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BackgroundHemostatic benefits of platelet transfusions in thienopyridine-treated acute coronary syndrome (ACS) patients may be compromised by residual metabolite in circulation.ObjectivesTo estimate the earliest time after a prasugrel loading-dose when added platelets are no longer inhibited by prasugrel's active metabolite.MethodsBaseline platelet reactivity of healthy subjects (n=25, 30 ± 5 years, 68% male) on ASA 325 mg was tested using maximum platelet aggregation (MPA, ADP 20 μm) and VerifyNow(®) P2Y12 and was followed by a 60 mg prasugrel loading-dose. At 2, 6, 12 and 24 h post-dose, fresh concentrated platelets from untreated donors were added ex-vivo to subjects' blood, raising platelet counts by 0% (control), 40%, 60% and 80%. To estimate the earliest time when prasugrel's active metabolite's inhibitory effect on the added platelets ceases, platelet function in supplemented samples was compared across time-points to identify the time when effect of supplementation on platelet function stabilized (i.e. the increase in platelet reactivity was statistically similar to that at the next time-point).ResultsSupplemented samples showed concentration-dependent increases in platelet reactivity vs. respective controls by both MPA and VerifyNow(®) at all assessment time-points. For each supplementation level, platelet reactivity showed a sharp increase from 2 to 6 h but was stable (P=NS) between 6 and 12 h.ConclusionsThe earliest measured time when supplemented platelets were not inhibited by circulating active metabolite of prasugrel was 6 h after a prasugrel loading-dose. These findings may have important implications for prasugrel-treated ACS patients requiring platelet transfusions during surgery.

Objectives: The purpose of this study was to investigate the frequency and clinical impact of incomplete left atrial appendage (LAA) sealing and consequent peri-device residual blood flow in patients undergoing percutaneous LAA closure with the Watchman device (Atritech, Inc., Plymouth, Minnesota). Background: During percutaneous LAA closure for stroke prophylaxis, the geometric variability of the LAA ostium may result in an incomplete seal of the LAA. On the one hand, this could enhance thrombus formation and embolization of thrombi around the device into the circulation; on the other hand, the relatively small size of these leaks may preclude clinically relevant embolizations. Methods: Patients randomly assigned to device implantation in the PROTECT AF (Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in Patients With Atrial Fibrillation) trial were analyzed. Transesophageal echocardiography was performed at 45 days, 6 months, and 12 months. Per the study protocol, patients discontinued warfarin therapy if the 45-day Transesophageal echocardiogram revealed either minimal or no peri-device flow (jet ≤5 mm width). The impact of peri-device flow severity, defined as minor, moderate, or major (<1 mm, 1 mm to 3 mm, >3 mm, respectively) on the composite primary efficacy endpoint (stroke, systemic embolism, and cardiovascular death) is expressed as hazard ratio (HR) with 95% confidence interval (CI). Results: Transesophageal echocardiography follow-up revealed that 32.0% of implanted patients had at least some degree of peri-device flow at 12 months. The HR of the primary efficacy endpoint per 1 mm larger per-device flow was 0.84 (95% CI: 0.62 to 1.14; p = 0.256). Compared to patients with no peri-device flow, the HRs were 0.85 (95% CI: 0.11 to 6.40), 0.83 (95% CI: 0.33 to 2.09), and 0.48 (95% CI: 0.11 to 2.09) for minor, moderate, and major peri-device flow, respectively (p = 0.798). Compared to patients with no peri-device flow who discontinued warfarin, the HR for patients with any peri-device flow and continuing warfarin was 0.63 (95% CI: 0.14 to 2.71; p = 0.530). Conclusions: These data indicate that residual peri-device flow into the LAA after percutaneous closure with the Watchman device was common, and is not associated with an increased risk of thromboembolism. This finding should be interpreted with caution as the low event rate decreases the confidence of this conclusion. [ABSTRACT FROM AUTHOR]

The possible causes are many, including Alzheimer's disease, dementia with Lewy bodies, and Parkinson's disease. Key findings and test results can help you narrow the differential diagnosis to the most likely possibilities. [ABSTRACT FROM AUTHOR]

Since 2000, centers across Central America have shared treatment guidelines for Wilms tumor, using histology (anaplasia present or absent) and tumor stage to stratify patients into low-, intermediate-, and high-risk groups. Weekly virtual tumor board meetings involving local and international experts were held to ensure consistent treatment assignments. We analyzed data from 367 children with unilateral tumors treated per these guidelines. Five-year abandonment-sensitive event-free and overall survival estimates were: low risk 82% ± 3.8% and 86% ± 3.6%, intermediate risk 50% ± 3.4% and 60% ± 3.4%, and high risk 36% ± 7.6% and 45% ± 7.9%. Survival outcomes were suboptimal, primarily due to advanced disease in fragile children at presentation and abandonment of treatment., (© 2025 The Author(s). Pediatric Blood & Cancer published by Wiley Periodicals LLC.)

Introduction: Total knee arthroplasty (TKA) is a procedure associated with risks of electrolyte and kidney function disorders, which are rare but can lead to serious complications if not correctly identified. A routine check-up is very often carried out to assess the seric ionogram and kidney function after TKA, that rarely requires clinical intervention in the event of a disturbance. The aim of this study was to identify perioperative variables that would lead to the creation of a machine learning model predicting the risk of kalaemia disorders and/or acute kidney injury after total knee arthroplasty., Hypothesis: A predictive model could be constructed to estimate the risk of kalaemia disorders and/or acute kidney injury after total knee arthroplasty., Material and Methods: This single-centre retrospective study included 774 total knee arthroplasties (TKA) operated on between January 2020 and March 2023. Twenty-five preoperative variables were incorporated into the machine learning model and filtered by a first algorithm. The most predictive variables selected were used to construct a second algorithm to define the overall risk model for postoperative kalaemia and/or acute kidney injury (K + A). Two groups were formed of K + A and non-K + A patients after TKA. A univariate analysis was performed and the performance of the machine learning model was assessed by the area under the curve representing the sensitivity of the model as a function of 1 - specificity., Results: Of the 774 patients included who had undergone TKA surgery, 46 patients (5.9%) had a postoperative kalaemia disorder requiring correction and 13 patients (1.7%) had acute kidney injury, of whom 5 patients (0.6%) received vascular filling. Eight variables were included in the machine learning predictive model, including body mass index, age, presence of diabetes, operative time, lowest mean arterial pressure, Charlson score, smoking and preoperative glomerular filtration rate. Overall performance was good with an area under the curve of 0.979 [CI95% 0.938-1.02], sensitivity was 90.3% [CI95% 86.2-94.4] and specificity 89.7% [CI95% 85.5-93.8]. The tool developed to assess the risk of impaired kalaemia and/or acute kidney injury after TKA is available on https://arthrorisk.com., Conclusion: The risk of kalaemia disturbance and postoperative acute kidney injury after total knee arthroplasty could be predicted by a model that identifies low-risk and high-risk patients based on eight pre- and intraoperative variables. This machine learning tool is available on a web platform accessible for everyone, easy to use and has a high predictive performance. The aim of the model was to better identify and anticipate the complications of dyskalaemia and postoperative acute kidney injury in high-risk patients. Further prospective multicentre series are needed to assess the value of a systematic postoperative biochemical work-up in the absence of risk predicted by the model., Level of Evidence: IV; retrospective study of case series., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Introduction: Total knee arthroplasty (TKA) carries a significant hemorrhagic risk, with a non-negligible rate of postoperative transfusions. The blood-sparing strategy has evolved to reduce blood loss after TKA by identifying the patient's risk factors preoperatively. In practice, a blood count is often performed postoperatively but rarely altering the patient's subsequent management. This study aimed to identify the preoperative variables associated with hemorrhagic risk, enabling the creation of a machine-learning model predictive of transfusion risk after total knee arthroplasty and the need for a complete blood count., Hypothesis: Based on preoperative data, a powerful machine learning predictive model can be constructed to estimate the risk of transfusion after total knee arthroplasty., Material and Methods: This retrospective single-centre study included 774 total knee arthroplasties (TKA) operated between January 2020 and March 2023. Twenty-five preoperative variables were integrated into the machine learning model and filtered by a recursive feature elimination algorithm. The most predictive variables were selected and used to construct a gradient-boosting machine algorithm to define the overall postoperative transfusion risk model. Two groups were formed of patients transfused and not transfused after TKA. Odds ratios were determined, and the area under the curve evaluated the model's performance., Results: Of the 774 TKA surgery patients, 100 were transfused postoperatively (12.9%). The machine learning predictive model included five variables: age, body mass index, tranexamic acid administration, preoperative hemoglobin level, and platelet count. The overall performance was good with an area under the curve of 0.97 [95% CI 0.921-1], sensitivity of 94.4% [95% CI 91.2-97.6], and specificity of 85.4% [95% CI 80.6-90.2]. The tool developed to assess the risk of blood transfusion after TKA is available at https://arthrorisk.com., Conclusion: The risk of postoperative transfusion after total knee arthroplasty can be predicted by a model that identifies patients at low, moderate, or high risk based on five preoperative variables. This machine learning tool is available on a web platform that is accessible to all, easy to use, and has a high prediction performance. The model aims to limit the need for routine check-ups, depending on the risk presented by the patient., Level of Evidence: II; diagnostic study., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: Symptomatic rotator cuff (RC) repair continues to be a complex issue. Leaving the long head of the biceps (LHB) in place might increase the risk of residual pain, even in the case of a healed RC. The purpose of this study was to assess the clinical outcomes of isolated LHB tenotomy and tenodesis as a revision procedure in symptomatic patients that had previously undergone an arthroscopic RC repair with no clinical or MRI evidence of RC retear. Methods: A retrospective analysis was conducted on patients with a persisting painful shoulder after an arthroscopic RC repair with no clinical or MRI signs of cuff retear, undergoing an isolated arthroscopic biceps tenotomy or tenodesis as a revision procedure. Functional outcomes were assessed preoperatively and at a minimum of 24 months of follow-up. Results: A total of 88 patients were included. The biceps tendon was managed with biceps tenodesis in 64 patients and tenotomy in 24 patients. VAS, Constant Score, SSV and active anterior elevation were all significantly improved after revision surgery. There was no significant difference between pre- and postoperative anterior passive elevation. No significant difference was shown between the tenodesis and tenotomy groups. Conclusions: The present study demonstrated that both isolated tenotomy and tenodesis are effective and safe in treating patients with a symptomatic shoulder after RC repair at a 2-year follow-up with a very low complication rate. Although tenodesis did not show any significant clinical benefit outcomes compared to tenotomy, it might be associated with a lower risk of Popeye deformity.

The Flexor Hallucis Longus (FHL) is a muscle that can be subject to multiple conflicts. The most common conflict is due to inflammation of the tendon at the retrotalar pulley. The constraints exerted on the FHL are responsible for a pathology called functional Hallux Limitus. The purpose of this anatomical study is to describe morphologic finding about retrotalar pulley, which may account the impingement between FHL and the hindfoot. Using a retrospective approach at a single center, a detailed analysis was conducted on a cohort of 350 patients. Precise measurements were taken to document the angles, areas, and distances that define the relationship between the Flexor Hallucis Longus (FHL) tendon and its surrounding anatomical structures. The angle between the retrotalar pulley and the sustentaculum tali exhibited a range of 124 to 170 degrees in profile and 113.3 to 178 degrees in frontal view. The dimensions of the retrotalar pulley varied from 1.1 to 54 mm², while the posterolateral and posteromedial tubercles displayed dimensions ranging from 3.4 to 77.9 mm² and 2.6 to 35.2 mm², respectively. Distances between posterior tubercles further underscored the anatomical diversity, ranging from 4.3 to 17 cm proximally and 10.5 to 18.4 cm distally. In unraveling the morphological complexities surrounding FHL impingement, this study provides valuable insights into the biomechanical intricacies of the foot. These findings not only deepen our understanding of musculoskeletal anatomy but also pave the way for future investigations into the dynamic interplay between structure and function in the lower extremities., Competing Interests: Declaration of competing interest Pr Gonzalez is a paid consultant for Amplitude. The other authors have no conflicts of interest., (Copyright © 2025. Published by Elsevier Inc.)

Aim: To assess the long-term (>10 years) outcomes in anatomical total shoulder arthroplasty (aTSA) and implant survival in patient under 60 years and identify risk factors for complications and revision., Methods: This was a retrospective, multicenter study conducted from 1993 to 2008. Over 104 aTSA, 87 in 82 patients (55 years, 36 to 60yo) were included at a mean follow-up of 14±4 years (10 to 25y). Outcome measures included pain, motion, Constant score and subjective shoulder value at 10 years minimum. On AP radiograph, the radiolucent line (RLL) score of Molé was used to assess loosening around the glenoid. A glenoid was considered "loose" in 3 circumstances: (1) revision for glenoid loosening, (2) radiological migration of the implant or (3) RLL score≥12. Preoperative glenoid morphology according to Walch, glenohumeral mismatch and cementing technic were evaluated. Survivorship free of revision and free of glenoid loosening were calculated at 10 and 15 years. The mean follow-up was 14±4 years (10 to 25y) or until revision., Results: Revision-free survivorship was 81% at 10 years and 65% at 15 years. Glenoid failure was the main cause of revision: among the 28 (32%) revised shoulders, 19 (22%) were revised for glenoid loosening. Heavy labor was a risk factor for glenoid component loosening (p=0.029). The curettage technique and flat-back glenoids were risk factors for glenoid revision (p= 0.035) but presented a longer follow-up than compaction technique and convex-back glenoids. The type of preoperative glenoid erosion (Walch type) and glenohumeral mismatch did not correlate with a higher glenoid loosening rate., Conclusion: aTSA is a reliable procedure for primary OA under 60, but survivorship declines after 10 years. Glenoid loosening, often combined with cuff deficiency or infection, is the main cause of failure and revision. Glenoid morphology as classified by the modified Walch classification does not influence revision rate beyond 10 years., (Copyright © 2025. Published by Elsevier Inc.)

Introduction: Perioperative analgesia after total knee arthroplasty (TKA) reduces morphine consumption and speeds up rehabilitation. The primary objective of this study was to compare the pain experienced by patients with an adductor canal and posterior capsule block with those with a continuous femoral nerve block combined with a popliteal sciatic nerve block. The secondary objectives were to analyze the time to recovery from early walking, length of hospital stay, and block-related complications between the two groups., Hypothesis: Patients with an adductor canal block and posterior capsular infiltration had less pain 24 h after TKA., Material and Methods: This single-center retrospective study included 774 TKA between January 2020 and March 2023. Two types of locoregional blocks were evaluated: patients who had a continuous femoral nerve block with a single-shot popliteal sciatic nerve block (FN-PSN group) operated on before March 2022 and those who had a single-shot adductor canal block combined with posterior capsular infiltration (ACB-PI group) operated on after March 2022. One patient in the ACB-PI group was matched to two patients in the NF-BS group according to sex, age, and BMI. A total of 725 TKA were included: 500 in the FN-PSN group and 225 in the ACB-PI group. The primary endpoint was pain assessed using the numerical pain rating scale (NPRS) and opioid consumption at 24 h after TKA. Resumption of walking, defined as getting up for the first time and walking ten steps until discharge from the hospital, and complications between the two groups were also assessed. The study population consisted of 471 women (64.9%) with a mean age of 72.2 ± 8.2 years and a mean BMI of 28.2 ± 4.6., Results: Patients in the FN-PSN group had less pain at NPRS (1.3 versus 1.9; p < 0.001), and fewer patients required morphine titration (13.8% versus 6.8%, p = 0.02) within the first 8 h of surgery with no difference at 24 h, 48 h and 72 h. The mean doses of morphine administered were similar between the groups. Resumption of walking was significantly longer in the FN-PSN group (1.5 versus 2.0 days, p = 0.003), and hospitalization times and complications were similar between the groups., Conclusion: Adductor canal block combined with posterior capsular infiltration did not reduce postoperative pain compared with femoral and popliteal sciatic block at 24 h after TKA. Opioid consumption and pain were similar between the groups, with more patients requiring morphine in the first eight hours in the ACB-PI group but with a faster return to walking., Level of Evidence: III; comparative study., Competing Interests: Declaration of competing interest JFG is a consultant for Amplitude group. GM has received benefits from Sanofi Aventis. JCO has received benefits from Fresenius Kabi. NB is a consultant for Si-Bone. The other authors declare that they have no links of interest., (Copyright © 2024. Published by Elsevier Masson SAS.)

Background: Anterior cruciate ligament (ACL) reconstruction is increasingly being performed in patients >50 years old; however, the long-term outcomes are unclear., Purpose: To analyze the functional results, osteoarthritic progression, reoperation rate, and failure rate at minimum 10-year follow-up in patients >50 years old who have undergone primary ACL reconstruction., Study Design: Case series; Level of evidence, 4., Methods: Included in this study were patients >50 years old who underwent primary ACL reconstruction and had at least 10 years of follow-up data. All patients had instability with limitation of their activities, indicating the necessity of surgical intervention. Patients with revision surgeries, ACL repairs, and nonoperative treatment were excluded. Failure was defined as the presence of revision, high-grade Lachman, positive pivot shift (2+), or subjective instability. The Knee injury and Osteoarthritis Outcome Score (KOOS), subjective and objective functional scores, and osteoarthritic progression were analyzed at final follow-up., Results: A total of 38 patients were identified. The mean age at surgery was 56.8 ± 5.7 years (range, 50.6-70 years). The mean clinical follow-up was 16.2 ± 4.3 years (range, 10.9-23.3 years). The failure rate was 10.5% (4/38): 1 of the 4 patients had a recurrence of instability at 13 years postoperatively and underwent revision with a modified Lemaire extra-articular tenodesis, 1 patient had a positive pivot shift (2+) without subjective instability, and 2 patients underwent total knee arthroplasty. The overall KOOS was 74.2 ± 22.2, and 91.4% of patients were satisfied or very satisfied with the results of the procedure. Radiographic osteoarthritis was identified in 88.5% of patients at final follow-up; however, there was no statistical significance on clinical outcomes ( P  > .05). Concomitant partial medial meniscectomy ( P  < .01) and meniscal repair ( P  < .01) were associated with the presence of Ahlbäck grade 3 or 4 osteoarthritic manifestations., Conclusion: In patients over the age of 50 years who underwent primary ACL reconstruction, there was a low long-term failure rate and a high level of patient satisfaction, despite osteoarthritic progression in 88.5% of cases. Concomitant meniscal procedures were associated with more severe osteoarthritic progression., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: J.E. has received grant support from Arthrex, education payments from Arthrex and Smith+Nephew, and consulting fees from DePuy/Medical Device Business Services. J.-.F.G. has received consulting fees from Amplitude. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2024.)

Background: Mechanical alignment after total knee arthroplasty (TKA) is still widely used in the surgical community, but the alignment finally obtained by conventional techniques remains uncertain. The recent Coronal Plane Alignment of the Knee (CPAK) classification distinguishes 9 knee phenotypes according to constitutional alignment and joint line obliquity (JLO). The aim of this study was to assess the phenotypes of osteoarthritic patients before and after TKA using mechanical alignment and to analyze the influence of CPAK restoration on functional outcomes., Methods: This retrospective multicenter study included 178 TKAs with a minimum follow-up of 2 years. Patients were operated on using a conventional technique with the goal of neutral mechanical alignment. The CPAK grade (1 to 9), considering the arithmetic Hip-Knee-Ankle angle (aHKA) and the JLO, was determined before and after TKA. Functional results were assessed using the following patient-reported outcome measures: Knee Injury and Osteoarthritis Outcome Score, the Simple Knee Value, and the Forgotten Joint Score., Results: A true neutral mechanical alignment was obtained in only 37.1%. Isolated restoration of JLO was found in 31.4%, and isolated restoration of the aHKA in 44.9%. Exact restoration of the CPAK phenotype was found in 14.6%. Restoration of the CPAK grade was associated with an improvement in the "daily living": 79.2 ± 5.3 versus 62.5 ± 2.3 (R 2  = 0.05, P < .05) and "Quality of life" Knee Injury and Osteoarthritis Outcome Score subscales: 73.8 ± 5.0 versus 62.9 ± 2.2 (R 2  = 0.02, P < .05)., Conclusions: This study shows that few neutral mechanical alignments are finally obtained after TKA by conventional technique. A major number of patients present a postoperative modification of their constitutional phenotype. Functional results at 2 years of follow-up appear to be improved by the restoration of the CPAK phenotype, JLO, and aHKA., Level of Clinical Art Evidence: III, Retrospective Cohort Study., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Rationale: Understanding the migration of marine animals is hindered by the limitations of traditional tracking methods. It is therefore crucial to develop alternative methods. Stable isotope-based tracking has proven useful for this task, although it requires detailed isoscapes in the focal area. Here, we present predator-based isoscapes of the coastal zone of the Patagonian Shelf Large Marine Ecosystem (PSLME), which offers a novel tool for geolocation., Methods: Whole-blood samples from breeding Magellanic penguins nesting at 11 colonies were used to create δ 15 N and δ 13 C isoscapes. Isotopic values were assigned to random positions inside their corresponding foraging area. Spatial analysis and data interpolation resulted in δ 15 N and δ 13 C isoscapes for the coastal zone of the PSLME, which were validated through cross-validation., Results: The isoscapes mean standard error ranged from 0.05 to 0.41 for δ 15 N and from 0.07 to 0.3 for δ 13 C, similar to the error range of the mass spectrometer used for measuring isotope ratios. Predictive surfaces reflected the latitudinal trends, with δ 13 C and δ 15 N values increasing northwards. δ 13 C values showed a strong latitudinal gradient, while δ 15 N values had two distinct domains, with higher values in the north. The error surface indicated the highest certainty within 130 km from the shore and within the reported Magellanic penguin foraging areas., Conclusions: Both isoscapes revealed strong spatial variation. The δ 13 C isoscape showed a latitudinal gradient, consistent with patterns in other oceans. The δ 15 N isoscape clearly separated northern and southern colonies, likely influenced by nitrogen sources. The error obtained fell within the measurement error ranges, adding credibility to the models., (© 2024 John Wiley & Sons Ltd.)

Chronic exertional compartment syndrome is a well-described potential cause of leg pain in high-level athletes and soldiers. Surgical treatment of chronic exertional compartment syndrome usually involves fasciotomy, with a reported rate of complications of up to 16%, including failure of complete compartmental release and delayed return to normal daily activity, which can take up to 6 to 12 weeks. The use of a minimally invasive approach under ultrasound guidance seems to improve clinical outcomes in young active patients. We recommend the following steps for effective execution of ultrasound-guided percutaneous fasciotomy: (1) location of the compartmental fascia and identification of the superficial peroneal nerve, (2) skin incision, (3) insertion of a hook under the compartmental fascia, and (4) sectioning of the fascia., Competing Interests: All authors (A.M., R.F., J.C., N.B., N.C., J-F.G., A.R., G.M.) 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 Authors.)

The object is to objectively identify the 100 most influential scientific publications in total knee arthroplasty (TKA) and provide an analysis of their main characteristics. The Clarivate Analytics Web of Knowledge database was used to obtain data and metrics of TKA research. The search list was sorted by the number of citations, and articles were included or excluded based on relevance to TKA. The information extracted for each article included author name, publication year, country of origin, journal name, article type, and the level of evidence. These 100 studies generated a total of 35,399 cita- tions, with an average of 355.9 citations per article. The most-cited article was cited 1273 times. The 100 studies included in this analysis were published between 2000 and 2017. 23 different journals published these 100 publications. Majority of the publications were from United States (n = 52), followed by UK (n = 10) and Canada (n = 8). The most prevalent study designs were case series (n = 32) and cohort studies (n = 30). The 100 most influential articles in TKA were cited a total of 35,399 times. The study designs most prevalent were case series and cohort studies. This article serves as a reference to direct orthopedic surgeons to the 100 most influential studies in total knee arthroplasty. More than half of the studies are from North America, and three journals hold two-thirds of the 100 most cited publications on the topic.

Introduction: Femoral neck fractures constitute a public health problem due to significant associated morbidity and mortality amongst the ageing population. Perioperative blood loss can increase this morbidity. Blood loss, as well as the influence that the surgical approach exerts on it, remains poorly evaluated. We therefore conducted a retrospective comparative study in order to: (1) compare total blood loss depending on whether the patients were operated on using an anterior or posterior approach, (2) compare the transfusion rates, operating times and hospital stays between these two groups and, (3) analyze dislocation rates., Hypothesis: Total blood loss is greater from an anterior approach following a hip hemiarthroplasty for femoral neck fracture, compared to the posterior approach., Material and Methods: This retrospective single-center comparative study included 137 patients operated on by hip hemiarthroplasty between December 2020 and June 2021, and seven patients were excluded. One hundred and thirty patients were analyzed: 69 (53.1%) had been operated on via the anterior Hueter approach (AA) and 61 (46.9%) via the posterior Moore approach (PA). The analysis of total blood loss was based on the OSTHEO formula to collect perioperative "hidden" blood loss. The risk of early dislocation (less than 6 months) was also analyzed., Results: Total blood loss was similar between the two groups, AA: 1626±506mL versus PA: 1746±692mL (p=0.27). The transfusion rates were also similar between the two groups, AA: 23.2% versus PA: 31.1% (p=0.31) as well as the duration of hospitalization, AA: 8.5±3.2 versus PA: 8.2±3.3 days (p=0.54). The operating time was shorter in the PA group (Δ=10.3±14.1minutes [p<0.001]) with a greater risk of early dislocation when the patient was operated on by PA with AA: 9.8% versus PA: 1.4% (p=0.03)., Conclusion: This study does not demonstrate any influence of the approach (anterior or posterior) on total blood loss. Transfusion rates and length of hospitalization were similar between the groups with a slightly shorter operating time but a greater risk of early dislocations after posterior hemiarthroplasty in a population at high anesthesia-related risk., Level of Proof: III, comparative study of continuous series., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Hypothesis: Chronic epilepsy may cause important bipolar bony lesions. We aim to compare the specific pathoanatomic metrics of the bony lesions in chronic shoulder anterior instability that occur in patients with epilepsy vs. patients without epilepsy., Methods: From 2006 to 2020, we included epileptic and nonepileptic patients with anterior recurrent shoulder instability. We randomly adjusted the patients of the 2 groups according to the sex, age, and type of management. We included 50 patients. For each included patient, we performed an in-depth analysis and comparison of the glenoid bone loss based on the computed tomography scan: PICO method (patient/population, intervention, comparison and outcomes) using the best-fit circle; and the Hill-Sachs lesion: the depth and width were given as a percentage of the humeral head diameter on an axial view. We also evaluated the engaging character of the involved lesion using the on-track vs. off-track analysis. Those characteristics were compared between the 2 groups., Results: We found a glenoid bone loss in 32 patients. Glenoid bone loss was not significantly greater in patients with epilepsy (P = .052). A Hill-Sachs lesion was found in 42 patients (22 in the group with epilepsy and 20 in the group without epilepsy). Hill-Sachs lesions were significantly deeper and larger in the group with epilepsy (depth: 22% vs. 9%, P < .001; width: 43% vs. 28%, P = .003). In the group with epilepsy, 90% of the bone lesions were off-track vs. 30% in the group without epilepsy. Thus, the patients with epilepsy presented more engaging bony lesions than patients without epilepsy (P = .001) (OR = 23)., Conclusions: In a population of patients with epilepsy who had shoulder instability, Hill-Sachs lesions are larger and deeper than in normal patients with shoulder instability. By contrast, there is no significant difference regarding the characteristics of the glenoid bone loss if present. This implies that bone lesions in instable shoulders of patients with epilepsy need at least a bony stabilization procedure on the humeral side in the majority of cases., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: We aim to predict a clinical difference in the postoperative range of motion (RoM) between 2 reverse shoulder arthroplasty (RSA) stem designs (Inlay-155° and Onlay-145°) using preoperative planning software. We hypothesized that preoperative 3D planning could anticipate the differences in postoperative clinical RoM between 2 humeral stem designs and by keeping the same glenoid implant., Methods: Thirty-seven patients (14 men and 23 women, 76 ± 7 years) underwent a BIO-RSA (bony increased offset-RSA) with the use of preoperative planning and an intraoperative 3-dimensional-printed patient-specific guide for glenoid component implantation between January 2014 and September 2019 with a minimum follow-up of 2 years. Two types of humeral implants were used: Inlay with a 155° inclination (Inlay-155°) and Onlay with a 145°inclination (Onlay-145°). Glenoid implants remained unchanged. The postoperative RSA angle (inclination of the area in which the glenoid component of the RSA is implanted) and the lateralization shoulder angle were measured to confirm the good positioning of the glenoid implant and the global lateralization on postoperative X-rays. A correlation between simulated and clinical RoM was studied. Simulated and last follow-up active forward flexion (AFE), abduction, and external rotation (ER) were compared between the 2 types of implants., Results: No significant difference in RSA and lateralization shoulder angle was found between planned and postoperative radiological implants' position. Clinical RoM at the last follow-up was always significantly different from simulated preoperative RoM. A low-to-moderate but significant correlation existed for AFE, abduction, and ER (r = 0.45, r = 0.47, and r = 0.57, respectively; P < .01). AFE and abduction were systematically underestimated (126° ± 16° and 95° ± 13° simulated vs. 150° ± 24° and 114° ± 13° postoperatively; P < .001), whereas ER was systematically overestimated (50° ± 19° simulated vs. 36° ± 19° postoperatively; P < .001). Simulated abduction and ER highlighted a significant difference between Inlay-155° and Onlay-145° (12° ± 2°, P = .01, and 23° ± 3°, P < .001), and this was also retrieved clinically at the last follow-up (23° ± 2°, P = .02, and 22° ± 2°, P < .001)., Conclusions: This study is the first to evaluate the clinical relevance of predicted RoM for RSA preoperative planning. Motion that involves the scapulothoracic joint (AFE and abduction) is underestimated, while ER is overestimated. However, preoperative planning provides clinically relevant RoM prediction with a significant correlation between both and brings reliable data when comparing 2 different types of humeral implants (Inlay-155° and Onlay-145°) for abduction and ER. Thus, RoM simulation is a valuable tool to optimize implant selection and choose RSA implants to reach the optimal RoM., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: The proximal tibial epiphyseal inclination can be used as a prognostic factor for good results after knee osteotomy and measured using the tibial bone varus angle (TBVA). This angle depends on the visibility of the epiphyseal plate, which has shown poor reproducibility when measured on standard radiographs by conventional methods., Purpose: To evaluate the measurement reliability of the TBVA and other angles based on the epiphyseal scar using a digital image display., Study Design: Cohort study (diagnosis); Level of evidence, 3., Methods: A total of 100 whole-leg radiographs were analyzed twice by 3 orthopaedic surgeons from 2 countries in a blinded and randomized manner. Observers measured the hip-knee-ankle angle, mechanical lateral distal femoral angle, medial proximal tibial angle, and TBVA. The growth plate-tibial plateau (GPTP) angle, defined as the angle between the epiphyseal scar and tibial plateau, was measured; this angle has not yet been described for osteotomy. In addition, a modified version of the TBVA (mTBVA), defined as that between the epiphyseal scar, its center, and the center of the talus, was measured. The Ahlbäck score for osteoarthritis and a 3-grade score for epiphyseal scar visibility were also determined. The reliability of the angle measurements and scoring was evaluated using the Fleiss kappa and intraclass correlation coefficient (ICC)., Results: The scores for epiphyseal scar visibility showed fair interobserver (Fleiss kappa correlation coefficient [κ] = 0.29-0.35) and strong intraobserver (Fleiss κ = 0.62-0.69) reliability. TBVA, GPTP angle, and mTBVA measurements showed good interobserver reliability (ICC, 0.76-0.77), while the GPTP angle achieved excellent intraobserver reliability (ICC, >0.9)., Conclusion: Using digital image display, angles that depend on the epiphyseal scar-such as TBVA, GPTP angle, and mTBVA-can achieve acceptable measurement reliability despite the low agreement on the visibility of the epiphyseal scar., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: P.S. created and maintains Tyche software. J.-F.G. has received consulting fees from Amplitude. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2024.)

Avulsions of the retrospinal surface are rare injuries resulting from high-energy trauma. Displacement of this fracture frequently indicates a surgical treatment to restore posterior cruciate ligament function. Several approaches have been proposed in the literature, either open or arthroscopic, which can be tricky due to the fracture's proximity to the popliteal vascular-nervous elements. Badet's open approach is a medial trans-gastrocnemius approach, providing a direct access to the retro-spinal surface for osteosynthesis. In this technique, an L-shaped incision is made along precise skin lines, followed by discision of the muscle fibers. The capsule is then approached, allowing a view of the retro-spinal surface protected from the popliteal vasculo-nervous elements by the muscular lateral lip of the gastrocnemius. A reduction followed by screw osteosynthesis is usually performed, allowing early mobilization of the patient. In this technical note, we describe the Badet approach supporting by video and case series. LEVEL OF EVIDENCE: IV., (Copyright © 2024. Published by Elsevier Masson SAS.)

Le Dantec virus (LDV), assigned to the species Ledantevirus ledantec, genus Ledantevirus, family Rhabdoviridae has been associated with human disease but has gone undetected since the 1970s. We describe the detection of LDV in a human case of undifferentiated fever in Uganda by metagenomic sequencing and demonstrate a serological response using ELISA and pseudotype neutralisation. By screening 997 individuals sampled in 2016, we show frequent exposure to ledanteviruses with 76% of individuals seropositive in Western Uganda, but lower seroprevalence in other areas. Serological cross-reactivity as measured by pseudotype-based neutralisation was confined to ledanteviruses, indicating population seropositivity may represent either exposure to LDV or related ledanteviruses. We also describe the discovery of a closely related ledantevirus in blood from the synanthropic rodent Mastomys erythroleucus. Ledantevirus infection is common in Uganda but is geographically heterogenous. Further surveys of patients presenting with acute fever are required to determine the contribution of these emerging viruses to febrile illness in Uganda., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Shepherd et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Primary glenohumeral osteoarthritis is associated with both excessive posterior humeral subluxation (PHS) and excessive glenoid retroversion in 40% of cases. These morphometric abnormalities are a particular issue because they may be responsible for a deterioration in long-term clinical and radiologic outcomes. The aim of this study was to perform a computed tomographic (CT) analysis of patients who underwent total shoulder arthroplasty (TSA) for primary osteoarthritis (OA) with B2-, B3-, or C-type glenoids in whom an attempt was made to correct for excessive glenoid retroversion and excessive posterior humeral subluxation intraoperatively., Material: We performed a retrospective, single-center study including 62 TSA patients with a preoperative PHS of the glenohumeral joint (31 men, 31 women, 70 ± 9 years) between January 2000 and January 2014. Glenoids were classified as B2 (32 cases), B3 (13 cases), or C (17 cases). Glenoid retroversion was corrected by anterior asymmetric reaming. Patients were reviewed for clinical and CT scan assessment with a mean follow-up of 8.3 years (minimum 5 years). At final follow-up, the CT images were reconstructed in the scapular plane. A PHS index >65% defined persistence., Results: The revision-free rate was estimated at 93%. Correlation between PHS and retroversion was moderate preoperatively (ρ = 0.58) and strong at final follow-up (ρ = 0.73). Postoperative CT scans on average showed a surgical correction of PHS compared to preoperatively (79% vs. 65% respectively, P < .05) and retroversion (20° vs. 10° respectively, P < .05). At final follow-up, 25 of 62 patients had a persistence in the 2-dimensional (2D) model and 41 of 62 in the corrected 2D model. Persistence of PHS had no influence on clinical outcomes but did demonstrate a significantly higher glenoid loosening rate (20% vs. 59%, P < .05)., Conclusion: Correlation between PHS and retroversion was moderate preoperatively and strengthened at long-term follow-up. Anterior asymmetric reaming allowed for a surgical improvement of both PHS and retroversion, but it was not sufficient to maintain a correction over time. Glenoid loosening was more frequent in case of PHS persistence but seemingly without clinical relevance., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Surgical site infections (SSIs) contribute to negative outcomes for patients and health care organizations. Compliance with clinical practice guidelines likely can help prevent SSIs. An interdisciplinary team at a regional referral center in Michigan sought to reduce SSIs by improving compliance with the facility's preoperative antibiotic selection, dosing, timing, and redosing protocol. The interventions for the quality improvement project included adding the preprocedural antibiotics and doses to the master OR schedule; holding an education session for all preoperative nurses, intraoperative nurses, and anesthesia professionals; and posting a reference guide in the preoperative and intraoperative areas. Compliance with the facility's protocol for antibiotic selection, dosing, and timing significantly improved. However, SSI rates and compliance with redosing recommendations did not change significantly. The team decided to add the antibiotic order information to the master OR schedule permanently. The team plans to consider providing education sessions on administering preprocedural antibiotics outside the OR., (© AORN, Inc, 2024.)

Introduction: Degenerative sacroiliac (SI) joint syndrome is known to be more common after lumbosacral fusion. While this diagnosis is suspected based on various clinical criteria and diagnostic tests, it is confirmed with a diagnostic nerve block. If conservative treatment fails, SI joint fusion through a minimally invasive approach is a useful palliative approach for patients at a treatment crossroads. The aim of this study was to evaluate the clinical and functional results at 2years postoperative after minimally invasive SI joint fusion in patients with SI joint syndrome following lumbosacral fusion., Materials and Methods: We carried out a single-center retrospective study of patients operated between June 2017 and October 2020. Included were patients who had a confirmed diagnosis of SI joint syndrome after lumbosacral fusion surgery, who underwent SI joint fusion and had at least 2years' follow-up. The primary outcome was the improvement in lumbar and radicular pain on a numerical rating scale (NRS). The secondary outcomes were the functional scores (Oswestry and SF-12) along with the level of patient satisfaction. Our study population consisted of 54 patients (41 women, 13 men) with a mean age of 59years (27-88). Thirty-one of these patients were operated on both sides (85 fusions in all). The patients had undergone a mean of 3 lumbar surgeries (1-7) before the SI fusion., Results: The lumbar and radicular NRS were 8.4 (7-10) and 5.1 (2-10) preoperatively and 5.2 (0-8) and 3.0 (0-8) at 2years postoperatively, which was a reduction of 37% and 42% (p<0.001), respectively. The Oswestry score went from 69.4 (52-86) preoperatively to 45.6 (29-70) at 2years, which was a 33% improvement (p<0.001). Eighty-six percent of patients were satisfied or very satisfied with the surgery., Discussion: After minimally invasive SI joint fusion, the patients in this study had clear clinical and functional improvements. Previous publications analyzing the results of SI joint fusion found even more improvement, but those patients were relatively heterogenous; in our study, only patients who had a history of lumbosacral fusion were included., Conclusion: Minimally invasive SI joint fusion helped patients who developed SI joint syndrome after lumbosacral fusion to improve clinically and functionally., Level of Evidence: IV, retrospective study., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Introduction: The Harris Hip Score (HHS) and the Merle D'Aubigné Postel (MDP) score both provide an objective and subjective evaluation of hip function. These scores are collected during the follow-up of patients who have a hip disease. The objectives of this prospective study were (1) to analyze the differences between the two new French self-report versions of the HHS and MDP, and the traditional surgeon-assessed HHS and MDP; (2) to analyze the correlation between the self-report HHS and MDP and the surgeon-assessed HHS and MDP; (3) to analyze the floor and ceiling effects of the two self-report scores and the reliability of these self-report scores in operated and non-operated patients., Hypothesis: The French self-report HHS and MDP are sufficiently reliable to accurately estimate the patient's objective and subjective outcomes compared to the clinical examination done by a surgeon., Methods: A prospective multicenter study was done with patients who had a hip disease. Two self-report questionnaires were completed by the patient, independently of the clinical examination done by the surgeon. The questionnaires were in French and consisted solely of checkboxes, with sample photos that corresponded to the various range of motion items in the HHS and MDP. The agreement between the self-report scores and the surgeon-assessed scores were evaluated using the intraclass correlation coefficient (ICC). Differences in the mean values were evaluated with a paired t test., Results: The analysis involved 89 patients. The self-report HHS was 2.7±3.7 points (/100) lower than the surgeon-assessed HHS, but this difference was not statistically significant (p=0.34). The self-report MDP was significantly less by 1.2±2.9 points (/18) than the surgeon-assessed MDP (p=0.01). The agreement between the self-report HSS and the surgeon-assessed HSS was excellent (ICC=0.86) as was the one between the self-report MDP and the surgeon-assessed MDP (ICC=0.75). There was a strong positive correlation between the surgeon-assessed and self-report HHS in operated patients (ICC= 0.84; R=0.75; p<0.001) and in non-operated patients (ICC=0.96; R=0.89; p<0.001). This positive correlation was also found between the surgeon-assessed and self-report MDP for operated patients (ICC=0.73; R=0.62; p<0.001) and non-operated patients (ICC=0.79; R=0.64; p<0.001). A ceiling effect (maximum of 100 points) was found in 22% of patients (20/89) for the self-report HHS and in 34% of patients (30/89) for the self-report MDP (maximum of 18 points). No floor effect was observed for either questionnaire., Conclusion: The French version of the HHS self-report questionnaire is an excellent overall estimator of the HHS score for patients with hip osteoarthritis or fracture, whether operated or not. The addition of the MDP, whose self-report version is less accurate, is also a reliable tool. These self-report questionnaires, when validated on a larger scale, will be useful for the long-term follow-up of patients undergoing hip arthroplasty., Level of Evidence: III; prospective diagnostic study., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: Osteoporosis (OP) is a pathology characterized by bone fragility affecting 30% of postmenopausal women, mainly due to estrogen deprivation and increased oxidative stress. An autophagy involvement is suspected in OP pathogenesis but a definitive proof in humans remains to be obtained., Methods: Postmenopausal women hospitalized for femoral neck fracture (OP group) or total hip replacement (Control group) were enrolled using very strict exclusion criteria. Western blot was used to analyze autophagy level., Results: The protein expression level of the autophagosome marker LC3-II was significantly decreased in bone of OP patients relative to the control group. In addition, the protein expression of the hormonally upregulated neu-associated kinase (HUNK), which is upregulated by female hormones and promotes autophagy, was also significantly reduced in bone of the OP group., Conclusions: These results demonstrate for the first time that postmenopausal OP patients have a deficit in bone autophagy level and suggest that HUNK could be the factor linking estrogen loss and autophagy decline., Clinical Trial Registration Number: ClinicalTrials.gov Identifier: NCT03175874, 2/6/2017., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Endocrinology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Acute compartment syndrome (ACS) of the lower limbs is a function-threatening event usually managed by extended dermofasciotomy. Closure of the skin may be delayed, creating a risk of complications when there is an underlying fracture. Early treatment at the pre-ACS stage might allow isolated fasciotomy with no skin incision. The primary objective of this study was to compare intracompartmental pressure (ICP) changes after fasciotomy and after dermofasciotomy. The secondary objectives were to evaluate potential associations linking the starting ICP to achievement of an ICP below the physiological cut-off of 10mm Hg and to determine whether the ICP changes after fasciotomy and dermofasciotomy varied across muscle compartments., Hypothesis: Fasciotomy with no skin incision may not provide a sufficient ICP decrease, depending on the initial ICP value., Material and Methods: A previously validated model of cadaver ACS of the lower limbs was used. Saline was injected gradually to raise the ICP to>15mmHg (ICP 15 ), >30mmHg (ICP 30 ), and >50mmHg (ICP 50 ). We studied 70 leg compartments (anterior, lateral, and superficial posterior) in 13 cadavers (mean age, 89.1±4.6years). ICP was monitored continuously. Percutaneous, minimally invasive fasciotomy consisting in one to three 1-cm incisions was performed in each compartment. ICP was measured before and after fasciotomy then after subsequent skin incision. The objective was to decrease the ICP below 10mmHg after fasciotomy or dermofasciotomy., Results: Overall, mean ICP was 37.8±19.1mmHg after the injection of 184.0±133.01mL of saline. In the ICP 15 group, the mean ICP of 16.1mmHg fell to 1.4mmHg after fasciotomy (ΔF=14.7) and 0.3mmHg after dermofasciotomy (ΔDF=1.1). Corresponding values in the ICP 30 group were 33.9mmHg, 4.7mmHg (ΔF=29.2), and 1.2mmHg (ΔDF=3.5); and in the ICP 50 group, 63.7mmHg, 17.0mmHg (ΔF=46.7), and 1.2mmHg (ΔDF=15.8). Thus, in the group with initial pressures >50mmHg, the ICP decrease was greater after both procedures, but fasciotomy alone nonetheless failed to achieve physiological values (<10mmHg). The pressure changes were not significantly associated with the compartment involved (anterior, lateral, or superficial posterior) (p<0.05)., Conclusion: Under the conditions of this study, higher baseline ICPs were associated with larger ICP drops after fasciotomy and dermofasciotomy. Nevertheless, when the baseline ICP exceeded 50mmHg, fasciotomy alone failed to decrease the ICP below 10mmHg. Adding a skin incision achieved this goal., Level of Evidence: IV, experimental study., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Purpose: One-stage bilateral shoulder arthroplasty has the advantage of requiring a single hospital stay and a single anaesthesia. The topic has been little reported, unlike one stage bilateral hip and knee arthroplasty, which have demonstrated their interest. The aim of the present study was to determine peri- and early post-operative morbidity and mortality after this procedure. The study hypothesis was that peri- and early post-operative morbidity and mortality in one stage bilateral shoulder arthroplasty is low in selected patients and that satisfaction is high., Methods: A single-centre retrospective study assessed peri- and early post-operative morbidity and mortality in one stage bilateral shoulder arthroplasty. Twenty-one patients, aged < 80 years, with ASA score ≤ 3, were consecutively operated on between 1999 and 2020. Indications comprised primary osteoarthritis, aseptic osteonecrosis, inflammatory arthritis, massive rotator cuff tear, and dislocation fracture, involving both shoulders., Results: There were no early deaths. The complication rate was 10% (4/21 cases). No prosthesis dislocation or sepsis was reported. Mean blood loss was 145 ± 40 cc, mean surgery time 164 ± 63 min, and mean hospital stay five ± four days. Only one patient required postoperative transfusion. Functional results at six months showed significantly improved range of motion and good patient satisfaction., Conclusions: One-stage bilateral shoulder arthroplasty was feasible in selected patients. Mortality was zero, and morbidity was low. Surgery time was reasonable and required no repositioning. Postoperative home help is indispensable for patient satisfaction during rehabilitation., (© 2023. The Author(s) under exclusive licence to SICOT aisbl.)

The effective operation of distributed energy sources relies significantly on the communication systems employed in microgrids. This article explores the fundamental communication requirements, structures, and protocols necessary to establish a secure connection in microgrids. This article examines the present difficulties facing, and progress in, smart microgrid communication technologies, including wired and wireless networks. Furthermore, it evaluates the incorporation of diverse security methods. This article showcases a case study that illustrates the implementation of a distributed cyber-security communication system in a microgrid setting. The study concludes by emphasizing the ongoing research endeavors and suggesting potential future research paths in the field of microgrid communications.

Purpose: The alignment obtained after unicompartmental knee arthroplasty (UKA) influences the risk of failure. Kinematic alignment after UKA based on Cartier angle restauration is likely to improve clinical outcomes compared with mechanical alignment. The purpose of this study is to analyze the influence of implant alignment and native knee restoration after UKA using the conventional techniques on clinical outcomes., Methods: This retrospective study included 144 medial UKA patients from 2015 to 2020. Radiographic measurements were performed pre- and postoperatively. Outliers were defined as follows: Δ Cartier > 3° (difference between the preoperative and postoperative Cartier angle); Δ MPTA (Medial Proximal Tibial angle) and postoperative TCA (Tibial Coronal component Angle) > 3° (difference between the positioning of the tibial implant and the preoperative proximal tibial deformity). The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee score, the Forgotten Joint Score (FJS), and the Subjective Knee Value (SKV) were evaluated. A Student t test or a non-parametric Wilcoxon test was used for non-normal data to compare pre- and postoperative values for functional scores and angular measurements. The correlation of postoperative angles with functional outcomes was assessed by the Spearman's rank correlation coefficient., Results: During the inclusion period, 214 patients underwent medial UKA, 71 patients were excluded, and 19 were lost to follow-up leaving 124 patients with 144 knees (20 bilateral UKA) included for analysis with a mean follow-up of 54.7 months ± 22.1 (24-95). The Δ Cartier was significantly correlated with IKS function (R 2  = 0.06, p < 0.001) and FJS (R 2  = 0.05, p < 0.01) scores. The Δ preoperative MPTA-TCA was significantly correlated (p < 0.001) with KOOS (R 2  = 0.38), IKS Knee (R 2  = 0.17), IKS function (R 2  = 0.34), SKV (R 2  = 0.08), and FJS (R 2  = 0.37) scores. In subgroup analysis, non-outliers (< 3°) for Δ preoperative MPTA-TCA had better KOOS score (Δ = 23.5, p < 0.001) and IKS Function (Δ = 17.7, p < 0.001) compared to outliers (> 3°) patients., Conclusion: Functional results after medial UKA can be influenced by implant alignment in the coronal plane with slight clinical improvement when positioning the tibial implant close to the preoperative tibial deformity, rather than by restoring the Cartier angle. This series suggests the interest of a more personalized alignment strategy, but these results will have to be confirmed by other controlled studies., Level of Evidence: IV, retrospective case series., (© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)

We report three Co II -based complexes with the general formula [Co II (L)(X) 2 ] by changing the halide/pseudo-halide ions [X = NCSe (1SeCN); Cl (2Cl) and Br (3Br)]. The obtained τ 5 and CShM values confirm a distorted square pyramidal geometry around the Co II ion in all these complexes. In these three complexes, the central Co II ion is situated above the basal plane of the square pyramidal geometry. The extent of distortion from the ideal SPY-5 geometry differs upon changing the coordinating halide/pseudo-halide ion in these complexes. This essentially results in the alteration of the anisotropic parameter D and hence impacts the magnetic properties in these complexes. This phenomenon has been corroborated with the aid of theoretical investigations. All these complexes display field-induced SIM behaviour with magnetic relaxation occurring through a combination of processes depending on the applied dc magnetic field values and dilution.

Purpose: The objectives of this study were to evaluate functional results, revision-free survival, and the influence of postoperative alignment on outcomes after MCWHTO., Methods: This retrospective study included 27 MCWHTO operated on from 2009 to 2021. Radiographic measurements were performed pre- and postoperatively. The HKA (Hip-Knee-Ankle angle), MPTA (Medial Proximal Tibial angle), LDFA (Lateral Distal Femoral Angle), JLO (Joint Line Obliquity), and JLCA (Joint Line Convergence Angle) were evaluated. The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee Score, and the Subjective Knee Value (SKV) as well as revision-free survival were evaluated. Postoperative alignment and its influence on clinical outcomes were also analysed., Results: The mean follow-up was 61.9 months ± 31.4 (13-124). The HKA, MPTA, and JLCA angles were decreased post-operatively (respectively, Δ = 5.9° ± 2.6, p < 0.001; Δ = 6.1° ± 3.2, p < 0.001 and Δ = 2.5° ± 1.9, p < 0.001). LDFA and JLO were unchanged, post-operatively (respectively, Δ = 0.1° ± 2.2, p = 0.93 and Δ = 1.2° ± 3.3, p = 0.23). Postoperative HKA correlated with knee IKS (R = - 0.15, p = 0.04) and function IKS (R = - 0.44, p = 0.03). Postoperative LDFA correlated with knee IKS(R = 0.8, p < 0.01). Patients with postoperative HKA ≤ 180° had better KOOS (Δ = 12.3, p = 0.04) and IKS function (Δ = 28.1, p < 0.01) than those with HKA > 180°., Conclusion: Functional results and revision-free survival after MCWHTO are satisfactory when the deformity is located in the proximal tibia. The joint line obliquity is not significantly altered with small tibial correction and, obtaining an overall neutral or slightly varus alignment under the conditions of this study allowed an improvement in the postoperative clinical scores. The literature is still inconclusive on the ideal alignment for valgus deformities and larger series are needed to draw definitive conclusions., Level of Evidence: IV, case series., (© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)

Purpose: To evaluate the efficacy and safety of embolization of hyperemic synovial tissue for the treatment of persistent pain after total knee arthroplasty (TKA)., Materials and Methods: Twelve patients with persistent pain after TKA were enrolled in this prospective, single-center pilot study. Genicular artery embolization (GAE) was performed using 75-μm spherical particles. The patients were assessed using a 100-point Visual Analog Scale (VAS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline and 3 and 6 months thereafter. Adverse events were recorded at all time points., Results: A mean of 1.8 ± 0.8 abnormal hyperemic genicular arteries were identified and embolized, with a median volume of diluted embolic material of 4.3 mL in all 12 (100%) patients. The mean VAS score on walking improved from 73 ± 16 at baseline to 38 ± 35 at the 6-month follow-up (P < .05). The mean KOOS pain score improved from 43.6 ± 15.5 at baseline to 64.6 ± 27.1 at the 6-month follow-up (P < .05). At the 6-month follow-up, 55% and 73% of the patients attained a minimal clinically important change in pain and quality of life, respectively. Self-limited skin discoloration occurred in 5 (42%) patients. The VAS score increased by more than 20 immediately after embolization in 4 (30%) patients, who required analgesic treatment for 1 week., Conclusion: GAE is a safe method of treating persistent pain after TKA that demonstrates potential efficacy at 12 months., (Copyright © 2023 SIR. Published by Elsevier Inc. All rights reserved.)

Reduced expression and/or activity of Kv1.5 channels (encoded by KCNA5 ) is a common hallmark in human or experimental pulmonary arterial hypertension (PAH). Likewise, genetic variants in KCNA5 have been found in patients with PAH, but their functional consequences and potential impact on the disease are largely unknown. Herein, this study aimed to characterize the functional consequences of seven KCNA5 variants found in a cohort of patients with PAH. Potassium currents were recorded by patch-clamp technique in HEK293 cells transfected with wild-type or mutant Kv1.5 cDNA. Flow cytometry, Western blot, and confocal microscopy techniques were used for measuring protein expression and cell apoptosis in HEK293 and human pulmonary artery smooth muscle cells. KCNA5 variants (namely, Arg184Pro and Gly384Arg) found in patients with PAH resulted in a clear loss of potassium channel function as assessed by electrophysiological and molecular modeling analyses. The Arg184Pro variant also resulted in a pronounced reduction of Kv1.5 expression. Transfection with Arg184Pro or Gly384Arg variants decreased apoptosis of human pulmonary artery smooth muscle cells compared with the wild-type cells, demonstrating that KCNA5 dysfunction in both variants affects cell viability. Thus, in addition to affecting channel activity, both variants were associated with impaired apoptosis, a crucial process linked to the disease. The estimated prevalence of dysfunctional KCNA5 variants in the PAH population analyzed was around 1%. The data indicate that some KCNA5 variants found in patients with PAH have critical consequences for channel function, supporting the idea that KCNA5 pathogenic variants may be a causative or contributing factor for PAH.

Background: Linked datasets that enable longitudinal assessments are scarce in low and middle-income countries., Objectives: We aimed to assess the linkage of administrative databases of live births and under-five child deaths to explore mortality and trends for preterm, small (SGA) and large for gestational age (LGA) in Mexico., Methods: We linked individual-level datasets collected by National statistics from 2008 to 2019. Linkage was performed based on agreement on birthday, sex, residential address. We used the Centre for Data and Knowledge Integration for Health software to identify the best candidate pairs based on similarity. Accuracy was assessed by calculating the area under the receiver operating characteristic curve. We evaluated completeness by comparing the number of linked records with reported deaths. We described the percentage of linked records by baseline characteristics to identify potential bias. Using the linked dataset, we calculated mortality rate ratios (RR) in neonatal, infants, and children under-five according to gestational age, birthweight, and size., Results: For the period 2008-2019, a total of 24,955,172 live births and 321,165 under-five deaths were available for linkage. We excluded 1,539,046 records (6.2%) with missing or implausible values. We succesfully linked 231,765 deaths (72.2%: range 57.1% in 2009 and 84.3% in 2011). The rate of neonatal mortality was higher for preterm compared with term (RR 3.83, 95% confidence interval, [CI] 3.78, 3.88) and for SGA compared with appropriate for gestational age (AGA) (RR 1.22 95% CI, 1.19, 1.24). Births at <28 weeks had the highest mortality (RR 35.92, 95% CI, 34.97, 36.88). LGA had no additional risk vs AGA among children under five (RR 0.92, 95% CI, 0.90, 0.93)., Conclusions: We demonstrated the utility of linked data to understand neonatal vulnerability and child mortality. We created a linked dataset that would be a valuable resource for future population-based research., (© 2023 The Authors. Paediatric and Perinatal Epidemiology published by John Wiley & Sons Ltd.)