Nielsenbean8679

OBJECTIVE We sought to understand factors associated with refusal of adjuvant radiotherapy in endometrial cancer and its impact on outcomes. METHODS Data from the National Cancer Database for patients who underwent surgery for nonmetastatic endometrial cancer between 2004 and 2015 were pooled. The Pearson χ test and multivariate logistic regression analyses were used to assess demographic, clinical, and treatment factors. Inverse probability of treatment weighting was used to account for differences in baseline characteristics. Kaplan-Meier analyses and doubly-robust estimation with multivariate Cox proportional hazards modeling were used to analyze overall survival (OS). RESULTS We identified 4739 of 80,803 patients (5.9%) who refused radiotherapy. Factors associated with refusal were no insurance (relative risk [RR]=1.66, P$63,000 (RR=0.89, P=0.044), undergoing chemotherapy (RR=0.17, P less then 0.01), FIGO stages IB (RR=0.81, P less then 0.01) and II (RR=0.70, P less then 0.01) disease, and lymphadenectomy (RR=0.79, P less then 0.01). After weighting, 5-year OS was significantly lower with refusal (74.3% vs. 79.7%, P less then 0.01). This survival decrement was maintained across FIGO stages. CONCLUSIONS We identified characteristics associated with radiation refusal, including socioeconomic barriers, advanced disease stage, and histology. MAPK inhibitor Refusal of radiotherapy conferred decreased OS across FIGO stages.Notable advances in hip arthroplasty implants and techniques over the past 60 years have yielded excellent survivorship of fully cemented, hybrid, and reverse hybrid total hip replacements as demonstrated in joint registries worldwide. Major advances in noncemented implants have reduced the use of cement, particularly in North America. Noncemented implants predominate today based on procedural efficiency, concern related to thromboembolic risk, and a historic belief that cement was the primary cause of osteolysis and implant loosening. With the decline of cemented techniques, press-fit fixation has become common even in osteoporotic elderly patients. Unfortunately, there is a troubling rise in intraoperative, as well as early and late postoperative periprosthetic fractures associated with the use of noncemented implants. Despite the success of noncemented fixation, an understanding of modern cement techniques and cemented implant designs is useful to mitigate the risk of periprosthetic fractures. Cemented acetabular components can be considered in elderly patients with osteoporotic or pathologic bone. Cemented stems should be considered with abnormal proximal femoral morphology, conversion of failed hip fixation, inflammatory arthritis, patient age over 75 (especially women), osteoporotic bone (Dorr C), and in the treatment of femoral neck fractures.INTRODUCTION Maternity leave among orthopaedic surgeons is not well understood. This study seeks to quantify past and current maternal leave characteristics of female orthopaedic surgeons. METHODS A survey was distributed to the members of the Ruth Jackson Orthopaedic Society and Women in Orthopaedics, an online group exclusive to female orthopaedic surgeons in practice or in training. The survey was open from April 2018 to October 2018 with access gained by way of a web-based link. Respondents were queried regarding demographics and maternity leave characteristics including age at conception, length of leave given/taken, and cost. RESULTS A total of 801 surveys were completed with 452 surveys returning with information regarding past pregnancies. Of the 452 surgeons with children, the average leave offered was 4.6 ± 4.2 weeks for the first child, with 8.2 ± 7.4 weeks taken. A difference was observed (P less then 0.001) between the amount of leave taken between residents (6.3 ± 5.0 weeks), fellows (8.3 ± 7.2 weeks), and practicing surgeons (9.6 ± 8.5 weeks). The average cost of the first leave was $40,932 ± 61,258. The average cost during training was different than during practice ($154 versus $45,350, P less then 0.001). The length of leave offered (P = 0.05) and taken (P less then 0.001) affects the cost, whereas delivery type, timing of stopping clinic, taking calls, and operating did not. Each additional week of leave offered saved a surgeon $2,583, and each additional week taken cost $3,252. DISCUSSION Residents take shorter leaves than fellows and attendings. The cost of taking leave is substantial, and the cost during practice is higher than during training. The amount of leave taken is greater than the amount of paid leave offered.The ideal solution for the irreparable rotator cuff tear remains in question. A recent innovative technique, superior capsular reconstruction (SCR), has demonstrated promising results with some early clinical outcomes demonstrating statistically notable improvements in active forward flexion and American Shoulder and Elbow Surgeons scores. Multiple biomechanical studies have also demonstrated its ability to reduce superior translation of the humerus after massive rotator cuff tear. Even so, these results are still early and durability of the reconstruction over time needs to be determined. Although more than 15,000 SCRs have been done worldwide, there remains a paucity of outcome data and one must be vigilant to not allow enthusiasm to overtake critical evaluation. The potential mechanisms of action, including tenodesis effect, force coupler, or subacromial spacer, need further elucidation and the ideal indications for this procedure, as well as its technical optimization, and limitations have yet to be fully determined. The purpose of this review is to critically evaluate the biomechanical and clinical literature that has assessed SCR, along with the controversies and considerations encountered with this procedure.PURPOSE To evaluate uveal biocompatibility and capsular bag opacification of a new hydrophobic acrylic microincision intraocular lens (IOL) in comparison with a commercially available 1-piece hydrophobic acrylic IOL. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Eight New Zealand rabbits underwent bilateral phacoemulsification and implantation of the preloaded Nanex multiSert IOL in one eye and a commercially available preloaded lens (AcrySof IQ in UltraSert, model AU00T0) in the contralateral eye. A slitlamp examination was performed weekly for 4 weeks. The rabbits were then killed humanely and their globes enucleated. Capsular bag opacification was assessed from the Miyake-Apple view, and the eyes were subjected to histopathologic evaluation. RESULTS Postoperative inflammatory reactions were similar between the test and control eyes in the 8 New Zealand rabbits. The mean postmortem central posterior capsule opacification (PCO) was 0.93 ± 0.