Off-the-Shelf Tibial Cone Sizes May Not Accommodate All Patients' Bone Morphology and May Lead to Cortical Breaches in Revision Total Knee Arthroplasty: A 3D Modeling Study.

Background: In revision total knee arthroplasty, tibial cones have demonstrated improved longevity and reduced incidence of aseptic loosening. Several currently available "off-the-shelf" (OTS) cone systems may not have sizes to accommodate all patient bone morphologies.

Methods: Computed tomographies from one hundred primary total knee arthroplasty patients and dimensions of 4 OTS cones were obtained.

The value of national accreditation program for rectal cancer: A survey of accredited programs and programs seeking accreditation.

Background: Significant variation in rectal cancer care has been demonstrated in the United States. The National Accreditation Program for Rectal Cancer was established in 2017 to improve the quality of rectal cancer care through standardization and emphasis on a multidisciplinary approach. The aim of this study was to understand the perceived value and barriers to achieving the National Accreditation Program for Rectal Cancer accreditation.

"Come try it out. Get your foot in the door:" Exploring patient perspectives on low-barrier treatment for opioid use disorder.

Purpose: Low-barrier treatment is an emerging strategy for opioid use disorder (OUD) care that prioritizes access to evidence-based medication while minimizing requirements that may limit treatment access in more traditional delivery models, particularly for marginalized patients. Our objective was to explore patient perspectives about low-barrier approaches, with a focus on understanding barriers to and facilitators of engagement from the patient point of view.

Methods: We conducted semi-structured interviews with patients accessing buprenorphine treatment from a multi-site, low-barrier mobile treatment program in Philadelphia, PA from July-December 2021.

Stereochemistry and functions of the new cysteinyl-resolvin, 4S,5R-RCTR1, in efferocytosis and erythrophagocytosis of human senescent erythrocytes.

Specialized pro-resolving lipid mediators play key functions in the resolution of the acute inflammatory response. Herein, we elucidate the stereochemical structure of the new 4S,5R-RCTR1, a cysteinyl-resolvin, recently uncovered in human leukocytes incubated with a 4S,5S-epoxy-resolvin intermediate, using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and ultra-violet (UV) spectrophotometry. With this approach, the physical properties of the new mediator prepared by total organic synthesis were matched to enzymatically produced biogenic material.

A curious case of a blue finger.

This article describes an unusual presentation of a blue finger in a middle-aged woman with no significant past medical history. The patient was diagnosed with Achenbach syndrome, a rare condition that is generally considered transient and benign. The underlying pathophysiology of this condition is unclear, but may be related to transient subcutaneous ecchymosis, possibly from microtrauma.

Personalizing Revision Tibial Baseplate Position and Stem Trajectory With Custom Implants Using 3D Modeling to Optimize Press-fit Stem Placement.

Background: A common tibial construct for revision total knee arthroplasty includes a long diaphyseal engaging press-fit stem. Due to tibial canal bowing, compromises are often necessary to match patient anatomy when choosing stemmed implants. The objective of this study is to determine through 3-D modeling whether current implant press-fit options appropriately fit patient anatomy, or whether an alternative angle between the stem and baseplate could increase the cortical engagement of long press-fit tibial stems.

Fusobacterium nucleatum: More Than Just an Oral Anaerobe.

is a strict anaerobe that is indigenous to the human oral cavity, where it coexists with more than 500 other species. It is associated with paranasal sinus, odontogenic, and pulmonary infections. In literature, cases of are rare.

An Extremely Rare Presentation of an Alpha-Fetoprotein-Producing Esophageal Adenocarcinoma.

Alpha-fetoprotein (AFP)-producing esophageal adenocarcinoma (EAC) is an extremely rare occurrence with very few cases reported in the literature. We report the case of a 76-year-old female who presented with progressive weakness, fatigue, and a decrease in appetite for weeks and who was found to have an AFP-producing EAC with an extraordinarily high AFP level of 46,135 ng/mL. CT angiography revealed abnormal thickening of the esophagus and multiple metastatic masses throughout the liver.

Evolution: A Developmental Tradeoff that Wins in Changing Environments.

Changing how hormones regulate development can influence the complex trade-offs involved in the competition to survive and reproduce. A new report identifies a molecular variant of eak-3 that trades lower growth rates for the ability to survive sudden temperature extremes.

Increased cardiovascular events and mortality in females with NAFLD: a meta-analysis.

Non-alcoholic fatty liver disease (NAFLD) and cardiovascular diseases (CVD) share similar risk factors. Recent studies have focused on obesity and insulin resistance, but the link between NAFLD and CVD persists regardless of traditional risk factors. Despite the increased incidence and prevalence of NAFLD worldwide, there has been no thorough investigation of gender disparities nor a closer look taken into investigating the role gender may play in increased cardiovascular (CV) mortality in people with NAFLD.

In-Hospital Outcomes of Patients with Acute Decompensated Heart Failure and Cirrhosis: An Analysis of the National Inpatient Sample.

Introduction: Heart failure increases morbidity and mortality in patients admitted for cirrhosis. Our objective was to determine if patients with acute decompensated heart failure (ADHF) and cirrhosis would have increased mortality, hospital length of stay (LOS), and total hospital charges compared to patients with only ADHF. There is also a paucity of data regarding the influence of gender, race, ethnicity, insurance, and cirrhosis-related complications on mortality, hospital length of stay, and total hospitalization charges.

Targeting Implicit Bias in Medicine: Lessons from Art and Archaeology.

Implicit bias training is not currently a required component of residency education, yet implicit bias in medicine exists and may influence care provided to patients. We propose an innovative exercise that allows trainees to explore implicit bias outside of the clinical environment, in an interdisciplinary manner with museum anthropologists and archaeologists. The curriculum was designed with leaders at the Penn Museum and focuses on differentiating between objective and subjective assessments of historical objects.

Synergistic Bradycardia from Beta Blockers, Hyperkalemia, and Renal Failure.

Background: Bradycardia is a common vital sign encountered in the emergency department. These patients are often hemodynamically stable and require no emergent intervention. On occasion, bradycardia can cause hemodynamic instability, and there are established treatment pathways involving atropine, ionotropic and vasopressive infusions, and eventual mechanical pacing, if necessary.

Spinal Epidural Abscess in Children: Case Report and Review of the Literature.

Background: Spinal epidural abscess (SEA) is a rare but serious infection in the epidural space along the spinal cord. SEA should be considered in patients with backache, fever, neurological deficits and/or spinal tenderness. Early diagnosis is imperative to prevent permanent neurological sequelae.

Union Rates and Complications After Thumb Metacarpophalangeal Fusion.

Fusion of the thumb metacarpophalangeal joint (MPJ) can be performed using tension band wiring (TBW) or plate and screw (PS) fixation. This study evaluated results and complications using these techniques. A retrospective review of patients who underwent thumb MPJ fusion at our institution from 2010 to 2016 was performed.

Considering noradrenergically mediated facilitation of sensory signal processing as a component of psychostimulant-induced performance enhancement.

Prescription stimulants are used to treat attention deficit hyperactivity disorder (ADHD). Psychostimulants are also used off-label by non-ADHD patients as performance-enhancing agents across academic, occupational, athletic, and social settings. Extensive work has focused on the reinforcing effects and abuse liability of psychostimulants, but understanding the mechanisms through which these agents regulate neural circuit functions that govern cognitive and sensorimotor processes to result in their performance-enhancing effects has received less attention.

Identification and Complete Stereochemical Assignments of the New Resolvin Conjugates in Tissue Regeneration in Human Tissues that Stimulate Proresolving Phagocyte Functions and Tissue Regeneration.

Resolvin conjugates in tissue regeneration (RCTRs) are new chemical signals that accelerate resolution of inflammation, infection, and tissue regeneration. Herein, using liquid chromatography-tandem mass spectrometry-based metabololipidomics, we identified RCTRs in human spleen, lymph node, bone marrow, and brain. In human spleen incubated with Staphylococcus aureus, endogenous RCTRs were increased along with conversion of deuterium-labeled docosahexaenoic acid, conferring pathway activation.

Participatory implementation science to increase the impact of evidence-based cancer prevention and control.

It is critical to accelerate the integration of evidence-based programs, practices, and strategies for cancer prevention and control into clinical, community, and public health settings. While it is clear that effective translation of existing knowledge into practice can reduce cancer burden, it is less clear how best to achieve this. This gap is addressed by the rapidly growing field of implementation science.

Reproduction: Sperm with Two X Chromosomes and Eggs with None.

A new study shows that the nematode Auanema rhodensis manipulates X chromosome segregation in surprising ways that depend on both the sex of the parent and the type of gamete. The result is a complex mating system that produces unusual sex ratios and inheritance patterns.

Reverse Sural Adipofascial Flaps with Acellular Dermal Matrix and Negative-Pressure Wound Therapy.

The reverse sural adipofascial flap (RSAF) is used to reconstruct challenging wounds of the foot and ankle. It offers several advantages over the traditional reverse sural flap, including less venous congestion. To complete the reconstruction, split-thickness skin grafting (STSG) may be done immediately or in a delayed fashion; however, both scenarios result in suboptimal take rates and prolonged healing.

Consensus Recommendations for the Clinical Application of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression.

Objective: To provide expert recommendations for the safe and effective application of repetitive transcranial magnetic stimulation (rTMS) in the treatment of major depressive disorder (MDD).

Participants: Participants included a group of 17 expert clinicians and researchers with expertise in the clinical application of rTMS, representing both the National Network of Depression Centers (NNDC) rTMS Task Group and the American Psychiatric Association Council on Research (APA CoR) Task Force on Novel Biomarkers and Treatments.

Evidence: The consensus statement is based on a review of extensive literature from 2 databases (OvidSP MEDLINE and PsycINFO) searched from 1990 through 2016.

"What have we GANEd?" A theoretical construct to explain experimental evidence for noradrenergic regulation of sensory signal processing.

The GANE (glutamate amplifies noradrenergic effects) theory posits a mechanism for amplifying noradrenergic modulatory actions and enhancing the processing of high-priority sensory signals for immediate or future experience-guided action. This theoretical construct is thought provoking with respect to the central processing of high-priority versus low-priority stimuli, but it requires some refinement to account for physiological fluctuations in NE efflux as a function of naturally occurring transitions in behavioral state and the experimentally observed phenomena associated with noradrenergic regulation of sensory signal transfer.