Surgery:

IMPORTANCE: Intersystem medical error discovery (IMED) involves clinicians identifying errors that occurred outside of their facility while a patient was under another clinician's care. Despite its major implications for safety and quality of care, explicit guidance is limited. Given the complexity of disorders and specialization within otolaryngology, IMED is a considerable concern, yet little is known about current practices or management strategies.

CONCLUSIONS: Lead glasses were most effective (∼100% reduction), followed by surgical loupes (97%), whereas plastic face shields showed no significant reduction in radiation dose. Surgical loupes can substantially reduce ocular radiation exposure.

CONCLUSIONS: In this study of patients ≥60 years of age with a femoral neck fracture, the rates of all-cause revision and mortality were found to be similar between the FNS and multiple cannulated screws.

According to the Banff classification, intimal arteritis (v-lesion) contributes to diagnosing T cell-mediated rejection (TCMR) and antibody-mediated rejection (AMR), and signifies more severe TCMR. This multicenter cohort study (N=5323 kidney transplants, N=16774 post-transplant biopsies) evaluated the impact of v-lesions (N=707 v-positive biopsies in N=534 transplants) on biopsy classification and outcomes. The first v-positive biopsy of each transplant was categorized by additional Banff TCMR/(p)AMR-MVI criteria: 166 (31.1%) isolated v, 87 (16.3%) borderline changes with v, 66 (12.4%) TCMR grade I (TCMR-I) with v, 148 (27.7%) (p)AMR-MVI ((probable) AMR/DSAnegC4dneg MVI) with v, and 67 (12.5%) TCMR-I + (p)AMR-MVI with v. Cases with additional TCMR/(p)AMR-MVI criteria were more often indication biopsies, had lower eGFR, and were more frequently HLA-DSA positive than isolated v. While borderline changes with v had borderline higher 10-year graft failure rates than isolated v, TCMR-I, (p)AMR-MVI, and TCMR-I + (p)AMR-MVI with v were associated with significantly worse outcomes, although variably treated. Matching N=534 v-positive cases to v-negative controls showed no significant impact of v-lesions on outcomes. These findings question the role of isolated v-lesions in rejection diagnosis and emphasize the greater prognostic value of additional TCMR and (p)AMR-MVI criteria. Reconsideration of v-lesions in the Banff classification may be appropriate.

CONCLUSIONS: A preoperative weight loss intervention using a dietitian and a mobile app was feasible and viewed favorably among patients. Remote dietitians and mobile apps may address gaps in access to obesity treatment before TJA. While the intervention subjects lost more weight and were more likely to achieve a BMI of <40 kg/m 2 , the differences were not significant. More intensive interventions may be needed to achieve enough weight loss for clinically important improvements in TJA.

CONCLUSIONS: Based on our findings, a macroscopically normal-appearing biceps tendon should be released when treating stage-1 supraspinatus tendon tears.

Ongoing research should focus on improving healing of rotator cuff repairs at the tendon-to-bone interface. "Cells, scaffolds, and signals" is useful in categorizing orthobiologic-related approaches to augmenting RCR. Cell-based therapies such as platelet rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) exert positive effects through production of signaling molecules that modulate the inflammatory process, promote angiogenesis, and facilitate new tendon tissue growth. "Scaffolds" refer to structural and non-structural augments that may facilitate concentration of biologically active constituents at the healing site and provide time zero tissue strength of repaired tissues. Owing to challenges associated with the use of cell-based products, isolation and targeted delivery of the signaling molecules represent a promising avenue for optimizing tendon repair healing. "Exosomes" are small extracellular vesicles (30-150 nanometers) secreted by cells that serve as natural carriers of bioactive molecules. The role of exosomes in influencing intercellular communication-modulating inflammation, promoting angiogenesis, and regulating extracellular matrix (ECM) remodeling-makes them uniquely suited for tissue repair applications and a natural target for RCR-related basic science research. The use of exosomes represents a promising adjunct that appears to improve the biomechanical and histological properties of rotator cuff repairs. Rotator cuff repairs augmented with exosomes in a rabbit model may be stronger and histologically superior to repairs performed in isolation.

➢ Risk stratification in orthopaedic surgery is complex and depends on the outcome of interest and multiple interdependent factors. Effective risk stratification has uses for limiting and predicting adverse events in patients undergoing discretionary surgery, avoiding the penalization of surgeons for operating on candidates whose health is situated in more difficult circumstances, and ensuring that inordinate attention is not placed on discrete musculoskeletal pathophysiology when there are other pressing health priorities.➢ For individual patient decision-making, no comprehensive risk-stratification tool currently exists, in part due to the heterogeneity of orthopaedic procedures performed and the diverse patient population treated. The Elixhauser Comorbidity Measure and the Risk Stratification Index 3.0 appear to be most promising.➢ At a population level, risk stratification may be useful in alternative payment models to ensure that hospitals that treat a disproportionate number of high-risk patients are not penalized and that cherry-picking (preferentially selecting only healthier patients with a lower risk of complications) does not occur. Any attempt to risk-stratify may have unintended consequences.➢ Orthopaedic surgeons must be aware of the tools available, their strengths, and their limitations in order to be included in decision-making as payment models and public health policies are implemented.

Cerebral arteriovenous malformations (AVMs) are an uncommon type of central nervous system vascular anomaly that have the potential to rupture and cause intracranial hemorrhage. AVM hemorrhagic risk assessment has been mainly based on anatomical features derived from imaging; the most recent focus on AVM hemodynamics, vessel wall imaging, and molecular analysis of the inflammatory response, provide new insights into the hemorrhagic risk stratification. The greater data availability provided by innovative imaging techniques and biological analysis of biomarkers and genetic polymorphism further demonstrates the existence of a complex interaction between anatomically altered vasculature, non-physiological hemodynamics, and inflammatory molecular activity. The accurate prediction of cerebral AVM rupture, essential to guide the management decision by comparing the risk of observation to the risk of intervention, has yet to be solved. This review of several studies aims to summarize the current evidence on brain AVM rupture risk stratification.

One of the breast-conserving surgery goals is to achieve negative resection margins and avoid reoperation. Therefore, accurate intraoperative margin assessment is essential, but still challenging. Recently, confocal microscopy devices, such as Histolog Scanner (HS), have shown promise for intraoperative margin assessment. The aim of this study was to assess HS for the intraoperative examination of lumpectomy specimens by the pathologists of our institute. Intraoperative margin assessment was performed by macroscopic assessment and by HS imaging to provide information for re-excision decision-making. The specific contribution of HS was evaluated by comparing the HS-based findings with the final pathology reports based on formalin-fixed paraffin-embedded tissue analysis. The study population included 20 women with histologically confirmed invasive breast carcinoma who underwent breast-conserving surgery (mean age of 62.9 y; 41 to 88 y; 21 tumors in total). HS led to the same decision as macroscopic examination in 76.2% of cases and prompted additional re-excisions in 19% of cases. Compared with the pathology reports, the accuracy rates of the macroscopic and HS assessments were 81% (58.1 to 94.6) and 95.2% (76.2 to 99.9), respectively. Moreover, 5 cases are described to illustrate HS practical contribution and limitations. In conclusion, HS is user-friendly, generally reliable, and enhances the routine macroscopic examination by providing detailed imaging of lumpectomy specimens. In combination with macroscopic examination, HS is an effective tool for intraoperative margin assessment, assisting both pathologists and surgeons in making accurate intraoperative decisions regarding margin re-excision, thereby preventing the need for new surgical operations.

CONCLUSIONS: Tourniquet use was associated with more patients achieving the MCID for the KOOS JR at 1 month compared with no tourniquet use. This difference disappeared at 3 and 6 months. At 1, 3, and 6 months, there were no differences in opioid consumption, health-care utilization, or complications between patients undergoing TKA with a tourniquet versus without a tourniquet. Tourniquet use did not have a clinically meaningful impact on PROMs in the multivariable analysis. Arthroplasty surgeons may use these data during preoperative discussions with patients regarding tourniquet use as it relates to the surgeon's preference and how it could influence postoperative function.

No abstract available

CONCLUSIONS: Different statistical approaches resulted in substantial variation in the MCID threshold value, which affected the number of patients who reached the MCID. This study demonstrates the ambiguity of the MCID and casts some doubt regarding its utility for assessing the surgical benefit of total joint arthroplasty.

CONCLUSIONS: The use of CADe during colonoscopy results in an increased detection of adenomas, and serrated lesions, in a FIT+ setting. The impact on advanced adenomas was not significant. Higher rates of unnecessary removal of nonneoplastic polyps were also reported.

BACKGROUND: Off-hour admissions can adversely affect clinical outcomes, though evidence in patients with acute ischemic stroke (AIS) associated with large vessel occlusion (LVO) remains limited. This study aimed to examine the impact of off-hour versus regular-hour admissions on outcomes in patients with AIS associated with LVO.

BACKGROUND: Whether rescue intracranial stenting (RIS) should be performed in patients with vertebrobasilar occlusions (VBO) refractory to endovascular mechanical thrombectomy (MT) remains an open question.

CONCLUSIONS: Depressive symptoms progressively increased in the years leading up to dementia diagnosis, with the most pronounced elevations occurring in non-Alzheimer's dementia.

IMPORTANCE: Metabolic bariatric surgery is the most effective and durable treatment for weight loss and improvement of cardiovascular diseases. With sleeve gastrectomy now surpassing gastric bypass as the most common procedure worldwide, comparing these procedures' associations with major adverse cardiac events (MACE) is needed.

CONCLUSIONS: Addition of NfL may improve clinical prognostic models for the prediction of inability to walk, but not of respiratory failure.

CONCLUSIONS: A deep, generative, active machine learning model was developed to output the prediction of post-TAVR time-varying pressure gradient from the pre-procedural time-varying gradient obtained from Doppler echocardiogram. Such a predictive method may help guide decision-making for the prevention of various post-TAVR complications. Further studies are necessary to investigate the gradient change of other valve types.