Gastroduodenal Tuberculosis Presenting as a Gastric Outlet Obstruction: A Case Report.

Abdominal tuberculosis (TB) can affect any part of the gastrointestinal tract, solid organs, peritoneum, or lymph nodes. The diagnosis of abdominal TB is usually delayed due to a lack of specific clinical signs and symptoms and the mimicking of other intra-abdominal diseases. We present a case of gastroduodenal tuberculosis with peripancreatic lymph node involvement presented as a gastric outlet obstruction that was treated conservatively with anti-tuberculosis medications.

Functional Anterior Knee Pain and Return to Sport Following Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction.

Background: Bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction is a frequently used technique but has been associated with a high incidence of postoperative anterior knee pain. However, previous studies have not evaluated if this anterior knee pain is functionally limiting for patients. This study introduces the concept of functional anterior knee pain, or kneecap pain that limits patients' ability to return to their prior level of activity or sport. Methods: We reviewed BPTB ACL reconstructions from April 2013 to May 2017. Patients included in the analysis had a minimum of 1 year of clinical follow-up and 3 years of survey follow-up. Statistical analyses were performed using paired t tests and binomial test. Results: Sixty-seven patients met the inclusion criteria. Compared to the mean preoperative visual analog scale (VAS) pain score of 6.1, patients reported statistically significant reductions in VAS scores at 1 year and 3 years postoperatively to 0.9 and 1.8, respectively (P<0.01). The incidence (28.4%) of anterior knee pain was highest at the 3-month time point. This incidence decreased to 6.0% at 1 year and 7.5% at 3 years postoperatively. At 3 years postoperatively, 94% (63/67) of the patients in this study were not limited by functional anterior knee pain and returned to preoperative levels of activity and sport. Conclusion: To our knowledge, this investigation is the first to define and quantify the relationship between postoperative anterior knee pain and resultant functional limitations. This study shows that ACL reconstruction with BPTB autograft was not significantly associated with functional anterior knee pain in our population and that the incidence of postoperative anterior knee pain following BPTB ACL reconstruction may be less than previously reported.

Differential Impact of Body Mass Index in Hip Arthroscopy: Obesity Does Not Impact Outcomes.

Background: Hip arthroscopy is commonly used for the treatment of hip pathologies. As population obesity rates continue to increase, elucidating the impact of body mass index (BMI) on hip arthroscopy outcomes is essential. This investigation was conducted to quantify the effects of BMI on hip arthroscopy outcomes. Methods: We conducted a retrospective medical records review of 459 patients undergoing hip arthroscopy at a single center from 2008 to 2016. The Harris Hip Score (HHS) and 2 component scores of the 12-Item Short Form Survey-the physical component score (PCS-12) and the mental component score (MCS-12)-were used to measure outcomes. Patients were stratified into 4 cohorts based on their BMI: underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5 to 24.9 kg/m2), overweight (BMI 25.0 to 29.9 kg/m2), and obese (BMI ≥30.0 kg/m2). Results: At 1 and 2 years postoperatively, all cohorts experienced statistically significant improvements in the HHS and PCS-12. At 3 years postoperatively, statistically significant improvements were seen in the HHS for all cohorts; in the PCS-12 for the normal weight, overweight, and obese cohorts; and in the MCS-12 for the normal weight cohort. Intercohort differences were not statistically significant at 1, 2, or 3 years postoperatively. Conclusion: In our population, BMI did not have statistically significant effects on patient outcome scores following hip arthroscopy. All patient cohorts showed postoperative improvements, and differences between BMI cohorts were not statistically significant at any postoperative time point.

Leveraging joint incremental learning objective with data ensemble for class incremental learning.

A class-incremental learning problem is characterized by training data becoming available in a phase-by-phase manner. Deep learning models suffer from catastrophic forgetting of the classes in the older phases as they get trained on the classes introduced in the new phase. In this work, we show that the change in orientation of an image has a considerable effect on the model prediction accuracy, which in turn demonstrates the different rates of catastrophic forgetting for the different orientations of the same image, which is a novel finding. Based on this, we propose a data-ensemble approach that combines the predictions for the different orientations of the image to help the model retain information regarding the previously seen classes and thereby reduce the rate of forgetting in the model predictions. However, we cannot directly use the data-ensemble approach if the model is trained using traditional techniques. Therefore, we also propose a novel training approach using a joint-incremental learning objective (JILO) that involves jointly training the network with two incremental learning objectives, i.e., the class-incremental learning objective and our proposed data-incremental learning objective. We empirically demonstrate that JILO is vital to the data-ensemble approach. We apply our proposed approach to state-of-the-art class-incremental learning methods and empirically show that our approach significantly improves the performance of these methods. Our proposed approach significantly improves the performance of the state-of-the-art method (AANets) on the CIFAR-100 dataset by absolute margins of 3.30%, 4.28%, 3.55%, 4.03%, for the number of phases P=50, 25, 10, and 5, respectively, which establishes the efficacy of the proposed work.

Twitter Use Among Orthopedic Surgery Journals Correlates With Increased Citation Rates.

Use of alternative online means of distribution for research is a rapidly evolving area in orthopedics. In this study, we investigate the impact of Twitter on research citation rates and the association between Altmetric Attention Score (AAS) and citation rates across major orthopedic journals. Original research articles published in a selection of 10 journals between January 2018 and December 2018 were analyzed for number and source of tweets, AAS, and number of citations. We determined the relationship between Twitter use of different sources and number of citations across all journals and within each individual journal, any statistical differences in citations and AAS for tweeted vs nontweeted articles, and the correlation between journal impact factor and average number of monthly tweets. We included 2916 articles in our study, at an average of 26 months after publication. The mean AAS was 9.7 (SD, 45.1; range, 0-1125), and mean citation rate was 6.4 (SD, 8.5; range, 0-166). Impact factor was strongly correlated with average monthly tweets (r2=0.77). Tweeted articles received 8.51 citations on average, compared with 2.56 citations for nontweeted articles (P<.05). Tweets sent by the author/department had the highest impact on future citations (P<.01). Tweets by news outlets had a smaller, positive effect on citations (P<.01). Tweets sent by Arthroscopy (P<.01) and Journal of Pediatric Orthopaedics (P<.01) had high impacts compared with other journals. [Orthopedics. 2023;46(1):e38-e44.].

Management of Insertional Achilles Tendinopathy.

Insertional Achilles tendinopathy is a common condition that can lead to chronic, debilitating heel pain in athletes and nonathletes alike. Conservative treatment options include activity and shoe wear modification, physical therapy, injections, and extracorporeal shock wave therapy. When nonsurgical treatment fails, surgical treatment is recommended. Although there are options aimed at preserving the tendon and débriding the retrocalcaneal bursa and excess bone formation, others are aimed at detaching the Achilles tendon to perform a thorough débridement and subsequent reattachment. Additional or alternate procedures may include a calcaneal closing wedge osteotomy, gastrocnemius lengthening, and flexor hallucis longus tendon transfer. Recent advances in suture anchor techniques further add to the complexity of available options. This review discusses the relevant anatomy, biomechanics, and pathophysiology as well as the recent available evidence for nonsurgical and surgical management of this condition to guide surgeons in selecting the most appropriate treatment for their patients.

Ruptured Suprarenal Abdominal Aortic Pseudoaneurysm with Superior Mesenteric and Celiac Arteries Occlusion, Revealing Behçet’s Disease: A Case Report

Behçet’s disease (BD) is a multisystemic, chronic autoimmune inflammatory vasculitic disease with an unknown etiology. Although the literature reports that vascular involvement occurs in 7% to 38% of all BD cases, the arteries are rarely involved; however, arterial involvement is usually associated with significant mortality and morbidity. We report the case of a young female patient who presented to the emergency department with severe abdominal pain and a history of weight loss. The patient was evaluated using computed tomography angiography, which revealed a ruptured suprarenal aortic pseudoaneurysm with occlusion of both the superior mesenteric and celiac arteries. Urgent surgery was performed with aortic repair with an interposition graft and superior mesenteric artery embolectomy. The patient’s clinical history and radiological imaging findings were strongly suggestive of the diagnosis of BD with vascular involvement.

Neuroprotective effect of Spirulina fusiform and amantadine in the 6-OHDA induced Parkinsonism in rats.

BACKGROUND: Multi-factorial etiology exists in pathophysiology of neurodegenerative diseases. The imbalance of anti-oxidant enzymes and dopamine level leads to Parkinsonism. The objective of this study was to assess the protective effect of Spirulina fusiform alone and in combination with amantadine against Parkinsonism effect in 6-hydroxydopamine (6-OHDA) induced rat model. METHODS: S. fusiform was administered in different groups (500 mg/kg, once daily and twice daily) and a combination of spirulina (500 mg/kg, once daily) with amantadine (20 mg/kg once daily) for 30 days before and 14 days after a single injection of 6-OHDA into the dorsal striatum. Post lesion produced rotational behavior which was measured at two week intervals (37th and 44th day). Locomotors activity was also done at 44th and muscle coordination at 48th day. Dorsal striatum was isolated from rat brain for evaluating the antioxidant assays and dopamine content at 49th day. RESULTS: Both the body rotations (ipsilateral and contralateral) were found to have a statistically significant (p<0.001) decrease by 34.26 and 52% after treatment with spirulina (Twice a day) in spirulina treated lesioned group. A higher percentage of improvement was shown in the reduction of ipsilateral (57.34%) and contralateral (78.3%) rotations in combination of spirulina with amantadine treated lesioned group rather than spirulina alone treated lesioned groups when compared with positive control lesioned group. Body movements and locomotor activity were improved statistically (p<0.0001) significant in both treated lesioned groups (Combination of spirulina with amantadine and spirulina twice daily). Similar results were also seen in anti-oxidant levels which later on reached to the normal value. The levels of dopamine content had a statistically significant (p<0.0001) increase by 78.3% only in case of spirulina with amantadine treated lesioned group. CONCLUSION: Spirulina is a potent nutraceutical supplement all over the world, so my preclinical study may contribute to give an additional adjuvant drug therapy in aging related disorders (Neurodegenerative as well as diabetes associated neurodegenerative disorders).