Telemedicine Visits During COVID-19 Improved Clinic Show Rates.

OBJECTIVE: We aimed to explore the impact of telehealth in the setting of COVID-19 on patient access to ambulatory rheumatologic care at our academic public health system and to determine whether telemedicine visits had a beneficial impact on access to our rheumatology ambulatory clinics. METHODS: We compared completed, no-show, and cancellation rates between in-person clinic visits and telemedicine appointments over a 10-week time period before Ohio's initial executive order responding to COVID-19 (premandate period) and a 10-week time period afterward (postmandate period). Scheduling and appointment data were retrospectively extracted from the medical center's electronic health record. RESULTS: During the premandate period, when all visits were in-person, the total number of completed visits was 930. The percentages of cancellations, no-shows, and completed appointments of all appointment activities were 31.43%, 13.12%, and 55.46%, respectively. During the postmandate period, when telemedicine visits were added, the overall total number of completed visits was 1038. The percentages of cancellations, no-shows, and completed appointments of all appointment activities were 53.45%, 13.91%, and 32.64%, respectively, for in-person appointments and 0.12%, 8.48%, and 91.39%, respectively, for telemedicine appointments. CONCLUSION: Telemedicine during the COVID-19 pandemic resulted in higher rates of completed appointments and lower rates of missed appointments in the rheumatology outpatient clinic compared with in-person visits during and prior to the pandemic.

Evaluating the Native Length-Tension Relationship in Arthroscopic Suprapectoral Biceps Tenodesis: An MRI Assessment of Contralateral Shoulders.

BACKGROUND: Successful tenodesis of the proximal biceps relies on accurate reproduction of the native length-tension relationship of the long head of the biceps (LHB). While open tenodesis procedures can reproduce this relationship by referencing the position of the LHB musculotendinous junction (MTJ) to a visible anatomic landmark, arthroscopic suprapectoral tenodesis does not afford such advantage because the MTJ is usually not visible. No studies to date have evaluated the position of the MTJ of the LHB following arthroscopic suprapectoral biceps tenodesis. METHODS: Patients undergoing arthroscopic suprapectoral biceps tenodesis between January 2013 and May 2014 at one center were evaluated for inclusion. Patients included in the study underwent a postoperative MRI of bilateral shoulders. The distance from the superior portion of the humeral head to the LHB MTJ was measured bilaterally. The measurements from each matched pair were compared using a paired t-test to determine if arthroscopic suprapectoral biceps tenodesis anatomically restored the LHB length-tension relationship. RESULTS: A total of 17 patients met the inclusion criteria. Fourteen of the seventeen patients underwent a postoperative MRI of bilateral shoulders. The distance from the superior portion of the humeral head to the LHB musculotendinous junction was significantly larger on the operative side when compared to the nonsurgical side (operative side mean 98.34 mm, standard deviation 13.38 mm; nonsurgical mean 87.26 mm, standard deviation 9.09; mean difference 11.08 mm; p=0.0105). CONCLUSION: The musculotendinous junction of the LHB in patients who underwent arthroscopic suprapectoral biceps tenodesis was located significantly more distal than the contralateral control, as measured on MRI.

Impaired pneumovax-23-induced monocyte-derived cytokine production in patients with common variable immunodeficiency.

INTRODUCTION: Streptococcus pneumoniae is one of the most common infectious pathogens in common variable immunodeficiency (CVID). Both innate and adaptive immune response appears to play a role in defense against S. pneumoniae. In mice, it has been established that TLR2 and macrophages-derived cytokines (IL-6, TNF-alpha) play a crucial role in defense against S. pneumoniae. In humans, monocyte/macrophage-derived cytokines in response to S. pneumoniae have not been studied. Patients with CVID respond poorly to Pneumovax-23 (containing all capsular polysaccharides) vaccination. FINDINGS: In this study, we show that Pneumovax-23, in a concentration and time-dependent manner, induced secretion of IL-6, IL-10, and TNF-alpha by monocytes and not by B cells or T cells from healthy controls. Furthermore, Pneumovax-23-induced secretion of IL-6 and TNF-alpha was significantly less in patients with CVID as compared with controls. In addition, Pneumovax-23-induced upregulation of TLR2 in all four subsets of monocytes; however, differences between control and CVID were not significant. CONCLUSION: Pneumovax-23-induced monocytes-derived cytokine production is impaired in CVID, which may play an important role in increased susceptibility of CVID patients to S. pneumoniae infection.

Magnetic resonance imaging of the hip.

Standard magnetic resonance imaging (MRI) as well as MR arthrography (MRA) have been important diagnostic tools to assess for a spectrum of clinical presentations related to the hip. MRA has allowed the radiologist to closely examine intracapsular structures such as the acetabular labrum. In this article, we provide a general review of soft tissue and osseous anatomy of hips, especially focusing on the MR appearances of the acetabular labrum and the osseous morphology of the greater trochanter and ischial tuberosity with their muscle and tendon attachments. In addition, current topics in recent literature will be discussed such as femoroacetabular impingement (FAI) and rotator cuff tears of the hip.

Effects of cold stress on morphine-induced nitric oxide production and mu-opiate receptor gene expression in Mytilus edulis pedal ganglia.

OBJECTIVES: Subjecting the marine bivalve Mytilus edulis to an immediate temperature change has been shown to rapidly alter the animals' ganglionic monoamine levels, as well as its ciliary activity. Recently, we extended this observation to include the organism's ganglionic mu opiate receptor and morphine levels. In the past, we demonstrated that M. edulis ganglionic mu receptors exposed to morphine was coupled to the immediate release nitric oxide (NO). In this study, we measured morphine-induced NO release in M. edulis subjected to acute cold stress. METHODS: NO release was monitored with an NO-selective microprobe. Temporal changes in mu opiate receptor expression were also examined over 24 hours. RESULTS: In this study, we demonstrate that after 12h cold exposure (4 degrees C from 24 degrees C), the estimated relative mu opiate receptor (MOR) gene expression in M. edulis pedal ganglia, measured by real-time PCR, did not differ significantly from the control group (1.23+/-0.25, p>0.05). However, the measured M. edulis pedal ganglia MOR expression demonstrated that ganglia significantly (0.77+/-0.05, p<0.001) down regulated their mu opiate receptor mRNA expression after 24h exposure to the cold water. The mean value for control animal (24 degrees C, n=14) morphine-stimulated NO release was 36.7 +/- 9.8 nM. Morphine additions to cold-treated tissues (4 degrees C, n=7) produced an average of 6.7 +/- 4.9 nM NO, which was a statistically significant difference between 25 degrees C and 4 degrees C animals (p=0.025). CONCLUSION: The study further demonstrates that mu opiate receptor expression is coupled to NO release.