Augmentation of a Transosseous-Equivalent Repair in Posterosuperior Nonacute Rotator Cuff Tears With a Bioinductive Collagen Implant Decreases the Retear Rate at 1 Year: A Randomized Controlled Trial.

PURPOSE: To determine whether the addition of a bioinductive collagen implant (BCI) over a transosseous equivalent (TOE) repair of medium-to-large posterosuperior rotator cuff tears improves the healing rate determined by magnetic resonance imaging (MRI) at 12-month follow-up. METHODS: A Level I randomized controlled trial was performed in 124 subjects with isolated, symptomatic, reparable, full-thickness, medium-to-large posterosuperior nonacute rotator cuff tears, with fatty infiltration ≤2. These were randomized to 2 groups in which an arthroscopic posterosuperior rotator cuff tear TOE repair was performed alone (Control group) or with BCI applied over the TOE repair (BCI group). The primary outcome was the retear rate (defined as Sugaya 4-5) determined by MRI at 12 months of follow-up. Secondary outcomes were characteristics of the tendon (Sugaya grade and thickness of the healed tendon) and clinical outcomes (pain levels, EQ-5D-5L, American Shoulder and Elbow Surgeons, and Constant-Murley scores) at 12 months of follow-up. RESULTS: Of the 124 randomized patients, 122 (60 in the BCI group and 62 in the Control group) were available for MRI evaluation 12.2 ± 1.02 months after the intervention. There were no relevant differences in preoperative characteristics. Adding the BCI reduced the retear rate (8.3% [5/60] in the BCI group vs 25.8% [16/62] in the Control group, P = .010; relative risk of retear of 0.32 [95% confidence interval 0.13-0.83]). Sugaya grade was also better in the BCI group (P = .030). There were no differences between groups in the percentage of subjects who reached the MCID for CMS (76.7% vs 81.7%, P = .654) or American Shoulder and Elbow Surgeons (75% vs 80%, P = .829), in other clinical outcomes or in complication rates at 12.4 ± 0.73 (range 11.5-17) months of follow-up. CONCLUSIONS: Augmentation with a BCI of a TOE repair in a medium-to-large posterosuperior rotator cuff tear reduces the retear rate at 12-month follow-up by two-thirds, yielding similar improvements in clinical outcomes and without increased complication rates. LEVEL OF EVIDENCE: Level I, randomized controlled trial.

On the Security of Bluetooth Low Energy in Two Consumer Wearable Heart Rate Monitors/Sensing Devices.

Since its inception in 2013, Bluetooth Low Energy (BLE) has become the standard for short-distance wireless communication in many consumer devices, as well as special-purpose devices. In this study, we analyze the security features available in Bluetooth LE standards and evaluate the features implemented in two BLE wearable devices (a Fitbit heart rate wristband and a Polar heart rate chest wearable) and a BLE keyboard to explore which security features in the BLE standards are implemented in the devices. In this study, we used the ComProbe Bluetooth Protocol Analyzer, along with the ComProbe software to capture the BLE traffic of these three devices. We found that even though the standards provide security mechanisms, because the Bluetooth Special Interest Group does not require that manufacturers fully comply with the standards, some manufacturers fail to implement proper security mechanisms. The circumvention of security in Bluetooth devices could leak private data that could be exploited by rogue actors/hackers, thus creating security, privacy, and, possibly, safety issues for consumers and the public. We propose the design of a Bluetooth Security Facts Label (BSFL) to be included on a Bluetooth/BLE enabled device's commercial packaging and conclude that there should be better mechanisms for informing users about the security and privacy provisions of the devices they acquire and use and to educate the public on protection of their privacy when buying a connected device.

Instability severity index score values below 7 do not predict recurrence after arthroscopic Bankart repair.

PURPOSE: To evaluate the efficacy of the Instability Severity Index Score (ISIS) in predicting an increased recurrence risk after an arthroscopic Bankart repair. METHODS: Retrospective review of a cohort of patients operated in three different centres. The inclusion criteria (recurrent anterior instability [dislocation or subluxation] with or without hyperlaxity, arthroscopic Bankart repair) and the exclusion criteria (concomitant rotator cuff lesion, acute first-time dislocation, surgery after a previous anterior stabilization, surgery for an unstable shoulder without true dislocation or subluxation; multidirectional instability) were those used in the study that defined the ISIS score. The medical records and a telephone interview were used to identify the six variables that define the ISIS and identify recurrences. RESULTS: One hundred and sixty-three shoulders met the inclusion and exclusion criteria. Of these, 140 subjects (22 females/118 males; mean age 35.5 ± 7.9) with 142 (89.0%) shoulders were available for follow-up after 5.3 (1.1) (range 3.1-7.4) years. There were 20 recurrences (14.1%). The mean (SD) preoperative ISIS was 1.8 (1.6) in the patients without recurrence and 1.8 (1.9) in the patients with recurrence (n.s.). In the 117 subjects with ISIS between 0 and 3 the recurrence rate was 12.8%; in the 25 with ISIS 4 to 6 the rate was 20% (n.s.). CONCLUSION: For subjects with anterior shoulder instability in which an arthroscopic Bankart repair is being considered, the use of the ISIS, when the values obtained are ≤ 6 was not useful to predict an increased recurrence risk in the midterm in this retrospectively evaluated case series. The efficacy of the ISIS score in defining a group of subjects with a preoperative increased risk of recurrence after an arthroscopic Bankart instability repair is limited in lower risk populations (with ISIS scores ≤ 6). LEVEL OF EVIDENCE: Retrospective case series, Level IV.

Drug addiction: self-perception of oral health / Drogadição: Autopercepção em Saúde Bucal / Adicción a las drogas: auto percepción de la salud bucal

Objective: To report the self-perception of substance-abusing individuals who were in a recovery process regarding sociodemographic conditions and general and oral health. Methods: Descriptive cross-sectional study conducted in a recovery center for drug addiction in Alfenas, Minas Gerais, Brazil, in 2015, with 39 men aged over 18 years old. Data were collected using a semi-structured questionnaire that addressed: socioeconomic status, selfperception of general and oral health, access to dental care, relationship with the dentist, and other issues. In order to assess the self-perception of oral health, the variable was dichotomized into "satisfactory" and "unsatisfactory", which refer to what the individual acknowledges as a good or poor condition of oral health, using Fisher's exact test with 5% significance level. Results: Most frequent diseases were depression, 35.90% (n=14), insomnia, 35.9%, (n=14) and recurring headache (23.1%; n=9); however, 61.50% (n=24) of the participants reported not getting sick easily, which contrasts with their self-perception. Regarding oral health, only 30.50% (n=12) of the participants reported brushing their teeth three times a day; 53.80% (n=21) had dentinal hypersensitivity; 41.00% (n=16) had dry mouth and bad breath; 30.80% (n=12) claimed to have bruxism and reported having one or more loose teeth; 28.20% (n=11) reported clenching the teeth in an exaggerated way, and 33.30% (n=13) reported feeling tooth pain. Conclusion: The self-perception of individuals ­ under 30 years old, single, white or mulattos ­ regarding their general health was contradictory, as they rated it as good but have reported depression, insomnia and weight loss; additionally, oral health was considered poor with unsatisfactory conditions, which highlights the harmful effects of substance abuse.

Objetivos: Relatar a autopercepção de indivíduos drogaditos que se encontravam em estágio recuperatório, quanto às condições sociodemográficas, de saúde geral e bucal. Métodos: Estudo descritivo e transversal realizado em 2015 em um centro de triagem de recuperação de dependentes químicos, em Alfenas, MG, Brasil, com 39 internos do sexo masculino e acima de 18 anos. Por meio de um questionário semi-estruturado, investigaram-se temas referentes à condição socioeconômica, percepção dos internos em relação à própria saúde geral e bucal, acesso ao tratamento odontológico, relacionamento com o cirurgião-dentista, entre outros. A variável autopercepção em saúde bucal foi dicotomizada em "satisfatória" e "insatisfatória" para aplicação do teste Exato de Fisher, com nível de significância de 5%. Resultados: As doenças mais frequentes foram depressão, 35,90% (n=14), insônia, 35,9%, (n=14) e dor de cabeça recorrente (23,1%; n=9), apesar de 61,50% (n=24) dos internos afirmarem não ficar doentes, indicando autopercepção conflitante. Ao serem questionados sobre a frequência de escovação diária, apenas 30,50% (n=12) mencionaram três vezes ao dia, 53,80% (n=21) com sensibilidade dentinária; 41,00% (n=16) com sensação de boca seca e mal hálito; 30,80% (n=12) bruxismo, 28,20% (n=11) apertamento dental e 33,30% (n=13) dor em algum dente. Conclusão: A autopercepção dos internos analisados com menos de 30 anos, solteiros, brancos ou mulatos, quanto ao seu estado geral de saúde era contraditória, já que classificaram como boa, mas relataram depressão, insônia e perda de peso; e saúde bucal foi considerada ruim com condições insatisfatórias, que destacam os efeitos nocivos do uso de drogas.

Objetivo: Relatar la auto percepción de individuos drogadictos que estaban en proceso de recuperación, respecto las condiciones socio-demográficas y la salud general y bucal. Métodos: Estudio transversal y descriptivo realizado en un centro de recuperación para drogadicción en Alfenas, Minas Gerais, Brasil, en 2015, com 39 hombres con más de 18 años. Los datos fueron recogidos a través de un cuestionario semiestructurado que investigaba la posición socioeconómica, la auto percepción de la salud general y bucal, El acceso al cuidado dental, la relación con el dentista y otros temas. Para evaluar la auto percepción de la salud bucal la variable fue dividida en "satisfactoria" y "no satisfactoria" la cual refiere a los conocimientos del individuo sobre la buena o mala condición de salud bucal utilizando la prueba de Exacto de Fisher con El 5% de nivel de significancia. Resultados: Las enfermedades más frecuentes fueron la depresión con el 35,90% (n=14), el insomnio con el 35,9%, (n=14) y dolor de cabeza recurrente (23,1%; n=9); sin embargo, el 61,50% (n=24) de los participantes relataron no enfermarse con facilidad lo que contrasta con su auto percepción. Respecto a la salud bucal, solamente el 30,50% (n=12) de los participantes relataron cepillar los dientes tres veces al día; El 53,80% (n=21) tuvieron hipersensibilidad dental; el 41,00% (n=16) tuvieron la sensación de boca seca y mal aliento; El 30,80% (n=12) reclamaron de bruxismo y relataron tener uno o más dientes perdidos; el 28,20% (n=11) relataron apretar los dientes de manera exagerada y el 33,30% (n=13) relataron tener dolor de diente. Conclusión: La auto percepción de los individuos - por abajo de los 30 años, solteros, blancos o mulatos - respecto su salud general fue contradictoria ya que clasificaron como buena aunque reportaron la depresión, el insomnio y La pérdida de peso; además, la salud bucal fue considerada pobre con condiciones no satisfactorias, las cuales resalta los efectos nocivos de la substancia abusiva.