Iatrogenic nerve injury in primary and revision reverse total shoulder arthroplasty

INTRODUCTION Iatrogenic nerve injury in orthopedic surgery can impair functional outcomes. During the last years, a steady increase in the number of performed reverse total shoulder arthroplasties has been reported and complications associated with this procedure are continuously described. Neurological complications, however, remain underreported. The aims of this study were to calculate the incidence of iatrogenic nerve injury after primary and revision reverse total shoulder arthroplasty in a large patient cohort, as well as identify associated patient-and surgery-related risk factors. MATERIALS AND METHODS A retrospective review of our institution's internal Reverse Total Shoulder Arthroplasty (RTSA) database from September 2005 to December 2019 was undertaken and 34 patients with iatrogenic nerve injuries were identified, resulting in a neurological complication rate of 2.6%. Group comparisons between patients with nerve injuries (n = 34) and the remaining cohort without nerve injuries (n = 1275) were performed to identify patient- and surgery-related risk factors. RESULTS Of the 34 cases with iatrogenic nerve injury, damage to terminal nerve branches occurred in 21 patients, whereas a brachial plexus lesion was diagnosed in the other 13. Nerve revision surgery was necessary in four patients. At final follow-up 13 patients (45%) had residual motor deficits and 17 (59%) had residual sensory deficits. Higher numbers of previous surgeries of the affected shoulder correlated with subsequent nerve injury (p = 0.035). Operative time was significantly longer in patients, who developed a neurologic deficit, showing a correlation between duration of surgery and occurrence of nerve injury (p = 0.013). Patients with neurologic complications were significantly younger than patients without nerve damage (median 68 vs. 72 years, p = 0.017). CONCLUSIONS In specialists' hands reverse total shoulder arthroplasty is a rather safe procedure regarding the risk of neurologic injury. However, multiple previous surgeries of the affected shoulder increase the risk of neurological complications. Cases with post-operative neurologic compromise are rare and usually recover well, with few patients suffering long-term functional deficits from iatrogenic nerve injury. LEVEL OF EVIDENCE Level III, retrospective cohort study

Melanocortin 1 receptor ligands and methods of use

The subject invention pertains to a modified MC1R peptide ligand comprising a peptide that is a melanocortin 1 receptor (MC1R) ligand and a functionality or linker, such as a click functionality, for conjugation to a surface or agent. The modified MC1R peptide ligand can be coupled, e.g., via a click reaction with a complementary click functionality attached, to a moiety to form an MC1R-targeted agent. Drugs, contrast agents, polymers, particles, micelles, surfaces of larger structures, or other moieties can be targeted to the MC1R. The subject invention also pertains to a MC1R peptide ligand-micelle complex comprising a peptide that is a melanocortin 1 receptor ligand connected via a click reaction product to a micelle. The micelle is stable in vivo and can target melanoma tumor cells by association of the peptide ligand with the MC1R or the tumor and selectively provide a detectable and/or therapeutic agent (such as an imageable contrast agent and/or anti-cancer agent) selectively to the tumor cell.Board of Regents, University of Texas Syste

Targeting Conservation Investments in Heterogeneous Landscapes: A distance function approach and application to watershed management

To achieve a given level of an environmental amenity at least cost, decision-makers must integrate information about spatially variable biophysical and economic conditions. Although the biophysical attributes that contribute to supplying an environmental amenity are often known, the way in which these attributes interact to produce the amenity is often unknown. Given the difficulty in converting multiple attributes into a unidimensional physical measure of an environmental amenity (e.g., habitat quality), analyses in the academic literature tend to use a single biophysical attribute as a proxy for the environmental amenity (e.g., species richness). A narrow focus on a single attribute, however, fails to consider the full range of biophysical attributes that are critical to the supply of an environmental amenity. Drawing on the production efficiency literature, we introduce an alternative conservation targeting approach that relies on distance functions to cost-efficiently allocate conservation funds across a spatially heterogeneous landscape. An approach based on distance functions has the advantage of not requiring a parametric specification of the amenity function (or cost function), but rather only requiring that the decision-maker identify important biophysical and economic attributes. We apply the distance-function approach empirically to an increasingly common, but little studied, conservation initiative: conservation contracting for water quality objectives. The contract portfolios derived from the distance-function application have many desirable properties, including intuitive appeal, robust performance across plausible parametric amenity measures, and the generation of ranking measures that can be easily used by field practitioners in complex decision-making environments that cannot be completely modeled. Working Paper # 2002-01

Comparison of Two Core Biopsy Techniques Before and After Laparoscopic Cryoablation of Small Renal Cortical Neoplasms

A pre-ablation standard biopsy technique resulted in the most accurate pathologic diagnosis for patients undergoing cryoablation for renal cortical neoplasms

Electron-wall interaction in Hall thrusters

Electron-wall interaction effects in Hall thrusters are studied through measurements of the plasma response to variations of the thruster channel width and the discharge voltage. The discharge voltage threshold is shown to separate two thruster regimes. Below this threshold, the electron energy gain is constant in the acceleration region and therefore, secondary electron emission (SEE) from the channel walls is insufficient to enhance electron energy losses at the channel walls. Above this voltage threshold, the maximum electron temperature saturates. This result seemingly agrees with predictions of the temperature saturation, which recent Hall thruster models explain as a transition to space-charge saturated regime of the near-wall sheath. However, in the experiment, the maximum saturation temperature exceeds by almost three times the critical value estimated under the assumption of a Maxwellian electron energy distribution function. The channel narrowing, which should also enhance electron-wall collisions, causes unexpectedly larger changes of the plasma potential distribution than does the increase of the electron temperature with the discharge voltage. An enhanced anomalous crossed-field mobility (near wall or Bohm-type) is suggested by a hydrodynamic model as an explanation to the reduced electric field measured inside a narrow channel. We found, however, no experimental evidence of a coupling between the maximum electron temperature and the location of the accelerating voltage drop, which might have been expected due to the SEE-induced near-wall conductivity.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87763/2/057104_1.pd

Autoradiographic localization of [delta] opioid receptors in the rat brain using a highly selective bis-penicillamine cyclic enkephalin analog

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25669/1/0000221.pd

Characterization of SNF 9007, A Novel Cholecystokinin/Opoid Ligand in Mouse Ileum in Vitro: Evidence for Involvement of CholecystokininA and CholecystokininB Receptors in Regulation of Ion Transport1

ABSTRACT The effects of cholecystokinin (CCK) fragments and Asp-Tyr-DPh Gly-Trp-[N-Me]Nle-Asp-Phe-NH

Quantum Kinks: Solitons at Strong Coupling

We examine solitons in theories with heavy fermions. These ``quantum'' solitons differ dramatically from semi-classical (perturbative) solitons because fermion loop effects are important when the Yukawa coupling is strong. We focus on kinks in a $(1+1)$--dimensional $\phi^4$ theory coupled to fermions; a large-$N$ expansion is employed to treat the Yukawa coupling $g$ nonperturbatively. A local expression for the fermion vacuum energy is derived using the WKB approximation for the Dirac eigenvalues. We find that fermion loop corrections increase the energy of the kink and (for large $g$) decrease its size. For large $g$, the energy of the quantum kink is proportional to $g$, and its size scales as $1/g$, unlike the classical kink; we argue that these features are generic to quantum solitons in theories with strong Yukawa couplings. We also discuss the possible instability of fermions to solitons.Comment: 21 pp. + 2 figs., phyzzx, JHU-TIPAC-92001

Block and gradient copoly(2-oxazoline) micelles : strikingly different on the inside

Herein, we provide a direct proof for differences in the micellar structure of amphiphilic diblock and gradient copolymers, thereby unambiguously demonstrating the influence of monomer distribution along the polymer chains on the micellization behavior. The internal structure of amphiphilic block and gradient co poly(2-oxazolines) based on the hydrophilic poly(2-methyl-2-oxazoline) (PMeOx) and the hydrophobic poly(2-phenyl-2-oxazoline) (PPhOx) was studied in water and water ethanol mixtures by small-angle X-ray scattering (SAXS), small angle neutron scattering (SANS), static and dynamic light scattering (SLS/DLS), and H-1 NMR spectroscopy. Contrast matching SANS experiments revealed that block copolymers form micelles with a uniform density profile of the core. In contrast to popular assumption, the outer part of the core of the gradient copolymer micelles has a distinctly higher density than the middle of the core. We attribute the latter finding to back-folding of chains resulting from hydrophilic hydrophobic interactions, leading to a new type of micelles that we refer to as micelles with a "bitterball-core" structure