Worse Postoperative Outcomes and Higher Reoperation in Smokers Compared to Nonsmokers for Arthroscopic Rotator Cuff Repair

Introduction: Smoking impairs healing potential and is a significant risk factor for complications following orthopaedic surgeries. The purpose of this study was to determine if a cohort of former or current smokers at time of surgery met the minimally clinical important difference (MCID) for Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS-UE), Depression (PROMIS-D), and Pain Interference (PROMIS-PI) scores in comparison to nonsmokers. Methods: A retrospective review of patients who underwent rotator cuff repair was performed. Patients who completed preoperative and 6-month postoperative PROMIS scores were included. The MCID was calculated using a distribution technique with a threshold of 0.5 standard deviations above the mean. A cohort of nonsmokers was compared to current/former smokers in terms of clinical outcomes and PROMIS scores. Results: A total of 182 patients, 80 current/former smokers and 102 nonsmokers, were included. Smokers had significantly more massive-sized tears and more reoperations (16.3% vs 5.9%,P=0.02). No differences were found in change in PROMIS scores, proportion meeting MCID for PROMIS scores, and retear rate. In the sub-analysis, 74 current/former smokers were matched to 74 nonsmokers. Smokers had lower change in PROMIS-UE (8.6±9.8 vs 12.3±10.0,P=0.007) and PROMIS-PI (-9.1±8.5 vs -12.8±10.1,P=0.03) postoperatively. Fewer met MCID for PROMIS UE postoperatively (60.3% vs 82.4%,P=0.003) and more had reoperations (16.2% vs 4.1%,P=0.02). Conclusion: Smokers or former smokers demonstrated smaller improvements in function, pain scores, and were less likely to meet MCID for PROMIS-UE when compared to nonsmokers after arthroscopic rotator cuff repair. Smokers were more likely to undergo reoperations within 6 months

Reduced Career Longevity but Return to Baseline Performance After Arthroscopic Shoulder Labral Repair in National Hockey League Players

PURPOSE: To investigate the impact of arthroscopic shoulder labral repair without shoulder instability on career longevity, game use, and performance in National Hockey League (NHL) athletes. METHODS: A retrospective review of all NHL players who underwent arthroscopic shoulder labral repair from 2004 to 2020 was performed. A 2:1 matched control group was used for comparison. Controls were matched by age, body mass index, position, and experience prior to the index year. Demographic characteristics, game use, and performance metrics were collected for all athletes. Statistical analysis examined game use and performance both at 1-year and 3-year follow-up compared with one season before injury. RESULTS: Twenty-nine players who underwent arthroscopic shoulder labral surgery returned to play (100%) and were matched with 55 control players. The operative cohort experienced shorter careers compared with controls (4.4 ± 3.1 vs 6.0 ± 3.6 seasons, P < .05). After one season, injured players experienced significant reductions in goals per 60 (0.6 ± 0.4 vs 0.8 ± 0.5, P = .013), points per 60 (1.5 ± 0.9 vs 2.0 ± 0.9, P = .001), and shooting percentage, (8.5 ± 5.8 vs 10.5 ± 5.2, P = .02) compared with the year prior. The reduction in goals (0.6 ± 0.4 vs 0.8 ± 0.5, P = .01) and shooting % (8.5 ± 4.7 vs 10.5 ± 5.2, P = .04) persisted at 3 years. Compared with controls, the surgical group experienced significant reductions at one season postindex in percentage of goals, assists, points per 60, and shooting percentage. Only the reduction in goals per 60 persisted at 3 seasons postindex. CONCLUSIONS: Following return to play after arthroscopic shoulder labral repair, NHL players demonstrated reduced career longevity compared with healthy controls. Players exhibited significant reductions in game use and performance at one season after injury but returned closer to baseline after 3 seasons. LEVEL OF EVIDENCE: Level III; retrospective case control

Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes

BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events

Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes.

Abstract BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo. (Funded by Amylin Pharmaceuticals; EXSCEL ClinicalTrials.gov number, NCT01144338 .)

Acoustics on a Real Scale Model: Application to Fractured Media

Fluid migration depends on the properties of the geological medium. It increases in fractured media. A better understanding of fractured media can be obtained by the full waveform acoustic technique only if the accuracy and the efficiency of the acoustic method can be correctly calibrated on a known medium. For this purpose, a real scale model made of concrete was built. The first part of the paper describes the real scale model, with its advantages and pitfalls. It illustrates the benefit of using data obtained on the model for tool development. The second part shows acoustic data recorded in the real scale model which represents a fractured medium. The open fracture is perpendicular to the borehole axis. The acoustic know-how acquired from the model has been used to develop an acoustic dipmeter method. This method is briefly described. Two field examples of full waveform acoustic data recorded in fractured media are shown in the third part. The first example shows open and cemented fractures observed on a constant offset section recorded in a vertical well. The second example shows both dipping reflectors and fractures observed in a highly deviated well. In both examples, the fractures and reflectors are confirmed by a core analysis

Acoustics on a Real Scale Model: Application to Fractured Media Diagraphies acoustiques sur modèle physique à l'échelle 1 : application aux milieux fracturés

Fluid migration depends on the properties of the geological medium. It increases in fractured media. A better understanding of fractured media can be obtained by the full waveform acoustic technique only if the accuracy and the efficiency of the acoustic method can be correctly calibrated on a known medium. For this purpose, a real scale model made of concrete was built. The first part of the paper describes the real scale model, with its advantages and pitfalls. It illustrates the benefit of using data obtained on the model for tool development. The second part shows acoustic data recorded in the real scale model which represents a fractured medium. The open fracture is perpendicular to the borehole axis. The acoustic know-how acquired from the model has been used to develop an acoustic dipmeter method. This method is briefly described. Two field examples of full waveform acoustic data recorded in fractured media are shown in the third part. The first example shows open and cemented fractures observed on a constant offset section recorded in a vertical well. The second example shows both dipping reflectors and fractures observed in a highly deviated well. In both examples, the fractures and reflectors are confirmed by a core analysis. La migration de fluide après injection dépend du taux de fracturation du milieu géologique. La diagraphie acoustique en champ total est un outil d'investigation du milieu fracturé. Cet outil est d'autant plus performant qu'il est bien maîtrisé. Un modèle physique à l'échelle 1 permet l'utilisation d'outils acoustiques standards. Il permet d'acquérir des données sur milieu à géométrie connue et aux paramètres mécaniques connus. Il permet de juger de la complexité de la réponse acoustique à une hétérogénéité (fractures ouvertes, fractures cimentées). La première partie de l'article est consacrée à la description du modèle physique avec ses avantages et ses inconvénients. Elle montre quelques exemples d'application du modèle utilisé pour le développement d'outil acoustique. La deuxième partie montre les enregistrements acoustiques obtenus sur le modèle physique qui représente un milieu fracturé. La fracture est ouverte et perpendiculaire à l'axe du puits. Le savoir-faire acquis sur le modèle a permis de développer une méthode de pendagemétrie par acoustique. La dernière partie de l'article est consacrée à la présentation d'exemples d'imagerie acoustique obtenue en milieu fracturé. Le premier exemple montre sur des sections isodéport l'influence de fractures ouvertes ou cimentées. Le deuxième exemple montre une imagerie acoustique réalisée en puits fortement dévié, traversant un réservoir fracturé. Dans cet exemple, l'imagerie acoustique permet de localiser en profondeur à la fois des marqueurs géologiques et des zones fracturées et d'en déterminer leur pendage. Dans les deux exemples, la nature des fractures (ouvertes ou cimentées) et leur géométrie sont confirmées par des analyses sur carottes

A comparison of clinical and patient-reported outcome measures of TKR: Comparison of Asian to North American patients

Background: Cultural differences between continents may also affect the outcome on interventions. This study compared an Asian and North American cohort of total knee replacement (TKR) patients. Questions/purposes: This study aims to compare the patient-reported outcome measures as well as a functional outcome after TKR between these two different patient populations with a different cultural societal background in two different countries. Patients and Methods: A retrospective study on two cohorts of 76 Asian TKR patients and 64 North American TKR patients were compared. Demographics, patient-reported outcome measures (Knee Society Score (KSS), Patient-Administered Questionnaire (PAQ), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)), knee range of motion (RoM), and radiographic component position were compared. Results: The Asian cohort had more females compared to the North American and significantly worse preoperative RoM, and worse KSS function score and PAQ pain scores. The preoperative KSS knee score and WOMAC scores were comparable between the two groups. Postoperatively, the differences in WOMAC and KSS knee scores were significant, while KSS function and PAQ were comparable between groups. Conclusions: Even though Asian TKR patients had significantly worse preoperative scores, their postoperative outcomes were comparable to North Americans. The higher preoperative functional deficit and the higher pain levels in the Asian population might be due to cultural differences and/or socioeconomic reasons, which made Asian patients present with more severe conditions in the preoperative consultation for a possible surgical treatment compared to North Americans. More research is needed to investigate the difference between these cultural impacts on TKR outcomes.Orthopaedics, Trauma Surgery and Rehabilitatio

High Return to Play Rate and Diminished Career Longevity are Seen Following Arthroscopic Shoulder Labral Repair in Major League Baseball Players

PURPOSE: To evaluate the impact of arthroscopic shoulder labral repair, not related to instability, on return to play (RTP), return to prior performance (RTPP), game utilization, and performance in Major League Baseball (MLB) pitchers and positional players. METHODS: A retrospective review of all MLB athletes who underwent arthroscopic shoulder labrum repair from 2002 to 2020 was performed. Players with a history of instability events were excluded. A 2:1 control cohort of healthy MLB players were matched to the operative cohort by age, years of experience, position, height, and body mass index (BMI). Player demographics, game utilization, and performance metrics were collected for all players. RESULTS: Twenty-six of 39 MLB pitchers (66%) and 18 of 25 (72%) positional players, who underwent arthroscopic shoulder labral repair RTP, with 46.2% of pitchers and 72% of positional players successfully RTP. At one season postsurgery, pitchers and positional players experienced a significant reduction in games played compared to their one season preinjury (44.7 ± 29.3 vs 109.5 ± 73.2 games; P \u3c .001 and 75.7 ± 47.1 vs 98.0 ± 50.7 games; P = .04). When compared with matched controls at one season postinjury, pitchers had significantly fewer runs allowed per 9 innings (5.8 ± 2.0 vs 4.3 ± 1.4; P = .0061) and walk and hits per inning pitched (WHIP) (1.5 ± 0.3 vs 1.3 ± 0.2; P = .0035), while positional players had worse on-base percentage (0.3 ± 0.1 vs 0.3 ± 0.1; P = .0116). Both pitchers and positional players experienced significantly shorter career lengths after surgery (P = .002) when compared to controls. CONCLUSIONS: Following arthroscopic shoulder labral surgery, most MLB pitchers and positional players were able to RTP successfully but experienced shorter careers thereafter. These players also experienced declines in game utilization and performance one season after surgery but were able to return to baseline at 3 seasons after surgery. LEVEL OF EVIDENCE: Level III, retrospective case control

High Return to Play Rate and Diminished Career Longevity are Seen Following Arthroscopic Shoulder Labral Repair in Major League Baseball Players

Purpose: To evaluate the impact of arthroscopic shoulder labral repair, not related to instability, on return to play (RTP), return to prior performance (RTPP), game utilization, and performance in Major League Baseball (MLB) pitchers and positional players. Methods: A retrospective review of all MLB athletes who underwent arthroscopic shoulder labrum repair from 2002 to 2020 was performed. Players with a history of instability events were excluded. A 2:1 control cohort of healthy MLB players were matched to the operative cohort by age, years of experience, position, height, and body mass index (BMI). Player demographics, game utilization, and performance metrics were collected for all players. Results: Twenty-six of 39 MLB pitchers (66%) and 18 of 25 (72%) positional players, who underwent arthroscopic shoulder labral repair RTP, with 46.2% of pitchers and 72% of positional players successfully RTP. At one season postsurgery, pitchers and positional players experienced a significant reduction in games played compared to their one season preinjury (44.7 ± 29.3 vs 109.5 ± 73.2 games; P \u3c .001 and 75.7 ± 47.1 vs 98.0 ± 50.7 games; P = .04). When compared with matched controls at one season postinjury, pitchers had significantly fewer runs allowed per 9 innings (5.8 ± 2.0 vs 4.3 ± 1.4; P = .0061) and walk and hits per inning pitched (WHIP) (1.5 ± 0.3 vs 1.3 ± 0.2; P = .0035), while positional players had worse on-base percentage (0.3 ± 0.1 vs 0.3 ± 0.1; P = .0116). Both pitchers and positional players experienced significantly shorter career lengths after surgery (P = .002) when compared to controls. Conclusion: Following arthroscopic shoulder labral surgery, most MLB pitchers and positional players were able to RTP successfully but experienced shorter careers thereafter. These players also experienced declines in game utilization and performance one season after surgery but were able to return to baseline at 3 seasons after surgery