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Background Restoration of external (ER) and internal rotation (IR) after Grammont-style reverse shoulder arthroplasty (RSA) is often unreliable. The purpose of this systematic review was to evaluate the influence of RSA medio-lateral offset and subscapularis repair on axial rotation after RSA. Methods We conducted a systematic review of studies evaluating axial rotation (ER, IR, or both) after RSA with a defined implant design. Medio-lateral implant classification was adopted from Werthel et al. Meta-analysis was conducted using a random-effects model. Results Thirty-two studies reporting 2,233 RSAs were included (mean patient age, 72.5 years; follow-up, 43 months; 64% female). The subscapularis was repaired in 91% (n=2,032) of shoulders and did not differ based on global implant lateralization (91% for both, P=0.602). On meta-analysis, globally lateralized implants achieved greater postoperative ER (40° [36°–44°] vs. 27° [22°–32°], P

Introduction Spinal cord injury (SCI) leads to significant changes in morbidity, mortality and quality of life (QOL). Currently, there are no effective therapies to restore function after chronic SCI. Preliminary studies have indicated that epidural spinal cord stimulation (eSCS) is a promising therapy to improve motor control and autonomic function for patients with chronic SCI. The aim of this study is to assess the effects of tonic eSCS after chronic SCI on quantitative outcomes of volitional movement and cardiovascular function. Our secondary objective is to optimise spinal cord stimulation parameters for volitional movement.Methods and analysis The Epidural Stimulation After Neurologic Damage (ESTAND) trial is a phase II single-site self-controlled trial of epidural stimulation with the goal of restoring volitional movement and autonomic function after motor complete SCI. Participants undergo epidural stimulator implantation and are followed up over 15 months while completing at-home, mobile application-based movement testing. The primary outcome measure integrates quantity of volitional movement and similarity to normal controls using the volitional response index (VRI) and the modified Brain Motor Control Assessment. The mobile application is a custom-designed platform to support participant response and a kinematic task to optimise the settings for each participant. The application optimises stimulation settings by evaluating the parameter space using movement data collected from the tablet application and accelerometers. A subgroup of participants with cardiovascular dysautonomia are included for optimisation of blood pressure stabilisation. Indirect effects of stimulation on cardiovascular function, pain, sexual function, bowel/bladder, QOL and psychiatric measures are analysed to assess generalisability of this targeted intervention.Ethics and dissemination This study has been approved after full review by the Minneapolis Medical Research Foundation Institutional Review Board and by the Minneapolis VA Health Care System. This project has received Food and Drug Administration investigational device exemption approval. Trial results will be disseminated through peer-reviewed publications, conference presentations and seminars.Trial registration number NCT03026816.

Background: Current treatment of a trapped temporal horn consists primarily of ventriculo-peritoneal (VP) shunting. Objective: As a less invasive alternative, we examined an endoscopic-stereotactic approach to connect the trapped temporal horn with the prepontine cistern. Methods: Six patients with different etiology of entrapment were studied. Using frame-based stereotaxy, image fusion and endoscopy a Rickham catheter was placed connecting both compartments. Results: After median follow-up of 22.1 ± 7.8 months all patients improved symptomatically and the size of the temporal horn was normalized. No morbidity was encountered. Conclusion: Endoscopic-stereotactic internal shunting of trapped temporal horns into the prepontine cistern can be done with favorable risk profile, and it offers an elegant alternative to traditional VP shunting, by avoiding the inherent complications.

Background: Chronic spinal cord injury (SCI) portends a low probability of recovery, especially in the most severe subset of motor-complete injuries. Active spinal cord stimulation with or without intensive locomotor training has been reported to restore movement after traumatic SCI. Only three cases have been reported where participants developed restored volitional movement with active stimulation turned off after a period of chronic stimulation and only after intensive rehabilitation with locomotor training. It is unknown whether restoration of movement without stimulation is possible after stimulation alone.Objective: We describe the development of spontaneous volitional movement (SVM) without active stimulation in a subset of participants in the Epidural Stimulation After Neurologic Damage (ESTAND) trial, in which locomotor training is not prescribed as part of the study protocol, and subject’s rehabilitation therapies are not modified.Methods: Volitional movement was evaluated with the Brain Motor Control Assessment using sEMG recordings and visual examination at baseline and at follow-up visits with and without stimulation. Additional functional assessment with a motor-assisted bicycle exercise at follow-up with and without stimulation identified generated work with and without effort.Results: The first seven participants had ASIA Impairment Scale (AIS) A or B thoracic SCI, a mean age of 42 years, and 7.7 years post-injury on average. Four patients developed evidence of sustained volitional movement, even in the absence of active stimulation after undergoing chronic epidural spinal cord stimulation (eSCS). Significant increases in volitional power were found between those observed to spontaneously move without stimulation and those unable (p < 0.0005). The likelihood of recovery of spontaneous volitional control was correlated with spasticity scores prior to the start of eSCS therapy (p = 0.048). Volitional power progressively improved over time (p = 0.016). Additionally, cycling was possible without stimulation (p < 0.005).Conclusion: While some SVM after eSCS has been reported in the literature, this study demonstrates sustained restoration without active stimulation after long-term eSCS stimulation in chronic and complete SCI in a subset of participants. This finding supports previous studies suggesting that “complete” SCI is likely not as common as previously believed, if it exists at all in the absence of transection and that preserved pathways are substrates for eSCS-mediated recovery in clinically motor-complete SCI.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03026816.

When you are planning your experiment how many of you think of the climate and whether it matches the period that your experiment is based in? Depending on the type of experiment there are many factors that may influence the results. You need to consider parameters such as; humidity, ambient temperature, how effective your clothes are, burning the right firewood, keeping a shelter warm, or the quality of the grass that your animals are living on.

Background. Transesophageal echocardiogram (TEE) is a valuable tool in healthcare today with its ease of use, ability to visualize important structures not seen on transthoracic echocardiogram (TTE), and the relatively lower cost of TEE, high yield, and no significant radiation exposure. The American Society of Echocardiography (ASE) has developed an appropriate use criteria for use of TTE and TEE, which outline various scenarios where a TEE is indicated as an initial diagnostic testing modality and when it is useful as an adjunctive test in hopes of decreasing inappropriate use. Using these criteria as a guide, we devised a quality assessment study to investigate how well TEEs performed at our institution fit the appropriate use criteria specifically for the diagnostic workup of infective endocarditis. Methods. A retrospective chart review was performed for all TEEs performed in 2017 with the indication of endocarditis. Baseline patient characteristics, presence of bacteremia, and the quality of the TTE preceding the TEE were noted, as well as whether a vegetation, abscess, or perforation was visualized. We also determined if there was a cardiology consultation placed prior to TEE and if the patient had met the definition for endocarditis as defined by the Duke criteria. Finally, we made note of the TEE findings and assessed whether the TEE met appropriate use criteria developed by the American Society of Echocardiography. Results. A total of 50 patients who underwent TEE with the indication of “endocarditis” were identified. 36% of the TTEs prior to the TEE were rated as good quality, 40% as adequate, 4% as fair, 4% as suboptimal, 12% as technically difficult, and 4% were not rated. Vegetations were visualized on 12% of TTEs, 6% of patients had a prosthetic valve, and 6% had a cardiac device. In 20% of the cases, there was no cardiology consultation prior to the TEE and in 20% of the cases, there was no documented bacteremia. 26% of patients met the Duke criteria for endocarditis prior to TEE. Only 36% of TEEs revealed evidence of infection and of the patients with no evidence of infection, only 38% met appropriate use criteria. Overall, only 56% of patients met appropriate use criteria for TEE. Conclusion. Transesophageal echocardiography is a valuable tool in a modern physician’s arsenal for managing a variety of diseases and conditions. However, the procedure is not without associated risks and its ease of use and widespread adoption has led to frequent questionable appropriateness of use of the test. Only 56% of the TEEs performed in our analysis met appropriate use. More awareness and education is needed for the appropriate use criteria for transesophageal echocardiography as outlined by the ASE to help reduce patient exposure to procedure related complications and to decrease medical costs on unnecessary procedures.

We prove that the standard double bubble is the least-area way to enclose and separate two regions of equal volume in ℍ3, and in S3 when the exterior is at least ten percent of S3.

α-synuclein dysregulation is a critical aspect of Parkinson's disease pathology. Recent studies have observed that α-synuclein aggregates are cytotoxic to cells in culture and that this toxicity can be spread between cells. However, the molecular mechanisms governing this cytotoxicity and spread are poorly characterized. Recent studies of viruses and bacteria, which achieve their cytoplasmic entry by rupturing intracellular vesicles, have utilized the redistribution of galectin proteins as a tool to measure vesicle rupture by these organisms. Using this approach, we demonstrate that α-synuclein aggregates can induce the rupture of lysosomes following their endocytosis in neuronal cell lines. This rupture can be induced by the addition of α-synuclein aggregates directly into cells as well as by cell-to-cell transfer of α-synuclein. We also observe that lysosomal rupture by α-synuclein induces a cathepsin B dependent increase in reactive oxygen species (ROS) in target cells. Finally, we observe that α-synuclein aggregates can induce inflammasome activation in THP-1 cells. Lysosomal rupture is known to induce mitochondrial dysfunction and inflammation, both of which are well established aspects of Parkinson's disease, thus connecting these aspects of Parkinson's disease to the propagation of α-synuclein pathology in cells.

Catalyzed by the #MeToo movement, states have adopted a spate of laws restricting secret settlements--controversial contracts that shield misconduct from public scrutiny. In 2018, California led the charge with the Stand Together Against Non-Disclosure (STAND) Act, which targets secrecy in the resolution of sex discrimination, harassment, and abuse cases. In the intervening years, more than a dozen states followed suit with restrictions of their own. Reigniting a decades-old debate, transparency advocates hail these reforms as a major win for victims. They celebrate STAND and its legislative progeny as a way to promote accountability, facilitate accuracy in case adjudication, and publicize (and thus deter) abuse. Critics, meanwhile, warn that the reforms will hurt those they intend to help. By reducing defendants' incentive to settle, confidentiality bans will undercut victims' negotiating leverage, depress settlement sums, clog courts, and, perhaps worst of all, discourage victims from coming forward in the first place. Nested within this debate sits a raft of confident, conflicting--and also eminently testable--claims about what exactly happens in the wake of reform. Will defendants still settle, even if secrecy isn't on offer? How do anti-secrecy reforms actually We do. Analyzing more than a quarter-million case filings from the Los Angeles County Superior Court and deploying a mix of quantitative and qualitative empirical methods, including advanced machine-learning techniques and in-depth interviews with two dozen practitioners, we explore litigation patterns before and after STAND took effect. Our findings tell a clear and consequential story. Contrary to critics' fears, the STAND Act did not yield a sharp increase or decrease in case filings. Nor did the Act appear to significantly prolong cases or amplify their intensity. The upshot: cases still settle even when secrecy isn't on offer. Further, and though our evidence is more tentative, interviews with employment attorneys indicate that STAND does not even seem to have depressed settlement sums. Finally, and perhaps most importantly, it appears that positive effects did come to pass. Unlocking what we call a "liberation effect," it appears that the STAND Act has improved the lives of many assault and harassment survivors, freeing them from the long shadow of an oppressive nondisclosure agreement. Taken together, these findings ought to reboot and recast the long-simmering debate about secret settlements, in California and beyond. alter the litigation landscape? Will case filings disappear? Or will they spike and drag on, as litigation turns scorched-earth? Debate over these questions has raged since the 1980s; the #MeToo movement only unleashed its modern incarnation. And, over these decades, the debate has always centered on fervent predictions regarding each. Yet no one has meaningfully tested them. [ABSTRACT FROM AUTHOR]

Government use of artificial intelligence ("AI") to make, implement, and enforce law is fueling anxieties among a growing cast of critics. Some are accelerations of concerns raised by other technology adoptions: error, bias, gaming, and the oversight challenges that come with reliance on procurement. Others are more AI-specific: the power of machine learning and big data to draw privacy-violating inferences, or AI's "black box" opacity and inability to engage in democratic reason-giving. The reforms AI's critics demand in response range from the sharp and specific (e.g., outright prohibitions and full-blown, Food and Drug Administration-like licensure) to the gauzy and unproven (e.g., calls to "democratize AI" via participatory design or impact assessments). This Essay sketches an alternative, "realist" view in three parts. First, policymakers are unlikely to enact the bespoke new regulation of the sort critics are demanding because of AI's twin capacity to cause and cure error, bias, and inequity. For every horror story there will be a success story--a way new tech makes government's work more efficient, accurate, rule-of-law-respecting, and equitable. Second, public law has always been radically limited in reach relative to critics' demands. Indeed, even progressive commentators have long warned that the problem with government may not be too little transparency, but too much, and new procedural burdens, however well-meaning, can stultify a government that already lacks vigor. A final insight follows: the urgent task ahead may be both more pedestrian and more ambitious than AI's critics suggest. Indeed, if algorithmic accountability will be litigated rather than legislated, then efforts should focus more than they have on legal adaptation--that is, the tailoring of existing legal frameworks, particularly ordinary administrative law, to the government's new algorithmic toolkit. Wise adaptation, not the blue-sky regulatory overhauls that occupy much of the scholarly literature, should be the order of the day. This Essay makes a start down that road. [ABSTRACT FROM AUTHOR]