Dual-Camera Technique for Arthroscopic Rotator Cuff Repair

An all-arthroscopic rotator cuff repair demands a high level of technical skill and is associated with a steep learning curve. It is well accepted that small rotator cuff tears or partial tears can be more difficult than large or even massive tears to repair. Part of the reason is the difficulty in visualizing the tear, as well as important surrounding structures, during repair. To improve visibility during the repair process, we have introduced a second arthroscopic camera. Two cameras allow the surgeon to observe the rotator cuff from both the articular and bursal sides. We find this technique has merit in small or partial-thickness rotator cuff tears; however, there may be other applications

What's in a Name? A Cost-Effectiveness Analysis of the Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features' Nomenclature Revision.

Background: The noninvasive subtype of encapsulated follicular variant of papillary thyroid carcinoma (eFVPTC) has been reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in 2016 to reflect the indolent behavior and favorable prognosis of this type of tumor. This terminology change has also de-escalated its management approach from cancer treatment to a more conservative treatment strategy befitting a benign thyroid neoplasm. Objective: To characterize the reduced health care costs and improved quality of life (QOL) from management of NIFTP as a nonmalignant tumor compared with the previous management as eFVPTC. Methods: A cost-effectiveness analysis was performed by creating Markov models to simulate two management strategies for NIFTP: (i) de-escalated management of the tumor as NIFTP involving lobectomy with reduced follow-up, (ii) management of the tumor as eFVPTC involving completion thyroidectomy/radioactive iodine ablation for some patients, and follow-up recommended for carcinoma. The model was simulated for 5 and 20 years following diagnosis of NIFTP. Aggregate costs and quality-life years were measured. One-way sensitivity analysis was performed for all variables. Results: Over a five-year simulation period, de-escalated management of NIFTP had a total cost of $12,380.99 per patient while the more aggressive management of the tumor as eFVPTC had a total cost of$16,264.03 per patient (saving $3883.05 over five years). Management of NIFTP provided 5.00 quality-adjusted life years, whereas management as eFVPTC provided 4.97 quality-adjusted life years. Sensitivity analyses showed that management of NIFTP always resulted in lower costs and greater quality-adjusted life years (QALYs) over the sensitivity ranges for individual variables. De-escalated management for NIFTP is expected to produce ∼$6-42 million in cost savings over a five-year period for these patients, and incremental 54-370 QALYs of increased utility in the United States. Conclusion: The degree of cost savings and improved patient utility of de-escalated NIFTP management compared with traditional management was estimated to be $3883.05 and 0.03 QALYs per patient. We demonstrate that these findings persisted in sensitivity analysis to account for variability in recurrence rate, surveillance approaches, and other model inputs. These findings allow for greater understanding of the economic and QOL impact of the NIFTP reclassification

Observation of Three-Neutron Sequential Emission from ²⁵O

Background: Measurements of neutron-unbound states can test nuclear models in very neutron-rich nuclei that in some cases cannot be probed with other methods. Purpose: Search for highly excited neutron-unbound states of 25O above the three neutron separation energy. Method: The decay energy of 25O was reconstructed using the invariant mass spectroscopy method. A 101.3 MeV/u 27Ne beam collided with a liquid deuterium target. Two-proton removal reactions populated excited 25O that decayed into three neutrons and an 22O fragment. The neutrons were detected by arrays of plastic scintillator bars, while a 4 Tm dipole magnet placed directly after the target redirected charged fragments to a series of charged-particle detectors. The data were compared with detailed Monte Carlo simulations of the reaction process and subsequent decay. Results: The data show evidence of neutron-unbound level(s) in 25O at an excitation energy of about 9 MeV which decay sequentially by the emission of three neutrons to 22O. Conclusion: The observation of resonance strength in 25O at about 9 MeV is consistent with shell-model/eikonal calculations for the two-proton removal reaction from 27Ne.</p

Reproductive biology and postnatal development in the tent-making bat Artibeus watsoni (Chiroptera: Phyllostomidae)

In this study we investigated the reproductive patterns and postnatal development in the tent‐making bat Artibeus watsoni. We sampled two populations in the Golfito Wildlife Refuge and Corcovado National Park, south‐western Costa Rica, from June 2003 to March 2005. Most females were pregnant during the months of January and June, and most were lactating in March and July, indicating that this species exhibits seasonal bimodal polyoestry, with the first parturition peak occurring in February–March and the second in June–July. Additionally, we observed a postpartum oestrus following the first parturition, but not after the second. Females entered oestrus again in November–December and had a gestation period of c. 3 months. A female‐biased sex ratio of neonates was observed during the second parturition period, and young were born at 32 and 56% of their mothers' body mass and length of forearm, respectively. Adult proportions in length of forearm were attained faster than adult proportions in body mass, and sustained flight was only possible after 35 days of age, when pups had achieved 100 and 80% of adult length of forearm and body mass proportions, respectively. Weaning and roosting independence occurred when young were c. 30–40 days old, and young females appeared to remain close to their place of birth, at least for their first mating period, whereas adult males were never recaptured near their birth site. In addition, sexual maturity was reached in as little as 3 months in females born during the first parturition period, whereas females born during the second birth period in June–July seemed to reach maturity at 6 months of age. Our results show that A. watsoni belongs to the faster lane of the slow–fast continuum of life‐history variation in bats, which may be attributed primarily to its roosting and feeding ecology.Idea Wild/[]//Estados UnidosConsejo Nacional de Ciencia y Tecnología/[]/Conacyt/MéxicoMinisterio de Ciencia, Tecnología y Telecomunicaciones/[]/MICITT/Costa RicaAmerican Society of Mammalogists/[]/ASM/Estados UnidosCleveland Metroparks Zoo/[]//Estados UnidosBat Conservation International/[]/BCI/Estados UnidosConservation, Food and Health Foundation/[]//Estados UnidosBoston University’s Center/[]//Estados UnidosUniversidad de Costa Rica/[]/UCR/Costa RicaUCR::Sedes Regionales::Sede del Su