Citations

Background: The radiolunate joint is conventionally thought to be spared from radiocarpal osteoarthritis, but proximal lunate degenerative changes have been noted. An investigation of radiolunate arthrokinematics in ostensibly healthy wrists may improve understanding of posttraumatic and postoperative outcomes. We hypothesize that four-dimensional computed tomography (4DCT)-derived radiolunate arthrokinematics during motion will differ between wrists with type 1 and type 2 lunates. The clinical-translational relevance of this analysis is highlighted using a 4DCT case study of scaphoid excision with 4-corner arthrodesis (SEFCA). Methods: Four-dimensional computed tomography data were collected during flexion-extension and radioulnar deviation in 19 healthy wrists (mean [SD] age: 43.6 [11.7] years, 21.1% female) and 1 wrist 3 years after SEFCA (male, 52 years). Carpal osteokinematics and joint arthrokinematics were calculated to derive median radiolunate interosseous proximities at each 4DCT-captured timepoint. Results: Median radiolunate interosseous proximities during motion are well approximated by second-order regressions in uninjured wrists. In the arthrodesed wrist, closest proximities occurred at the extremes of motion except maximum radial deviation. Conclusions: This study quantifies a normative range of median radiolunate interosseous proximities during wrist motion. The normative 4DCT datasets provide a reference range for evaluating postoperative arthrokinematics, suggesting the clinical-translational potential of dynamic imaging. The case study highlights applications for patient-level postoperative evaluation, which can be expanded to other pathologies, surgeries, or conditions in the future.

Abstract Rumination syndrome (RS) is a common pediatric disorder of gut–brain interaction. However, a dearth of research on efficacious treatment to help guide clinical decision‐making remains. Thus, relying on well‐established treatment recommendations for other conditions with similar mechanisms or symptom profiles may be helpful; for example, conceptualizing RS treatment targets to address it as a “tic disorder of the gut” could be beneficial. To demonstrate the clinical utility of this conceptualization, we presented two cases that provide broad implications for treating pediatric RS. In both cases, akin to pediatric tic and related disorders, cognitive distress and physical discomfort were alleviated temporarily by rumination episodes. Thus, we recommend a targeted diagnostic assessment, including a functional analysis incorporating a transdiagnostic evaluation of symptoms. Close comanagement with specialty physicians and psychologists is also highly recommended. The patients represent complex yet standard cases seen in pediatric psychology outpatient clinics, suggesting the clinical utility of implications for psychologists and allied health professionals.

ABSTRACT Background Geriatric screening and multidisciplinary assessment of older adults in the Emergency Department (ED) decrease hospitalizations and ED revisits. The impact on patient‐reported outcomes of health‐related quality of life (HRQoL) and functional status is not known. Methods A hybrid type II implementation/effectiveness prospective cohort study was conducted in an academic ED. The intervention bundle was geriatric screening for delirium, fall risk, and transition of care needs, and multidisciplinary assessment. All older adults (≥ 65 years) placed in the ED observation unit were eligible. HRQoL and functional status were obtained at the ED visit, 30, and 90 days, and were compared between the pre‐ and post‐intervention implementation cohorts. Secondary outcomes included ED revisits, falls, mortality, and intervention adoption measures. Results From 2019 to 2023, 368 adults participated in the study: Most were community‐dwelling (97%) and had multiple comorbidities. The pre ( n = 138) and post ( n = 230) cohorts did not differ in baseline functional status or HRQoL. The rate of geriatric screening improved from 12.3% in the pre‐implementation cohort to 91.3% in the post‐implementation cohort ( p < 0.01). Multispecialty consultation also increased (68.1%–91.3%, p < 0.01). The proportion who had a post‐ED visit decline in functional status did not differ between cohorts. Physical HRQoL declined similarly in both cohorts (−0.73 vs. −0.33, p = 0.61) at 90 days. Mental HRQoL improved in both cohorts; improvement was greater in the pre‐cohort (2.35 vs. 0.32, p = 0.02). ED revisits and re‐hospitalizations were unchanged (30 days: 23.0% vs. 17.2%, p = 0.18, and 90 days: 37.8% vs. 34.8%, p = 0.57). The intervention decreased falls at 30 and 90 days (30 days: 9.7% vs. 3.2%, p = 0.04; 90 days: 22.1% vs. 7.9%, p < 0.01). Conclusions Geriatric screening in the ED increased identification of geriatric syndromes and multidisciplinary consultation. The intervention was associated with decreased falls but did not affect HRQoL or reduce functional decline post ED visit. Trial Registration clinicaltrials.gov : NCT04068311

Abstract Anterior cruciate ligament reconstruction (ACLR) using bone–patellar tendon–bone autograft remains one of the most common autografts used, and there is significant evidence to support its title as the “gold standard.” There are nuances and technical challenges associated with every step of an ACLR, which always leave room for improvement. The purpose of this Technical Note is to provide reproducible, technical pearls where errors are commonly encountered during ACLR. In this article, we detail 10 technical pearls that surgeons should consider to enhance operative workflow and optimize success during ACLR with a bone–patellar tendon–bone autograft. Technique Video video See video under supplementary data.

Purpose: To assess the prevalence, associated conditions, diagnostic and treatment modalities, and provider education regarding the diagnosis and management of keratoconus (KCN) in sub-Saharan Africa (SSA) based on the currently available body of literature. Methods: Peer-reviewed publications from any year and any language were included. The databases included Cochrane Database of Systematic Reviews, Embase, and Ovid. A separate search of African Journals Online was conducted using the same Medical Subject Heading (MeSH) terms as the database search. Additional publications were identified in the references during full-text extraction. The abstracts of all publications were evaluated by two reviewers. The full text was then examined by one reviewer for inclusion. A data extraction tool was used by a single reviewer to document the findings. Results: Sixty-two publications were included in data extraction. Fourteen countries in SSA were represented. Prevalence was reported in eight SSA countries and ranged from 0% to 2.8%. The highest prevalence of 1.2% was found in a cross-sectional study in Banjul, Gambia. Diagnosis in urban areas is often made using slit lamps, although some sites had access to keratometry and/or topography, whereas rural areas use penlight exams alone. Penetrating keratoplasty was reported as an available treatment in 14 manuscripts, glasses and hard contact lenses in 10, and corneal cross-linking in two. Publications discussing provider education reported a knowledge gap. Conclusions: There is a need for increased data on KCN in SSA to better inform public health policy to improve KCN patients’ access to care and quality of life.

Abstract Objective Autoimmune encephalitis is a cause of brain inflammation characterized by auto‐antibodies, which target cell surface neuronal proteins and lead to neuronal dysfunction. The most common form is associated with auto‐antibodies to leucine‐rich glioma‐inactivated 1 (LGI1) protein, the presentation of which includes frequent focal seizures. The exact cause of these auto‐antibodies remains unknown, but established predispositions include overrepresented human leukocyte antigen ( HLA ) alleles. Yet, these HLA alleles are themselves common in the healthy ancestry‐matched population. One potential etiological hypothesis is that an environmental trigger, such as the gut microbiome, interacts with a genetically predisposed individual. Methods To investigate this, we studied 42 patients with LGI1‐antibody encephalitis (LGI1‐Ab‐E) and 27 familial/environmentally matched controls, and performed metagenomic shotgun sequencing, to describe the compositional and functional differences in the gut microbiome. Results We observed that LGI1‐Ab‐E gut microbiomes exhibited a significant reduction in the ratio of Firmicutes (or Bacillota) and Bacteroidetes phyla, which is associated with the dosage of HLA susceptibility allele count in patients with LGI1‐Ab‐E. Furthermore, we identified differences in functional gene profiles in the gut microbiome that led to a reduction of neuroinflammatory protective short‐chain fatty acids (SCFAs) in LGI1‐Ab‐E patients. Significance Taken together, our results suggest that a compositional shift in the gut microbiome of LGI1‐Ab‐E associates with a neuroinflammatory state, possibly through the reduction of SCFA production. Our study highlights the potential of the gut microbiome to explain some of the complex condition and unravel etiological questions. Validation studies with greater sample sizes are recommended.

Gastrointestinal (GI) defects pose a significant clinical challenge, impacting patient outcomes and healthcare costs. Endoscopic closure techniques have emerged as effective and minimally invasive approaches to manage these defects. This review explores the various endoscopic techniques, including over-the-scope clips (OTSC), endo suturing systems, through-the-scope (TTS) clips, and the X-Tack system. Each technique offers distinct advantages and limitations, making it suitable for specific clinical scenarios. While these devices have demonstrated promising results in clinical practice, further research is needed to optimize their use and address knowledge gaps. Large-scale randomized controlled trials are essential to establish evidence-based guidelines for device selection and procedural techniques. By embracing technological advancements and addressing research limitations, the field of endoscopic closure devices has the potential to revolutionize GI care, leading to improved patient outcomes and expanded therapeutic possibilities.

BACKGROUND Approximately 10% of patients report penicillin allergy. Based on historical guidelines, patients with a penicillin allergy should receive an alternative to cephalexin for prophylaxis in dermatologic surgery. OBJECTIVE To determine, based on evidence, if cephalexin should be used as a first-line prophylactic antibiotic in dermatologic surgery for patients with penicillin allergy. METHODS Systematic review of the literature was performed with defined search terms. RESULTS Less than 5% of those with penicillin allergy labels have a true penicillin allergy. For patients with true, persistent penicillin allergy, there is an overall low cross-reactivity with cephalosporins, especially with cephalosporins that do not share identical R1 side chain. The first-generation cephalosporins, including cephalexin, have a slightly higher risk of cross-reactivity in patients with reported allergy to amino-penicillins (amoxicillin, ampicillin) but not other penicillins. The risk of severe cross-reactivity of cephalosporins in patients with low-risk penicillin allergies is extremely low. Cephalexin has a superior side effect profile and efficacy compared to alternatives. CONCLUSION Cephalexin should be used as the first-line prophylactic antibiotic in dermatologic surgery for patients with documented penicillin allergy, including anaphylaxis. There may be a higher risk of cross-reactivity with cephalexin in patients with a confirmed amino-penicillin allergy.