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(83%, 810 of 980) were revised to a TKA. CONCLUSIONS The revision risk of PFA in all registries surveyed was more than three times higher than the reported revision risk of TKA at the same times. The survivorship of PFA is similar to that of the no-longer-used procedure of metal-on-metal conventional hip replacement. Although there may be potential functional benefits from PFA, these findings of consistent and alarmingly high rates of revision should create concern, particularly as this procedure is often used in younger patients. LEVEL OF EVIDENCE Level III, therapeutic study.BACKGROUND Lewinnek's recommendation for orienting the cup in THA is criticized because it involves a static assessment of the safe zone and because it does not consider stem geometry. A revised concept of the safe zone should consider those factors, but to our knowledge, this has not been assessed. QUESTIONS/PURPOSES (1) To determine the shape, size, and location of target zones for combined cup and stem orientation for a straight stem/hemispheric cup THA to maximize the impingement-free ROM and (2) To determine whether and how these implant positions change as stem anteversion, neck-shaft angle, prosthetic head size and target range of movements are varied. METHODS A three-dimensional computer-assisted design model, in which design geometry was expressed in terms of parameters, of a straight stem/hemispheric cup hip prosthesis was designed, its design parameters modified systematically, and each prosthesis model was implanted virtually at predefined component orientations. Functional component orientation ris study accurately defines the hypothetical impingement-free, design-specific component orientation in THA. Transforming it into clinical precision may be the case for navigation and/or robotics, but this is speculative, and as of now, unproven.BACKGROUND Ceramic bearings in THA have been used to reduce wear and, more recently, to avoid metals in the bearing because of the risk of metal ions adverse effects. Potential disadvantages to ceramic bearings are their brittleness and the ceramic fracture risk, which may lead to revision surgery. The frequency of revision for a fracture ceramic bearing, however, has not been thoroughly studied. QUESTIONS/PURPOSES (1) What is the frequency of revision for a fractured ceramic bearing in ceramic-on-polyethylene (CoP) and ceramic-on-ceramic (CoC) THAs, and is there any difference between alumina ceramics and alumina matrix composites (AMC)? (2) What are the factors associated with this complication? (3) To what extent did the patients who underwent revision for a fractured ceramic bearing undergo subsequent revisions, and for what reason? METHODS The Norwegian Arthroplasty Register has collected data on hip arthroplasty since 1987 and has a completeness of reporting of 97.3% for primary THAs and 93.3% for revisrticulations and in males. Bearings made of AMC appear to be at lower risk than those made from alumina ceramics. However, the long-term clinical wear performance of AMC bearings has not been extensively studied and should be studied further. LEVEL OF EVIDENCE Level III, therapeutic study.Tofacitinib is a novel oral janus kinase (JAK) inhibitor approved for the treatment of psoriatic arthritis. It was also investigated for the treatment of plaque psoriasis, although it is not approved by the Food and Drug Administration for this indication. This article aims to summarize the efficacy and safety data of tofacitinib for treatment of psoriatic disease. A comprehensive review of literature was conducted on the PubMed database using the search terms "((tofacitinib) AND (psoriasis)) OR ((tofacitinib) AND (psoriatic arthritis))". Data from the pivotal clinical trials evaluating tofacitinib in the treatment of psoriatic disease were summarized. The Oral-treatment Psoriasis Trial (OPT) study series demonstrated that tofacitinib is efficacious in the treatment of plaque psoriasis with an acceptable safety profile. The OPT studies also demonstrated the non-inferiority of tofacitinib 10mg twice daily compared to etanercept. The Oral Psoriatic Arthritis triaL (OPAL) study series demonstrated that tofacitinib significantly improved psoriatic arthritis outcomes compared to placebo and had an acceptable safety profile. Its efficacy is comparable to adalimumab in psoriatic arthritis. Patients treated with tofacitinib should be monitored for herpes zoster, malignancies, blood clots, and changes in laboratory values. Overall, tofacitinib is a useful new systemic agent in the treatment of psoriatic disease. Its oral route of administration, novel JAK pathway target, short half-life, and strong recapture rates after treatment interruption make it a unique new tool for psoriatic disease management. Further long-term studies will help determine its role in the treatment algorithm for psoriatic arthritis and its indication for plaque psoriasis.Inflammatory response in the skin is important for host defence against a broad spectrum of insults including microorganisms, chemicals, radiation and physical trauma. When the inflammatory process becomes prolonged and self-perpetuating, illness occurs. In this review, we discuss recent findings regarding the complex inflammatory mechanisms in allergic contact dermatitis, atopic dermatitis and psoriasis.BACKGROUND Seborrheic keratosis is a benign skin tumour. None of the common therapies is satisfactory. This study compared the efficacy of 30% hydrogen peroxide versus 50% trichloroacetic acid in treatment of seborrheic keratoses. Triapine in vitro METHODS This unblinded, comparative interventional study was conducted on 85 patients of seborrheic keratosis. Lesions were graded using physician's lesion assessment (PLA) scale (0, clear; 1, nearly clear; 2 ≤1mm thick; 3 ≥1mm thick). Patients were randomly assigned into two groups A and B. Five target seborrheic keratosis lesions with PLA score of three were selected in each patient. Group A was treated with 30% hydrogen peroxide and group B with 50% trichloroacetic acid. Both groups received treatment every week up to 5 weeks or till complete resolution of lesions. Clinical photographs of all patients were taken every 2 weeks. RESULTS Both the groups were comparable in terms of age and sex. At the end of 6 weeks, lesions were cleared completely in 41.8% of patients in group A and in 23.8% in group B. Mean PLA score decreased significantly in group A from 3 to 1.79 (40.3%) at 2 weeks and to 0.63 (79%) at 6 weeks (p less then 0.001). The decrease in PLA score in group B was 2.41 (19.7%) and 1.13 (62.3%) at 2, and 6 weeks respectively (p less then 0.001). Hydrogen peroxide produced greater clearance of seborrheic keratosis (p=0.017) than trichloroacetic acid. Also, no major adverse effects were observed in the two groups. CONCLUSIONS Application of 30% hydrogen peroxide appears to be more efficacious as compared to trichloroacetic acid (50%) for treatment of seborrheic keratosis.BACKGROUND Cancer survivors are rising up, but this better survival is accompanied by possible treatments side-effects. In particular, cardiovascular effects are commonly reported, even if vascular damage is not necessarily connected to clinical manifestations. Periungual microcyrcle evaluation through capillaroscopy could identify asymptomatic patients with high risk of cerebro-cardio- vascular disease. The aim of this pivotal study is to evaluate videocapillaroscopy in patients who undergo chemotherapy, in order to understand if it could represent in future a prognostic tool to predict the risk of cardio-cerebro-vascular events. METHODS We conducted an open-label, uncontrolled study. Patients affected by solid tumors were enrolled. Each subject underwent a clinical evaluation and a videocapillaroscopic examination. RESULTS We selected 25 patients. Mean age was 55.48 years. Time interval between the start of chemotherapy and capillaroscopy average 41 months. From our analysis it emerges that ectasia and hemorrhages could be a possible markers of capillary insult caused by chemotherapy. CONCLUSIONS Our study shows the presence of capillaroscopic features that may be peculiar in chemotherapy-induced endothelial damage. The individuation of capillaroscopic alteration specific for chemotherapy-induced endothelial injury could be an important tool to identify patients with high cardiovascular risk.INTRODUCTION Calcium channel blockers (CCBs) are commonly used but have the potential to cause substantial toxicity. One such underreported toxicity of CCB use is the development of acute respiratory distress syndrome (ARDS). CASE PRESENTATION 44-year-old previously healthy woman presented to the emergency department (ED) having taken 60 tablets of 125 mg extended-release verapamil and 90 tablets of 0.25 mg clonazepam with the intent to commit suicide. On presentation to the ED, she was sedated and intubated for airway protection. She received aggressive medical resuscitation and was ventilated using low tidal volume mechanical ventilation. The hospital course was complicated by worsening hypoxia and a chest x-ray demonstrating bilateral patchy geographic areas of airspace opacities consistent with ARDS. On day 5 of hospitalization, the patient's clinical status improved significantly, and she was subsequently weaned off vasopressors and extubated. DISCUSSION CCB toxicity can result in profound hypotension, shock, bradycardia, and conduction blocks, as well as hyperglycemia, acidosis and acute kidney injury, and ARDS. It is important for clinicians to understand the signs and symptoms of CCB toxicity, as well as how to treat it. Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.INTRODUCTION Methicillin-resistant staphylococcus aureus (MRSA) bacteremia is a life-threatening illness and a major global health care problem. It can cause metastatic and complicated infections. CASE PRESENTATION A 58-year-old man with uncontrolled type 2 diabetes mellitus presented with altered mental status after a fall. He was found to have a hip fracture, diabetic ketoacidosis, and MRSA bacteremia. This was complicated by septic knee arthritis, prostatic abscess, intraretinal abscess, periapical abscesses, and pulmonary abscesses. He was treated with intravenous vancomycin and oral linezolid and eventually recovered. DISCUSSION Severe metastatic MRSA infection was likely due, in part, to the patient's uncontrolled diabetes, as he has no underlying immunodeficiency and was HIV negative. Prostatic abscesses are a relatively rare occurrence that typically develop in immunocompromised patients. CONCLUSION This case is an interesting confluence of sequelae of MRSA bacteremia and reinforces the necessity for clinicians to be diligent when evaluating a patient with a suspected prostatic abscess. Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.BACKGROUND Associations between poor health and sociodemographics exist, but the role of coping strategies in this relationship is understudied. Therefore, we examined how adaptive and maladaptive coping affected the relationship between social determinants of health and health outcomes. METHODS Participants completed survey questions about demographics, health status, and coping strategies. Mediation analyses examined whether education, income, and race affected health status indirectly through coping behaviors. RESULTS Maladaptive, but not adaptive, coping strategies, mediated the relationship between income and health and education and health. DISCUSSION The use of maladaptive coping strategies plays an intervening role in the relationship between income and health and education and health for some groups. Recommendations for promoting education and policies to reduce the use of maladaptive coping are discussed. Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.