Evaluation of Rotator Cuff Repair with Concomitant Biceps Tenodesis

Introduction: Surgical rotator cuff repair (RCR) has proven to be an effective treatment for rotator cuff tears. Commonly, rotator cuff tears are associated with concomitant biceps pathology, which are often treated by biceps tenodesis (BT). We hypothesize that patient outcomes will be similar in those that have undergone RCR with concomitant BT and isolated RCR. Methods: This is a retrospective cohort study comparing patients who underwent arthroscopic RCR with arthroscopic or open BT to patients who underwent isolated RCR at a multisurgeon orthopaedic practice during the time period of November 2016 to December 2016. The outcome for comparison is the American Shoulder and Elbow Surgeons score (ASES). Patients with postoperative scores of at least 6 months after surgery were included. The data was collected from the Rothman Institute registry and OBERD. It was analyzed via independent t-test. Results: A total of 53 patients (37 = M; 16 = F) were in the isolated RCR group and 34 patients (27 = M; 7 = F) were in the RCR with BT group. The average age in the isolated RCR group was 58.6 years vs. 58.9 years in the RCR with BT group. There was no statistical difference between postoperative ASES scores (83.69 and 79.43, P = .40) and difference in preoperative and postoperative ASES scores (34.26 and 35.30, P = .85) in the isolated RCR and RCR with BT groups, respectively. Conclusion: There was no significant difference in postoperative ASES scores as well as difference in preoperative and postoperative ASES scores in patients undergoing isolated RCR and RCR with BT. This supports the hypothesis that patients undergoing RCR with BT will have similar outcomes to those undergoing isolated RCR

Vitamin K2 (menaquinone) Supplementation and its Benefits in Cardiovascular Disease, Osteoporosis, and Cancer

Vitamin K is known to play an essential role in the coagulation cascade; however, a growing body of research has found that a subtype of this vitamin, vitamin K2 (menaquinone) may have a beneficial effect in osteoporosis, cardiovascular disease, and cancer. This purpose of this article is to provide a comprehensive review of recent literature regarding menaquinone and its role in human health. This review discusses the physiology of menaquinone, its clinical benefits in cardiovascular disease, osteoporosis, and cancer, and how it may interact with certain medications. The authors conclude that menaquinone supplementation has been shown to improve carboxylation of osteocalcin and matrix-Gla protein to their active forms, two proteins that possess important roles in calcium distribution. In the setting of cardiovascular disease, menaquinone intake has been shown to lower the risk of coronary calcification and coronary heart disease, and a randomized controlled trial has demonstrated that it can reduce arterial stiffness. In osteoporosis, menaquinone has been shown by numerous randomized controlled trials to decrease the rate of bone loss at the lumbar spine and forearm and reduce the risk of fracture. In cancer, menaquinone intake has been shown to reduce overall incidence and mortality; clinical trials have suggested that it may have a role in reducing recurrence and death from hepatocellular carcinoma. However, in all clinical settings, more large randomized controlled trials are needed to definitively determine the clinical benefits of menaquinone supplementation, as many studies have failed to show any significant benefit. Lastly, more research is needed to determine how menaquinone supplementation interacts with medications such as warfarin, bile-acid sequestrants, orlistat, mineral oil and CYP3A4 substrates

School-based Sexuality Education Experiences across Three Generations of Sexual Minority People

Sexual minority people face greater risk for compromised sexual health than their heterosexual peers, yet school-based sexuality education often excludes them. Little is known about whether or how sexual minority people's sexuality education experiences have varied across sociohistorical contexts of rapid social change in both sexuality education and sexual minority visibility. Semi-structured qualitative interviews were conducted among 191 sexual minority people from three distinct sociohistorical generations (ages 18-25, 34-41, and 52-59, respectively) and four geographic regions of the United States. Data were analyzed using thematic content analysis following a consensual qualitative protocol. Fifty-one participants (i.e., 27%) discussed school-based sexuality education experiences despite the lack of an explicit question in the interview protocol prompting them to do so. Four distinct yet overlapping themes emerged in participants' experiences of sexuality education: 1) Silence; 2) The profound influence of HIV/AIDS; 3) Stigma manifest through fear, shame, and prejudice; and, 4) Comparing school-based experiences to sexuality education outside of school. The presence of themes varied across groups defined by sociohistorical generation. The implications of sexuality education experiences for the wellbeing of sexual minority people are discussed

Application of Magnetic Resonance to Assess Lyophilized Drug Product Reconstitution

Purpose Dynamic in-situ proton (1H) magnetic resonance imaging (MRI) and 1H T2-relaxometry experiments are described in an attempt to: (i) understand the physical processes, that occur during the reconstitution of lyophilized bovine serum albumen (BSA) and monoclonal antibody (mAb) proteins; and (ii) objectify the reconstitution time. Methods Rapid two-dimensional 1H MRI and diffusion weighted MRI were used to study the temporal changes in solids dissolution and characterise water mass transport characteristics. One-shot T2 relaxation time measurements were also acquired in an attempt to quantify the reconstitution time. Both MRI data and T2-relaxation data were compared to standard visual observations currently adopted by industry. The 1H images were further referenced to MRI calibration data to give quantitative values of protein concentration and, percentage of remaining undissolved solids. Results An algorithmic analysis the 1H T2-relaxation data shows it is possible to classify the reconstitution event into three regimes (undissolved, transitional and dissolved). Moreover, a combined analysis of the 2D 1H MRI and 1H T2-relaxation data gives a unique time point that characterises the onset of a reconstituted protein solution within well-defined error bars. These values compared favourably with those from visual observations. Diffusion weighted MRI showed that low concentration BSA and mAb samples showed distinct liquid-liquid phase separation attributed to two liquid layers with significant density gradients. Conclusions T2 relaxation time distributions (whose interpretation is validated from the 2D 1H MR images) provides a quick and effective framework to build objective, quantitative descriptors of the reconstitution process that facilitate the interpretation of subjective visual observations currently adopted as the standard practice industry.Medimmune PL

Evaluation of Arthroscopic Repair to Pan-Labral Lesions of the Glenoid: A Retrospective Review of Patient Outcomes Over a Ten-Year Period and Matched Cohort Analysis

Introduction: Most shoulder labral tears are partial and treated with surgery, but rarely they are “panlabral” around the entire shoulder. Due to infrequency panlabral tears aren’t well understood, and thus this study compares outcomes between panlabral and more common SLAP tears. We hypothesize no difference in outcomes based on surgeon experiences. Methods: This is a retrospective cohort study of shoulder labrum repairs at Rothman Institute from 2006-2016. All patients received arthroscopic repair and were categorized to compare panlabral to SLAP tears. The primary outcome is return-to-activity rate at six months post-surgery and secondary outcomes include post-operative range of motion, strength, and identifying the incidence of this rare injury. Chart abstraction into Excel and patient phone calls/emails for return-to-activity rates will be analyzed via Independent T-tests and Chi-squared tests. Results: The panlabral tear incidence was 3.9%. Currently the primary outcome (return-to-activity rate) lacks enough panlabral patients for analysis with 140 patients (60 SLAP, 3 panlabral, 77 other) of 739 total (350 SLAP, 29 panlabral, 360 other) answering phone calls/emails. Secondary outcome analysis indicated no difference in range of motion, strength, or complications between SLAP and panlabral repairs. Discussion: Compared to existing reports of 2.4% incidence, using one of (if not) the largest cohorts we suggest the true incidence of panlabral tears is higher at 3.9%. Though primary outcome analysis is ongoing, secondary outcomes demonstrate that, as hypothesized, panlabral repairs perform as well as SLAP repairs. This may represent the highest level of evidence support yet for current treatment of this rare injury

Prior Low- or High-Intensity Exercise Alters Pacing Strategy, Energy System Contribution and Performance during a 4-km Cycling Time Trial

We analyzed the influence of prior exercise designed to reduce predominantly muscle glycogen in either type I or II fibers on pacing and performance during a 4-km cycling time trial (TT). After preliminary and familiarization trials, in a randomized, repeated-measures crossover design, ten amateur cyclists performed: 1) an exercise designed to reduce glycogen of type I muscle fibers, followed by a 4-km TT (EX-FIB I); 2) an exercise designed to reduce glycogen of type II muscle fibers, followed by a 4-km TT (EX-FIB II) and; 3) a 4-km TT, without the prior exercise (CONT). the muscle-glycogen-reducing exercise in both EX-FIB I and EX-FIB II was performed in the evening, similar to 12 h before the 4-km TT. Performance time was increased and power output (PO) was reduced in EX-FIB I (432.8 +/- 8.3 s and 204.9 +/- 10.9 W) and EX-FIB II (428.7 +/- 6.7 s and 207.5 +/- 9.1 W) compared to CONT (420.8 +/- 6.4 s and 218.4 +/- 9.3 W; P0.05). the PO was lower in EX-FIB I than in CONT at the beginning and middle of the trial (P0.05). the integrated electromyography was unchanged between conditions (P>0.05). Performance may have been impaired in EX-FIB I due a more conservative pacing at the beginning and middle, which was associated with a reduced aerobic contribution. in turn, the PO profile adopted in EX-FIB II was also reduced throughout the trial, but the impairment in performance may be attributed to a reduced glycolytic contribution (i.e. reduced lactate accumulation).Foundation of Aids to Scientific Research of the State of Alagoas (FAPEAL)Univ Fed Pernambuco, CAV, Dept Phys Educ & Sports Sci, Sports Sci Res Grp, Vitoria de Santo Antao, Pernambuco, BrazilUniv São Paulo, Sch Phys Educ & Sport, Endurance Performance Res Grp, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Med, Div Nephrol, São Paulo, BrazilVictoria Univ, Coll Sport & Exercise Sci, Inst Sport Exercise & Active Living, Melbourne, Vic 8001, AustraliaUniversidade Federal de São Paulo, Dept Med, Div Nephrol, São Paulo, BrazilWeb of Scienc

Perceived Stress, Coping Behaviors, Social Support and Subjective Health among Unmarried Older Adults

The purpose of this study was to examine coping behaviors and social support as mediators and moderators between perceived stress and subjective health among older adults. A sample of 227 unmarried older adults was recruited. A hierarchical regression analysis was performed in order to analyze mediator and moderator effects of coping behaviors and social support. The results suggest that problem-focused coping and social support partially mediated the association between perceived stress and subjective health. We conclude that stress in older adults should be minimized and effectively managed to prevent negative effects on subjective health. Intervention programs focusing on problem-focused coping and social support should be developed for older adults

Total Knee Arthroplasty in Patients with Prior Meniscus Surgery: A Matched Case Control Study

Introduction: Meniscus surgery is one of the most commonly performed orthopedic surgical procedures in the United States. However, outcomes following a Total Knee Arthroplasty (TKA) in patients with a history of prior knee arthroscopy are varied with small patient cohorts, warranting further research. The research question investigates how the clinical outcomes of TKA compare between patients with and without prior meniscectomy history. It is hypothesized that there will be no significant difference in clinical outcomes between the two cohorts. Methods: The study design is a retrospective case-control study. The study population included patients from Rothman Institute with TKA and prior meniscal surgery on the ipsilateral knee. Patients were matched on a 2:1 basis to the control group undergoing TKA without meniscal history. Physician chart notes, operative reports, and images were reviewed to compare outcomes. The outcomes were based on postoperative complications, including the rate of revision, re-operation, infection, and clinical outcome score. Results: 1028 patients met the inclusion criteria for the study population and were available for analysis. To date, 111 patients have been analyzed. Preliminary data shows that 97% (108) of the study population experienced no TKA complications. 2.7% (3) of the analyzed patients experienced TKA complications, warranting revision. Statistical analysis between the study and control group complication rates is pending. Discussion: The results implicate that there is no statistical difference between the two cohorts, which may support the hypothesis. This data might serve as a point of education for TKA patients and provide modifiable risk factors for meniscectomy patients