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A double cortical button technique for ulnar collateral ligament reconstruction (UCLR) has advantages including significant control over graft tensioning, less concern about graft length, and minimized risk of bone tunnel fracture compared with traditional UCLR techniques. This double cortical button technique was recently found to be noninferior in mechanical performance to the traditional docking technique regarding joint strength, joint stiffness, and graft strain. However, clinical outcomes have not been compared between these UCLR techniques. Therefore, the purpose of this study was to determine whether baseball players who underwent UCLR with a double cortical button (double button) technique have similar return-to-sport (RTS) outcomes to baseball players who underwent UCLR with the traditional docking (docking) technique. Baseball players who underwent primary UCLR from 2011 to 2020 across 2 institutions were identified. Included patients were contacted to complete a follow-up survey evaluating reoperations, RTS, and functional outcome scores. Functional outcome surveys include the Kerlan-Jobe Orthopaedic Clinic score, the Conway-Jobe score, the Andrews-Timmerman elbow score, and the Single Assessment Numeric Evaluation score. Overall, 78 male baseball players (age: 18.9 ± 2.4 years) with an average follow-up of 3.1 ± 2.4 years were evaluated, with 73 of the players being baseball pitchers. Players in the double button group more frequently received palmaris longus autografts (78% vs. 30%) and less frequently received gracilis autografts (22% vs. 58%) compared with players in the docking group (P =.001); however, all other demographic factors were similar between the groups. All players in the double button group were able to RTS in 11.1 ± 2.6 months, whereas 96% of players in the docking group were able to RTS in 13.5 ± 3.4 months (P >.05). All postoperative outcomes and patient-reported outcomes were statistically similar between the groups and remained similar after isolating pitchers only and after separating partial-thickness from full-thickness UCL tears (all P >.05). RTS and other postoperative outcomes may be similar between baseball players who underwent UCLR with the double button technique and the docking technique. Although future research may be necessary to strengthen clinical recommendations, these findings provide the first clinical outcomes in light of a recent cadaveric study finding similar elbow strength, joint stiffness, and graft strain compared with the docking technique. [ABSTRACT FROM AUTHOR]

Discussion of online bibliographic database searches focuses on a software system, SORT-AID/SABRE, that ranks retrieved citations in terms of relevance. Results of a comprehensive user evaluation of the relevance ranking procedure to determine its effectiveness are presented, and implications for future work are suggested. (10 references) (LRW)

Diabetic patients have a greater incidence of adhesive capsulitis (AC) and a more protracted disease course than patients with idiopathic AC. The purpose of this study was to compare gene expression differences between AC with diabetes mellitus and AC without diabetes mellitus. Shoulder capsule samples were prospectively obtained from diabetic or nondiabetic patients who presented with shoulder dysfunction and underwent arthroscopy (N = 16). Shoulder samples of AC with and without diabetes (n = 8) were compared with normal shoulder samples with and without diabetes as the control group (n = 8). Shoulder capsule samples were subjected to whole-transcriptome RNA sequencing, and differential expression was analyzed with EdgeR. Only genes with a false discovery rate < 5% were included for further functional enrichment analysis. The sample population had a mean age of 47 years (range, 24-62 years), and the mean hemoglobin A 1c level for nondiabetic and diabetic patients was 5.18% and 8.71%, respectively. RNA-sequencing analysis revealed that 66 genes were differentially expressed between diabetic patients and nondiabetic patients with AC whereas only 3 genes were differentially expressed when control patients with and without diabetes were compared. Furthermore, 286 genes were differentially expressed in idiopathic AC patients, and 61 genes were differentially expressed in diabetic AC patients. On gene clustering analysis, idiopathic AC was enriched with multiple structural and muscle-related pathways, such as muscle filament sliding, whereas diabetic AC included a greater number of hormonal and inflammatory signaling pathways, such as cellular response to corticotropin-releasing factor. Whole-transcriptome expression profiles demonstrate a fundamentally different underlying pathophysiology when comparing diabetic AC with idiopathic AC, suggesting that these conditions are distinct clinical entities. The new genes expressed explain the differences in the disease course and suggest new therapeutic targets that may lead to different treatment paradigms in these 2 subsets. [ABSTRACT FROM AUTHOR]

Smoking is a poor prognostic factor for healing after rotator cuff repair and is associated with inferior results. We hypothesized that smokers would have higher recurrent tear rates and more postoperative myotendinous junction (MTJ) retraction in healed repairs than nonsmokers three months postoperatively. Rotator cuff repairs (RCRs) were retrospectively reviewed over a 2-year period. Patients underwent magnetic resonance imaging (MRI) within 6 months prior to surgery and again at 3 months postoperatively. Seventy-nine patients were included and stratified by smokers versus nonsmokers. Baseline patient demographics, tear characteristics, and surgical factors were collected. Preoperative and postoperative MRIs were assessed to quantify the MTJ position and to establish the recurrent tear rate. For the total cohort (nonsmokers, n = 56; smokers, n = 23), significant differences in age, race, and traumatic onset of injury existed between groups. There were no significant differences in recurrent tear between smokers (26%) and nonsmokers (27%), but nonsmokers were more satisfied. For patients with healed RCRs (nonsmokers, n = 41; smokers, n = 17), there were significant differences in race. On univariate analysis, nonsmokers had a significantly more lateral MTJ postoperatively (P = 0.05). On multivariable regression analysis, medialized postoperative MTJ position in healed cuffs was driven only by greater preoperative rotator cuff retraction preoperatively. There were no significant differences in MTJ position based on smoking status for patients with healed RCRs. Smoking does not appear to be an independent risk factor for postoperative MTJ retraction in healed RCRs, also known as failure in continuity. Preoperative tear size and retraction play the biggest roles in predicting postoperative MTJ position, regardless of smoking status. There are no significant differences in patient-reported outcomes for patients with healed RCRs, but nonsmokers had more satisfaction following RCR in the total cohort. Level III; Retrospective cohort study; Diagnostic study [ABSTRACT FROM AUTHOR]

Describes a hardware/software configuration based on personal computers and commercially available generic software that has been assembled to support online bibliographic database searchers. Searchers' ability to trade scripts to transfer expertise in this complex field, and to provide facilities for post-processing of downloaded citations are considered. (Author/MBR)

Purpose: The goals of this study were 2-fold: (1) to determine the risk factors for cerebral desaturation events (CDEs) after implementation of a comprehensive surgical and anesthetic protocol consisting of patient risk stratification, maintenance of normotensive anesthesia, and patient positioning in a staged fashion, and (2) to assess for subclinical neurologic decline associated with intraoperative ischemic events through cognitive testing.Methods: One hundred patients undergoing shoulder surgery in the beach chair position were stratified for risk of CDE based on Framingham stroke criteria, body mass index (BMI), and history of cerebrovascular accidents. Cerebral oxygen saturation was monitored with near-infrared spectroscopy. As per a standardized protocol, mean arterial pressure was maintained between 70 and 90 mm Hg. The head was raised in 2 stages separated by 3 minutes. CDE were defined as >20% drop from baseline or <55% O2 absolute threshold. Patients completed a Mini-Mental State Examination during preoperative examination and at the first postoperative visit.Results: The CDE rate was 4% overall and 4.3% in patients undergoing general anesthesia. Forty-five patients were in the higher risk category, and all CDEs occurred in that group. Patients with a Framingham score ≥ 10 or BMI ≥ 35 who underwent general anesthesia had an increased risk of CDE (P = .04). No significant change was noted in Mini-Mental State Examination scores between pre- and postoperative visits. No correlation was shown between CDE and history of diabetes, smoking, cardiovascular disease, or left ventricular hypertrophy.Conclusions: Our observed CDE rate was lower than previously reported rates, likely because of risk stratification, staged positioning, and normotensive anesthesia. Framingham score ≥ 10 and BMI ≥ 35 are risk factors for CDE in the beach chair position.Level Of Evidence: Level II, prospective observational study with >80% follow-up. [ABSTRACT FROM AUTHOR]

For the two stable phases of Ni(OH)2, viz. α-Ni(OH)2 and β-Ni(OH)2, structural and magnetic properties are compared employing x-ray diffraction (XRD), scanning electron microscopy/transmission electron microscopy (TEM/SEM), and variation of the magnetization (M) with temperatures (2-350 K) and magnetic fields (up to ≈65 kOe). Both phases crystallize in the layered hexagonal structure with a=3.04 Å (3.12 Å) and c=23.6 Å (4.67 Å) for the α(β) phase with clear evidence for turbostraticity in the α-phase. From TEM/SEM, the β-phase consists of nanoplates of dimensions 30(10)×3(1) nm, whereas the α-phase has flowerlike morphology with petal thickness ≈5(1) nm. The low-field M versus T data for the zero-field-cooled/field cooled cases bifurcates at Tp=25 K (13 K) for the β(α) phase. For T>Tp, Curie-Weiss variation of M versus T is observed yielding positive θ=20.6 K (32 K) with μ=2.95 μB (3.13 μB) for the Ni2+ ions in the β(α) phase. The M versus H data at 2 K shows antiferromagnetic (ferromagnetic) like variation for the β(α) phase with dM/dH showing peaks at Hc1=28 kOe and Hc2=55 kOe for the β-phase. It is concluded that β-Ni(OH)2 is a metamagnet for T2 is a hard ferromagnet with Tc=13 K and domain structure for H<5 kOe. [ABSTRACT FROM AUTHOR]

Magnetic properties of oleic acid/oleylamine coated magnetite nanoparticles of average diameter D=4, 6, 8, 10, and 12 nm are reported. The samples were characterized by transmission electron microscopy and x-ray diffraction (XRD) with XRD showing increasing disorder with decreasing D. Magnetization M vs temperature T data show the blocking temperature TB decreasing with decreasing D from TB=38 K for 12 nm to TB=6.5 K for D=4 nm. The saturation magnetization Ms at 2 K also decreases from Ms=62 emu/g for 12 nm to Ms=17 emu/g for 4 nm but the coercivity at 2 K increases with a decrease in D. It is shown that Ms fits Ms=92(1-2d/D)3 with d=0.68 nm for D>4 nm and d=0.86 for D=4 nm. This equation is derived assuming a core-shell model with shell of thickness d consisting of disordered spins not contributing to Ms. [ABSTRACT FROM AUTHOR]

Background A variety of techniques currently exist for ulnar collateral ligament (UCL) reconstruction in symptomatic overhead athletes, all with the potential complication of fracture about the humeral or ulnar tunnels. Far cortical button fixation is a reproducible, biomechanically attractive option; however, no clinical series has been published on this technique to date. This study reports the clinical outcomes, with minimum 2-year follow-up, of a dual far cortical button suspension technique for UCL reconstruction in athletes. Methods A retrospective evaluation was performed of 23 consecutive athletes who underwent UCL reconstruction with the use of ulnar and humeral-sided far cortical button fixation with minimum 2 years of follow-up. Data were collected from electronic medical records and patient telephone calls. The primary outcome was return to sport. Secondary outcomes included Disabilities of the Arm, Shoulder and Hand score, range of motion, and complications. Results We included 23 athletes with a mean follow-up of 47.2 months (range, 24-81 months). Autograft was used in 22 patients (16 palmaris, 6 gracilis, 1 semitendinosus, and 1 gracilis allograft). Overall, 82.6% (19 of 23) of patients returned to sport. At final follow-up, the average Disabilities of the Arm, Shoulder and Hand score was 3.8, and range of motion averaged 0° to 140°, with 87% (20 of 23) of patients achieving full motion. The visual analog scale score improved from 3.8 preoperatively to 0.2 at the final follow-up ( P  < .0001). There was 1 reconstruction failure. Conclusions The humeral and ulnar far cortical button suspension technique provides a new UCL fixation option with theoretically lower concern for tunnel fracture and with predictable return to sport and good functional outcomes. [ABSTRACT FROM AUTHOR]

Starting with 7 nm γFe2O3 nanoparticles, synthesis of DNA-γFe2O3 nanocomposite and its structural/magnetic properties vis-a-vis the parent γFe2O3 are reported. Analysis of the x-ray diffraction shows an increase in the particle strain and average particle size (to 9.7 nm) in DNA-γFe2O3 nanocomposite. Transmission electron microscopy also shows an increase in size and a considerably wider size distribution. Temperature (5–300 K) variation of the magnetization (M) shows a wider distribution of the blocking temperatures (TB), as expected from the wider size distribution. Above TB, the data of M vs H fit the modified Langevin function with magnetic moment/particle μp≈11 000μB, somewhat larger than μp≈8000μB for the parent γFe2O3. However, M/g(γFe2O3) is not significantly affected. In electron magnetic-resonance spectroscopy at 9.28 GHz, only a single line is observed in DNA-γFe2O3 nanocomposite compared to two lines in γFe2O3. These effects are discussed in terms of the above structural differences. [ABSTRACT FROM AUTHOR]

Background Little is known about the time dependence of the failure rate of surgically repaired rotator cuffs. Retears are significant, as they are common and may lead to less satisfactory outcomes and additional operations. Their timing is critical foundational information for understanding failure mechanisms. However, this remains unclear. Currently, there exist a number of studies that have reported retear rates at specific time points. Combining data from these publications can reveal when cuffs retear, which will help inform expectations and guidelines for progression of activity after surgery. Methods PubMed, Medline, and Embase were searched for studies relating to rotator cuff repair. Abstracts and articles were evaluated on the basis of predefined inclusion and exclusion criteria. Data were extracted from those publications that satisfied all requirements, and regression analysis was performed. Results Thirteen articles were included in the final meta-analysis. Retear rates for medium tears increased for approximately 15 months and leveled off at approximately 20%. Retear rates for large tears progressed steadily for about 12 months and approached an upper limit of approximately 40%. Retear rates for massive tears ranged from 20% to 60%, but the distribution of retear rate over time for these cuff tears is not clear from these data. Conclusion Retear rates for medium and large tears generally increase until at least 10-15 months after surgery, after which they are likely to level off. Retear rates for massive tears are variable and may follow a time course different from that of other tear sizes. Retear rates depend on size of the original tear. [ABSTRACT FROM AUTHOR]

Provides information on a study that investigated the nature of magnetism and electron paramagnetic resonance spin dynamics in iron oxyhydroxide particles. Experimental procedures; Results and discussion.