Single-center outcomes of artificial intelligence in management of pulmonary embolism and pulmonary embolism response team activation.

Multidisciplinary pulmonary embolism response teams (PERTs) have shown that timely triage expedites treatment. The use of artificial intelligence (AI) may help improve pulmonary embolism (PE) management with early CT pulmonary angiogram (CTPA) screening and accelerate PERT coordination. This study aimed to test the clinical validity of an FDA-approved PE AI algorithm.

Fibrosis resolution in the mouse liver: Role of Mmp12 and potential role of calpain 1/2.

Although most work has focused on resolution of collagen ECM, fibrosis resolution involves changes to several ECM proteins. The purpose of the current study was twofold: 1) to examine the role of MMP12 and elastin; and 2) to investigate the changes in degraded proteins in plasma (i.e.

Simultaneous Upregulation of Elastolytic and Elastogenic Factors Are Necessary for Regulated Collateral Diameter Expansion.

During arteriogenesis, outward remodeling of the arterial wall expands luminal diameter to produce increased conductance in developing collaterals. We have previously shown that diameter expansion without loss of internal elastic lamina (IEL) integrity requires both degradation of elastic fibers and LOX-mediated repair. The aim of this study was to investigate the expression of genes involved in remodeling of the extracellular matrix (ECM) using a model of arteriogenesis.

Survey of the extracellular matrix architecture across the rat arterial tree.

Objective: To understand arterial remodeling and the pathophysiology of arterial diseases, it is necessary to understand the baseline qualities and variations in arterial structure. Arteries could differ in wall thickness, laminar structure, and laminar fenestration depending on their position within the arterial tree. We endeavored to evaluate and compare the extracellular matrix structure of different arteries throughout the arterial tree, from the aorta to the adductor muscle arteriole, with a particular focus on the internal elastic lamina (IEL).

Elastic Laminar Reorganization Occurs with Outward Diameter Expansion during Collateral Artery Growth and Requires Lysyl Oxidase for Stabilization.

When a large artery becomes occluded, hemodynamic changes stimulate remodeling of arterial networks to form collateral arteries in a process termed arteriogenesis. However, the structural changes necessary for collateral remodeling have not been defined. We hypothesize that deconstruction of the extracellular matrix is essential to remodel smaller arteries into effective collaterals.

Cost Reduction for Knee-Spanning External Fixation in the Staged Treatment of Tibial Plateau Fractures: A Practical Intervention.

Objective: To determine whether an educational intervention affects surgeon implant decision making measured by total implant costs for temporizing a knee-spanning external fixation construct.

Design: A total of 24 cases were prospectively collected after an educational intervention and matched to 24 cases before intervention using Schatzker classification and by surgeon.

Setting: A single Level 1 trauma center.

External Fixation Characteristics Drive Cost of Care for High-Energy Tibial Plateau Fractures.

Objective: To determine the total cost for a 30-day episode of care for high-energy tibial plateau fractures and the aspects of care associated with total cost.

Design: Time-driven activity-based costing analysis.

Setting: One Level 1 adult trauma center.

Immediate Weightbearing After Operative Treatment of Bimalleolar and Trimalleolar Ankle Fractures: Faster Return to Work for Patients with Nonsedentary Occupations.

The goal of this study was to compare immediate weightbearing (IWB) and traditional weightbearing (TWB) postoperative protocols in unstable ankle fractures, as this has not been compared in prior works. We hypothesize that an immediate weightbearing protocol after ankle fracture fixation will lead to an earlier return to work. An ankle fracture registry was reviewed for operatively treated unstable bimalleolar and trimalleolar ankle fractures at an ambulatory surgery center and followed up at associated outpatient clinics.

Improvement in Functional Outcomes After Elective Symptomatic Orthopaedic Implant Removal.

Introduction: The relative indications for removing symptomatic implants after osseous healing are not fully agreed on. The purpose of this study was to (1) determine whether patients showed improvement in functional outcomes after the removal of symptomatic orthopaedic implants, (2) compare the outcomes between upper and lower extremity implant removal, and (3) determine the rate of implant removal complications.

Methods: A prospective study was conducted between 2013 and 2016.

Minimum Clinically Important Difference in Short Musculoskeletal Function Assessment: What Change Matters in Ankle Fractures.

Accurate interpretation of the clinical significance of patient-reported outcome (PRO) research requires determination of the threshold where a difference in PRO score represents a clinical benefit to patients, termed the (MCID). The Short Musculoskeletal Function Assessment (SMFA) is one of the most commonly utilized PRO tools in orthopaedics. However, to date, no MCID has been determined.

Radiographic correlation of clinical shoulder deformity and patient perception following scapula fracture.

Background: Interest in operative management of scapular fractures is increasing based upon defined radiographic displacement criteria and growing awareness that certain extra-articular fractures will not do well and result in dysfunction and deformity (slumped shoulder). We intend to quantify clinical deformity, analyze correlations of these novel measures with defined radiographic measures of fracture displacement and with the patients' reported perception of their deformity.

Methods: Prospectively enrolled patients underwent standardized questioning regarding their perception of the deformity.

Financial Implications for the Treatment of Medicare Patients With Isolated Intertrochanteric Femur Fractures: Disproportionate Losses Among Healthier Patients.

Introduction: With an aging American public, the rising incidence of geriatric hip fractures provides a significant impact on the financial sustainability for hospitals. To date, there is little research comparing reimbursement to hospital costs for geriatric hip fracture treatment. The purpose of this study is to compare hospital costs to reimbursement for patients treated surgically with an isolated intertrochanteric femur fracture, insured by the Center of Medicare and Medicaid Services (CMS).

Factors Associated with a Second Opioid Prescription Fill in Total Knee Arthroplasty.

Background: Total knee arthroplasty (TKA) creates a relatively large degree of nociception, making it a good setting to study variation in pain intensity and pain alleviation. The purpose of this study is to investigate factors associated with a second prescription of opioid medications within 30 days of primary TKA.

Methods: Using an insurance database, we studied 1372 people over a 6-year period with no mental health comorbidities including substance misuse and no comorbid pain illness at the time of TKA.

Patient-Level Value Analysis: An Innovative Approach to Optimize Care Delivery.

Background: An increasing emphasis has been placed on developing value-based care delivery systems in orthopaedics to combat rising health care costs. The goal of these systems is to both measure and improve the provisional value of care. Patient-level value analysis creates a mechanism to quantify and optimize value within a procedure, in contrast to traditional methods, which only measures value.

Cost Variation in Temporizing External Fixation of Tibial Plateau Fractures.

Background: Rising health care expenditures and declining reimbursements have generated interest in providing interventions of value. The use of external fixation is a commonly used intermediate procedure for the staged treatment of unstable fractures. External fixator constructs can vary in design and costs based on selected component configuration.

Interpreting Patient-Reported Outcome Results: Is One Minimum Clinically Important Difference Really Enough?

Patient-reported outcomes (PROs) are the gold standard for reporting clinical outcomes in research. A crucial component of interpreting PROs is the minimum clinically important difference (MCID). Patient-Rated Wrist Evaluation (PRWE) is a disease-specific PRO tool developed for use in distal radius fractures.

Time-Driven Activity-Based Costing in Fracture Care: Is This a More Accurate Way to Prepare for Alternative Payment Models?

Objectives: To use surgical treatment of isolated ankle fractures as a model to compare time-driven activity-based costing (TDABC) and our institution's traditional cost accounting (TCA) method to measure true cost expenditure around a specific episode of care.

Methods: Level I trauma center ankle fractures treated between 2012 and 2016 were identified through a registry. Inclusion criteria were age greater than 18 years and same-day ankle fracture operation.

A modified rat model of hindlimb ischemia for augmentation and functional measurement of arteriogenesis.

Arteriogenesis (collateral artery development) is an adaptive pathway critical for salvage of tissue in the setting of arterial occlusion. Rodent models of arteriogenesis typically involve an experimental occlusion (ligation) of a hindlimb artery and then rely on indirect measures such as laser Doppler perfusion imaging to assess blood flow recovery. Unfortunately, the more commonly utilized measures of distal tissue perfusion at rest are unable to account for hemodynamic and vasoactive variables and thus provide an incomplete assessment of collateral network capacity.

Functional Outcomes of Symptomatic Implant Removal Following Ankle Fracture Open Reduction and Internal Fixation.

Background: Orthopedic implant removal following open reduction internal fixation of a fracture is a common procedure, especially in the foot and ankle. The purpose of this study was to evaluate functional change after the removal of symptomatic implants following ankle fracture open reduction internal fixation (ORIF) using the Short Musculoskeletal Function Assessment (SMFA) outcome score. We hypothesized that implant removal after ankle fracture would result in improved functional outcomes.

Publication of Podium Presentations at the Orthopaedic Trauma Association Annual Meetings: 2008-2012.

Objective: To determine journal publication rates of podium presentations from the OTA Annual Meetings between 2008 and 2012.

Methods: Podium presentations from the 2008 to 2012 OTA annual meeting were compiled from the Annual Meeting archives. During December 2016, and Google Scholar were performed using individual keywords in the abstract title and content.

Unbiased, High-Throughput Electron Microscopy Analysis of Experience-Dependent Synaptic Changes in the Neocortex.

Unlabelled: Neocortical circuits can be altered by sensory and motor experience, with experimental evidence supporting both anatomical and electrophysiological changes in synaptic properties. Previous studies have focused on changes in specific neurons or pathways-for example, the thalamocortical circuitry, layer 4-3 (L4-L3) synapses, or in the apical dendrites of L5 neurons- but a broad-scale analysis of experience-induced changes across the cortical column has been lacking. Without this comprehensive approach, a full understanding of how cortical circuits adapt during learning or altered sensory input will be impossible.