Near‐complete aortic mechanical valve dehiscence due to endocarditis reinfection

Prosthetic valve infective endocarditis (IE) is one of the most serious postimplantation complications. Prosthetic aortic valve IE constitutes 1%–6% of all prosthetic valve IE cases. We present a dramatic echocardiographic case of prosthetic aortic valve IE leading to near‐complete valve dehiscence. Echocardiographic evidence of prosthetic aortic valve rocking motion is indicative of significant dehiscence. Aside from IE, other causes and risk factors for prosthetic aortic valve dehiscence include inflammatory and autoimmune vasculitides, concomitant ascending aorta aneurysm, and aortic root calcification.     

Injury Due to Mechanical Falls: Future Directions in Gender‐specific Surveillance,Screening, and Interventions in Emergency Department Patients

The Centers for Disease Control and Prevention report that among older adults (≥65 years), falls are the leading cause of injury‐related death. Fall‐related fractures among older women are more than twice as frequent as those for men. Gender‐specific evidence‐based fall prevention strategy and intervention studies show that improved patient‐centered outcomes are elusive. There is a paucity of emergency medicine literature on the topic. As part of the 2014 Academic Emergency Medicine (AEM) consensus conference on “Gender‐Specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes,” a breakout group convened to generate a research agenda on priority questions to be answered on this topic. The consensus‐based priority research agenda is presented in this article.     

Body mass index is a predictor of discharge to a postacute care facility following total shoulder arthroplasty

BackgroundThe purpose of this study is to evaluate the effect of body mass index (BMI) on discharge to a postacute care (PAC) facility following elective total shoulder arthroplasty (TSA).MethodsThe National Surgical Quality Improvement Program database was queried to identify adult patients (>18 years old) who underwent inpatient TSA for primary osteoarthritis between 2005 and 2018. Hemiarthroplasty, revision TSA, trauma indications, and outpatient procedures were excluded. Patient and perioperative data were identified. Univariate analysis and multivariate logistic regression were used to assess the relationship between BMI and discharge to PAC facilities.ResultsA total of 10,198 patients with a primary TSA were identified. The majority (93%) of patients were discharged home vs. 7% to PAC facilities. Patients discharged to PAC had significantly higher mean BMI (P = .006). After controlling for demographic and comorbid factors, BMI was the only modifiable risk factor that was independently associated with an increased risk of discharge to a PAC. For every increase in BMI point, there was an increased risk of discharge to a PAC by 2.9% (odds ratio [OR] 1.029, confidence interval [CI] 1.016-1.041, P < .001). Additional covariates associated with PAC discharge were older age (OR 1.113, CI 1.099-1.127, P < .001), female gender (OR 3.037, CI 2.489-3.705, P < .001), and dependent functional status (OR 8.322, CI 5.544-12.492, P < .001).ConclusionMost patients undergoing TSA were discharged home following surgery. While age, sex, and functional status also affect disposition, elevated BMI is the only modifiable risk factor that independently predicts PAC discharge. Consideration of patient BMI prior to elective TSA may greatly improve discharge planning and management of patient expectations.     

Mesenchymal progenitor cells derived from traumatized muscle enhance neurite growth

The success of peripheral nerve regeneration is governed by the rate and quality of axon bridging and myelination that occurs across the damaged region. Neurite growth and the migration of Schwann cells is regulated by neurotrophic factors produced as the nerve regenerates, and these processes can be enhanced by mesenchymal stem cells (MSCs), which also produce neurotrophic factors and other factors that improve functional tissue regeneration. Our laboratory has recently identified a population of mesenchymal progenitor cells (MPCs) that can be harvested from traumatized muscle tissue debrided and collected during orthopaedic reconstructive surgery. The objective of this study was to determine whether the traumatized muscle‐derived MPCs exhibit neurotrophic function equivalent to that of bone marrow‐derived MSCs. Similar gene‐ and protein‐level expression of specific neurotrophic factors was observed for both cell types, and we localized neurogenic intracellular cell markers (brain‐derived neurotrophic factor and nestin) to a subpopulation of both MPCs and MSCs. Furthermore, we demonstrated that the MPC‐secreted factors were sufficient to enhance in vitro axon growth and cell migration in a chick embryonic dorsal root ganglia (DRG) model. Finally, DRGs in co‐culture with the MPCs appeared to increase their neurotrophic function via soluble factor communication. Our findings suggest that the neurotrophic function of traumatized muscle‐derived MPCs is substantially equivalent to that of the well‐characterized population of bone marrow‐derived MPCs, and suggest that the MPCs may be further developed as a cellular therapy to promote peripheral nerve regeneration. Copyright © 2012 John Wiley & Sons, Ltd.