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for the treatment of comminuted isolated greater tuberosity fractures as it provided reliable stability and satisfactory radiographic and functional results. The described technique is a simple and effective method and provides a new reliable option for the treatment of isolated greater tuberosity fractures.

Patients with subacromial pain syndrome (SAPS) frequently present with coexisting psychosocial problems; however, whether this also associates with long-term outcome is currently unknown. We assessed whether psychosocial functioning in patients with SAPS is associated with persistence of complaints after 4 years of routine care.

In a longitudinal study, 34 patients with SAPS were selected after clinical and radiologicevaluation and assessed at baseline and after 4 years. For the assessment of psychosocial functioning, the RAND-36 questionnaire domains of social functioning, role limitations due to emotional problems, mental health, vitality, and general health were evaluated. Complaintpersistence at follow-up was assessed by (1) an anchor question (reduced, persistent, or increased symptoms), (2) change in pain (change in visual analog scale score), and (3) change in quality of life (change in Western Ontario Rotator Cuff index score).

Lower baseline mental health (odds ratio [OR], 0.92; 95% confidence ies may investigate whether a multimodal treatment with assessment of psychosocial functioning may facilitate pain relief and recovery in SAPS.

This study aimed to determine the prevalence of the Buford complex and to investigate its association with labral pathologies (superior labrum anterior-posterior [SLAP] lesion and anterior, posterior, or multidirectional instability) using a very large patient database. Furthermore, the prevalence of the Buford complex in patients without any labral pathology was also determined.

A total of 3129 consecutive shoulder arthroscopy procedures were retrospectively evaluated for the presence of the Buford complex and coexisting labral pathologies. The relationships between the Buford complex and SLAP lesions, as well as instability, were evaluated statistically.

The Buford complex was observed in 83 shoulders (2.65%). SLAP lesions were significantly more frequent in patients with the Buford complex than in those without it (81.9% vs. 33.1%, P < .001) Shoulders with the Buford complex presented a lower frequency of anterior instability (10.8% vs. 19.3%, P = .052) and a higher frequency of posterior instabilhan that reported previously. In addition to the aforementioned conclusions, the identification of the Buford complex should prompt a thorough evaluation for concomitant SLAP lesions.

Studies evaluating the mid-term performance of reverse shoulder arthroplasty (RSA) have identified a drop in the Constant-Murley score between 6 and 8 years after surgery, which is most affected by a loss of forward elevation and strength. Alterations of the deltoid length and moment arm after RSA leadto nonphysiological stress on the deltoid muscle. Concern has arisen that the long-term implications of increased deltoid work may be causing "deltoid fatigue." The purpose of this study was to evaluate the long-term effects of RSA on overhead range of motion (ROM) and validate the hypothesis of deltoid fatigue.

We performed a retrospective review of 165 RSAs over a 5-year period. Diagnoses were limited to cuff tear arthropathy, osteoarthritis with rotator cuff deficiency, and irreparable rotator cuff tear. All procedures were performed using a single implant system. Patients were evaluated longitudinally at multiple time points. They were required to undergo a minimum of 3 follow-up visits, with at least 1 ogressive decline in overhead ROM in well-functioning RSA shoulders was observed, averaging 0.8° of overhead ROM per year. This progressive deterioration occurs at a slightly greater rate than that observed in the natural shoulder. The observed rate of functional decline was found to be independent of age, sex, and preoperative diagnosis.

This study challenges the previous theory of deltoid fatigue resulting in a significant loss of overhead ROM beginning 6-8 years after index arthroplasty. However, a slower progressive decline in overhead ROM in well-functioning RSA shoulders was observed, averaging 0.8° of overhead ROM per year. CHIR-99021 order This progressive deterioration occurs at a slightly greater rate than that observed in the natural shoulder. The observed rate of functional decline was found to be independent of age, sex, and preoperative diagnosis.

There is a growing population of transplant survivors receiving both a solid organ (SOT) and a hematopoietic cell transplantation (HCT). This group remains underreported and not well described.

We conducted a single center retrospective study aimed at assessing safety and long-term survival outcomes of 40 patients receiving both HCT and SOT at the University of Minnesota.

We conducted a retrospective analysis of HCT and SOT research databases at the University of Minnesota. We descriptively assessed characteristics and overall survival for patients receiving either a HCT with subsequent SOT (n=27) or patients receiving an SOT with subsequent HCT (n=13).

Twenty-seven patients underwent HCT followed by SOT (13 kidney, 10 lung, 2 liver, 1 heart, 1 heart/kidney) with median age of 40 years (range 5-72) at time of SOT at a median of 88 months (range 24-302) following the HCT. The 1, 5 and 10-year overall survival (OS) from the SOT was 93%, 76%, and 49% respectively with only 4 organ failures reported. Thirgs show that in a select patient population, undergoing a second transplant at a specialized center can lead to favorable outcomes with long-term survival and low incidence of graft rejection, organ failure and malignant disease relapse. A large-scale study is needed to determine the incidence and risk factors preferred for a successful subsequent SOT or HCT. Those studies are crucial to further guide selection and management of patients who would benefit most from a second transplant.Outcomes of patients with primary refractory diffuse large B cell lymphoma (DLBCL) are dismal. The role of autologous hematopoietic cell transplant (autoHCT) in this population is not well defined in the modern era. Most data sets combine these patients with those with relapsed disease. We report the outcomes of autoHCT in patients with primary refractory DLBCL that subsequently demonstrated chemosensitive disease with salvage therapies, using the Center for International Blood and Marrow Transplant Research registry. Between 2003 and 2018, 169 patients met the inclusion criteria. The median age of the cohort was 54 years, and 64% were male. The patients had advanced stage disease (73%) at diagnosis, 27% patients had stable disease, and 73% had progressive disease after frontline chemoimmunotherapy. Following salvage therapy, 36% patients were in complete remission (CR) and 64% in partial remission (PR). Nonrelapse mortality, progression/relapse, progression-free survival (PFS), and overall survival of this cohort at 4 years were 10.

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