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Background Historically, in-person physical therapy serves as a foundational component of nonoperative treatment of adhesive capsulitis (AC). This study compares the effectiveness of an at-home high-intensity stretch (HIS) device to traditional physical therapy (PT) and to PT in combination with the HIS device. We hypothesize that the HIS device will be as effective as PT alone or as combination therapy in the first-line treatment of AC and use of the HIS device will exhibit improvement at higher rate. Methods Thirty-four patients with idiopathic adhesive capsulitis and a minimum of 12 months follow-up were included in this study. Patients were randomized into one of the three groups: HIS device, PT alone, or HIS device + PT. Passive range of motion (ROM), American Shoulder and Elbow Surgeons (ASES), and Simple Shoulder Test (SST) scores were measured. Additionally, patient satisfaction, compliance and complications were recorded. Paired t-test, ANOVA and Chi-squared tests were used in analysis. Results Final ROM in all planes improved for all groups compared to baseline ( p  < 0.001), with only HIS device group able to restore > 95% of contralateral ROM in all planes at final follow-up. Patients with PT alone were on average slowest to improve ROM from baseline, at 3 months, 6 months, and 1 year in all planes except internal rotation. ASES and SST scores improved for all groups when compared to baseline ( p  < 0.001). Use of HIS-device resulted in greater improvement in SST and ASES Total scores compared to PT alone ( p  = 0.045, and p  = 0.048, respectively). Conclusions Use of an at-home high-intensity stretching device for conservative treatment of idiopathic adhesive capsulitis improves outcomes in ROM and in ASES and SST scores both when used as an adjunct to physical therapy and when used alone. Trial registration The study protocol was registered at www.clinicaltrials.gov (20/05/2022, NCT05384093).

Background: Medial meniscal tears are commonly seen during anterior cruciate ligament reconstruction (ACLR). A subset of these injuries includes posterior meniscocapsular junction or “ramp” tears. One criterion that may correlate with a ramp lesion is the presence of posterior medial tibial plateau (PMTP) edema. Purpose: To compare patients with ramp lesions to patients with nonramp (meniscal body) medial meniscal tears and correlate PMTP edema on preoperative magnetic resonance imaging (MRI) to the incidence of ramp tears. Study Design: Case-control study; Level of evidence, 3. Methods: From 2006 to 2016, a total of 852 patients underwent ACLR and had operative reports available for review. Age, sex, laterality, mechanism of injury (contact/noncontact), sport, revision procedure, multiligament injury, time to MRI, and time to surgery were recorded. Preoperative MRI scans were reviewed for PMTP edema using axial, coronal, and sagittal T2 and proton-density sequences. Differences between groups were analyzed using a 2-sample t test and chi-square test. Univariate and multivariate logistic regression models examined correlations with tear type. Results: Overall, 307 patients had medial meniscal tears identified during ACLR (127 ramp lesions, 180 meniscal body lesions). The ramp group was 7.5 years younger than the meniscal body group (P < .01). The groups were not different regarding sex, contact injury, revision surgery, laterality, or multiligament injury. Patients with delayed ACLR were significantly more likely to have a meniscal body tear than a ramp lesion (odds ratio, 3.3 [95% CI, 1.9-5.6]; P < .01). The sensitivity of PMTP edema for a ramp tear was 66.3%, and 54.5% of patients with ACLR and a medial meniscal tear had PMTP edema. Patients with PMTP edema were significantly more likely to have a ramp tear than a meniscal body tear (odds ratio, 2.1 [95% CI, 1.1-4.1]; P < .03). Conclusion: The overall incidence of ramp tears in patients undergoing ACLR was 14.9%, and these tears were more prevalent in younger patients. Meniscal body tears were significantly more likely than ramp tears with delayed ACLR. In patients undergoing ACLR with an associated medial meniscal tear, the presence of PMTP edema demonstrated significantly greater odds for ramp lesions compared with meniscal body tears.

Mini-Medical school programs have become an increasingly popular means of encouraging high-school students to consider medical professions. However, there is little research evaluating the long-term effect of these programs on influencing career choice. The purpose of our study was to determine the motivational factors for attending the Mini-Medical school programs at our institution, student satisfaction with their experience, and whether it impacts intended secondary education and career choices. An online anonymous survey was distributed to Drexel University College of Medicine Mini-Medical school program graduates to determine factors influencing student participation and program satisfaction. The most influential factors in attending the program were to confirm an interest in medicine (n = 55, 95%) and parental advice (n = 29, 50%). Most maintained an interest in medicine: 57% (n = 33) pursued a pre-med degree, 55% (n = 32) planned to apply to medical school within 3 years; and 12% (n = 7) were either in medical school or matriculating in the fall of 2015. 91% (n = 53) participants noted the program's influence on choosing a pre-med undergraduate track. Our results suggest Mini-Medical school programs significantly impacted students' decision to pursue a medical career through fostering interest and effectively answering students' questions about the field.

Background Obtaining an orthopaedic surgery residency is competitive. Advisors must understand what factors may help unmatched candidates reapply successfully. Questions/purposes We determined (1) the attitude of leaders of orthopaedic surgery residency programs toward interviewing unmatched students; (2) whether a surgical internship or a research year is preferred in considering reapplicants; (3) the importance of United States Medical Licensing Examination (USMLE) scores, recommendations, and Alpha Omega Alpha (AOA) membership; and (4) whether academic and nonacademic programs evaluate reapplicants differently. Methods We sent an anonymous 19-question survey to 151 Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic surgery residency programs in five waves, 1 week apart (December 5, 2009–January 5, 2010). Investigators were blinded to the respondents’ identities. Results Ninety-one of the 151 programs (60%) responded. Sixty-eight of the 91 programs (75%) stated they rarely accept unmatched applicants. Sixty-eight programs (75%) agreed an unmatched applicant should do a surgery internship for 1 year. Of the 36 programs that recommended a research year, 32 were academic programs. Academic programs were more likely than nonacademic programs to view as important new recommendations (85% versus 67%), minimum scores of 220 on Step I (67% versus 49%) and Step II (64% versus 36%), and AOA membership (85% versus 67%). Conclusions By completing a surgical internship, unmatched students may increase their chances of matching. Students considering academic programs should ensure their academic record meets certain benchmarks and may consider a research year but risk limiting their acceptance to academic programs.

Background One complication of TKA is postoperative anterior knee pain. Balancing retinacular tissue tension to improve patellar tracking is essential in preventing pain. Lateral release might help balance tension although the quantitative changes in patellofemoral force and pressure differentials after lateral release are unknown. Questions/purposes We asked if there are differences in patellofemoral forces and pressures for knees resurfaced with standard and gender-specific components and whether lateral release changes these differentials. Methods We studied six fresh-frozen cadaver knees with native knees and knees that had TKAs with patellofemoral resurfacing using traditional and gender-specific components. The knees were taken through passive ROM, and the means for medial and lateral peak pressure and maximum force were calculated before and after a lateral release was performed. Results In traditional resurfaced knees, lateral peak pressure was greater than medial peak pressure by 727.6 ± 550.0 kPa and lateral maximum force was greater than medial maximum force by 29.6 ± 15.9 N. Lateral release decreased the pressure (71.4 ± 826.0 kPa) and force (10.0 ± 32.1 N) differentials in the traditional but not in the gender-specific design. In gender-specific resurfaced knees, lateral peak pressure was greater than medial peak pressure by 158.7 ± 360.0 kPa and lateral maximum force was greater than medial maximum force by 15.5 ± 10.4 N. Lateral release increased the pressure (285.7 ± 565.0 kPa) and force (16.8 ± 10.8 N) differentials. Conclusions Our preliminary data suggest lateral release is more effective in reducing peak pressure and maximum force differentials in knees resurfaced with traditional standard components than with gender-specific components. Clinical Relevance The lateral release technique might help with tissue balancing when using standard components in TKA.

Developing molecular communication platforms based on orthogonal communication channels is a crucial step towards engineering artificial multicellular systems. Here, we present a general and scalable platform entitled ‘biomolecular implementation of protocellular communication’ (BIO-PC) to engineer distributed multichannel molecular communication between populations of non-lipid semipermeable microcapsules. Our method leverages the modularity and scalability of enzyme-free DNA strand-displacement circuits to develop protocellular consortia that can sense, process and respond to DNA-based messages. We engineer a rich variety of biochemical communication devices capable of cascaded amplification, bidirectional communication and distributed computational operations. Encapsulating DNA strand-displacement circuits further allows their use in concentrated serum where non-compartmentalized DNA circuits cannot operate. BIO-PC enables reliable execution of distributed DNA-based molecular programs in biologically relevant environments and opens new directions in DNA computing and minimal cell technology.Semipermeable proteinosome membranes allow complex DNA message communication through compartmentalization and protect the DNA circuits from degradation in a biological environment.

Rapid global warming directly impacts agricultural productivity and poses a major challenge to the present-day agriculture. Recent climate change models predict severe losses in crop production worldwide due to the changing environment, and in wheat, this can be as large as 42 Mt/°C rise in temperature. Although wheat occupies the largest total harvested area (38.8%) among the cereals including rice and maize, its total productivity remains the lowest. The major production losses in wheat are caused more by abiotic stresses such as drought, salinity, and high temperature than by biotic insults. Thus, understanding the effects of these stresses becomes indispensable for wheat improvement programs which have depended mainly on the genetic variations present in the wheat genome through conventional breeding. Notably, recent biotechnological breakthroughs in the understanding of gene functions and access to whole genome sequences have opened new avenues for crop improvement. Despite the availability of such resources in wheat, progress is still limited to the understanding of the stress signaling mechanisms using model plants such as , rice and and not directly using wheat as the model organism. This review presents an inclusive overview of the phenotypic and physiological changes in wheat due to various abiotic stresses followed by the current state of knowledge on the identified mechanisms of perception and signal transduction in wheat. Specifically, this review provides an in-depth analysis of different hormonal interactions and signaling observed during abiotic stress signaling in wheat.