UNASSIGNED: Tendon transfers in conjunction with reverse total shoulder arthroplasty can significantly improve functional outcomes in patients with glenohumeral arthritis and irreparable rotator cuff deficiency. There have been multiple promising new techniques described within the last 20 years that shoulder surgeons should become familiar with.
UNASSIGNED: The authors reviewed the literature on tendon transfers in the setting of reverse total shoulder arthroplasty. Procedures to restore various shoulder functions were described including surgical anatomy, techniques, pearls and pitfalls, and photos.
UNASSIGNED: Subscapularis insufficiency can be reconstructed with a pectoralis major transfer or latissimus dorsi transfer, with the latter having better clinical outcomes and a more anatomic line of pull. Posterosuperior rotator cuff deficiency can be reconstructed with a latissimus transfer (L\'Episcopo transfer) or lower trapezius transfer, with the latter proving superior in biomechanical and short-term studies. Deltoid deficiency can be reconstructed with a pedicled upper pectoralis major transfer. Massive proximal humerus bone loss can be reconstructed with an allograft-prosthetic composite, and any of the aforementioned transfers can be utilized in this setting as well.
UNASSIGNED: Tendon transfers in conjunction with reverse shoulder arthroplasty can significantly improve functional outcomes in patients with glenohumeral arthritis and irreparable rotator cuff deficiency. There have been multiple promising new techniques described within the last 20 years that shoulder surgeons should become familiar with.

UNASSIGNED: The annual utilization of reverse total shoulder arthroplasty (RTSA) and anatomic total shoulder arthroplasty (ATSA) has grown exponentially, in part due to the expanded indications of RTSA. This evolution in shoulder arthroplasty prompts the need to evaluate outcomes between ATSA and RTSA. However, many other studies comparing outcomes between ATSA and RTSA lacked a large nationally-represented sample, a matched cohort analysis, or both. In this study, we compare outcomes between patients undergoing ATSA or RTSA in a large matched-cohort analysis.
UNASSIGNED: Patients undergoing RTSA or ATSA from the National Inpatient Sample database between 2016 and 2019 were identified. Groups were propensity-matched based on demographics and comorbidities. We compared medical and surgical complications, length of stay, and total hospital charges. T-tests and chi-square tests were performed for continuous and categorical variables, respectively. Odds ratios were calculated as a ratio between RTSA and ATSA groups.
UNASSIGNED: Following matching, there were 38,782 patients in the ATSA group and 35,461 patients in the RTSA group. The RTSA group had higher odds of acute renal failure (OR 1.35), blood loss anemia (OR 1.39), and pneumonia (OR 1.19). There were no differences for myocardial infarction, pulmonary embolism, deep venous thrombosis, mortality, periprosthetic fracture, or dislocation. The RTSA group had higher odds of periprosthetic mechanical complication (OR 1.92), but lower odds of periprosthetic joint infection (OR 0.65). The mean length of stay and total hospital charges were both higher in the RTSA group (p < 0.001).
UNASSIGNED: We found patients undergoing RTSA are at higher odds of inpatient medical complications, including acute renal failure and acute blood loss anemia. RTSA is associated with higher odds of short-term periprosthetic mechanical complications.

BACKGROUND: The two major reverse shoulder arthroplasty (RSA) designs are the Grammont design and the lateralized design. Even if the lateralized design is biomechanically favored, the classic Grammont prosthesis continues to be used. Functional and subjective patient scores as well as implant survival described in the literature so far are comparable to the lateralized design. A pure comparison of how the RSA design influences outcome in patients has not yet been determined. The aim of this study was a comparison focused on patients with cuff tear arthropathy (CTA).
METHODS: We analyzed registry data from 696 CTA patients prospectively collected between 2012 and 2020 in two specialized orthopedic centers up to 2 years post-RSA with the same follow-up time points (6,12 24 months). Complete teres minor tears were excluded. Three groups were defined: group 1 (inlay, 155° humeral inclination, 36 + 2 mm eccentric glenosphere (n = 50)), group 2 (inlay, 135° humeral inclination, 36 + 4 mm lateralized glenosphere (n = 141)) and group 3 (onlay, 145° humeral inclination, + 3 mm lateralized base plate, 36 + 2 mm eccentric glenosphere (n = 35)) We compared group differences in clinical outcomes (e.g., active and passive range of motion (ROM), abduction strength, Constant-Murley score (CS)), radiographic evaluations of prosthetic position, scapular anatomy and complications using mixed models adjusted for age and sex.
RESULTS: The final analysis included 226 patients. The overall adjusted p-value of the CS for all time-points showed no significant difference (p = 0.466). Flexion of group 3 (mean, 155° (SD 13)) was higher than flexion of group 1 (mean, 142° (SD 18) and 2 (mean, 132° (SD 18) (p < 0.001). Values for abduction of group 3 (mean, 145° (SD 23)) were bigger than those of group 1 (mean, 130° (SD 22)) and group 2 (mean, 118° (SD 25)) (p < 0.001). Mean external rotation for group 3 (mean, 41° (SD 23)) and group 2 (mean, 38° (SD 17)) was larger than external rotation of group 1 (mean, 24° (SD 16)) (p < 0.001); a greater proportion of group 2 (78%) and 3 (69%) patients reached L3 level on internal rotation compared to group 1 (44%) (p = 0.003). Prosthesis position measurements were similar, but group 3 had significantly less scapular notching (14%) versus 24% (group 2) and 50% (group 1) (p = 0.001).
CONCLUSIONS: Outcome scores of different RSA designs for CTA revealed comparable results. However, CTA patients with a lateralized and distalized RSA configuration were associated with achieving better flexion and abduction with less scapular notching. A better rotation was associated with either of the lateralized RSA designs in comparison with the classic Grammont prosthesis.
METHODS: Therapeutic study, Level III.

UNASSIGNED: This retrospective review aimed to assess if open payments made by industry arthroplasty companies to physicians and hospital systems were significantly affected by implant type and geographic variation.
UNASSIGNED: Data was obtained from the Centers for Medicare and Medicaid Services (CMS) publicly available open payment datasets (2016-2019). Geographic locations were identified using regions as defined by the US Census Bureau. A linear regression was calculated to predict the open payment made based on the created variable region, the most used implant type (reverse vs anatomic, n > 30 to be included), and their hypothesized interaction.
UNASSIGNED: A significant regression equation was found for the hypothesized interaction between implant and region, F(13,11 186) = 3.446, P < .0001, with an R2 of 0.005. Within the regression, the implant type alone was not significantly related to the open payment (P = .070) but only became significant when paired with the region in the South (US$5807; P < .0001) and West (US$5638; P = .0012) compared to the Northeast.
UNASSIGNED: Our multivariate linear regression model revealed that reverse total shoulder implants were associated with higher open payments, but only within the South and West regions. This indicates that the contributions made by industry arthroplasty companies are a function of both implant and region.

UNASSIGNED: The purpose of our study was to compare the outcomes and complications after a two- vs. six-week duration of sling immobilization following reverse total shoulder arthroplasty (rTSA).
UNASSIGNED: We conducted a retrospective review from our institutional database on 960 patients treated by primary rTSA between 2011 and 2021. Patients were separated into two cohorts of postoperative sling immobilization (a two-week and six-week group). Multivariate analysis was conducted to evaluate what factors were associated with patients experiencing either a postoperative complication or requiring reoperation.
UNASSIGNED: A total of 276 patients were instructed to keep their operative arm in a sling for six weeks postoperatively, and 684 patients discontinued use at two weeks. There was no difference in postoperative complication rate (15.0% vs. 12.0%, P = .21), dislocation rate (P = .79), acromion stress fractures (P = .06), implant loosening (P = .15), and periprosthetic joint infections (P = .48) between the six- and two-week sling cohorts. In the immediate 90-day postoperative time period, no difference was seen in the reoperation rates (P = .73).
UNASSIGNED: Shorter duration of sling immobilization (two weeks) does not incur additional risk of complications compared to standard duration (six weeks) of sling immobilization following rTSA.

BACKGROUND: Riding lawn mower injuries are the most common cause of major limb loss in young U.S. children. Our study objective was to investigate the circumstances surrounding pediatric riding lawn mower injuries and to identify potential contributing risk factors and behaviors leading to these events.
METHODS: Followers/members of both a public and a private lawn mower injury support and prevention Facebook page who had or were aware of children who had suffered a lawn mower-related injury were invited to complete an electronic survey on Qualtrics. Duplicate cases and those involving push mowers were removed. Frequencies and chi-square analyses were performed.
RESULTS: 140 injured children were identified with 71% of surveys completed by parents and 19% by an adult survivor of a childhood incident. The majority of injured children were Caucasian (94%), male (64%), and ≤ 5 years of age at the time of the incident (63%). Bystanders were 69% of those injured, 24% were lawn mower riders, and mower operators and others accounted for 7%. The lawn mower operator was usually male (77%), being the father/stepfather in almost half. Overall, 59% of injuries occurred while traveling in reverse, 29% while moving forward. Nearly all (92%) had an amputation and/or permanent disability. Subgroup analysis (n = 130) found injured bystanders were younger than injured passengers with 71% versus 45% being < 5 years of age, respectively (p = 0.01). Over three-quarters of bystander incidents occurred while moving in reverse as compared to 17% of passenger incidents (p < 0.01). Amputations and/or permanent disabilities were greater among bystanders (97%) as compared to passengers (79%, p = 0.01). Only 3% of bystanders had an upper extremity injury as compared to 21% of passengers (p = 0.01). Seventy-three percent of bystander victims had received at least one ride on a lawn mower prior to their injury incident.
CONCLUSIONS: Child bystanders seriously injured by riding lawn mowers were frequently given prior rides likely desensitizing them to their inherent dangers and leading them to seek rides when mowers were being used. Engineering changes preventing blade rotation when traveling in reverse and not giving children rides (both when and when not mowing) may be critical in preventing mower-related injuries.

Following the publication of the above article, an interested reader drew to the authors\' attention that, in Fig. 2 on p. 1408, the microscopic images shown for the light scope images (upper row) and the green fluorescence images (lower row) appeared to be overlapping, such that these images appeared to have been derived from the same original sources even though they were intended to portray the results from differently performed experiments. After having re‑examined their figures, the authors realized that this figure was assembled incorrectly. The revised version of Fig. 2, showing the correct data for all four experimental panels, is shown below. Note that the errors made during the assembly of these figures did not affect the overall conclusions reported in the paper. All the authors agree with the publication of this corrigendum, and are grateful to the Editor of International Journal of Molecular Medicine for allowing them the opportunity to publish this. They also apologize to the readership for any inconvenience caused. [International Journal of Molecular Medicine 37: 1405‑1411, 2016; DOI: 10.3892/ijmm.2016.2539].

Diabetes constitutes a world-wide pandemic that requires searching for new treatments to halt its progression. Cellular senescence of pancreatic beta cells has been described as a major contributor to development and worsening of diabetes. The concept of reversibility of cellular senescence is critical as is the timing to take actions against this \"dormant\" senescent state. The reversal of cellular senescence can be considered as rejuvenation of the specific cell if it returns to the original \"healthy state\" and doesn\'t behave aberrantly as seen in some cancer cells. In rodents, treatment with senolytics and senomorphics blunted or prevented disease progression, however their use carry drawbacks. Modulators of cellular senescence is a new area of research that seeks to reverse the senescence. More research in each of these modalities should lead to new treatments to stop diabetes development and progression.

Over the last few decades, although the age-standardized mortality rate (ASMR) of injury has shown a significant declining trend in China, this pattern has dramatically reversed recently.
We aimed to elucidate the geographical, demographic, and temporal trends of cause-specific injuries, the reversal phenomenon of these trends, and the fluctuations of injury burden from 2005 to 2019 in China.
A longitudinal observational study was performed using the raw data of injury deaths in the National Cause-of-Death surveillance data provided by the disease surveillance points system in 2005-2019. The cause-specific injuries were divided into disparate subgroups by sex, age, urban/rural region, and eastern/central/western areas of China. The burden of injury was assessed using potential years of life lost (PYLL), average years of life lost (AYLL), and PYLL rate (PYLLR). Temporal trends of mortality rates and burden were evaluated using best-fitting joinpoint models.
Injury deaths accounted for 7.51% (1,156,504/15,403,835) of all-cause deaths in China in 2005-2019. The crude mortality rate of all-cause injury was 47.74 per 100,000 persons. The top 3 injury types (traffic accident, falls, and suicide) accounted for 70.57% (816,145/1,156,504) of all injury-related deaths. The ASMR of all-cause injury decreased (P=.003), while the crude mortality rate remained unchanged (P=.52) during 2005-2019. A significant reverse trend in ASMR of all-cause injury was observed in urban older adults since 2013, mainly due to the inverted trend in injuries from falls. A reverse trend in ASMR of suicide was observed among individuals aged 10-24 years, with notable increases by 35.18% (annual percentage change 15.4%, 95% CI 4.1%-28.0%) in men since 2017. The AYLL and PYLLR of all-cause injury among older adults showed consistent ascending trends from 2005 to 2019 (average annual percentage change [AAPC] 6.1%, 95% CI 5.4%-6.9%, 129.04% increase for AYLL; AAPC 5.4%, 95% CI 2.4%-8.4%, 105.52% increase for PYLLR). The AYLL due to suicide for individuals aged 10-24 years showed a considerable upswing tendency (AAPC 0.5%, 95% CI 0.4%-0.7%, 8.02% increase).
Although the ASMR of all-cause injury decreased in China from 2005 to 2019, the trend in suicide among adolescents and young adults and falls among older adults has been on the rise in recent years. Interventions should be encouraged to mitigate the cause-specific burdens of injury death.

UNASSIGNED: The aim of this systematic review was to summarize the clinical outcomes and associated predictors of outcomes for chronic glenohumeral dislocations treated with arthroplasty.
UNASSIGNED: A systematic literature search was performed with Embase, PubMed, CENTRAL, BIOSIS, and CINAHL databases from the inception of these databases through January 1, 2021 to identify all articles that examined outcomes or predictors of outcomes of arthroplasty in patients with chronic glenohumeral dislocations. Studies that examined outcomes for patients with a chronic glenohumeral dislocation (≥3 weeks) treated with hemiarthroplasty, anatomic total shoulder arthroplasty, or reverse total shoulder arthroplasty were included. Those with acute or subacute dislocations (<3 weeks), fracture dislocations, and those treated with joint preserving treatment modalities were excluded.
UNASSIGNED: We identified 195 articles; of which, 22 (201 patients/205 shoulders) met our inclusion criteria. A total of 14 studies reported outcomes of hemiarthroplasty, 10 studies reported outcomes of anatomic total shoulder arthroplasty, and 9 studies reported outcomes of reverse total shoulder arthroplasty. All studies documented clinical improvement after arthroplasty. Among 16 studies that measured range of motion, all 16 studies demonstrated improvement in range of motion postoperatively. Thirty-one reoperations (15%) were performed across all studies.
UNASSIGNED: We found improved clinical outcomes after arthroplasty for the treatment of chronic glenohumeral fewer dislocations at a long-term follow-up. Some evidence suggests that reverse total shoulder arthroplasty may have superior outcomes and less complications compared with hemiarthroplasty and anatomic total shoulder arthroplasty. There is insufficient evidence regarding the potential influence that duration of dislocation, direction of dislocation, addition of concomitant procedures, or humeral component retroversion have on outcomes.