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Purpose Minimal data exists on whether adolescents with both autism spectrum disorder (ASD) and scoliosis exhibit distinct curve types or require varying surgical management compared to neurotypical adolescents. Our study at a high-volume scoliosis center compares patterns of scoliosis in ASD patients with those of neurotypical patients. We hypothesized adolescents with ASD would present with atypical scoliosis curve characteristics compared to neurotypical adolescents. Methods Using ICD-10 codes, we constructed an electronic database of adolescents aged 10 to 18 with diagnoses of both scoliosis and ASD. To avoid confounding with syndromic conditions, adolescents with a syndrome independently associated with scoliosis were excluded. Additionally, a 1:2 matched cohort analysis was performed to compare adolescents with ASD and scoliosis (ASD-S) to neurotypical individuals diagnosed with adolescent idiopathic scoliosis (AIS). Results In our study, we describe demographics, radiographic characteristics, and complications experienced by 37 patients with both scoliosis and ASD. Almost half of ASD-S patients (18/37 patients; 48.6%) exhibited sagittal plane abnormalities. In comparison to the matched cohort of neurotypical patients, ASD-S patients had increased T5-12 thoracic kyphosis (31.6 vs. 24.4 degrees, p  = 0.005), maximum thoracic kyphosis (36.8 vs. 30.9 degrees, p  = 0.040) and lumbar lordosis (50.9 vs. 46.1 degrees, p  = 0.043). Sagittal vertical axis ≥ 5 cm was more prevalent in ASD-S patients than patients with AIS ( p  = 0.015). Furthermore, ASD-S patients were more likely to demonstrate an abnormal trunk shift (46% versus 19%) compared to the neurotypical cohort. Social and behavioral barriers prevented three ASD-S patients (8%) and no patients with AIS who were indicated for posterior spinal fusion from undergoing the procedure. Conclusion ASD-S patients had increased thoracic kyphosis compared to both controls and published AIS norms, suggesting scoliosis in ASD could potentially be considered a form of syndromic scoliosis rather than truly idiopathic. Additionally, the impact of social and behavioral barriers must be considered when treating this patient population. Level of Evidence III.

Purpose Modern multimodal analgesia has been shown to significantly reduce opioid use following total knee arthroplasty (TKA). This study was conducted to determine if changing TKA discharge opioid prescriptions from automatic to upon request resulted in more opioid free recoveries without compromising pain control. Methods Between December 2019 and August 2021, an orthopedic surgeon performed 144 primary unilateral TKAs; patients received the same multimodal analgesia protocol except for postoperative opioid prescribing. The first consecutively-treated cohort automatically received an opioid prescription following discharge (automatic group) and the second cohort received opioid prescriptions only upon request (upon request group). Opioid prescription data were derived from a prescription monitoring program and patient-reported outcomes (PROs) were collected preoperatively and at 2 and 12 weeks postoperatively. Results A higher percentage of the upon request group was opioid free 3 months after TKA compared with the automatic group (55.6% vs 4.3%, p  < 0.0001) without compromising pain or function. Among opioid-naïve patients, 72% in the upon request group were opioid free after TKA compared with 5.4% in the automatic group. Opioid prescribing was not significantly reduced among opioid-experienced patients regardless of the pain protocol. Conclusion Requiring patients to request opioid prescriptions following TKA resulted in a higher rate of opioid free TKA, especially among opioid-naïve patients, without increasing pain compared with offering all patients an initial opioid prescription. Level of evidence Level III.

Background and Objectives: Most studies based on self-reported data indicate that female patients more often than males have a same-gender preference for their primary care physician (PCP). Because self-reported preferences may not reflect true preferences, we analyzed objective data to investigate patients’ preferences for PCP gender. Methods: Analyses were performed on 2192 new patients seen within a university-based healthcare system by 13 PCPs (2 male, 11 female) during 2017. New patients were asked about their PCP gender preference when assigned a PCP. We compared the expected prevalence (proportion of males/females in overall patient population) and observed prevalence (gender distribution of patients for each PCP) by PCP gender. A mixed model with PCP as a random effect examined the odds of male and female patients being assigned a same-gender physician. Results: The expected prevalence of new patients was 65% female and 35% male. The observed prevalence (95% confidence interval [CI]) of male patients among male and female PCPs was, respectively, 59.7% (49.0%-69.5%) and 28.0% (24.0%-32.4%), with neither CI containing the expected prevalence of male patients (35%). Similarly, the observed prevalence of female patients among male and female PCPs was, respectively, 40.3% (95% CI 30.5%-51.0%) and 72.0% (95% CI 67.6%-76.0%), with neither CI containing the expected prevalence of female patients (65%). Conclusions: Both male and female patients often preferred to see a same-gender PCP with this preference more pronounced in males. Future research should seek to clarify the relationships between patients’ gender preferences, patient-physician gender concordance/discordance, patient satisfaction, and health outcomes.

Aims & Objectives The purpose of this study was to identify patient characteristics associated with engagement and completion of physical therapy (PT) following total knee arthroplasty (TKA) and examine the relationship between number of PT sessions attended and outcomes during the first 12 weeks after surgery. Methods Patients underwent unilateral primary TKA by a single surgeon and were advised to complete 17 PT sessions over 6 weeks at a hospital-affiliated facility. Analyses examined predictors of PT engagement (attendance of ≥2 sessions) and completion (attendance of 17 ± 1 sessions) within 6 weeks and associations between number of PT sessions attended and changes in range of motion (ROM) and Knee Injury and Osteoarthritis Outcome Score (KOOS) values. Results Patients living <40 km were more likely to be engaged in PT than those living ≥40 km from the clinic (P < .0001). Among patients who completed PT within 6 weeks, 95.0%, 85.1%, and 56.4% achieved flexion of, respectively, ≥90°, ≥100°, and ≥110°. Among engaged patients, the active flexion thresholds of ≥90°, ≥100°, and ≥110° were achieved by, respectively, 94.4%, 82.5%, and 58.1% by 6 weeks and by 96.7%, 92.1%, and 84.2% by 12 weeks. Improvement in KOOS Symptoms (P = .029), Function in daily living (P = .030) and quality of life (P = .031) linearly decreased as number of PT sessions increased. Conclusions These results raise the question of whether patients who meet satisfactory outcomes before completing 6 weeks of prescribed PT and those who attend more PT sessions than prescribed may be over-utilizing healthcare resources without additional benefit.

Over the past ten years, medical students have increased their research activity to be competitive for orthopaedic residency positions throughout the country. This increase may favor students at institutions with a strong history of research production and well-established research departments with supporting staff. To compete with these institutions, a Musculoskeletal Research Committee was developed at a southern academic institution to provide a mutually beneficial link between orthopaedic research faculty and medical students. This manuscript describes the formation of this committee and the resultant involvement of young medical students in departmental research over a one year period. Composed of students and faculty, the committee developed a Research Guide for Medical Students, Research Database and Student List, Medical Students' Webpage, and Routing Form, and holds quarterly meetings for those students active in orthopaedic research. With this platform, the committee aimed to increase young student involvement in research and provide a stratified level of study participation among upper-level students for continued mentorship. In one calendar year, the total number of first and second-year students participating in department research increased 460% (5 to 28). Also, the total number of research projects with student involvement from these two classes increased 780% (5 to 44). The introduction of a research committee is an effective method of stimulating student interest in departmental research. Early participation results are promising, and this method may be applicable to other departments and institutions hoping to increase research productivity. Abbreviations: IRB: Institutional Review Board

Poly(lactic-co-glycolic) acid (PLGA) nanoparticles containing the hydrophobic antifungal itraconazole (ITZ) were developed to address the need for more effective means of treating fungal infections. PLGA-ITZ nanoparticles were synthesized using an oil-in-water emulsion evaporation method. Nanoparticle morphology (studied by transmission electron microscopy), size zeta potential (dynamic light scattering), encapsulation efficiency (UV-visible spectroscopy), release profile and antifungal activity were characterized. PLGA-ITZ nanoparticles (of 220 nm in diameter) completely inhibited Aspergillus flavus growth over 11 days at 0.03 mg/ml ITZ; a similar effect was achieved at ×100 ITZ concentrations (3 mg/ml) in emulsified form. The ITZ in water formulation had the least antifungal effect, inhibiting growth for only 2 days at 3 mg/ml ITZ. This system is envisioned to increase bioavailability of ITZ by improving aqueous dispersibility and increasing antifungal penetration, thereby increasing antifungal activity of the entrapped drug.

Minimal data exists on whether adolescents with both autism spectrum disorder (ASD) and scoliosis exhibit distinct curve types or require varying surgical management compared to neurotypical adolescents. Our study at a high-volume scoliosis center compares patterns of scoliosis in ASD patients with those of neurotypical patients. We hypothesized adolescents with ASD would present with atypical scoliosis curve characteristics compared to neurotypical adolescents. Using ICD-10 codes, we constructed an electronic database of adolescents aged 10 to 18 with diagnoses of both scoliosis and ASD. To avoid confounding with syndromic conditions, adolescents with a syndrome independently associated with scoliosis were excluded. Additionally, a 1:2 matched cohort analysis was performed to compare adolescents with ASD and scoliosis (ASD-S) to neurotypical individuals diagnosed with adolescent idiopathic scoliosis (AIS). In our study, we describe demographics, radiographic characteristics, and complications experienced by 37 patients with both scoliosis and ASD. Almost half of ASD-S patients (18/37 patients; 48.6%) exhibited sagittal plane abnormalities. In comparison to the matched cohort of neurotypical patients, ASD-S patients had increased T5-12 thoracic kyphosis (31.6 vs. 24.4 degrees, p = 0.005), maximum thoracic kyphosis (36.8 vs. 30.9 degrees, p = 0.040) and lumbar lordosis (50.9 vs. 46.1 degrees, p = 0.043). Sagittal vertical axis [greater than or equal to] 5 cm was more prevalent in ASD-S patients than patients with AIS (p = 0.015). Furthermore, ASD-S patients were more likely to demonstrate an abnormal trunk shift (46% versus 19%) compared to the neurotypical cohort. Social and behavioral barriers prevented three ASD-S patients (8%) and no patients with AIS who were indicated for posterior spinal fusion from undergoing the procedure. ASD-S patients had increased thoracic kyphosis compared to both controls and published AIS norms, suggesting scoliosis in ASD could potentially be considered a form of syndromic scoliosis rather than truly idiopathic. Additionally, the impact of social and behavioral barriers must be considered when treating this patient population.

PurposeCurrently, rural residents in the United States (US) experience a greater cancer burden for tobacco-related cancers and cancers that can be prevented by screening. We aim to characterize geographic determinants of colorectal cancer (CRC) incidence in Louisiana due to rural residence and other known geographic risk factors, area socioeconomic status (SES), and cultural region (Acadian or French-speaking).MethodsPrimary colorectal cancer diagnosed among adults 30 years and older in 2008–2017 were obtained from the Louisiana Tumor Registry. Population and social and economic data were obtained from US Census American Community Survey. Rural areas were defined using US Department of Agriculture 2010 rural–urban commuting area codes. Estimates of relative risk (RR) were obtained from multilevel binomial regression models of incidence.ResultsThe study population was 16.1% rural, 18.4% low SES, and 17.9% Acadian. Risk of CRC was greater among rural white residents (RR Women: 1.09(1.02–1.16), RR Men: 1.11(1.04–1.18)). Low SES was associated with increased CRC for all demographic groups, with excess risk ranging from 8% in Black men (RR: 1.08(1.01–1.16)) to 16% in white men (RR: 1.16(1.08–1.24)). Increased risk in the Acadian region was greatest for Black men (RR: 1.21(1.10–1.33)) and women (RR: 1.21(1.09–1.33)). Rural–urban disparities in CRC were no longer significant after controlling for SES and Acadian region.ConclusionSES remains a significant determinant of CRC disparities in Louisiana and may contribute to observed rural–urban disparities in the state. While the intersectionality of CRC risk factors is complex, we have confirmed a robust regional disparity for the Acadian region of Louisiana.

Introduction/PurposeThe obesity epidemic is rapidly growing, and visceral adiposity is associated with metabolic consequences secondary to peroxisome proliferator-activated receptor (PPAR)-induced inter-organ signaling pathways. PPARs are ligand-activated transcription factors that modulate vagal pathways which can improve blood pressure, arterial remodeling, cholesterol levels, and insulin sensitivity. However, an obesity-induced inflammatory milieu can interfere with the beneficial effects of PPAR activity, suggesting that a dysregulated PPAR-vagus pathway may play a role in the pathogenesis of obesity-related hypertension. Therefore, we hypothesized that hepatic vagotomy (HV) in patients with obesity would result in a significant reduction in blood pressure and/or the number of hypertension medications compared to control.MethodsWe conducted a retrospective chart review of 160 patients undergoing laparoscopic sleeve gastrectomy. Patients were divided into HV and control groups, and information was collected at each clinic visit.ResultsAt six-months post-operation, the HV group was found to have significantly lower total cholesterol (TC)/high-density lipoprotein (HDL) ratios than the control group. The HV group also had a numerically better blood profile for TC, HDL, low-density lipoprotein (LDL), triglycerides, C-reactive protein, and LDL/HDL ratio. Hypertensive patients in the HV group showed numerically lower hypertension medication counts after six weeks when compared to control.ConclusionWe present the first study to report clinically significant changes related to HV in human subjects. Our results did not support our initial hypothesis but did demonstrate an improvement of the TC/HDL ratio with HV in patients with obesity. Future studies should confirm these findings in a randomized control trial.