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1.
PLoS One ; 18(11): e0292595, 2023.
Article in English | MEDLINE | ID: mdl-37917728

ABSTRACT

Since the 2017 discovery of established populations of the Asian longhorned tick, (Haemaphysalis longicornis Neumann) in the United States, populations continue to be detected in new areas. For this exotic and invasive species, capable of transmitting a diverse repertoire of pathogens and blood feeding on a variety of host species, there remains a lack of targeted information on how to best prepare for this tick and understand when and where it occurs. To fill this gap, we conducted two years of weekly tick surveillance at four farms in Tennessee (three H. longicornis-infested and one without) to identify environmental factors associated with each questing life stage, to investigate predictors of abundance, and to determine the likelihood of not collecting ticks at different life stages. A total of 46,770 ticks were collected, of which 12,607 H. longicornis and five other tick species were identified. Overall, abundance of H. longicornis were associated with spring and summer seasons, forested environments, relative humidity and barometric pressure, sunny conditions, and in relation with other tick species. The likelihood of not collecting H. longicornis was associated with day length and barometric pressure. Additional associations for different life stages were also identified and included other tick species, climatic variables, and environmental conditions. Here, we demonstrated that environmental variables can be useful to predict the presence of questing H. longicornis and provide ideas on how to use this information to develop a surveillance plan for different southeastern areas with and without infestations.


Subject(s)
Ixodidae , Tick Infestations , Ticks , Animals , United States , Tick Infestations/epidemiology , Tick Infestations/veterinary , Forests , Introduced Species
2.
Environ Entomol ; 52(6): 1033-1041, 2023 Dec 15.
Article in English | MEDLINE | ID: mdl-37793030

ABSTRACT

Due to the increased frequency of human-tick encounters and expanding ranges of ticks in the United States, there is a critical need to identify environmental conditions associated with tick populations and their likelihood to contact human hosts. In a passive tick surveillance partnership with the US Department of Agriculture Forest Inventory and Analysis (FIA) program, we identified environmental variables associated with tick encounters by forestry personnel. Ticks were identified by species and life stage, and site-specific variables were associated with each tick using FIA forest inventory datasets and generalized linear models with negative binomial distributions. Of the 55 FIA variables available, we identified biotic and abiotic environmental variables associated with Amblyomma americanum L. (carbon in litter material and standing dead tree aboveground dry biomass), Dermacentor variabilis Say (seedling species unevenness and elevation), and Ixodes scapularis L. (carbon in dead woody material and seedling species unevenness). We propose conducting future treatment-control studies using these forestry-related environmental variables to test their ability to alter tick abundance at sites. Land management decisions not only affect common flora and fauna, but changes to these habitats can also alter the way ticks parasitize hosts and use vegetation to find those hosts. These results can be used with land management decisions to prevent future human-tick encounters and highlight risk areas.


Subject(s)
Ixodes , Humans , United States , Animals , Southeastern United States , Ecosystem , Forests , Carbon
3.
J Med Entomol ; 60(6): 1374-1379, 2023 11 14.
Article in English | MEDLINE | ID: mdl-37738311

ABSTRACT

Haemaphysalis longicornis Neumann is an exotic and invasive tick species rapidly expanding across the United States. Large infestations of these ticks on cattle can cause anemia, and in eastern regions of the country, they are transmitting Theileria orientalis Ikeda within herds. Methods for managing H. longicornis in the environment are rarely successful and rely on chemicals. To document population effects from producer management decisions, we investigated the change in H. longicornis populations to different tick management practices chosen by producers at 3 different H. longicornis-infested farms. Farm 1 kept a closed herd, chose to cut brush monthly, used on-animal acaricides, and allowed us to drag weekly. Farm 2 kept an open herd, chose to cut brush yearly, did not use on-animal acaricides, and allowed us to drag for ticks weekly/monthly. Farm 3 kept an open herd, chose to cut brush yearly, used on-animal acaracides, and allowed us to drag for ticks monthly. We assessed H. longicornis populations responding to those methods over time using active surveillance methods at each farm. Management decisions on Farms 1 and 3 significantly reduced H. longicornis on farms. Importantly, Farm 1 management decisions reduced the chance of a tick being present by 90%; the number of questing ticks collected fell from 5,000 to 12 H. longicornis in 2 years. Therefore, combined management strategies such as keeping a closed herd, use of on-animal chemical control, mechanical control, and reducing the amount of vegetation on farms were effective ways for producers to manage Haemaphysalis longicornis Neuman (Ixodidae).


Subject(s)
Acaricides , Ixodidae , Theileria , Female , Cattle , Animals , Farms , Tennessee , Introduced Species
4.
Med Vet Entomol ; 37(2): 195-208, 2023 06.
Article in English | MEDLINE | ID: mdl-36695750

ABSTRACT

There is an urgent need for continued research on the ecology of tick-borne diseases in Africa. Our objective was to provide a preliminary description of the ecology and epidemiology of tick species, tick-borne pathogens, and animal hosts in Zimbabwe, focusing efforts at Victoria Falls National Park, for a single season. We tested the hypothesis that tick surveillance and pathogen screening data can be used to model associations among ticks, hosts, and pathogens. We collected ticks from domesticated animals and wildlife in Zimbabwe and screened the ticks for the presence of Anaplasma and Ehrlichia bacteria. Nearly 30% of the screened ticks were PCR-positive; 89% of tick species were PCR-positive, and 88% of animal species carried at least one PCR-positive tick. We sequenced a subset of amplicons that were similar to three Anaplasma species and three Ehrlichia species. The odds of a tick being PCR-positive increased when many ticks were collected from the host or the tick was collected from a cow (domesticated animal). Tick species shared host species more often than expected. We demonstrate that ticks in northwestern Zimbabwe present a One Health problem for nearby wildlife and humans.


Subject(s)
Rickettsia , Tick-Borne Diseases , Ticks , Cattle , Female , Animals , Humans , Anaplasma , Zimbabwe/epidemiology , Parks, Recreational , Seasons , Ehrlichia , Animals, Wild , Tick-Borne Diseases/microbiology , Tick-Borne Diseases/veterinary
5.
J Vector Ecol ; 47(1): 29-37, 2022 03.
Article in English | MEDLINE | ID: mdl-35366677

ABSTRACT

Prior research on baiting and feeding of wildlife found changes in habitat and the concentration of wildlife on a local scale (e.g., hundreds of meters). Since changes in habitat and host density affect ticks, feeding wildlife may lead to changes in tick and tick-borne disease ecology. We quantified the effect of feeding deer on ticks and tick-borne diseases at 79 pairs of sites with and without deer feeders during May-August of 2019 and 2020. We captured 0.4 fewer adult (p<0.05) and 1.2 fewer nymphal ticks (p=0.01) at feeder sites. This effect intensified over time with one fewer tick trapped at old feeders (≥5 years) compared to new feeders (<5 years, p<0.05). Greater daily wildlife visitation rates (p<0.001) may have allowed questing ticks to encounter hosts more readily. Most collected ticks were Amblyomma americanum (92.8%), a vector of Ehrlichia and Rickettsia pathogens, though prevalence of these pathogens did not differ (p>0.13) at a local scale. Supplemental deer feeding appears to influence ticks, possibly due to decreased tick habitat and increased wildlife use around feeders. Our findings indicate feeding does not lead to increased prevalence of Ehrlichia or Rickettsia bacteria within A. americanum locally.


Subject(s)
Deer , Rickettsia , Ticks , Animals , Ehrlichia , Mississippi
6.
J Med Entomol ; 58(6): 2514-2518, 2021 11 09.
Article in English | MEDLINE | ID: mdl-34197609

ABSTRACT

Haemaphysalis longicornis Neumann (Asian longhorned tick) is an exotic and invasive tick species presenting a health and economic threat to the United States (U.S.) cattle industry due to its ability to transmit pathogens and infest hosts in large numbers. The objective of this study was to evaluate available products at causing H. longicornis mortality in a laboratory bioassay. The efficacy of products was evaluated at label rates using H. longicornis nymphs collected from a cattle farm in eastern Tennessee in two different bioassays (spray or dip) against untreated controls. After exposure, ticks were transferred to clean petri dishes and checked for mortality at 0, 1, 2, 3, 4, 21, 24, and 48 h post exposure. No mortality occurred in the untreated controls, whereas all treated ticks were dead within 24 h of exposure (P < 0.0001). These findings support the hypothesis that currently available spray and pour-on products are effective at causing H. longicornis mortality. We conclude that these acaricides can be used as a component to prevent H. longicornis dispersal and for control in the U.S.


Subject(s)
Acaricides , Introduced Species , Ixodidae , Tick Control , Animals , Ixodidae/growth & development , Nymph/growth & development , Tennessee , Tick Control/instrumentation
7.
Int J Sports Phys Ther ; 16(3): 816-826, 2021 Jun 01.
Article in English | MEDLINE | ID: mdl-34123533

ABSTRACT

BACKGROUND: Arm care programs consisting of upper extremity strengthening and stretching have been recommended for injury prevention for pitchers of all ages. There has been no investigation into high school baseball coaches' usage and perceptions of arm care programs to mitigate physical impairments associated with injuries in baseball players. HYPOTHESIS/PURPOSE: The purpose of this study was to investigate the current usage of arm care programs by high school baseball coaches. The primary objective was to determine if coaches use group-based or individualized arm care programs. The secondary objective sought to determine if the use of arm care programs is influenced by coaches' age, education, and experience level. Finally, this study explored the potential barriers to arm care implementation and high school baseball coaches' current awareness and beliefs of injury prevention. STUDY DESIGN: Descriptive cross-sectional survey. METHODS: A 29-item online survey was emailed to 18,500 high school baseball coaches throughout the United States. Data were collected for three months, and the response rate was 3.7%. RESULTS: A total of 87.3% (n=571/654) of responding coaches use arm care programs with their players. Of coaches performing arm care, only 18.5% of 571 individualize their arm care exercises based on specific player needs. However, older and more experienced coaches are more likely to individualize their programs. Among the 12.7% (n=83/654) of coaches who do not use arm care programs, the two most commonly cited reasons for not implementing arm care were lack of observed benefit (41%) and insufficient staff (31%). Although 42% of 654 coaches recognized reduced shoulder mobility as a major contributor to injury, risk factors such as throwing with a fatigued arm, previous injury history, and throwing > 8 months per year were not consistently identified as primary risk factors. CONCLUSION: The results of this study suggest that the majority high school baseball coaches implement group-based arm care exercise programs to prevent injury. Lack of confidence in the effectiveness and staffing limitations were major barriers to implementation of arm care programming. However, the responding coaches exhibited inconsistent risk factor awareness and dated injury prevention beliefs. Therefore, better educational collaboration between rehabilitation professionals and high school coaches regarding injury risk factors and preventative strategies is warranted. LEVEL OF EVIDENCE: Level 3.

8.
Ann Biomed Eng ; 49(8): 1909-1922, 2021 Aug.
Article in English | MEDLINE | ID: mdl-33768411

ABSTRACT

Pelvic organ prolapse (POP) is common among older women who have delivered children vaginally. While the pathophysiology is not fully delineated, POP can occur in part from insufficient repair of disrupted elastic matrix fibers. Quantification of structural changes to elastic fibers has not been described previously for POP. The goal of this paper is to present a validated technique for morphometric analysis of elastic fibers in vaginal tissue cultures from lysyl oxidase like-1 knock out (LOXL1 KO) mice with POP. The effect of LOXL1 KO, effect of POP, effect of culture, and effect of elastogenic treatment on the changes in elastin fiber characteristics were tested using vaginal tissues from wild type multiparous (WT), LOXL1 KO multiparous prolapsed (POP) and LOXL1 KO multiparous non-prolapsed (NP) mice. Our results show significantly higher mean aspect ratio, maximum diameter and perimeter length in POP compared to NP after 3 weeks of tissue culture. Further, treatment of POP tissues in culture with growth factors with previously documented elastogenic effects caused a significant increase in the mean area and perimeter length of elastic fibers. This technique thus appears to be useful in quantifying structural changes and can be used to assess the pathophysiology of POP and the effect of elastogenic treatments with potential for POP.


Subject(s)
Amino Acid Oxidoreductases/deficiency , Elastic Tissue , Pelvic Organ Prolapse , Vagina , Amino Acid Oxidoreductases/metabolism , Animals , Elastic Tissue/metabolism , Elastic Tissue/pathology , Elastic Tissue/physiopathology , Female , Mice , Mice, Knockout , Pelvic Organ Prolapse/genetics , Pelvic Organ Prolapse/metabolism , Pelvic Organ Prolapse/pathology , Pelvic Organ Prolapse/physiopathology , Vagina/metabolism , Vagina/pathology , Vagina/physiopathology
9.
J Med Entomol ; 58(3): 1470-1475, 2021 05 15.
Article in English | MEDLINE | ID: mdl-33629730

ABSTRACT

Investigations that analyze interspecific associations of vectors on their hosts are important for understanding community structure and implementing ways to comprehend mechanisms of pathogen transmission. We assessed the interspecific association of two tick species (Ixodes scapularis Say (Ixodida: Ixodidae) and Dermacentor variabilis Say (Ixodida: Ixodidae)) on the rodent host Peromyscus leucopus Rafinesque (Rodentia: Cricetidae) at the Hobart Ames Research and Education Center in southwestern Tennessee. Of the rodents captured, 95 (63%) had neither species of tick, 6 (4%) had both tick species, 25 (16%) had I. scapularis only, and 26 (17%) had D. variabilis only. A coefficient of association (C7 = -0.08) was calculated, which suggested there was competition between the two species of ectoparasites, but this value was not significant, indicating that there was a neutral relationship between the tick species on P. leucopus. The co-occurrence of both tick species on their host at the same time suggested that the two tick species can occupy the same host and use the same resources without competing.


Subject(s)
Dermacentor/physiology , Host-Parasite Interactions , Ixodes/physiology , Peromyscus , Rodent Diseases/epidemiology , Tick Infestations/veterinary , Animals , Dermacentor/growth & development , Ixodes/growth & development , Larva/growth & development , Larva/physiology , Nymph/growth & development , Nymph/physiology , Prevalence , Rodent Diseases/parasitology , Tennessee/epidemiology , Tick Infestations/epidemiology , Tick Infestations/parasitology
10.
J Appl Microbiol ; 130(2): 464-477, 2021 Feb.
Article in English | MEDLINE | ID: mdl-32687650

ABSTRACT

AIMS: To understand the genetics involved in surface attachment and biofilm formation of Listeria monocytogenes. METHODS AND RESULTS: An in vitro screen of a Himar1 transposon library of L. monocytogenes strain 15G01 identified three transposants that produced significantly different biofilm levels when compared to the wild-type strain; two mutants exhibited enhanced biofilm formation and one produced less biofilm biomass than the wild-type. The mutant 15G01 mprF::Himar1, which had a transposon insertion in the mprF gene, was selected for further analysis. The mutant produced a more densely populated biofilm on solid surfaces such as stainless steel and polystyrene, as determined using scanning electron and light microscopy. The 15G01 mprF::Himar1 mutant remained viable in biofilms, but showed an increase in sensitivity to the cationic antimicrobial gallidermin. The mutant also displayed reduced invasiveness in CaCo-2 intestinal cells, suggesting virulence properties are compromised by the inactivation of mprF. CONCLUSIONS: Biofilm formation and gallidermin resistance of L. monocytogenes is influenced by mprF, but this trait is associated with a compromise in invasiveness. SIGNIFICANCE AND IMPACT OF THE STUDY: The presence of pathogenic microorganisms in the food processing environment can cause a significant problem, especially when these microorganisms are established as biofilms. This study shows that the inactivation of the mprF gene results in enhanced biofilm formation and abiotic surface attachment of L. monocytogenes.


Subject(s)
Antimicrobial Cationic Peptides/pharmacology , Bacterial Proteins/metabolism , Biofilms/growth & development , Drug Resistance, Bacterial/genetics , Listeria monocytogenes/physiology , Bacterial Proteins/genetics , Caco-2 Cells , Humans , Listeria monocytogenes/drug effects , Listeria monocytogenes/genetics , Listeria monocytogenes/pathogenicity , Mutation , Virulence/genetics
11.
BMC Cancer ; 20(1): 1125, 2020 Nov 20.
Article in English | MEDLINE | ID: mdl-33218337

ABSTRACT

An amendment to this paper has been published and can be accessed via the original article.

12.
BMC Cancer ; 20(1): 899, 2020 Sep 22.
Article in English | MEDLINE | ID: mdl-32962660

ABSTRACT

BACKGROUND: Art therapy may improve the physical, mental, and emotional wellbeing of individuals for a variety of purposes. It remains understudied and underutilized in cancer care. We sought to determine the ability of a pilot art therapy program to improve the physical, mental, and emotional well-being of cancer patients. METHODS: Chemotherapy-recipients, age 18 years and older, diagnosed with any type or stage of cancer, were considered eligible to participate in this single arm, pilot study, using four visual analog scales (VAS) with visually-similar, 0-10 scale (10 being worst) thermometers assessing: 1) pain, 2) emotional distress, 3) depression, and 4) anxiety. Participants were asked to complete all 4 metrics, pre-treatment, post-treatment, and at 48-72 h follow-up, after an hour-long art therapy session. Primary endpoints included post-intervention changes from baseline in the 4 VAS metrics. RESULTS: Through a reasonable pilot sample (n = 50), 44% had breast cancer, 22% gastrointestinal cancers, 18% hematological malignancies, and 20% had other malignancies. A decrease in all VAS measures was noted immediately post-treatment but remained low only for pain and depression, not for emotional distress and anxiety upon follow up. There was a significant difference between the depression VAS scores of Hispanics (32%) compared to non-Hispanics (56%) (p = 0.009) at baseline. However, compared to non-Hispanics, Hispanics exhibited higher levels of depression after art therapy (P = 0.03) and during the follow-up intervals (p = 0.047). CONCLUSION: Art therapy improved the emotional distress, depression, anxiety and pain among all cancer patients, at all time points. While depression scores were higher pre-intervention for Hispanic patients, Hispanic patients were noted to derive a greater improvement in depression scores from art therapy over time, compared to non-Hispanics patients. Discovering simple, effective, therapeutic interventions, to aid in distress relief in cancer patients, is important for ensuring clinical efficacy of treatment and improved quality of life.


Subject(s)
Art Therapy/methods , Neoplasms/psychology , Psychological Distress , Adolescent , Adult , Aged , Anxiety/etiology , Anxiety/psychology , Anxiety/therapy , Cancer Pain/therapy , Female , Humans , Male , Middle Aged , Neoplasms/drug therapy , Pilot Projects , Prospective Studies , Young Adult
13.
Int J Parasitol Parasites Wildl ; 12: 150-154, 2020 Aug.
Article in English | MEDLINE | ID: mdl-32547921

ABSTRACT

Life histories can influence the degree of parasite infestations on a host. Pressures exerted on hosts based on age and sex convey varying degrees of parasite prevalence due to differences in host lifestyles, but it is not known how interactions between different host traits affect tick numbers. The objective of this study was to determine if host characteristics (e.g., age, sex, weight, and their interactions) affect the mean number of ticks found on small mammals regardless of host species or habitat. Sherman live traps were placed in forest and grass/forb habitats representative of the southeastern United States. After capture, host characteristics were recorded, and hosts were then searched for ticks. A total of 281 small mammals (148 Peromyscus leucopus, 34 P. maniculatus, 76 Sigmodon hispidus, 16 Microtus pinetorum, and 7 Ochrotomys nuttalli) and 610 ticks (488 Dermacentor variabilis, 114 Ixodes scapularis, 1 Amblyomma americanum, and 7 A. maculatum) were collected in this study. Host's age, sex, and weight affected the number of ticks collected from small mammals and significant interaction effects between host traits occurred (weight by sex, weight by age, and sex by age). For instance, female subadult rodents had significantly more ticks compared to female adults, male subadults had significantly fewer ticks compared to male adults, and the number of ticks on a host increased as host body mass increased. These results support the hypothesis that the number of ticks vary on rodent hosts based on life histories and trait interactions. Therefore, understanding the behavioral mechanisms of a host can aid in the management of parasites in the environment.

14.
Science ; 368(6498): 1477-1481, 2020 06 26.
Article in English | MEDLINE | ID: mdl-32587019

ABSTRACT

The closet exoplanets to the Sun provide opportunities for detailed characterization of planets outside the Solar System. We report the discovery, using radial velocity measurements, of a compact multiplanet system of super-Earth exoplanets orbiting the nearby red dwarf star GJ 887. The two planets have orbital periods of 9.3 and 21.8 days. Assuming an Earth-like albedo, the equilibrium temperature of the 21.8-day planet is ~350 kelvin. The planets are interior to, but close to the inner edge of, the liquid-water habitable zone. We also detect an unconfirmed signal with a period of ~50 days, which could correspond to a third super-Earth in a more temperate orbit. Our observations show that GJ 887 has photometric variability below 500 parts per million, which is unusually quiet for a red dwarf.

15.
Science ; 368(6489): 420-424, 2020 04 24.
Article in English | MEDLINE | ID: mdl-32327597

ABSTRACT

The global fossil record of marine animals has fueled long-standing debates about diversity change through time and the drivers of this change. However, the fossil record is not truly global. It varies considerably in geographic scope and in the sampling of environments among intervals of geological time. We account for this variability using a spatially explicit approach to quantify regional-scale diversity through the Phanerozoic. Among-region variation in diversity is comparable to variation through time, and much of this is explained by environmental factors, particularly the extent of reefs. By contrast, influential hypotheses of diversity change through time, including sustained long-term increases, have little explanatory power. Modeling the spatial structure of the fossil record transforms interpretations of Phanerozoic diversity patterns and their macroevolutionary explanations. This necessitates a refocus of deep-time diversification studies.


Subject(s)
Aquatic Organisms , Biodiversity , Fossils , Animals , Paleontology
17.
Sci Adv ; 6(3): eaax7467, 2020 01.
Article in English | MEDLINE | ID: mdl-31998838

ABSTRACT

Our nearest neighbor, Proxima Centauri, hosts a temperate terrestrial planet. We detected in radial velocities evidence of a possible second planet with minimum mass m c sin i c = 5.8 ± 1.9M ⊕ and orbital period P c = 5.21 - 0.22 + 0.26 years. The analysis of photometric data and spectro-scopic activity diagnostics does not explain the signal in terms of a stellar activity cycle, but follow-up is required in the coming years for confirming its planetary origin. We show that the existence of the planet can be ascertained, and its true mass can be determined with high accuracy, by combining Gaia astrometry and radial velocities. Proxima c could become a prime target for follow-up and characterization with next-generation direct imaging instrumentation due to the large maximum angular separation of ~1 arc second from the parent star. The candidate planet represents a challenge for the models of super-Earth formation and evolution.

19.
Neuroimage ; 206: 116323, 2020 02 01.
Article in English | MEDLINE | ID: mdl-31678228

ABSTRACT

Recent work in early visual cortex of humans has shown that the BOLD signal exhibits contrast dependent orientation tuning, with an inverse oblique effect (oblique > cardinal) at high contrast and a horizontal effect (vertical > horizontal) at low contrast. This finding is at odds with decades of neurophysiological research demonstrating contrast invariant orientation tuning in primate visual cortex, yet the source of this discrepancy is unclear. We hypothesized that contrast dependent BOLD orientation tuning may arise due to contrast dependent influences of feedforward (FF) and feedback (FB) synaptic activity, indexed through gamma and alpha rhythms, respectively. To quantify this, we acquired EEG and BOLD in healthy humans to generate and compare orientation tuning curves across all neural frequency bands with BOLD. As expected, BOLD orientation selectivity in V1 was contrast dependent, preferring oblique orientations at high contrast and vertical at low contrast. On the other hand, EEG orientation tuning was contrast invariant, though frequency-specific, with an inverse-oblique effect in the gamma band (FF) and a horizontal effect in the alpha band (FB). Therefore, high-contrast BOLD orientation tuning closely matched FF activity, while at low contrast, BOLD best resembled FB orientation tuning. These results suggest that contrast dependent BOLD orientation tuning arises due to the reduced contribution of FF input to overall neurophysiological activity at low contrast, shifting BOLD orientation tuning towards the orientation preferences of FB at low contrast.


Subject(s)
Contrast Sensitivity , Orientation, Spatial/physiology , Visual Cortex/diagnostic imaging , Visual Perception/physiology , Adult , Alpha Rhythm , Electroencephalography , Feedback , Female , Functional Neuroimaging , Gamma Rhythm , Humans , Magnetic Resonance Imaging , Male , Oxygen , Visual Cortex/physiology , Visual Pathways/diagnostic imaging , Visual Pathways/physiology , Young Adult
20.
J Orthop ; 17: 83-86, 2020.
Article in English | MEDLINE | ID: mdl-31879480

ABSTRACT

The purpose of this study was to compare patient reported functional outcomes following bilateral aTSA vs rTSA. A retrospective review was conducted on twenty-six pateints who underwent staged bilateral aTSA or rTSA, with a minimum of 2 years follow up. Thirteen patients were included in each group, and patient assessed functional outcomes were measured using the PENN Score, ASES, SST, and SF-12. No statistically significant differences were found between the two groups for all functional outcome scores, patient satisfaction, or SF-12. These findings suggest that patients undergoing bilateral rTSA can expect functional outcomes similar to those obtained after bilateral aTSA. None of the authors involved in the work nor any of the author's institutions at any time received payment or services from a third party for any aspect of the submitted work and have no conflicts of interest to disclose.

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