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Background Population-based cancer registry data from the Surveillance, Epidemiology, and End Results (SEER) Program at the National Cancer Institute (NCI) are mainly based on medical records and administrative information. Individual-level socioeconomic data are not routinely reported by cancer registries in the United States because they are not available in patient hospital records. The U.S. representative National Longitudinal Mortality Study (NLMS) data provide self-reported, detailed demographic and socioeconomic data from the Social and Economic Supplement to the Census Bureau's Current Population Survey (CPS). In 1999, the NCI initiated the SEER-NLMS study, linking the population-based SEER cancer registry data to NLMS data. The SEER-NLMS data provide a new unique research resource that is valuable for health disparity research on cancer burden. We describe the design, methods, and limitations of this data set. We also present findings on cancer-related health disparities according to individual-level socioeconomic status (SES) and demographic characteristics for all cancers combined and for cancers of the lung, breast, prostate, cervix, and melanoma. Methods Records of cancer patients diagnosed in 1973-2001 when residing 1 of 11 SEER registries were linked with 26 NLMS cohorts. The total number of SEER matched cancer patients that were also members of an NLMS cohort was 26,844. Of these 26,844 matched patients, 11,464 were included in the incidence analyses and 15,357 in the late-stage diagnosis analyses. Matched patients (used in the incidence analyses) and unmatched patients were compared by age group, sex, race, ethnicity, residence area, year of diagnosis, and cancer anatomic site. Cohort-based age-adjusted cancer incidence rates were computed. The impact of socioeconomic status on cancer incidence and stage of diagnosis was evaluated. Results Men and women with less than a high school education had elevated lung cancer rate ratios of 3.01 and 2.02, respectively, relative to their college educated counterparts. Those with family annual incomes less than $12,500 had incidence rates that were more than 1.7 times the lung cancer incidence rate of those with incomes $50,000 or higher. Lower income was also associated with a statistically significantly increased risk of distant-stage breast cancer among women and distant-stage prostate cancer among men. Conclusions Socioeconomic patterns in incidence varied for specific cancers, while such patterns for stage were generally consistent across cancers, with late-stage diagnoses being associated with lower SES. These findings illustrate the potential for analyzing disparities in cancer outcomes according to a variety of individual-level socioeconomic, demographic, and health care characteristics, as well as by area measures available in the linked database.

PurposeThe purpose of the current study was to determine if differences exist between cruciate-retaining (CR) and posterior-stabilized (PS) implant articulations for total knee arthroplasty (TKA) with regards to early post-operative pain.MethodsWe retrospectively reviewed patients who underwent primary TKA, with the same TKA implant design, at our institution between January 2018 and July 2021. Patients were stratified based on whether they received a CR or non-constrained PS (PSnC) articulation and propensity score matched in a 1:1 ratio. A sub-analysis matching patient who received a constrained PS implant (PSC) to those undergoing CR TKA and PSnC TKA was also carried out. Opioid dosages were converted to morphine milligram equivalents (MME).Results616 patients after CR TKA were matched 1:1 to 616 patients with a PSnC implant. There were no significant differences between demographic variables. There were no statistically significant differences in opioid usage measured by MME on post-operative day (POD) 0 (p = 0.171), POD1 (p = 0.839), POD2 (p = 0.307), or POD3 (p = 0.138); VAS pain scores (p = 0.175); or 90-day readmission rate for pain (p = 0.654). A sub-analysis of CR versus PSC TKA demonstrated no significant differences in opioid usage on POD0 (p = 0.765), POD1 (p = 0.747), POD2 (p = 0.564), POD3 (p = 0.309); VAS pain scores (p = 0.293); and 90-day readmission rate for pain (p > 0.9).ConclusionOur analysis demonstrated no significant difference in post-operative VAS pain scores and MME usage based on implant. The results suggest that neither the type of articulation or constraint used for primary TKA has a significant impact on immediate post-operative pain and opioid consumption.Level III EvidenceRetrospective Cohort Study.

In this study, we have investigated the ionospheric responses on the August 2017 solar eclipse event by using a three-dimensional tomography algorithm with the ground-based GNSS (Global Navigation Satellite System) total electron content observations around Northern America. This three-dimensional ionospheric electron density structure from the tomography can provide us more information regarding the density variations and propagations of disturbances. Results show that the ionospheric electron density depletion triggered by the solar eclipse started from the higher ionosphere and then extended to lower altitudes. The maximum electron density depletion is around 40% compared with the previous day of solar eclipse. After around 30 min of the totality, the electron density continuously returned to the normal level. We further conduct a procedure of Fourier analyses to derive the vertical phase and group velocities of the electron density propagations. Results show that the opposite directions of the vertical phase and group velocities around 220–240 km altitude imply the energy/oscillation source by the solar eclipse.

PurposeAs the goal of kinematic aligned (KA) total knee arthroplasty (TKA) is to preserve soft tissue tension to the native knee, many KA surgeons recommend cruciate-retaining (CR) prosthesis. However, how a posterior-stabilizing (PS) prosthesis affects the biomechanics of a KA TKA remains unclear. This cadaveric study tested the hypothesis that a PS prosthesis in KA TKA would produce biomechanics similar to CR prosthesis and KA TKA with a PS prosthesis would produce more native knee biomechanics than mechanical aligned (MA) TKA with PA prosthesis.MethodsFourteen cadaver knees (7 pairs) were mounted on a knee-testing system to measure knee motion during flexion. For each pair, 1 knee was assigned to KA TKA and the other to MA TKA. In the KA TKA group, the native knee, CR TKA, and PS TKA were tested sequentially. MA TKA was performed using conventional measured resection techniques with a PS prosthesis. All kinematics were measured and compared with the native knee before and after surgery.ResultsA PS prosthesis restored femoral rollback similar to a CR prosthesis. CR TKA showed less lateral rollback at knee flexion ≤ 60° than the native knee. There were no differences in soft tissue tensions among the native knee, CR, and PS prosthesis, except in varus tension at 30° of flexion. Varus tension of CR TKA was larger than those of PS TKA and the native knee after KA TKA with < 1 degree difference. Meanwhile, KA TKA achieved knee motion that was closer to the native knee than did MA TKA at ≥ 60° of flexion when using a PS prosthesis. There were no differences in soft tissue tension between KA-PS and MA-PS TKA.ConclusionsAfter KA TKA, a PS prosthesis affords similar femoral rollback and soft tissue tension when compared with a CR prosthesis. A PS TKA may be a feasible strategy for patients requiring a PS prosthesis when performing KA TKA.Level of evidenceTherapeutic Laboratory study, I.

Introduction This study aims to apply automated machine learning (AutoML) techniques for the diagnosis of granular corneal dystrophy (GCD), a rare inherited condition characterized by progressive protein deposition in the corneal stroma. Methods Patients diagnosed with GCD who had slit-lamp photographs of the affected eye(s) were enrolled in the study. Individuals with concomitant corneal conditions, ungradable imaging data, or uncertain diagnoses were excluded from the study. Slit-lamp photos depicting the GCD and non-GCD were obtained from the Byers Eye Institute, Stanford University. Image processing included resizing and cropping, focusing solely on the cornea. A deep learning model was subsequently deployed, utilizing Vertex-AI, the AutoML platform developed by Google (Menlo Park, CA). The area under the precision‒recall curve (AUPRC) was plotted, and the sensitivity, specificity, positive predictive value (PPV), accuracy (AC), and F1 score were calculated. Results The model was trained on a dataset comprising 223 images, consisting of 72 GCD and 151 non-GCD images. One hundred seventy six images were used for training, 24 were used for validation, and 23 were used for testing the model. The AUPRC for the model was 0.995 and precision and recall were both 95.70% at a confidence threshold of 0.5. The sensitivity, specificity, PPV, AC, and F1 score of the model were 93.30%, 100%, 100%, 95.70%, and 0.965, respectively. Conclusions A clinician-derived AutoML model successfully identified GCD from slit lamp photographs with high accuracy.

This study examines the day-to-day variability of low-latitude ionosphere using global ionospheric specification (GIS) electron density profiles derived from FORMOSAT-7/COSMIC-2 radio occultation measurements during a deep solar minimum period of August 2019 to July 2020. The measurements reveal significant daily variations over dayside low latitudes, yielding about 10 - 20% standard deviation in equinoxes, 20 - 30% in solstices, reaching 40 - 50% in winter. The nighttime deviations could be 30 - 60%, being largest in solstices. Day-to-day variations are also observed in the longitudinal wave-4 structures. The period mostly remained geomagnetically quiet except for some moderate disturbances on a few days. Tidal decomposition of the GIS electron density shows that in-situ forced migrating diurnal (DW1) terdiurnal (TW3) oscillations and the background zonal mean yield only ~25% of the daily variations despite accounting for almost 75 - 90% of the observed electron density. Thus, forcing from lower atmosphere dominates the contribution (~75%) to the observed daily variations. Only about one third of this lower atmospheric forcing comes from the migrating semidiurnal SW2 and the usually investigated non-migrating diurnal eastward DE2, DE3, stationary planetary wave SPW3, SPW4, and semidiurnal eastward SE1, and SE2 components. The residual tides other than those mentioned above, including secondary waves through non-linear interactions and other planetary waves, thus significantly influence the day-to-day variations in electron density and modify the longitudinal wave structures.

(1) Introduction: Precise femoral component rotation is critical for achieving symmetric flexion-gap balance and physiologic patellofemoral tracking in mechanically aligned total knee arthroplasty (TKA). Surgeons often infer an appropriate rotational target from the patient’s coronal limb alignment, yet the strength of this relationship remains uncertain. (2) Methods: We identified 695 consecutive patients undergoing primary TKA with a preoperative planning CT scan. The surgical transepicondylar axis (sTEA) and posterior condylar axis (PCAxis) were identified and the angle between them was measured. The angle between the mechanical axis of the femur and tibia was used to measure the coronal alignment of the limb. (3) Results: The mean sTEA was 3.0° externally rotated to the PCAxis (range 3.1° internal to 9.2° external). The mean coronal alignment was 4.3° varus (range −12.5° valgus to 24.5° varus). There were 465 patients with >2° varus and 101 patients with >2° valgus. The mean sTEA was 2.9 ± 1.9° externally rotated relative to the PCAxis in the valgus group and 2.8 ± 2.0° in the varus group, with no statistically significant difference (p = 0.7). (4) Conclusions: There is significant variation in the femoral rotation axes between patients, but no significant relationship between overall limb coronal alignment and the magnitude of femoral rotation axes variation. This reinforces the need for independent assessment of rotational landmarks when performing mechanically aligned TKA.

Population-based cancer registry data from the Surveillance, Epidemiology, and End Results (SEER) Program at the National Cancer Institute are based on medical records and administrative information. Although SEER data have been used extensively in health disparities research, the quality of information concerning race, Hispanic ethnicity, and immigrant status has not been systematically evaluated. The quality of this information was determined by comparing SEER data with self-reported data among 13,538 cancer patients diagnosed between 1973-2001 in the SEER—National Longitudinal Mortality Study linked database. The overall agreement was excellent on race (κ = 0.90, 95% CI = 0.88-0.91), moderate to substantial on Hispanic ethnicity (κ = 0.61, 95% CI = 0.58-0.64), and low on immigrant status (κ = 0.21. 95% CI = 0.10, 0.23). The effect of these disagreements was that SEER data tended to under-classify patient numbers when compared to self-identifications, except for the non-Hispanic group which was slightly over-classified. These disagreements translated into varying racial-, ethnic-, and immigrant status-specific cancer statistics, depending on whether self-reported or SEER data were used. In particular, the 5-year Kaplan-Meier survival and the median survival time from all causes for American Indians/Alaska Natives were substantially higher when based on self-classification (59% and 140 months, respectively) than when based on SEER classification (44% and 53 months, respectively), although the number of patients is small. These results can serve as a useful guide to researchers contemplating the use of population-based registry data to ascertain disparities in cancer burden. In particular, the study results caution against evaluating health disparities by using birth-place as a measure of immigrant status and race information for American Indians/Alaska Natives.

Residual knee instability and low rates of return to previous sport are major concerns after anterior cruciate ligament (ACL) reconstruction. To improve outcomes, surgical methods, such as the anatomical single-bundle technique or the double-bundle technique, were developed. However, these reconstruction techniques failed to adequately overcome these problems, and, therefore, new potential answers continue to be of great interest. Based on recent anatomical and biomechanical studies emphasizing the role of the anterolateral ligament (ALL) in rotational stability, novel surgical methods including ALL reconstruction and anterolateral tenodesis have been introduced with the possibility of resolving residual instability after ACL reconstruction. However, there is still little consensus on many aspects of the ALL, including: several anatomical issues, appropriate indications for ALL surgery, and the optimal surgical method and graft choice for reconstruction surgery. Therefore, further studies are necessary to advance our knowledge of the ALL and its contribution to knee stability.

More than 1.4 million S4-index profiles sounded by FORMOSAT-3/COSMIC (F3/C) radio occultation during 2007-2014 are used to construct a global scintillation occurrence model for the ground-based GNSS (Global Navigation Satellite System) users. The local maximums of each F3/C S4-index profile at every 10 km altitude window are integrated to simulate the worst-case L-band S4-index (S4conv) on the ground. The S4conv mega-data bind into 3° × 3° in latitude × longitude allows us computing the occurrence probability of the globe for a given S4-index threshold. The occurrence probability of S4 of the developed model agree well with those of ground-based GNSS receivers of the SCINDA (SCIntillation Network Decision Aid) network. Global patterns in the occurrence probability of the model are similar to that of in-situ plasma measurements probed by ROCSAT and FORMOSAT-7/ COSMIC-2 satellites in various solar activities. These agreements and similarities indicate that the constructed empirical model can be employed to calculate and predict L-band S4-index and its occurrence probability in the ionosphere.