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Introduction: Pleomorphic adenoma (PA) is the most common benign salivary gland tumor, primarily found in the parotid gland. Recurrences often extend into the parapharyngeal space (PPS), complicating management. This report presents a case of a recurrent giant PA in the PPS following a limited excision. Case Description: A 45-year-old male presented with a gradually enlarging neck mass, dysphagia, and mild dyspnea, having previously undergone limited excision of a PA. Clinical examination revealed a firm mass in the right parotid region. Magnetic resonance imaging (MRI) showed a large mass in the right parapharyngeal space. Surgical excision was performed using a cervical-transparotid and mandibular swing approach. The patient was discharged after 7 days and later received radiotherapy. Discussion: Parapharyngeal space tumors (PPT) are rare neoplasms, with 70% to 80% being benign, primarily PAs. Symptoms include neck masses, swallowing difficulties, and potential cranial nerve involvement. MRI is crucial for assessing tumor extent. A combined transparotid-transcervical approach was employed. Postoperative radiotherapy was recommended. Conclusions: PPTs present significant clinical challenges, highlighting the need for meticulous surgical planning and complete excision of PAs to minimize recurrence risk. The close proximity of vital neurovascular structures requires careful preoperative evaluation and strategic surgical approaches., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Sports physicians need to be aware of potential complications related to breast implants in athletes. Problems with breast implants can affect an athlete's physical health, overall mental well-being and performance. This case report explores the challenges sports physicians face in diagnosing and managing breast implant ruptures in athletes. It outlines the complexities of identifying ruptures, conducting appropriate screenings, and determining fitness to play following chest injuries sustained during sports. This publication also offers practical guidance on addressing these challenges and emphasises the importance of comprehensive evaluation, proactive screening, and a multidisciplinary approach to management., Competing Interests: Declaration of interest statement No disclosures., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Background: Due to the ageing population, the number of symptomatic degenerative rotator cuff tears has increased substantially, and some are challenging to repair due to poor tendon quality with significant retraction. In order to optimize repair integrity and function, rotator cuff repair reinforcement with a superior capsule reconstruction has been proposed. This study presents the results of a technique combining cuff repair and capsular reconstruction (CRACR) using acellular dermal allograft in patients with massive rotator cuff tears and retears., Methods: From December 2017 to July 2019, 50 consecutive patients with previous failed rotator cuff repairs or primary surgery on poor tendon quality defined as massive rotator cuff tear (full thickness rotator cuff tears with 2 or more tendons involved), were treated with the CRACR technique and enrolled prospectively. Contraindications for the CRACR procedure were Hamada stage ≥3 cuff tear arthropathy and patient's preference for reverse total shoulder arthroplasty. Patients were reviewed at 3, 6, 12, and 24 months (American Shoulder and Elbow Surgeons scores, Constant Murley Scores, Visual Analogue Scores, Oxford Shoulder Score, QuickDASH). Postoperative magnetic resonance imaging scans were requested at 6 weeks, 3 months, 6 months, 12 months, and 24 months postoperatively, to assess repair integrity., Results: Mean age at surgery was 58.0 years (SD 8.1, range 41-79). Of the 50 patients, 14 patients (28.0%) had previous failed rotator cuff repair. From the 36 primary cases, 28 (77.8%) had massive rotator cuff tears and one (2.8%) a perioperative irreparable tear, while 28 (77.8%) patients had a subscapularis tear. At 2 years of follow-up all scores improved significantly (Visual Analogue Scores 6.3 to 1.5; American Shoulder and Elbow Surgeons 34.0 to 79.0; Constant Murley Scores 30.9 to 68.0; OSS 23.3 to 40.1; QuickDASH 56.2 to 20.3; all P < .001). Magnetic resonance imaging scans were conducted at a mean of 14.4 months (SD 7.0, range 3-26) after surgery showing 6 isolated superior capsular reconstruction failures and 5 isolated rotator cuff retears., Conclusion: In the short term, the CRACR technique is a valid option for patients with massive rotator cuff tears and retears with a high chance of a postoperative retear due to poor tendon quality. Clinical results and repair integrity are promising. Longer term follow-up is ongoing to establish the efficacy of this procedure., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Primary glenohumeral osteoarthritis in young patients poses challenging treatment decisions. Arthroplasty options have different failure profiles and implant survivorship patterns. This registry study aims to analyze the cumulative per cent revision (CPR) rate of different types of arthroplasties conducted for primary osteoarthritis in patients below 55 years of age., Methods: This comparative observational national registry study included all shoulder arthroplasty for osteoarthritis in patients below 55 years of age undertaken between January 1st, 2005, and December 31st, 2022. Partial hemi resurfacing and hemi stemless procedures were excluded. The CPR was determined using Kaplan-Meier estimates of survivorship and hazard ratios (HRs) from Cox proportional hazard models adjusted for gender. Reasons for revision of each type of arthroplasty and cumulative incidence of revision diagnoses were analyzed., Results: Two thousand one-hundred eleven primary shoulder arthroplasties were compared. Glenoid erosion is the predominant cause of revision for humeral resurfacing (29.8%) and hemiarthroplasty (35.5%). Instability is the predominant cause of revision for stemmed anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA), while loosening is the predominant cause of revision for stemless aTSA. The 6-year CPR is 12.8% for humeral resurfacing, 14.1% for hemiarthroplasty, 12.4% for stemmed (aTSA), 7.0% for stemless aTSA, and 6.5% for rTSA. Stemmed aTSA had a higher revision rate than rTSA (entire period HR = 2.04 (95% confidence interval 1.16, 3.57), P = .012). In contrast, the revision rate of stemless aTSA was not different from rTSA (HR = 1.05 (95% confidence interval 0.51, 2.19), P = .889). Males outnumber females for all shoulder arthroplasty categories., Discussion: rTSA and stemless aTSA are viable options in young patients with primary osteoarthritis. Their short-to-medium term revision rates are comparable to those of older patients and lower than those associated with humeral resurfacing, hemiarthroplasty, and stemmed aTSA., Conclusion: In the predominantly male patient population below the age of 55, reverse shoulder arthroplasty and stemless aTSA have a lower short-term revision risk than stemmed aTSA., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Deep learning (DL) in orthopaedics has gained significant attention in recent years. Previous studies have shown that DL can be applied to a wide variety of orthopaedic tasks, including fracture detection, bone tumour diagnosis, implant recognition, and evaluation of osteoarthritis severity. The utilisation of DL is expected to increase, owing to its ability to present accurate diagnoses more efficiently than traditional methods in many scenarios. This reduces the time and cost of diagnosis for patients and orthopaedic surgeons. To our knowledge, no exclusive study has comprehensively reviewed all aspects of DL currently used in orthopaedic practice. This review addresses this knowledge gap using articles from Science Direct, Scopus, IEEE Xplore, and Web of Science between 2017 and 2023. The authors begin with the motivation for using DL in orthopaedics, including its ability to enhance diagnosis and treatment planning. The review then covers various applications of DL in orthopaedics, including fracture detection, detection of supraspinatus tears using MRI, osteoarthritis, prediction of types of arthroplasty implants, bone age assessment, and detection of joint-specific soft tissue disease. We also examine the challenges for implementing DL in orthopaedics, including the scarcity of data to train DL and the lack of interpretability, as well as possible solutions to these common pitfalls. Our work highlights the requirements to achieve trustworthiness in the outcomes generated by DL, including the need for accuracy, explainability, and fairness in the DL models. We pay particular attention to fusion techniques as one of the ways to increase trustworthiness, which have also been used to address the common multimodality in orthopaedics. Finally, we have reviewed the approval requirements set forth by the US Food and Drug Administration to enable the use of DL applications. As such, we aim to have this review function as a guide for researchers to develop a reliable DL application for orthopaedic tasks from scratch for use in the market., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Rare earth elements (REEs) are increasingly used in a wide range of applications. However, their toxicokinetic behaviors in animals and humans are not yet fully documented, hindering health risk assessments. We used a rat experimental model to provide novel data on the toxicokinetics of the insoluble oxide forms of praseodymium (Pr), neodymium (Nd), cerium (Ce) and yttrium (Y) administered intravenously. Detailed blood, urinary and fecal time courses were documented through serial sampling over 21 days in male Sprague-Dawley rats exposed to a mixture of these REE oxides administered at two different doses (0.3 or 1 mg kg -1 bw of each REE oxide commercially sold as bulk μm-sized particles). Tissue REE levels at the time of sacrifice were also measured. Significant effects of the dose on REE time courses in blood and on cumulative urinary and fecal excretion rates were observed for all four REE oxides assessed, as lower cumulative excretion rates were noted at the higher REE dose. In the liver, the main accumulation organ, the fraction of the administered REE dose remaining in the tissue at necropsy was similar at both doses. Toxicokinetic data for the REE oxides were compared to similar data for their chloride salts (also administered intravenously in a mixture, at 0.3 and 1 mg kg -1 bw of each REE chloride) obtained from a previous study. Compared to their chloride counterparts, faster elimination of REE oxides from the blood was observed in the first hours post-dosing. Furthermore, higher mean residence time (MRT) values as well as slower cumulative urinary and fecal excretion were determined for the REE oxides. Also, while liver REE retention was similar for both REE forms, the fractions of the administered REEs recovered in the spleen and lungs were noticeably higher for the REE oxides, at both dose levels. This study highlights the importance of both the dose and form of the administered REEs on their toxicokinetic profiles. Results indicate that chronic exposure and increased doses of REEs may favor bioaccumulation in the body, in particular for insoluble oxide forms of REEs, which are eliminated more slowly from the body., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)

Canada has recently invested in the large-scale exploitation of scandium oxide. However, there are no studies available to date to understand its toxicokinetics in the animal or human body, which is necessary to assess exposure and health risks. The aim of this research was to investigate the toxicokinetics of absorbed scandium oxide (Sc 2 O 3 ) using the rat as an experimental model. Male Sprague-Dawley rats were injected intravenously with 0.3 or 1 mg Sc 2 O 3 /kg body weight (bw). Blood and excreta (urine and feces) were collected sequentially during a 21-day period, and main organs (liver, spleen, lungs, kidneys, brain) were withdrawn at sacrifice on day 21. Inductively coupled plasma-mass spectrometry (ICP-MS) was used for the measurement of Sc element in the different samples. The mean residence time (MRT IV ) calculated from the blood profile was 19.7 ± 5.9 h and 43.4 ± 24.6 h at the lower and higher doses, respectively. Highest tissue levels of Sc were found in the lungs and liver; respective lung values of 10.6 ± 6.2% and 3.4 ± 2.3% of the Sc dose were observed at the time of sacrifice while liver levels represented 8.9 ± 6.4% and 4.6 ± 1.1%. Elimination of Sc from the body was not complete after 21 days. Cumulative fecal excretion over the 21-day collection period represented 12.3 ± 1.3% and 5.9 ± 1.0% of the lower and higher Sc doses, respectively, and showed a significant effect of the dose on the excretion; only a small fraction of the Sc dose was recovered in urine (0.025 ± 0.016% and 0.011 ± 0.004% in total, respectively). In addition to an effect of the dose on the toxicokinetics, results highlight the importance of the lung as a site of accumulation and retention of Sc 2 O 3 , which raises the question of the risks of effects related to respiratory exposure in workers. The results also question the relevance of urine as a matrix for biological exposure monitoring. A more in-depth inhalation toxicokinetic study would be necessary., Competing Interests: Declaration of Competing Interest There are no competing interests., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

We conducted a rat exposure study to assess the impacts of dose and co-exposure with other rare earth elements (REEs) on the toxicokinetics of praseodymium (Pr) and cerium (Ce). We first determined the kinetic profiles of elemental Pr and Ce in blood, urine and feces along with tissue levels at sacrifice on the seventh day following intravenous injection of PrCl 3 or CeCl 3 at 0.3 or 1 mg/kg bw (of the chloride salts) in adult male Sprague-Dawley rats (n = 5 per group). In blood, Pr and Ce half-lives for the initial phase (t1/2 α ) increased with increasing doses, while their half-lives for the terminal phase (t1/2 β ) were similar at both doses. In urine, a minor excretion route, no significant effect of the dose on the cumulative excretion was apparent. In feces, a major excretion route, the fraction of the Pr dose recovered was significantly lower at the 1 mg/kg bw dose compared to the 0.3 mg/kg bw dose, while no significant dose effect was apparent for Ce. In the liver and spleen, which are the main sites of REEs accumulation, there was a significant effect of the dose only for Ce retention in the spleen (i.e., increased retention of Ce in spleen at higher dose). Results were compared with those of a previous toxicokinetic study with a similar design but an exposure to a quaternary mixture of CeCl 3 , PrCl 3 , NdCl 3 and YCl 3 , each administered at 0.3 mg/kg bw or 1 mg/kg bw. A mixture effect was apparent for the initial elimination phase (t1/2 α ) of Pr and Ce from blood and for the fecal excretion of Ce at the 1 mg/kg bw. In urine and liver, there was no evident overall mixture effect; in the spleen, there was a higher retention of Pr and Ce in rats exposed to the mixture at the 0.3 mg/kg bw, but not at the 1 mg/kg bw dose. Overall, this study showed that the dose and mixture exposure are two important factors to consider as determinants of the toxicokinetics of REEs., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Investigate MRI evidence of anterior cruciate ligament (ACL) healing, patient-reported outcomes and knee laxity in patients with acute ACL rupture managed non-surgically with the Cross Bracing Protocol (CBP)., Methods: Eighty consecutive patients within 4 weeks of ACL rupture were managed with CBP (knee immobilisation at 90° flexion in brace for 4 weeks, followed by progressive increases in range-of-motion until brace removal at 12 weeks, and physiotherapist-supervised goal-oriented rehabilitation). MRIs (3 months and 6 months) were graded using the ACL OsteoArthritis Score (ACLOAS) by three radiologists. Mann-Whitney U tests compared Lysholm Scale and ACL quality of life (ACLQOL) scores evaluated at median (IQR) of 12 months (7-16 months) post-injury, and χ 2 tests compared knee laxity (3-month Lachman's test and 6-month Pivot-shift test), and return-to-sport at 12 months between groups (ACLOAS grades 0-1 (continuous±thickened ligament and/or high intraligamentous signal) versus ACLOAS grades 2-3 (continuous but thinned/elongated or complete discontinuity))., Results: Participants were aged 26±10 years at injury, 39% were female, 49% had concomitant meniscal injury. At 3 months, 90% (n=72) had evidence of ACL healing (ACLOAS grade 1: 50%; grade 2: 40%; grade 3: 10%). Participants with ACLOAS grade 1 reported better Lysholm Scale (median (IQR): 98 (94-100) vs 94 (85-100)) and ACLQOL (89 (76-96) vs 70 (64-82)) scores, compared with ACLOAS grades 2-3. More participants with ACLOAS grade 1 had normal 3-month knee laxity (100% vs 40%) and returned to pre-injury sport (92% vs 64%), compared with participants with an ACLOAS grades 2-3. Eleven patients (14%) re-injured their ACL., Conclusion: After management of acute ACL rupture with the CBP, 90% of patients had evidence of healing on 3-month MRI (continuity of the ACL). More ACL healing on 3-month MRI was associated with better outcomes. Longer-term follow-up and clinical trials are needed to inform clinical practice., Competing Interests: Competing interests: SRF served on the Osteoarthritis Research Society International (OARSI) Board of Directors in 2022-2023, and received funding (for travel and accommodation) to attend two board meetings. MA received reimbursement to attend and speak at Smith and Nephew symposium at The Combined TOSSM & APKASS conference in Thailand, October 2022. TC has formed a non-financial relationship with Bauerfeind, Germany, and Bauerfeind, Australia, to select a knee brace that optimises patient comfort and compliance. This relationship has had no impact on the completion of this study. After the completion of this study, Bauerfeind, Germany, donated 100 braces to TC for use in clinical practice. Donated braces were not used with participants in this study., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Total shoulder arthroplasty (TSA) has been the gold standard of care for end-stage glenohumeral arthritis. Outcomes are varied and have been affected by both patient and implant characteristics. Patient factors, such as age, preoperative diagnosis, and preoperative glenoid morphology, can affect the outcomes after TSA. Similarly, the different glenoid and humeral component designs significantly affect the survivorship of TSA. Significant evolution has occurred in the design of the glenoid component with the aim of decreasing the glenoid-sided causes of failure in TSA. On the other hand, focus on the humeral component has been increasing as well, with a trend towards using shorter humeral stems. This article aims to look at the outcomes of TSA as affected by the various patient characteristics and design options for the glenoid and the humeral components. This review also aims to compare survivorship data from global literature and the Australian joint replacement registry and to provide insights into the implant combination that may provide the best patient outcome., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Complete substitution of Li atoms for Ag atoms in AgGaSe 2 and AgInSe 2 was achieved, resulting in the solid solutions Li x Ag 1- x GaSe 2 and Li x Ag 1- x InSe 2 . The detailed crystal structures were determined by single-crystal X-ray diffraction and solid-state 7 Li nuclear magnetic resonance spectroscopy, which confirm that Li atoms occupy unique sites and disorder only with Ag atoms. The tetragonal CuFeS 2 -type structure (space group I 4̅2 d ) was retained within the entirety of the Ga-containing solid solution Li x Ag 1- x GaSe 2 , which is noteworthy because the end-member LiGaSe 2 normally adopts the orthorhombic β-NaFeO 2 -type structure (space group Pna 2 1 ). These structures are closely related, being superstructures of the cubic sphalerite and hexagonal wurtzite prototypes adopted by diamond-like semiconductors. For the In-containing solid solution Li x Ag 1- x InSe 2 , the structure transforms from the tetragonal to orthorhombic forms as the Li content increases past x = 0.50. The optical band gaps increase gradually with higher Li content, from 1.8 to 3.4 eV in Li x Ag 1- x GaSe 2 and from 1.2 to 2.5 eV in Li x Ag 1- x InSe 2 , enabling control to desired values, while the second harmonic generation responses become stronger or are similar to those of benchmark infrared nonlinear optical materials such as AgGaS 2 . All members of these solid solutions remain congruently melting at accessible temperatures between 800 and 900 °C. Electronic structure calculations support the linear trends seen in the optical band gaps and confirm the mostly ionic character present in Li-Se bonds, in contrast to the more covalent character in Ga-Se or In-Se bonds.

Revision shoulder arthroplasty is increasing with the number of primary shoulder replacements rising globally. Complex primary and revisions of shoulder arthroplasties pose specific challenges for the surgeon, which must be addressed preoperatively and intraoperatively. This article aimed to present strategies for the management of revision of shoulder arthroplasties through a single-stage approach. Preoperatively, patient factors, such as age, comorbidities, and bone quality, should be considered. The use of planning software can aid in accurately evaluating implants in situ and predict bony anatomy that will remain after explantation during the revision surgery. The planning from such software can then be executed with the help of mixed reality technology to allow accurate implant placement. Single-stage revision is performed in two steps (debridement as first step, implantation and reconstruction as the second step), guided by the following principles: adequate debridement while preserving key soft tissue attachments (i.e., rotator cuff, pectoralis major, latissimus dorsi, deltoid), restoration of glenoid joint line using bone grafting, restoration of humeral length, reconstruction and/or reattachment of soft tissues, and strict compliance with the postoperative antibiotic regimen. Preliminary results of single-stage revision shoulder arthroplasty show improvement in patient outcomes (mean 1 year), successful treatment of infection for those diagnosed with periprosthetic joint infection, and improved cost-benefit parameters for the healthcare system.