Reporting of Sex Specific Outcomes in High Impact Orthopedic Journals

Background: There are known biologic differences between men and women that affect all aspects of health and disease, including in orthopedics. Hormonal regulation influences bone density, tissue structure, joint laxity, and muscle mass. Differences in anatomy and neuromuscular control have also been identified. While previous studies on disease incidences have shown certain conditions are more common in one sex (e.g., osteoarthritis in women), it is not routine practice to evaluate or publish outcomes based on sex. Objectives: To evaluate the frequency with which papers in orthopedic journals published sex-specific outcomes with regard to knee osteoarthritis and rotator cuff pathology. Methods: Four high-impact orthopedic journals were reviewed: Journal of Bone and Joint Surgery (JBJS), Clinical Orthopedics and Related Research (CORR), American Journal of Sports Medicine (AJSM), and Journal of Arthroplasty (JOA). JBJS and CORR were reviewed for rotator cuff and knee osteoarthritis. AJSM was reviewed for rotator cuff, while JOA was reviewed for knee osteoarthritis. 100 articles from each journal were reviewed. If there was any further analysis of sex beyond the statement of how many men and women were included in each group, a study was designated as successfully reporting sexspecific outcomes. Results: 24-29% of rotator cuff articles reported on sex-specific outcomes. Sex specific outcomes were reported in 32-40% of knee osteoarthritis publications. Comparing rotator cuff to knee osteoarthritis articles, there was a trend toward more publications with sex-specific outcomes in knee osteoarthritis, however, this was not statistically significant (p = 0.0562). JBJS publishes significantly more articles reporting sex specific outcomes regarding knee osteoarthritis than rotator cuff (p= 0.0156). Conclusions: Sex-specific outcomes are not widely reported in high-impact orthopedic journals. Sexspecific outcomes are reported more often in knee osteoarthritis where there are already well-known sexbased differences. To improve care, sex-specific outcomes should be reported across all orthopedic conditions.https://jdc.jefferson.edu/sexandgenderhealth/1028/thumbnail.jp

Actions of melanotropins on mouse melanoma cell growth in vitro.

Melanotropins induce melanogenesis in mouse Cloudman S91 melanoma cells by stimulating the activity of tyrosinase. In monolayer culture, alpha-melanocyte-stimulating hormone and the superpotent analogue 4-norleucine, 7-D-phenylalanine-alpha-melanocyte, which had prolonged effects on tyrosinase activity, did not inhibit the proliferation of melanoma cells even at concentrations that elicited maximal tyrosinase stimulation. In soft agar the melanotropins stimulated the formation of melanized colonies and increased the cloning and proliferative potentials of melanoma cells. Both melanotropins increased the number of small (42-104 microns in diameter) colonies at initial plating densities ranging from 625 to 7,500 cells/dish. The number of larger (greater than 104 microns in diameter) colonies was also increased except at densities 5,000 cells or more/dish, wherein the proliferative capacity was inhibited; yet the cloning efficiency was still increased. Therefore, in bilayer soft agar cultures, melanotropins stimulate the growth of the clonogenic S91 melanoma cell population under conditions that allow for optimal expression of the cloning and proliferative potentials of these cells

Translational Radiomics: Defining the Strategy Pipeline and Considerations for Application-Part 1: From Methodology to Clinical Implementation.

Enterprise imaging has channeled various technological innovations to the field of clinical radiology, ranging from advanced imaging equipment and postacquisition iterative reconstruction tools to image analysis and computer-aided detection tools. More recently, the advancements in the field of quantitative image analysis coupled with machine learning-based data analytics, classification, and integration have ushered us into the era of radiomics, which has tremendous potential in clinical decision support as well as drug discovery. There are important issues to consider to incorporate radiomics as a clinically applicable system and a commercially viable solution. In this two-part series, we offer insights into the development of the translational pipeline for radiomics from methodology to clinical implementation (Part 1) and from that to enterprise development (Part 2)

Does Prior Acromioplasty Increase the Incidence of Acromial Fracture Following Reverse Total Shoulder Arthroplasty? A Retrospective Matched Cohort Analysis

Introduction: Reverse total shoulder arthroplasty (RTSA) is an effective treatment option for multiple shoulder pathologies. Arthroscopic acromioplasty is a treatment for subacromial impingement. RTSA can place excess stress on the acromion. No studies have evaluated outcomes following RTSA among patients with prior acromioplasty. The purpose of this study was to report outcomes in patients following RTSA who have had a prior acromioplasty. The authors hypothesized patients with prior acromioplasty who undergo RTSA will have significant improvements in clinical outcomes with no increased risk of acromial fracture. Methods: Patients from a single institution who underwent RTSA with a history of acromioplasty from 2009 to 2017 with two-year follow up were identified. Clinical outcome scores were obtained using ASES, SST, VAS, and SANE surveys. X-rays and charts will be reviewed to determine if patients sustained anacromion fracture following RTSA. Patients will be matched to a cohort of patients who underwent RTSA without a prior acromioplasty.These groups will be compared to determine any differences in clinical outcome scores or number of postoperative acromial fractures. Results: 45 patients were included.Average outcomes scores were: ASES:70.7%, SST: 62.1%, VAS: 2.4, and a SANE: 60.6%. On average, active external rotation improved from 33.1° to 37.1° and forward elevation improved from 92.2° to 136.1°. Discussion: While data collection in the matched cohort remains ongoing to compare the outcomes of RTSA with prior acromioplasty to the outcomes of RTSA alone, initial data suggests history of acromioplasty does not negatively impact RTSA outcomes

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

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

Should the Entire Team Learn Together? Piloting an Interprofessional, Palliative Care Communication Workshop

Learning Objectives To describe the main objective for an effective interprofessional communication workshop To list the essential elements of an effective interprofessional communication worksho

Deep Learning and Random Forest-Based Augmentation of sRNA Expression Profiles

The lack of well-structured annotations in a growing amount of RNA expression data complicates data interoperability and reusability. Commonly - used text mining methods extract annotations from existing unstructured data descriptions and often provide inaccurate output that requires manual curation. Automatic data-based augmentation (generation of annotations on the base of expression data) can considerably improve the annotation quality and has not been well-studied. We formulate an automatic augmentation of small RNA-seq expression data as a classification problem and investigate deep learning (DL) and random forest (RF) approaches to solve it. We generate tissue and sex annotations from small RNA-seq expression data for tissues and cell lines of homo sapiens. We validate our approach on 4243 annotated small RNA-seq samples from the Small RNA Expression Atlas (SEA) database. The average prediction accuracy for tissue groups is 98% (DL), for tissues - 96.5% (DL), and for sex - 77% (DL). The "one dataset out" average accuracy for tissue group prediction is 83% (DL) and 59% (RF). On average, DL provides better results as compared to RF, and considerably improves classification performance for 'unseen' datasets

Absent cervical spine pedicle and associated congenital spinal abnormalities - a diagnostic trap in a setting of acute trauma: case report

BACKGROUND: Congenital spinal abnormalities can easily be misdiagnosed on plain radiographs. Additional imaging is warranted in doubtful cases, especially in a setting of acute trauma. Case Presentation This patient presented at the emergency unit of our university hospital after a motor vehicle accident and was sent to our radiology department for imaging of the cervical spine. Initial clinical examination and plain radiographs of the cervical spine were performed but not conclusive. Additional CT of the neck helped establish the right diagnosis. CONCLUSION: CT as a three-dimensional imaging modality with the possibility of multiplanar reconstructions allows for the exact diagnosis and exclusion of acute traumatic lesions of the cervical spine, especially in cases of doubtful plain radiographs and when congenital spinal abnormalities like absent cervical spine pedicle with associated spina bifida may insinuate severe trauma

A rare case of complete C2–C3 dislocation with mild neurological symptoms

The authors report a rare case of complete C2–C3 dislocation with unexpectedly mild neurological symptoms in a 57 year old man involved in a motor vehicle accident, who had previously undergone posterior laminectomy from C3 through C7. A retrospective chart analysis and a thorough radiographic review were performed. X-rays and CT of the cervical spine demonstrated a complete dislocation at the C2–C3 level. Computed tomographic angiography revealed disruption of both vertebral arteries; however, blood flow was evident in the basilar artery. After radiologically guided placement in cervical traction with tongs that reduced the subluxation by approximately 50% the patient had spontaneous eye opening and was able to follow commands. A two-stage 360(o) stabilization and fusion was performed and the patient was finally discharged 24 days after admission with his neurological status essentially unchanged. In conclusion, our patient presented with surprisingly mild neurological symptoms. The previously performed laminectomy could have both predisposed to injury as well as protected his spinal cord from potentially fatal trauma