Durable remission of thrombotic thrombocytopenic purpura in the setting of pembrolizumab therapy.

Background: There is a small but growing number of thrombotic thrombocytopenic purpura (TTP) cases attributed to immune checkpoint inhibitor therapy, with nivolumab and ipilimumab therapy being the most frequently described in the literature.

Study Design And Methods: This report evaluates the course of a patient with a history of metastatic adenocarcinoma of the lung who developed TTP following treatment with the PD-1 inhibitor Pembrolizumab. The patient was treated with six sessions of therapeutic plasma exchange and appeared to be in remission.

What Factors Lead to Racial Disparities in Outcomes After Total Knee Arthroplasty?

Total knee arthroplasty (TKA) is one of the most commonly performed, major elective surgeries in the USA. African American TKA patients on average experience worse clinical outcomes than whites, including lower improvements in patient-reported outcomes and higher rates of complications, hospital readmissions, and reoperations. The mechanisms leading to these racial health disparities are unclear, but likely involve patient, provider, healthcare system, and societal factors.

How Teachers Adapt Their Cognitive Strategies When Using Entrustment Scales.

Purpose: Rater cognition is a field of study focused on individual cognitive processes used by medical teachers when completing assessments. Much has been written about the role of rater cognition in the use of traditional assessment scales. Entrustment scales (ES) are becoming the tool of choice for workplace-based assessments.

Blood group O convalescent plasma donations have significantly lower levels of SARS-CoV-2 IgG antibodies compared to blood group A donations.

Background: COVID-19 convalescent plasma (CCP) is plasma collected from individuals who have recovered from SARS-CoV-2 infection. The FDA Emergency Use Authorization restricts use of CCP to high-titer units only. The purpose of this study was to determine if donor ABO blood group was associated with SARS-CoV-2 antibody response, and subsequent qualification as high-titer CCP.

Defining recovery trajectories after shoulder arthroplasty: a latent class analysis of patient-reported outcomes.

Background: Patients undergoing total shoulder arthroplasty (TSA) can have varying levels of improvement after surgery. As patients typically demonstrate a nonlinear recovery trajectory, advanced analysis investigating the degrees of variation in outcomes is needed. Latent class analysis (LCA) is a mixed and multilevel model that estimates random slope variance to evaluate heterogeneity in outcome patterns among patient subgroups and can be used to outline differing recovery trajectories.

Reducing Time to Surgery for Hip Fragility Fracture Patients: A Resident Quality Improvement Initiative.

As part of an institutional quality improvement (QI) initiative for the 2018-2019 academic year, orthopedic residents at our tertiary center were incentivized to bring over 75% of hip fracture patients with American Society of Anesthesiologists (ASA) Class 2 or less to surgery in under 24 hours, compared to the baseline rate of 55.9%. The time between admission and surgery for hip fracture patients with ASA class 2 or less was prospectively recorded.

Incidence of anterior cruciate ligament graft tears in high-risk populations: An analysis of professional athlete and pediatric populations.

Background: Professional athletes are at increased risk of injury with high activity levels and additional pressure to return to sports quickly after anterior cruciate ligament (ACL) injury. The purpose of this study was to determine ACL graft re-tear rates in National Basketball Association (NBA), Major League Baseball (MLB), and National Hockey League (NHL) athletes using publicly available databases and to compare these to general populations, National Football League (NFL) athletes, and the pediatric population to establish a baseline for those partaking in high-risk sporting activity.

Methods: A comprehensive online search was performed to identify athletes in the NBA, MLB, and NHL who had a reported ACL tear between 2007 and 2017.

Fracture Epidemiology in Professional Baseball From 2011 to 2017.

Background: Fractures are a significant cause of missed time in Major League Baseball (MLB) and Minor League Baseball (MiLB). MLB and the MLB Players Association recently instituted rule changes to limit collisions at home plate and second base.

Purpose: To evaluate the epidemiologic characteristics of fractures in professional baseball and to assess the change in acute fracture incidence secondary to traumatic collisions at home plate and second base after the recently instituted rule changes.

Social Determinants of Health and Patient-Reported Outcomes Following Total Hip and Knee Arthroplasty in Veterans.

Background: Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work, and age. They are associated with disparities in outcomes following total joint arthroplasty (TJA). These disparities occur even in equal-access healthcare systems such as the Veterans Health Administration (VHA).

What Is the Appropriate Price for Platelet-Rich Plasma Injections for Knee Osteoarthritis? A Cost-Effectiveness Analysis Based on Evidence From Level I Randomized Controlled Trials.

Purpose: To identify the price of treatment at which platelet-rich plasma (PRP) is cost-effective relative to hyaluronic acid (HA) and saline solution intra-articular injections.

Methods: A systemized review process of the PubMed, Embase, and MEDLINE databases was undertaken to identify randomized controlled trials comparing PRP with HA and saline solution with up to 1 year of follow-up. Level I trials that reported Western Ontario and McMaster Universities Arthritis Index Likert scores were included.

Body Mass Index Screening in Knee Arthroscopy: An Analysis Using the National Surgical Quality Improvement Database.

Purpose: To analyze patients undergoing knee arthroscopy stratified by body mass index (BMI) and assess the tradeoffs in complications avoided versus access to care that occur when instituting BMI eligibility criteria.

Methods: The National Surgical Quality Improvement Program (NSQIP) database was used to identify patients who underwent knee arthroscopy from 2015 to 2016. Patients were categorized by BMI, and differences in complication rates between BMI categories were assessed.

The Impact of Body Mass Index on Complications After Shoulder Arthroscopy: Should Surgery Eligibility Be Determined by Body Mass Index Cutoffs?

Purpose: The goal of this study is to analyze postoperative complications after shoulder arthroscopy stratified by body mass index (BMI) and to quantify the trade-off in postsurgical complications and access to care that occurs with BMI eligibility cutoffs.

Methods: Patients who underwent shoulder arthroscopy in the National Surgical Quality Improvement Program database from 2015 to 2016 were identified. Patients were categorized on the basis of their BMI.

The interaction of depression and prior opioid use on pain and opioid requirements after total joint arthroplasty.

Background: Preoperative opioid use causes increased pain and opioid requirements after total joint arthroplasty (TJA), but the effect of depression on this relationship is not well defined.

Methods: We conducted a retrospective review of primary TJA patients using an institutional database. Demographic variables, inpatient opioid requirements, and discharge prescription quantities were collected and compared between patients with and without a prior diagnosis of depression in both the prior opioid-using and nonusing cohorts.

Evaluating meniscus allograft transplant using a cost-effectiveness threshold analysis.

Background: It is unknown if meniscal allograft transplant (MAT) delays progression of osteoarthritis (OA). Cost-effectiveness threshold analysis can demonstrate the necessary delay in OA progression required by MAT to be considered cost-effective compared to non-operative management. The purpose of this study is to identify the efficacy MAT requires in delaying progression to OA in previously meniscectomized knees in order to be considered cost-effective compared to non-operative treatment.

Arthroscopic Elbow Contracture Release in the Pediatric Patient.

Background: Elbow contracture is a sequelae of elbow trauma in pediatric patients. Arthroscopic contracture release has been shown to provide equivalent results to open contracture release with less associated morbidity and complications in the adult population. However, open contracture release is still commonly utilized in pediatric patients.

Risk factors for complications after primary repair of Achilles tendon ruptures.

Purpose: To identify patient characteristics associated with adverse events in Achilles tendon rupture (ATR) surgical repair cases.

Methods: A high risk (HR) cohort group of ATR patients were compared to healthy controls in the ACSNSQIP database with multivariate regression analysis.

Results: Overall, 2% (n = 23) of the group sustained an AE postoperatively, most commonly superficial SSI (0.

Post-biopsy MRI changes in the size and enhancement of intramuscular myxomas: A report of two cases.

Intramuscular myxomas are benign soft-tissue tumors, characterized by bland spindle-shaped cells and fibroblasts within an abundant mucoid matrix on histologic examination. Classically, these are slowly enlarging masses which may occasionally cause pain, paresthesia, and muscle weakness secondary to mass effect. We present an interesting phenomenon of two histologically confirmed cases of intramuscular myxomas that exhibited size and enhancement changes on follow-up imaging after image-guided biopsy.

Pectoralis Minor Contracture in Throwing Shoulders of Asymptomatic Adolescent Baseball Players.

Background: Although scapular malpositioning is commonly associated with rotational deficits and risk of injury, modifiable causes of such malpositioning in overhead athletes are not well described.

Purpose/hypothesis: The purpose of this study was to examine the scapulothoracic profile of adolescent baseball players, specifically, pectoralis minor (PM) length. We hypothesized that PM would be shorter in throwing shoulders compared with nonthrowing shoulders.

The Influence of Incision Type on Patient Satisfaction After Plate Fixation of Clavicle Fractures.

Background: Open reduction and internal fixation (ORIF) of the clavicle is a common procedure that has been shown to have improved outcomes over nonoperative treatment. Several incisions can be used to approach clavicle fractures, the decision of which is variable among surgeons.

Purpose: To compare patient satisfaction and subjective outcomes between patients with a longitudinal incision versus those with a necklace incision for the treatment of diaphyseal clavicle fractures.

TNF-α and sTNF-RII Are Associated with Pain Following Hip Fracture Surgery in Older Adults.

Objective: To explore whether plasma inflammatory mediators on postoperative day 3 (POD3) are associated with pain scores in older adults after hip fracture surgery.

Design: Cross-sectional study.

Setting: Mount Sinai Hospital, New York, New York.

Cost-benefit analysis of routine pathology examination in primary shoulder arthroplasty.

Background: The annual number of shoulder arthroplasty procedures is continuing to increase. Specimens from shoulder arthroplasty cases are routinely sent for pathologic examination. This study sought to evaluate the clinical utility and associated costs of routine pathologic examination of tissue removed during primary shoulder arthroplasty cases and to determine cost-effectiveness of this practice.

Shoulder Arthroscopy in Adults 60 or Older: Risk Factors That Correlate With Postoperative Complications in the First 30 Days.

Purpose: To investigate the 30-day postoperative adverse event (AE) rates of adults 60 years or older after shoulder arthroscopy and identify risk factors for complications in this patient population.

Methods: Patients aged 60 or more who underwent shoulder arthroscopy were identified in the American College of Surgeons National Surgery Quality Improvement Program database from 2006 to 2013 using 12 Current Procedural Terminology codes related to shoulder arthroscopy. Complications were categorized as severe AEs, minor AEs, and infectious AEs for separate analyses.

Lung cancer risk in never-smokers: a population-based case-control study of epidemiologic risk factors.

Background: We conducted a case-control study in the greater Toronto area to evaluate potential lung cancer risk factors including environmental tobacco smoke (ETS) exposure, family history of cancer, indoor air pollution, workplace exposures and history of previous respiratory diseases with special consideration given to never smokers.

Methods: 445 cases (35% of which were never smokers oversampled by design) between the ages of 20-84 were identified through four major tertiary care hospitals in metropolitan Toronto between 1997 and 2002 and were frequency matched on sex and ethnicity with 425 population controls and 523 hospital controls. Unconditional logistic regression models were used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between exposures and lung cancer risk.

Effect of adjuvant tamoxifen therapy on thyroid function in postmenopausal women with breast cancer.

Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4) and total tri-iodothyronine (TT3) concentrations were measured in 45 postmenopausal breast cancer patients before adjuvant treatment with tamoxifen and at 3- and 6-month intervals. A significant increase in TSH (p = 0.002) at the end of 3 months and a subsequent decrease at the end of 6 months was noted.