A Cost Analysis of Opioid/Acetaminophen Therapy Versus a Multidrug, Opioid-Free Multimodal Postoperative Pain Control Regimen.

Opioids are often part of the post-operative pain regimen after orthopaedic surgery. Novel multimodal post-operative pain control regimens have been developed to decrease the amount of opioid usage due to their negative side effects including nausea, constipation, and addiction. The purpose of this study was to compare the cost of postoperative pain management treatment methods after orthopaedic surgery between opioid/acetaminophen therapy and an opioid-free, multidrug, multimodal pathway.

Mobile health clinics for distribution of vaccinations to underserved communities during health emergencies: A COVID-19 case study.

Objectives: Mobile health clinics (MHCs) effectively provide healthcare to underserved communities. However, their application during health emergencies is understudied. We described the implementation of an MHC program delivering vaccinations during the COVID-19 pandemic, examined the program's reach to medically underserved communities, and investigated characteristics of vaccination uptake in order to inform the utility of MHCs during health emergencies.

Microstructural properties in subacute aphasia: concurrent and prospective relationships underpinning recovery.

Background: Few investigations examined the relationship between microstructural white matter integrity and subacute post-stroke linguistic performance or the relationship between microstructural integrity and the recovery of language function. We examined two key questions: (1) How does subacute language performance, measured in single words and discourse, relate to the microstructural integrity of key white matter regions of interest in the language network? and (2) Does the integrity of these regions before treatment predict the improvement or resolution of linguistic symptoms immediately and chronically following treatment?

Methods: 58 participants within the first three months of stroke were enrolled in a randomized, single-center, double-blind, sham-controlled, study of anodal transcranial direct current stimulation combined with a computer-delivered speech and language naming therapy for subacute aphasia and were asked to complete magnetic resonance imaging at enrollment. Microstructural integrity was evaluated using diffusion tensor imaging processed with atlas-based segmentation.

Open Ankle Fractures in Older Individuals: A Multi-center Study.

The purpose of this study is to identify demographics, etiology, comorbidities, treatment, complications, and outcomes for older patients with open ankle fractures. Patients ≥60 years old who sustained an open ankle fracture between January 1, 2004 and March 31, 2014 at 6 Level 1 trauma centers were retrospectively reviewed. Univariate analysis using chi-squared or Student's t test was performed to identify associations between preoperative variables and 2 postoperative outcomes of interest: amputation and 1-year mortality.

Prediction of the small aperture intraocular lens on visual acuity in patients with keratoconus.

Purpose: To investigate the impact of corneal higher-order aberrations (HOAs) on predicted corrected distance visual acuity (CDVA) in patients with keratoconus at varying simulated pupil apertures.

Setting: Ophthalmology Clinics, Medical University of South Carolina, Charleston, South Carolina.

Design: Retrospective chart review study.

How rural is All of Us? Comparing characteristics of rural participants in the National Institute of Health's All of Us Research Program to other national data sources.

Purpose: The National Institute of Health's All of Us Research Program represents a national effort to develop a database to advance health research, especially among individuals historically underrepresented in research, including rural populations. The purpose of this study was to describe the rural populations identified in the All of Us Research Program using the only proxy measure currently available in the dataset.

Methods: Currently, the All of Us Research Program provides a proxy measure of rurality that identifies participants who self-reported delaying care due to far travel distances associated with living in rural areas.

Off-label: The results of adjunctive bone morphogenetic protein for challenging femur fractures; a review of two cases.

Background: Although bone morphogenetic proteins (BMPs) are used as an adjunct to promote healing, they may have unintended effects such as heterotopic ossification (HO). The literature is limited regarding the effect of using off-label BMPs for femur fractures.

Case Presentation: We report two outcomes after off-label use of BMPs for the treatment of femur fractures and propose a possible explanation for the difference.

Clinical Observation or Further Excision: A Retrospective Review of Margin-positive Squamous and Basal Cell Carcinomas.

Background: Patients determined to have margin-positive nonmelanoma skin cancer (NMSC) after initial shave or punch biopsy performed by a primary care physician or dermatologist are commonly referred to extirpative surgeons for definitive removal. Not infrequently, the residual tumor is not appreciable, and the exact location of the lesion is indiscernible. The consulting surgeon must decide to excise the presumed lesion or clinically monitor for recurrence.

Age Effects in Facial Fracture Trauma: Disparities in Multisystem Injuries in Non-Fall-Related Trauma.

Background and objective Facial fractures represent a growing concern among an aging population prone to falls. In light of this, this study aimed to investigate differential facial fracture patterns and outcomes based on age effects. Determining the differences between the severity and type of facial fractures in populations of different ages will help guide clinical decision-making when managing patients with facial fractures.

Effect of body mass index on acute postoperative complications following Total Ankle Arthroplasty (TAA).

Background: Total ankle arthroplasty (TAA) is an effective treatment for various ankle pathologies, but some concern remains for the high associated complication and failure rates relative to major joint arthroplasty of the hip and knee. Patient body mass index (BMI) is a modifiable and potentially important preoperative variable when evaluating postoperative complications. The purpose of this study is to evaluate the effect of BMI, age and sex on the acute postoperative complication rate after TAA.

The O-GlcNAc dichotomy: when does adaptation become pathological?

O-Linked attachment of β-N-acetylglucosamine (O-GlcNAc) on serine and threonine residues of nuclear, cytoplasmic, and mitochondrial proteins is a highly dynamic and ubiquitous post-translational modification that impacts the function, activity, subcellular localization, and stability of target proteins. Physiologically, acute O-GlcNAcylation serves primarily to modulate cellular signaling and transcription regulatory pathways in response to nutrients and stress. To date, thousands of proteins have been revealed to be O-GlcNAcylated and this number continues to grow as the technology for the detection of O-GlcNAc improves.

The Effects of Blood Glucose Control in the Operative Spine Patient: A Systematic Review.

Objective: To our knowledge, this is the first systematic review to evaluate the available literature on the effects of perioperative serum glucose (SG) on outcomes for patients undergoing spine surgery. This review will add insight into how the perioperative management of SG affects the outcomes of patients undergoing spine surgery.

Methods: Three databases were used in this review including Embase, PubMed, and Cochrane Library.

A Potential New Use for Tocilizumab: Refractory Checkpoint Inhibitor Hepatitis.

Immune checkpoint inhibitors are becoming more commonly used for many forms of malignancy. With this class of medications being more heavily used, there has been an associated rise in medication-induced autoimmune hepatitis. This case involves a 35-year-old woman being treated with nivolumab/ipilimumab for renal cell carcinoma who developed a steroid-refractory autoimmune hepatitis.

A systematic review and meta-analysis on the influence of sociodemographic factors on amputation in patients with peripheral arterial disease.

Objective: To identify disparities in sociodemographic factors that are associated with major lower limb amputation in patients with peripheral arterial disease (PAD).

Methods: A systematic review of the literature was performed to identify studies that reported major lower limb amputation rates in patients with PAD among different sociodemographic groups. Data that compared amputation rates on the basis of sex, race, ethnicity, income, insurance, geography, and hospital type were collected and described.

Treatment with Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors (PCSK9i): Current Evidence for Expanding the Paradigm?

Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are low-density lipoprotein cholesterol (LDL-C)-lowering drugs that play a critical role in lipoprotein clearance and metabolism. PCSK9i are used in patients with familial hypercholesterolemia and for the secondary prevention of acute cardiovascular events in patients with atherosclerotic cardiovascular disease (CVD). We focused on the literature from 2015, the year of approval of the PCSK9 monoclonal antibodies, to the present on the use of PCSK9i not only in the lipid field but also by evaluating their effects on metabolic factors.

Telehealth services in an outpatient nephrology clinic during the COVID-19 pandemic: a patient perspective.

Purpose: In response to the COVID-19 pandemic, new policy waivers permitted reimbursement of telehealth services in urban settings. The aim of this study was to assess patient satisfaction with telehealth services during the COVID-19 pandemic in an outpatient urban nephrology practice.

Methods: Patients who had virtual encounters were asked to complete an online survey regarding their experiences with telehealth services.

Harm reduction and recovery services support (HRRSS) to mitigate the opioid overdose epidemic in a rural community.

Background: Rural areas in the United States (US) are ravaged by the opioid overdose epidemic. Oconee County, an entirely rural county in northwest South Carolina, is likewise severely affected. Lack of harm reduction and recovery resources (e.