Social determinants of health influence the risk of cirrhosis: A diverse nationwide cohort study.

Background And Aims: Cirrhosis is a leading cause of mortality in the United States, with significant disparities influenced by social determinants of health (SDOH). This study evaluated the effects of SDOH on the risk of cirrhosis in a nationwide cohort of patients.

Approach And Results: We conducted a retrospective cross-sectional cohort study from the All of Us Research Program (AOURP), enrolled from 2017 to 2022.

Postoperative Outcomes in Tofacitinib-Treated Patients With Acute Severe Ulcerative Colitis Undergoing Colectomy.

Background And Aims: Up to 30% of patients with acute severe ulcerative colitis (ASUC) will require urgent colectomy despite initiation of intravenous corticosteroids and rescue therapies. Janus kinase inhibitors, such as tofacitinib, have emerged as an effective agent for ASUC; however, there are currently limited data evaluating the risk of postoperative complications among patients who received tofacitinib treatment for an episode of ASUC compared with infliximab.

Methods: We conducted a multicenter, retrospective, case-control study of patients hospitalized with ASUC who underwent colectomy, comparing patients treated with tofacitinib prior to colectomy with infliximab-treated controls.

Severe asthma exacerbations associated with unconventional natural gas development activity in area of concentrated development.

Introduction: Residential proximity to unconventional natural gas development (UNGD) has been shown to be associated with asthma exacerbations, but there is limited evidence regarding whether exacerbations are associated with a particular distance or phase of well activity.

Objective: To study the impact of proximity to UNGD activity by well phase and buffer distance.

Methods: We included asthma patients 5-90 years old with a primary diagnosis of asthma and at least one order for medications prescribed for asthma residing in one of eight Southwestern Pennsylvania counties between 2011 and 2020.

Rurality and Neighborhood Socioeconomic Status are Associated With Overall and Cause-Specific Mortality and Hepatic Decompensation in Type 2 Diabetes.

Introduction: Social determinants of health are key factors driving disease progression. In type 2 diabetes there is limited literature on how distal or intermediate factors (eg, those at the neighborhood level) influence cause-specific mortality or liver disease outcomes.

Methods: This was a single-center retrospective study of patients with type 2 diabetes seen at an integrated healthcare system in the United States.

Novel Clinical Practice Assessments: Informational Statements by the Musculoskeletal Tumor Society.

Musculoskeletal oncology involves rare diseases. As a result, there is a paucity of literature to guide practitioners. Studies are often clinical experience, retrospective reviews, noncomparative studies, and involve small numbers of patients.

Bizarre Parosteal Osteochondromatous Proliferation With Malignant Transformation and Metastases.

A patient with a benign bizarre parosteal osteochondromatous proliferation (BPOP) located in the anterior knee was treated with resection in preparation for total knee arthroplasty (TKA). The BPOP reoccurred and was treated with re-resection at the time of TKA. The BPOP reoccurred a second time and underwent malignant transformation to a fungating high-grade pleomorphic sarcoma with metastatic lesions.

Understanding the Perspectives and Experiences of Patients with Acute Severe Ulcerative Colitis in the Hospital: A Qualitative Analysis.

Introduction: Acute severe ulcerative colitis (ASUC) is a life-treating presentation of ulcerative colitis (UC) that requires prompt initiation of treatment to avoid complication. Unfortunately, outcomes for ASUC are suboptimal, with as many as 20-30% of patients requiring colectomy. This can be challenging for patients and highlights the need to understand patient experiences and perspectives navigating ASUC.

HEAR-MHE study: Automated speech analysis identifies minimal hepatic encephalopathy and may predict future overt hepatic encephalopathy.

Background And Aims: HE is a major cause of poor quality of life in patients with cirrhosis. A simple diagnostic test to identify minimal hepatic encephalopathy (MHE) and predict future overt HE (OHE) is lacking. We aimed to evaluate if analysis of speech patterns using a modern speech platform (1) correlates with validated HE tests, (2) correlates with MHE, and (3) predicts future OHE.

PNPLA3 risk allele is associated with risk of hepatocellular carcinoma but not decompensation in compensated cirrhosis.

Background: The PNPLA3-rs738409-G, TM6SF2-rs58542926-T, and HSD17B13-rs6834314-A polymorphisms have been associated with cirrhosis, hepatic decompensation, and HCC. However, whether they remain associated with HCC and decompensation in people who already have cirrhosis remains unclear, which limits the clinical utility of genetics in risk stratification as HCC is uncommon in the absence of cirrhosis. We aimed to characterize the effects of PNPLA3, TM6SF2, and HSD17B13 genotype on hepatic decompensation, HCC, and liver-related mortality or liver transplant in patients with baseline compensated cirrhosis.

The Musculoskeletal Tumor Society Clinical Practice Guideline on the Management of Metastatic Humeral Disease.

Management of Metastatic Humeral Disease is based on a systematic review of published studies surrounding the management of metastatic disease, multiple myeloma, and lymphoma limited to the humerus. This guideline contains seven action statements to assist orthopaedic surgeons, orthopaedic oncologists, physicians, and any other qualified healthcare professionals involved in the surgical management of metastatic disease of the humerus. It is also intended to serve as an information resource for decision makers, researchers, and developers of clinical practice guidelines.

Extensile Exposures in Revision and Complex Primary Total Knee Arthroplasty: A Review of Anatomy, Biomechanics, and Techniques.

Developing adequate exposure when performing a revision total knee arthroplasty is critical to an efficient and safe intraoperative course. Proper planning and knowledge of the relevant anatomy are important when dissecting scar tissue associated with previous trauma or surgery and navigating bone loss. We present a review of the different total knee arthroplasty extensile exposure techniques that have been described in the literature.

American Academy of Orthopaedic Surgeons Appropriate Use Criteria: Prevention of Surgical Site Infections After Major Extremity Trauma.

High-energy extremity trauma rates can be difficult to precisely state given the complexity of contributing combined mechanisms; however, the rate of open fractures in the United States is 11.5 to 13 per 100,000 people. The management of high-energy extremity fractures presents many challenges for treating surgeons, including elevated risk of surgical site infections (SSIs).

Revision Total Knee Arthroplasty Utilizing Threaded Pins in Cement for Tibial Bone Loss.

: a primary goal in revision total knee arthroplasty is to recreate and restore near-normal knee biomechanics by reapproximating the native anatomy. Tibial bone loss poses a challenge for surgeons. Bone cement, bone allograft, screws-in-cement, metaphyseal sleeves or cones, and metallic augments are some options for addressing bony deficiency, with endoprosthetic proximal tibia replacement a consideration for the most severe cases.

American Academy of Orthopaedic Surgeons Appropriate Use Criteria: Prevention of Surgical Site Infections After Major Extremity Trauma.

The Major Extremity Trauma and Rehabilitation Consortium and the American Academy of Orthopaedic Surgeons have developed Appropriate Use Criteria for the Prevention of Surgical Site Infections (SSIs) After Major Extremity Trauma. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to determine appropriateness of various treatments for the prevention of SSIs after major extremity trauma. Scenarios were derived by identifying clinical indications typical of patients suspected of developing an SSI in clinical practice.

Time to Functional Outcome Optimization After Musculoskeletal Tumor Resection.

Background There is ample literature describing surgical outcomes after oncologic musculoskeletal tumor surgery, however, there is limited understanding of the time to optimization of functional outcome scores after resection. The purpose of this study was to identify the time to functional outcome optimization of Musculoskeletal Tumor Society (MSTS) scores after surgery for bone and soft tissue tumors and to identify factors correlated with recovery. Methods We retrospectively reviewed 187 patients from April 2016 to May 2021 that had undergone surgical treatment for musculoskeletal tumors.

Effects of Hypercarbia on Lower Extremity Primary Total Joint Replacement Infections.

Introduction: Prosthetic joint infection (PJI) is a serious complication after total joint replacement (TJR). Adequate wound oxygenation is critical for wound healing and infection prevention. As carbon dioxide (CO) is exchanged for oxygen (O) in the lungs, serum bicarbonate (HCO ) may be used as a marker for predicting relative serum O levels, and therefore, healing potential.

Simultaneous primary bilateral hip resection arthroplasty.

Hip resection arthroplasty is a useful procedure for the management of complex hip problems and in patients with high surgical and anesthetic risk factors. Unilateral procedures performed for failed total hip arthroplasty have been shown to be successful for pain relief with acceptable functional outcomes; however, to our knowledge, no research exists on simultaneous bilateral hip resection arthroplasty for femoral head osteonecrosis. We present two cases of single-stage bilateral hip resection arthroplasty performed under singular anesthetic procedures for femoral head osteonecrosis.

Osteoid Osteoma Treatment with Microwave Ablation: A Report of Two Cases.

Osteoid osteomas are one of the most common bone tumors. Although benign in nature, they can cause significant pain and distress to the afflicted patient. The main goal of treatment is to relieve pain.

Monoarticular, Multifocal, Localized Tenosynovial Giant Cell Tumor of the Knee: A Case Report.

Case: We present a 37-year-old man with uniarticular, multifocal, localized tenosynovial giant cell tumor (TSGCT) of the knee. He was treated with arthroscopic partial synovectomy of each tumor foci alone without the use of any adjuvants. At a 2-year follow-up, he had painless, full function of the knee with no signs of disease recurrence.

Long-term Results of Intercalary Endoprosthetic Short Segment Fixation Following Extended Diaphysectomy.

Intercalary endoprosthetic reconstruction following diaphyseal resection of osseous tumors offers functional advantages through preservation of native joints adjacent to the resected defect. Use of such implants is restricted by the amount of bone available for stem fixation adjacent to the defect. This study aimed to determine whether short osseous segment fixation with acceptable outcomes and complication rate can be reliably achieved with a customized intercalary endoprosthesis following extended diaphysectomy.

Unplanned Resection of Sarcoma.

Unplanned resection is a common problem in the management of sarcoma. Because sarcomas are so rare, they may be misdiagnosed initially as more common benign lesions. When the treating surgeon is unaware of or does not adhere to proper surgical principles of orthopaedic oncology, an intralesional procedure may be performed without the requisite preoperative imaging, staging, or wide resection margins for optimal management of sarcoma.

Relationship between hypothermia and blood loss in adult patients undergoing open lumbar spine surgery.

Context: Intraoperative blood loss during open lumbar spine surgery is associated with adverse events and is a contributor to higher medical costs. Intraoperative hypothermia has been shown to increase blood loss and postoperative allogeneic blood transfusion rates in other realms of orthopedic surgery, but it has not been studied extensively in patients undergoing spine surgery.

Objective: To determine whether a clinically relevant association exists between intraoperative core body temperature and blood loss or transfusion rates in adult patients undergoing open lumbar spine surgery.