Cirrhosis associated with increased complications and healthcare utilization following total shoulder arthroplasty.

Introduction: Cirrhosis is a known risk factor for morbidity and mortality following surgical procedures and has been associated with increased complications, hospital length of stay (LOS), and cost of admission following total joint arthroplasty. However, a paucity of literature exists evaluating the effect of cirrhosis on postoperative outcomes following total shoulder arthroplasty (TSA). The purpose of this study is to evaluate the short-term outcomes following elective primary TSA in patients with cirrhosis compared to matched controls.

Racial and ethnic disparities in short-stay primary total shoulder arthroplasty.

Background: There is a paucity of literature evaluating the utilization of short-stay total shoulder arthroplasty (TSA) in different racial groups. The purpose of this study is to compare short-stay TSA utilization and postoperative outcomes across racial groups.

Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried from 2010 to 2018 to identify patients who underwent primary short-stay TSA, defined as a length of stay of less than 2 midnights.

Frailty is Associated with Increased Complication, Readmission, and Hospitalization Costs Following Primary Total Shoulder Arthroplasty.

Introduction: Frailty is an age-related state of multi-system decline that has been associated with negative outcomes after surgery. Numerous methods have been utilized to quantify frailty and predict postoperative outcomes with variable results. The purpose of this study is to determine if the Hospital Frailty Risk Score (HFRS) is an independent predictor of postoperative complications and increased healthcare costs following elective primary total shoulder arthroplasty (TSA).

Lower Total Shoulder Arthroplasty Cost of Care at an Ambulatory Surgical Center Versus a Main Hospital.

Introduction: Total shoulder arthroplasty (TSA) is an increasingly common orthopaedic procedure. Expansion of TSA to outpatient surgical settings has the potential to reduce costs, although there is limited research on the cost and efficiency of this shift in surgical site of care. The purpose of this study is to compare costs and efficiency of TSA between an ambulatory surgical center (ASC) and a hospital.

Perioperative complications and readmission rates following total shoulder arthroplasty in patients aged 90 and older.

Background: Previous literature has cited age as an independent risk factor for surgical outcomes following total shoulder arthroplasty (TSA). The purpose of this study is to determine the short-term outcomes of nonagenarians following primary TSA and compare them to younger cohorts.

Methods: The Nationwide Readmission Database (NRD) was queried from 2010 to 2020 to identify patients who underwent a primary reverse or anatomic TSA (rTSA or aTSA).

Anatomic Total Shoulder Arthroplasty Revised to Reverse Total Shoulder Arthroplasty: Clinical and Radiographic Outcomes Compared to Primary Reverse Total Shoulder Arthroplasty.

Introduction: Reverse total shoulder arthroplasty (rTSA) has become the procedure of choice for a failed aTSA. Little data exists regarding outcomes; the few studies published to date have small numbers, short follow-up, and most do not have a control group or use first generation implants. The purpose of this study is to compare the clinical and radiographic outcomes of failed aTSA revised to rTSA to primary rTSA.

Comparing the Exactech Equinoxe reverse total shoulder arthroplasty for fracture versus degenerative conditions: 5-year minimum follow-up.

Background/hypothesis: Reverse total shoulder arthroplasty (rTSA) has become the operative treatment of choice for acute proximal humerus fractures in the elderly population, but little data exist on the long-term outcomes or how they compare to rTSA done for degenerative conditions. The purpose of this study is to compare the clinical and radiographic outcomes of patients undergoing rTSA for acute fracture versus degenerative conditions with a minimum 5-year follow-up.

Methods: Data was extracted from an international registry of patients with the Exactech Equinoxe rTSA implant from 2007 to 2018.

Medicaid status is independently predictive of increased complications, readmission, and mortality following primary total shoulder arthroplasty.

Background: In recent years, several studies have evaluated the effect of Medicaid insurance status on total shoulder arthroplasty (TSA) outcomes and have presented discordant findings. The purpose of this study is to determine if Medicaid status is an independent predictor of all-cause complications, readmission, revision, and mortality following elective primary TSA using a large, national administrative claims database.

Methods: The Nationwide Readmissions Database was queried to identify patients who underwent elective primary TSA from 2016 to 2020.

p53 mutation biases squamocolumnar junction progenitor cells towards dysplasia rather than metaplasia in Barrett's oesophagus.

Background: While p53 mutations occur early in Barrett's oesophagus (BE) progression to oesophageal adenocarcinoma (EAC), their role in gastric cardia stem cells remains unclear.

Objective: This study investigates the impact of p53 mutation on the fate and function of cardia progenitor cells in BE to EAC progression, particularly under the duress of chronic injury.

Design: We used a BE mouse model (L2-IL1β) harbouring a mutation (R172H) to study the effects of p53 on Cck2r cardia progenitor cells.

Discharge with home health care is associated with increased complications, readmission, and mortality following total shoulder arthroplasty.

Background: Patients undergoing primary anatomic and reverse total shoulder arthroplasty (TSA) are often discharged with home health care (HHC) to provide access to at-home services and facilitate postoperative recovery and continued medical management. The purpose of this study was to evaluate the short-term postoperative outcomes of patients following primary TSA discharged with HHC, including medical and surgical complications, total cost of care, and total hospital length of stay (LOS).

Methods: The Nationwide Readmissions Database was reviewed for patients who underwent elective primary TSA between 2016 and 2020 for a retrospective cohort analysis.

An engineered human cardiac tissue model reveals contributions of systemic lupus erythematosus autoantibodies to myocardial injury.

Systemic lupus erythematosus (SLE) is a heterogenous autoimmune disease that affects multiple organs, including the heart. The mechanisms of myocardial injury in SLE remain poorly understood. In this study, we engineered human cardiac tissues and cultured them with IgG from patients with SLE, with and without myocardial involvement.

Outcomes following humeral head autograft glenoid reconstruction in primary reverse total shoulder arthroplasty.

Background: Patients with severe glenoid bone loss are at increased risk for poor implant fixation, scapular notching, dislocation, joint kinematic disturbances, and prosthetic failure following reverse total shoulder arthroplasty (rTSA). Glenoid bone grafting has proven useful when performing rTSA in patients with inadequate glenoid bone stock, although the current literature is limited. The purpose of this study is to evaluate clinical outcomes in patients with significant glenoid deformity undergoing primary rTSA with one-stage glenoid reconstruction using a humeral head autograft.

Three-dimensional finite element modeling of glenoid bone loss and baseplate fixation in reverse total shoulder arthroplasty.

Background: Posterior glenoid bone loss is frequently observed in patients with osteoarthritis undergoing reverse total shoulder arthroplasty. Glenoid bone loss can reduce the baseplate back support area and the number of screws for fixation. The purpose of this study is to determine how initial baseplate fixation is affected by biomechanical factors introduced by glenoid bone loss such as reduced baseplate back support area and reduced screw number using three-dimensional finite element analysis.

Delayed elective total shoulder arthroplasty: causes and eventual outcomes.

Purpose: The purpose of this study is to identify risk factors for delays in planned total shoulder arthroplasty (TSA) and determine the perioperative outcomes of TSAs that experienced a delay.

Methods: The American College of Surgeons National Quality Improvement Program (NSQIP) database was queried from 2006 to 2019 for primary TSA. Delayed TSA was defined as surgery that occurred greater than one day after hospital admission.

Ulnar Collateral Ligament Repair With Internal Brace Using Linked Knotless Suture Anchors.

This article presents an adaptation of the internal brace ulnar collateral ligament (UCL) repair technique using knotless suture anchors, which shows promise for improved postsurgical functionality and a shortened recovery period in patients with UCL injuries. Traditional methods of UCL reconstruction often require a lengthy 12- to 18-month recovery period, presenting a significant challenge for athletes keen to return to their sport. The modified technique uses smaller sutures and drill holes, thereby eliminating the need for larger anchors and simplifying the surgical process.

An engineered human cardiac tissue model reveals contributions of systemic lupus erythematosus autoantibodies to myocardial injury.

Systemic lupus erythematosus (SLE) is a highly heterogenous autoimmune disease that affects multiple organs, including the heart. The mechanisms by which myocardial injury develops in SLE, however, remain poorly understood. Here we engineered human cardiac tissues and cultured them with IgG fractions containing autoantibodies from SLE patients with and without myocardial involvement.

Irreparable Subscapularis Tears: Current Tendon Transfer Options.

Purpose Of Review: Irreparable subscapularis tears, especially in younger patients with higher functional demands, present a challenging entity. Pectoralis major and latissimus dorsi tendon transfers are commonly considered for surgical management of this pathology, yet no consensus exists regarding the superior option. The purpose of this article is to review the most current tendon transfer techniques for irreparable subscapularis tears.

Perioperative complications and outcomes in patients with paraplegia undergoing rotator cuff repair.

Background: Patients with paraplegia often experience chronic shoulder pain due to overuse. We sought to determine if these patients have an increased prevalence of perioperative complications and higher rates of re-admissions and rotator cuff re-tears relative to able-bodied controls following rotator cuff repair (RCR).

Methods: We queried the NRD (2011-2018) to identify all patients undergoing primary RCR (n = 34,451) and identified cohorts of matched paraplegic and non-paraplegic patients (n = 194 each).

Angiopoietin-2 blockade suppresses growth of liver metastases from pancreatic neuroendocrine tumors by promoting T cell recruitment.

Improving the management of metastasis in pancreatic neuroendocrine tumors (PanNETs) is critical, as nearly half of patients with PanNETs present with liver metastases, and this accounts for the majority of patient mortality. We identified angiopoietin-2 (ANGPT2) as one of the most upregulated angiogenic factors in RNA-Seq data from human PanNET liver metastases and found that higher ANGPT2 expression correlated with poor survival rates. Immunohistochemical staining revealed that ANGPT2 was localized to the endothelial cells of blood vessels in PanNET liver metastases.

The Obesity Paradox: A Nonlinear Relationship Between 30-Day Postoperative Complications and Body Mass Index After Total Shoulder Arthroplasty.

Background: An inverse relationship coined the "obesity paradox" has been propositioned, in which body mass index (BMI) may be contradictorily protective in patients undergoing surgery or treatment of chronic disease. This study sought to investigate the BMI associated with the lowest rate of medical complications after total shoulder arthroplasty (TSA).

Methods: The American College of Surgeons National Surgical Quality Improvement Project database was queried to identify adults who underwent elective primary TSA between January 2012 and December 2020.

Experimentally Induced Peripheral Venous Congestion Exacerbates Inflammation, Oxidative Stress, and Neurohormonal and Endothelial Cell Activation in Patients With Systolic Heart Failure.

Background: Venous congestion (VC) is a hallmark of symptomatic heart failure (HF) requiring hospitalization; however, its role in the pathogenesis of HF progression remains unclear. We investigated whether peripheral VC exacerbates inflammation, oxidative stress and neurohormonal and endothelial cell (EC) activation in patients with HF with reduced ejection fraction (HFrEF).

Methods And Results: Two matched groups of patients with HFrEF and with no peripheral VC vs without recent HF hospitalization were studied.