ACDF for degenerative cervical spondylosis, with minimum 2-year follow-up was performed. Patients were subdivided into two cohorts: cases with procedures performed by one attending surgeon assisted by a resident physician and cases with procedures performed by an attending surgeon with another attending surgeon as first-assist. Patients were matched by age, sex, body mass index, smoking status, American Society of Anesthesia grade and Charlson Comorbidity Index. Perioperative data and complications were compared. Standard binomial and categorical comparative analysis were performed. Forty-two patients were included (21 in each group). There were 22 males and 20 females, with a mean age of 47.7 years and mean follow-up of 43.4 months. There were no differences in any demographic variable between groups, indicating successful matching. Cohort B had decreased anesthesia time (114.9 vs. 157.1 minutes, P < 0.001), operative time (58.1 vs. 98.9 minutes, P < 0.001) and blood loss (14.8 vs. 24.3 mL, P = 0.012). There were no significant differences in terms of post-operative complications including dysphagia, wound infection, neurologic or cardiovascular related complications. A two-attending surgeon team significantly reduces anesthesia time, surgical time, and blood loss in single-level ACDF procedures without an increase in complications or a decrease in fusion rates.

The confinement assembly of block copolymers shows great potential regarding the formation of functional microparticles with compartmentalized structure. Although a large variety of block chemistries have already been used, less is known about microdomain degradation, which could lead to mesoporous microparticles with particularly complex morphologies for ABC triblock terpolymers. Here, we report on the formation of triblock terpolymer-based, multicompartment microparticles (MMs) and the selective degradation of domains into mesoporous microparticles. A series of polystyrene- block -polybutadiene- block -poly( L -lactide) (PS- b -PB- b -P L LA, SBL) triblock terpolymers was synthesized by a combination of anionic vinyl and ring-opening polymerization, which were transformed into microparticles through evaporation-induced confinement assembly. Despite different block compositions and the presence of a crystallizable P L LA block, we mainly identified hexagonally packed cylinders with a P L LA core and PB shell embedded in a PS matrix. Emulsions were prepared with Shirasu Porous Glass (SPG) membranes leading to a narrow size distribution of the microparticles and control of the average particle diameter, d ≈ 0.4 µm-1.8 µm. The core-shell cylinders lie parallel to the surface for particle diameters d < 0.5 µm and progressively more perpendicular for larger particles d > 0.8 µm as verified with scanning and transmission electron microscopy and particle cross-sections. Finally, the selective degradation of the P L LA cylinders under basic conditions resulted in mesoporous microparticles with a pronounced surface roughness.

Background Context: Although highlighted in joint arthroplasty studies, long-term outcomes between differing biomaterial composites, such as metal-on-metal (MoM) and metal-on-plastic (MoP) in anterior cervical disc replacement (ACDR) have not been thoroughly investigated., Purpose: The purpose of this study was to evaluate the patient-reported clinical outcomes, overall reoperation rates, complications, and rates of ASD of MoM versus MoP artificial discs in two-level ACDR for the treatment of cervical DDD., Study Design/setting: Meta-analysis and systematic review., Patient Sample: Nine hundred eighty patients (442 MoM, 538 MoP) across seven studies., Outcome Measures: Patient reported clinical outcomes (NDI, VAS-n, VAS-a), overall reoperation rates, complications, and rates of ASD., Methods: A systematic search strategy of three electronic databases (PubMed, CINAHL Plus, and SCOPUS) was conducted utilizing terms related to two-level ACDR. All studies included had a sample size of >10 patients, had a minimum 5-year follow-up, and reported data on adjacent segment disease. Cadaver studies, non-English manuscripts, articles with less than 5-year follow-up and studies in which only single-level ACDR was investigated were excluded. A total of seven studies were included in this analysis. Studies were analyzed for demographic data, clinical outcome scores (NDI, VAS-neck, and VAS-arm), overall reoperation rates, complications, and rates of ASD. A random-effects model of meta-analysis was used for groups that were determined to be heterogenous and a fixed-effects model was utilized for groups that were not. An overlap of 95% confidence intervals suggests no statistically significant difference at the p<.05 level., Results: Seven studies were included with data on 980 patients (442 MoM, 538 MoP). The study population was 52.84% female, with a mean age of 48.01 years, and a mean follow-up of 85.66 months. The mean improvement in NDI was 34.42 (95% CI, 32.49-36.36) and 29.72 (95% CI, 27.15-32.29) for the MoM and MoP groups, respectively. The mean improvement in VAS-neck was 11.20 (95% CI, 10.69-11.70) and 8.78 (95% CI, 7.81-9.74) for the MoM and MoP groups, respectively. The mean improvement in VAS-arm was 10.73 (95% CI, 9.83-11.63) and 8.49 (95% CI, 7.59-9.39) for the MoM and MoP groups, respectively. 3.85% (95% CI, 2.40-6.10) of patients who underwent ACDR with a MoM implant required reoperation compared to 5.33% (95% CI, 3.68-7.65) of patients with a MoP implant. Heterotopic ossification and dysphagia were the most common complications in both groups. The MoM cohort showed a higher incidence of HO (72.62% vs. 21.07%), but a lower incidence of dysphagia (0.96% vs. 16.31%) compared to the MoP cohort. The MoM cohort had a larger proportion of patients with ASD who underwent subsequent surgery at an adjacent level (7.89% MoM versus 1.91% MoP)., Conclusions: Our present meta-analysis suggests that the use of MoM artificial discs in two-level ACDR results in superior clinical outcome score improvement, but higher rates of ASD requiring secondary surgery compared to MoP discs after a follow-up period of 5 years or more., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background Context: Obese patients can pose significant challenges to spine surgeons in lumbar fusion procedures. The increased risk of complications has led surgeons to be wary in pursing operative interventions in these patients. Since the advent of minimally-invasive techniques in lumbar fusion, surgeons are turning to these procedures in an attempt to minimize operative time, blood loss and overall cost. With an increased proportion of obese patients in the population, it is imperative to understand the long-term outcomes in these minimally-invasive approaches., Purpose: The purpose of this study was to evaluate the long-term safety and efficacy of extreme lateral interbody fusion (XLIF) in the obese., Study Design/setting: Retrospective cohort study., Patient Sample: A total of 115 patients (53 nonobese and 62 obese) who underwent XLIF with a minimum of 5-year follow-up., Outcome Measures: (1) Patient reported outcome scores: Visual Analog Scale (VAS) for back pain, Oswestry Disability Index (ODI), (2) Reoperation rate, (3) Pelvic incidence (PI)- Lumbar lordosis (LL) mismatch correction, (4) Graft subsidence and fusion rate METHODS: A retrospective review was performed to identify patients who underwent XLIF with percutaneous posterior stabilization since 2007 with a minimum follow-up of 5 years. Demographics including BMI were recorded and patients were subdivided into 2 cohorts: nonobese (BMI <30 kg/m 2 ) and obese (BMI ≥30 kg/m 2 ). Functional outcomes were assessed by comparing pre- and postoperative VAS and ODI scores. Reoperation rates were compared between cohorts. PI-LL mismatch was calculated from both pre- and postoperative radiographs. Rates of graft subsidence and fusion were measured at final follow-up., Results: A total of 115 consecutive patients were included (53 nonobese and 62 obese) with a mean follow up of 95.3 months. Mean BMI was 25.3 in the nonobese group and 35.3 in the obese group (p<.001). There were more females in nonobese cohort. VAS scores decreased by a mean of 5.7 in the nonobese cohort, and 5.4 in the obese cohort (p=.213). ODI improvement was also similar between the groups. 5.6% of nonobese patients required reoperation compared to 9.6% of obese patients (p=.503). Graft subsidence rates at final follow-up were 5.66% and 8.06% for the nonobese and obese groups, respectively (p=.613). Rates of successful fusion were 96.23% and 98.39% for the nonobese and obese groups, respectively (p=.469). Both cohorts achieved a similar proportion of PI-LL mismatch correction, 85% in obese versus 78% in nonobese patients (p=.526)., Conclusion: Obese patients have similar surgical outcomes to nonobese patients with respect to functional outcome scores, reoperation rates, graft subsidence and correction of PI-LL mismatch after long-term follow-up. With similar outcome and reoperation profiles, minimally-invasive approaches to the spine, such as XLIF, may be an acceptable alternative to traditional open procedures in obese patients., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The internet is increasingly used to access patient education materials. The average American reading level has been found to be that of a 7th- to 8th-grade student, prompting the National Institutes of Health (NIH) and the American Medical Association (AMA) to advise that patient education materials be written between the 4th- to 6th-grade reading level. The purpose of this study was to evaluate the reading level of current patient education materials for the most common musculoskeletal oncological tumors. A Google search was performed with all location filters off to account for geographic variability for patient education materials related to 28 orthopedic primary or secondary tumors. All patient education articles from the first 10 website hits for each tumor type were analyzed. Patient education materials from these websites were evaluated using 8 validated readability scales. Patient resources were found to be written at an average grade level nearly double the NIH and AMA recommendation. Patient education materials for soft tissue chondromas were written at the highest level (14.8±1.9), whereas education materials for chordomas (10.1±1.0) most closely approached national recommendations, despite still being written at a readability level nearly 4 grade levels higher than has been recommended. The Flesch Reading Ease assessment provided a mean score of 46.5±7.7, corresponding with a "difficult to read" result. Current patient education materials regarding oncological musculoskeletal-related patient education materials are written significantly above the recommended reading level. Further modification of these resources is warranted to ensure adequate comprehension and informed decision making in the clinical setting. [Orthopedics. 2021;44(1):38-42.]., (Copyright 2020, SLACK Incorporated.)

Due to electronic residency applications, US Medical Licensing Examination Step 1 scores are frequently used by orthopedic surgery program directors to screen applicants. Prospective applicants therefore often use Step 1 scores as a proxy for specialty competitiveness. The goal of this investigation was two-fold: (1) to determine whether trends in Step 1 scores are indicative of trends in competitiveness of orthopedic surgery and (2) to report the characteristics that optimize a US medical student's match success. A retrospective review of published National Resident Matching Program data from 2009 to 2018 was performed for orthopedic surgery residency applicants. Additional data from the Charting Outcomes reports were used for specific analyses of applicant characteristics. From 2009 to 2018, the number of orthopedic surgery residency positions grew at an annual rate of 1.51% (95% confidence interval [CI], 1.37% to 1.64%; P<.001), accommodating the 1.26% (95% CI, 0.63% to 1.90%; P=.006) annual increase in the number of applicants who ranked orthopedic surgery as their preferred specialty choice (only choice or first choice). There were no significant changes in the applicant-to-position ratio (95% CI, -0.85% to 0.37%; P=.483) or the match rate for US seniors who ranked orthopedic surgery as their preferred choice (95% CI, -0.23% to 0.87%; P=.313). Increases in mean Step 1 scores of matched orthopedic surgery applicants parallel national Step 1 growth trends (0.49% vs 0.44%, respectively). Although orthopedic surgery is currently a competitive specialty to match into, this has been the case since 2009. Increasing Step 1 scores of matched applicants is not unique to orthopedic surgery and should not be misinterpreted as a proxy for increasing competitiveness of the specialty. [Orthopedics. 2020;43(6):e616-e622.]., (Copyright 2020, SLACK Incorporated.)

In France, antiretroviral (ARV) treatment can be dispensed by hospital and/or community pharmacies. Since January 2016, an online patient medication file can be used to optimize dispensing, but medication interviews have not yet been incorporated into this system. To understand both people living with HIV (PLHIV) and their pharmacists' habits and expectations of patient medication file and interviews, two consecutive national surveys were organized. The first one, carried out in October 2016 in care centers, was an anonymous questionnaire for PLHIV. The second one was an online survey for community and hospital pharmacies conducted in February 2017. A total of 1137 PLHIV (68% men, of mean age 50.2 ± 11.5 years, CD4 count 671 ± 354, 90% with undetectable HIV viral load (VL) and 64.2% reporting comorbidities) and 246 pharmacies responded. While the existence of the online medication file is known by 58% of PLHIV, only 40% of pharmacists declare it to be systematically offered. It was offered to 120/694 (17%) PLHIV and 96 (80%) accepted it. Currently, 78 (7%) PLHIV feel well taken care of because they are offered medication interviews, 343/1078 (32%) would like to take advantage of this program, mainly those with a shorter ARV duration (OR ARV duration 0.97 [0.95-0.99]), a VL less often undetectable (OR undetectable VL 0.55 [0.31-0.98]), and those who feel anxious more often (OR anxious 2.38 [1.48-3.84]). These results suggest that better implementation of medication files and interviews will strengthen current clinical pathways., (© 2020 The Authors. Pharmacology Research & Perspectives published by British Pharmacological Society and American Society for Pharmacology and Experimental Therapeutics and John Wiley & Sons Ltd.)

Catalysis is one of the most important processes in nature, science, and technology, that enables the energy efficient synthesis of essential organic compounds, pharmaceutically active substances, and molecular energy sources. In nature, catalytic reactions typically occur in aqueous environments involving multiple catalytic sites. To prevent the deactivation of catalysts in water or avoid unwanted cross-reactions, catalysts are often site-isolated in nanopockets or separately stored in compartments. These concepts have inspired the design of a range of synthetic nanoreactors that allow otherwise unfeasible catalytic reactions in aqueous environments. Since the field of nanoreactors is evolving rapidly, we here summarize-from a personal perspective-prominent and recent examples for polymer nanoreactors with emphasis on their synthesis and their ability to catalyze reactions in dispersion. Examples comprise the incorporation of catalytic sites into hydrophobic nanodomains of single chain polymer nanoparticles, molecular polymer nanoparticles, and block copolymer micelles and vesicles. We focus on catalytic reactions mediated by transition metal and organocatalysts, and the separate storage of multiple catalysts for one-pot cascade reactions. Efforts devoted to the field of nanoreactors are relevant for catalytic chemistry and nanotechnology, as well as the synthesis of pharmaceutical and natural compounds. Optimized nanoreactors will aid in the development of more potent catalytic systems for green and fast reaction sequences contributing to sustainable chemistry by reducing waste of solvents, reagents, and energy.

Objective(s): To describe the clinical, virological and immune characteristics of internationally adopted children on arrival in France and after 6-months follow-up., Design: Multicenter retrospective study., Methods: 30 centers from 24 cities were asked to include, after informed consent, HIV+ children living in France and internationally adopted between 1st Jan 2005 and 1st Jan 2015. Sociodemographic, medical and biological variables collected during the first medical evaluation in France and 6 months later were analyzed., Results: 41 HIV+ adoptees were included (female: 56%; median age: 3.91 years) in 14 centers. Adoptees tend to represent an increasing part of newly diagnosed HIV positive children over the years. The majority came from East-Asia. At arrival, one child was diagnosed with lymphobronchial tuberculosis and three with latent chronic hepatitis B, cleared HBV infection and chronic active hepatitis C, respectively. The mean CD4% was 32.8 ± 9% (range: 13-49%). The 34 children (83%) have been initiated on treatment from their countries of origin. Of these, 25 (74%) had an undetectable viral load (VL) on arrival. Resistance to ART was detected in five. At 6 months, 36 adoptees received ART, and the VL was undetectable in 29 children (71%), with one acquired resistance to NRTI & NNRTI., Conclusions: An increasing number of HIV-infected children have been internationally adopted in France since 2005. Most of the children have been initiated on treatment from their countries of origin, had good immunity, with few opportunistic infections, and infrequently detectable VL. Low level of mutation conferring resistance was detected., Competing Interests: The authors have declared that no competing interests exist.

A recent study that evaluated the risk of facing a malpractice claim by physician specialty found that orthopedic surgeons were at a significantly greater risk of being sued than other medical specialists. To date, no studies have characterized trends in orthopedic surgery malpractice claims. The Westlaw legal database was used to locate state and federal jury verdicts and settlements related to medical malpractice and orthopedic surgery from 2010 to 2016. Eighty-one cases were analyzed. The mean age of the affected patients and/or plaintiffs was 53.4 years. Spine surgery (21 cases; 25.9%), knee surgery (17 cases; 21.0%), and hip surgery (11 cases; 13.6%) were litigated most often. Procedural error (71 cases; 87.7%) and negligence (58 cases; 71.6%) were the 2 most commonly cited reasons for litigation. The jury found in favor of the defendant in most (50 cases; 61.7%) of the cases. The mean plaintiff (17 cases; 21.0%) verdict payout was $3,015,872, and the mean settlement (13 cases; 16.0%) value was $1,570,833. Unnecessary surgery (odds ratio [OR], 12.29; 95% confidence interval [CI], 1.91-108.46; P=.040) and surgery resulting in death (OR, 26.26; 95% CI, 2.55-497.42; P=.040) were significant predictors of a verdict in favor of the plaintiff. Patient death (OR, 0.05; 95% CI, 0.01-0.38; P=.021) and male patient sex (OR, 0.26; 95% CI, 0.09-0.71; P=.033) were significant negative predictors of a verdict in favor of the defendant. The jury found in favor of the defendant orthopedic surgeon in most cases. Procedural error and/or negligence were cited most commonly by the plaintiffs as the bases for the claims. Verdicts in favor of the plaintiffs resulted in payouts nearly double those of settlements. [Orthopedics. 2018; 41(5):e615-e620.]., (Copyright 2018, SLACK Incorporated.)

Background: Pentraxin 3 (PTX3) is an acute phase reactant which has been used to detect intra-amniotic infections (IAI) in pregnancy, but the prognostic value of PTX3 concentrations on neonates has not been studied. We aimed to investigate the relationship between maternal PTX3-neonatal PTX3 concentrations and early neonatal outcome., Methods: The mothers diagnosed with preterm prelabor rupture of membranes (PPROM) (n = 28) and their preterm infants (n = 28) were included in the study. PTX3 concentrations were studied in plasma in the maternal peripheral blood and umbilical/peripheral vein in the neonates. The relationship between the mPTX3-nPTX3 concentrations and neonatal outcome were investigated using non-parametric tests and binary logistic regression analysis., Results: The mean mPTX3 concentration was 10.35 ± 7.82 μg/L. Ten (35.7%) of all mothers were within the normal range and 18 (64.3%) in high percentile (≥ 97.5 percentile). There was no relation between mPTX3 concentrations and clinical or histologic chorioamnionitis, latency of PPROM, and early neonatal outcome. Mean nPTX3 concentrations was 9.18 ± 7.83 μg/L and high nPTX3 concentrations were detected in five (17.8%) neonates. nPTX3 concentrations were inversely correlated with gestational age and correlated with rate of intraventricular hemorrhage (IVH) and mortality. Neonates with high nPTX3 concentrations also have lowered APGAR scores, increased rate of respiratory distress syndrome, clinical sepsis, IVH, necrotizing enterocolitis and prolonged NICU stay., Conclusion: High PTX3 concentrations of the newborns are associated with some worsened early neonatal outcome including lower gestational age at delivery, increased rate of IVH and mortality. Maternal PTX3 concentrations are not an adequate marker in defining clinical or histologic chorioamnionitis and early neonatal outcome.

Teratomas originating from the oral cavity are named as epignathus. It is a rare type of teratoma. An 11-day old male newborn was diagnosed with cleft palate and intraoral masses. The mass on the right side was protruding from the mouth. Another one on the left side was extending from the nasopharynx to the oropharynx. The diagnosis of mature teratoma was made based on the histopathological study of surgically excised masses. We desired to report on this case since multiple localized epignatus in a newborn with cleft palate has not been described yet in the literature.

Scope: The aim of the study was to examine the atheroprotective effect of dietary curcumin in a mouse model of atherosclerosis and to identify its cellular and molecular targets at the vascular level., Methods and Results: ApoE(-/-) mice were fed with curcumin at 0.2% (wt/wt) in diet for 4 months. This supplementation reduced the extent of atherosclerotic lesion by 26% and induced changes in expression of genes implicated in cell adhesion and transendothelial migration or cytoskeleton organization, as revealed by a transcriptomic analysis in the aorta. Expression profile of these genes suggests reduction in both leukocyte adhesion and transendothelial migration. In agreement with this hypothesis, we observed a reduction (-37%) in macrophage infiltration in the plaque, as measured by immunohistochemistry, and, in vitro, a lower adhesion of monocytes to TNF-α-stimulated endothelial cells (-32%) after exposure to a nutritionally achievable concentration of curcumin. These changes in gene expression could be related to the observed increased expression of IκB protein and decrease of TNF-α-induced NF-κB/DNA binding and NF-κB-transcriptional activity upon exposure to curcumin., Conclusion: Our findings pointed out that the antiatherogenic effect of curcumin could be linked to its effect on gene networks and cell functions related to leukocyte adhesion and transendothelial migration via NF-κB-dependent pathways., (© 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

There have been several studies confirming an association between maternal smoking during pregnancy and low birth weight. The detrimental effect of nicotine exposure beginning in fetal life continues during lactation, in infancy and in the early childhood period. In our previous studies, we found increased aortic intima-media thickness (aIMT) as a preatherosclerotic lesion in neonates with intrauterine growth restriction and in infants of smoking mothers. We aimed to evaluate histopathologically the effect of nicotine exposure during pregnancy and lactation period on fetal growth and aIMT at postnatal 45 days of age (end of the mid-adolescent period) in rat pups living in the same conditions. Gravid rats were assigned into three groups. In nicotine A, pregnant rats received 6 mg/kg/day nicotine intraperitoneally during pregnancy from 1 to 21 days of gestation and lactation (until postnatal day 21). Nicotine B received 3 mg/kg/day nicotine for the same period. Control pregnant rats received only saline intraperitoneally. Abdominal aIMT was studied histopathologically at postnatal 45 days of age. Nicotine exposure resulted in decreased birth weight and pregnancy weight gain. The mean aIMT values of the rat pups exposed to nicotine in both nicotine A and B groups were higher than those of the control group (103.78 ± 21.33 μm, 99.11 ± 30.12 μm, and 62.56 ± 7.18 μm, respectively). In conclusion, the detrimental effect on birth weight of nicotine exposure that began in fetal life is dose dependent. Nicotine exposure during intrauterine life and the lactation period causes increased aIMT in rat pups.

Vaginal delivery of the macrosomic fetus may result in hemorrhage of intra-abdominal organs. Mostly affected organs are the liver and adrenal glands. Hemorrhage of liver is usually occurs as a subcapsular hemorrhage and it is clinically presented an abdominal mass without symptoms of anemia. But intraparenchymal hemorrhage of liver is very rare and there is no sign of abdominal mass. However, in contrast to subcapsular hemorrhage, symptoms of anemia are rapidly developed in newborns. A macrosomic newborn by vaginal delivery at term. Within 6 h after delivery, the patient showed pallor without tachycardia and hypotension. In laboratory studies, hemoglobin level failed from 14 g/dL to 10 g/dL within 6 h. Physical examination revealed no signs of abdominal mass. Intraparenchymal hemorrhage in the sixth segment of liver and right adrenal hemorrhage were detected on the ultrasonographic scan. Hepatic function tests were normal in the whole follow-up period, and hemorrhage resolved within two weeks. Following months after discharge, adrenal hemorrhage also resolved without any complication. Hepatic hemorrhages, causing hemorrhagic anemia in neonates, usually occur in subcapsular form. Intraparenchymal hepatic hemorrhage should especially be considered in those newborns, which are rapidly developed symptoms of anemia without any abdominal mass.

Familial glucocorticoid deficiency (FGD) or hereditary unresponsiveness to adrenocorticotropin (ACTH) is an autosomal recessive disorder characterized by isolated glucocorticoid deficiency associated with normal mineralocorticoid secretion. Mutations in genes encoding either ACTH receptor or melanocortin 2 receptor accessory protein are responsible for the disease in about 50% of cases, named FGD type 1 and type 2, respectively. Patients may present with hyperpigmentation, recurrent infections, failure to thrive, hypoglycemic seizures, and coma in infancy or early childhood. Here we report the case of a 17-day-old newborn diagnosed with FGD type 1 who presented with hyperbilirubinemia and hyperpigmentation, a sign which was erroneously assumed to be due to prolonged phototherapy by the referring physician. Hormone analysis showed low cortisol and high ACTH levels with normal serum electrolytes and renin-aldosterone axis. Genetic analysis revealed a novel homozygous melanocortin 2 receptor mutation p.Leu225Arg in the patient. The healthy parents were heterozygous for the mutation., (Copyright © 2011 S. Karger AG, Basel.)

Subcutaneous fat necrosis of the newborn (ScFN) is an uncommon condition of neonates and infants. The disorder is caused by generalized and local tissue hypoperfusion. The ScFN tends to improve spontaneously with or without some severe complications such as hypercalcemia. The ScFN may occur as iatrogenic after hypothermic surgical interventions. We present iatrogenic ScFN in a newborn with uncomplicated hypercalcemia due to cold exposure on operating table during at an umbilical cord hernia operation. To our knowledge, this is the first report of a patient in whom ScFN occurred during a commonly performed and relatively short-term "nonhypothermic" operation.

Dandy-Walker malformation is characterized by cystic dilatation of the fourth ventricle and an enlarged posterior cranial fossa with upward displacement of the tentorium, lateral sinuses, and torcular, with agenesis or hypoplasia of the cerebellar vermis. Dandy-Walker malformation occurs in approximately the 4th week of gestation and is associated with various abnormalities involving the cardiac, skeletal, genitourinary, and gastrointestinal systems. The parathyroid gland also forms in the 3rd and 4th gestational weeks. Reported here is the case of a male infant with Dandy-Walker malformation with ventricular and atrial septal defect, unilateral renal agenesis, and hypoparathyroidism. To our knowledge, this rare association with neural crest events during the development of Dandy-Walker malformation has not been reported previously., (Crown Copyright © 2010. Published by Elsevier Inc. All rights reserved.)