BACKGROUND:Bone cement implantation syndrome (BCIS) is a life-threatening risk of cemented stems. There are limited methods to prevent BCIS and few published studies. A survey of the Musculoskeletal Tumor Society (MSTS) surgeons was conducted to evaluate their experiences with BCIS. A novel stem designed to reduce intramedullary pressure during insertion was evaluated. METHODS:A survey was distributed to MSTS members, and data was collected. The novel stem featured a hollow longitudinal channel, an entry hole at the tip, and an egress hole at the collar for cement to flow from the intramedullary canal during insertion. Bending stiffness was compared using finite element analysis to a standard solid stem. Stems were cemented into cadaveric femurs. Specimens were loaded with 8000 N tensile force and then maximally torqued until failure. Intramedullary pressures were measured for novel and standard stems cemented into sawbones. RESULTS:In 107 survey responses, 58% (n = 63) experienced severe BCIS, and 83% (n = 52) of those had ≥1 death from BCIS complications. Many surgeons avoid cementing long stems, and 78% (n = 14) report concern for BCIS as the reason. Seventy-nine percent (n = 84) use an average of 4.75 different methods to reduce BCIS risk. The novel stem demonstrated 2.8% reduced bending stiffness. When cemented into cadaveric bone, both stem designs achieved 8000 N of tensile force, and there was no significant difference in torque failure (140.6 Nm in the novel stem; 128 Nm in the standard stem). The average peak pressure was significantly lower for the novel stem (77 psi vs. 151 psi). CONCLUSIONS:The majority of surgeons have concerns regarding BCIS based on their experience and use multiple methods to reduce risk. A novel stem can reduce the intramedullary insertion pressure by approximately half and possibly reduce the risk of BCIS. Testing demonstrates similar stiffness and stability compared to standard solid stems.

AbstractCoronavirus disease (COVID)-related misinformation is prevalent online, including on social media. The purpose of this study was to explore factors associated with user engagement with COVID-related misinformation on the social media platform, TikTok. A sample of TikTok videos associated with the hashtag #coronavirus was downloaded on September 20, 2020. Misinformation was evaluated on a scale (low, medium, and high) using a codebook developed by experts in infectious diseases. Multivariable modeling was used to evaluate factors associated with number of views and presence of user comments indicating intention to change behavior. One hundred and sixty-six TikTok videos were identified and reviewed. Moderate misinformation was present in 36 (22%) videos viewed a median of 6.8 million times (interquartile range [IQR] 3.6–16 million), and high-level misinformation was present in 11 (7%) videos viewed a median of 9.4 million times (IQR 5.1–18 million). After controlling for characteristics and content, videos containing moderate misinformation were less likely to generate a user response indicating intended behavior change. By contrast, videos containing high-level misinformation were less likely to be viewed but demonstrated a nonsignificant trend towards higher engagement among viewers. COVID-related misinformation is less frequently viewed on TikTok but more likely to engage viewers. Public health authorities can combat misinformation on social media by posting informative content of their own.

Background:Female Reddit users frequently discussed potential causes of orgasm difficulties and its implications on mental health and relationships.Aim:This study aimed to evaluate the experiences of women discussing orgasms on the Internet site Reddit. We sought to qualitatively analyze the topics that arose in users' discussions to better understand the potential causes of orgasm difficulties and its implications on quality of life.Methods:Posts on the subreddit r/TwoXChromosomes containing the keywords "orgasm" and "climax" were included in the dataset. Posts and their associated comments were qualitatively analyzed using the grounded theory approach. Two independent researchers coded each thread to identify dominant themes and emergent concepts.Outcomes:The most frequently coded primary topics included: (1) orgasm (32.2% [n = 337]), (2) psychological (17.8% [n = 186]), (3) relationships (15.4% [n = 161]), and (4) treatment (10.7% [n = 112]).Results:Qualitative analysis of 107 threads and approximately 6300 comments resulted in 5 major categories: psychological aspect of orgasms, difficulty orgasming with partners, partners' responses to orgasmic dysfunction, types of orgasms, and treatments for orgasmic dysfunction. Preliminary themes included (1) the presence of an emotional component or history of trauma related to orgasmic difficulty, (2) difficulty orgasming with a partner regardless of ability to orgasm during masturbation and a variety of stimulation required to orgasm, (3) mixed partner responses to orgasmic dysfunction, (4) the definition of a normal orgasm, and (5) self-motivated treatment for orgasmic dysfunction, including clitoral stimulation devices and masturbation techniques. Notably, few posters discussed their orgasmic dysfunction with healthcare providers.Clinical Translation:The study reveals insights into the possible causes, psychosocial implications, and treatment of orgasm difficulties from a patient perspective, and can guide future research on female orgasms in a more precise, patient-oriented direction.Strengths and Limitations:The anonymous nature of the forum allowed for insight into sensitive topics related to female orgasms and sexual trauma. Limitations include the demographic distribution of Reddit users, which was primarily younger women in their 20s and 30s, which restricts generalizability.Conclusion:Reddit provides a medium for individuals with orgasm difficulties to discuss their experiences. Posts addressed users' inability to orgasm, their mental health and relationships, the stimulation required for orgasm, and treatments for orgasmic dysfunction. Interestingly, very few posts discussed healthcare, potentially suggesting that women do not classify their orgasmic dysfunction as a health issue.

BackgroundThe true prevalence of low sexual desire among women is disputed among researchers due to the complex nature and presentation of women's sexual problems.AimTo qualitatively analyze the aspects of libido/sexual desire frequently discussed by Reddit users and compare them with the current understanding of female sexual well-being and sexual desire disorders.MethodsBy using the Reddit application programming interface, the TwoXChromosomes subreddit was queried for posts with the keywords libido and sex drive. Posts that were deleted or unrelated to themes of libido/sex drive were excluded. A total of 85 threads-63 queried from the keyword libido and 22 from sex drive-and approximately 2900 comments were qualitatively analyzed per the grounded theory approach. Five independent researchers read and coded each thread to identify dominant themes and emergent concepts.OutcomesOutcomes of interest included codes related to sexual dysfunction, libido, orgasm, masturbation, types of sex, psychology, relationships, intimacy, treatment, medications, and health care.ResultsPosters were primarily heterosexual women in their 20s and 30s. The code categories with the highest frequency were relationships (22.7%, n = 272), libido (22.2%, n = 210), psychological (20.2%, n = 191), medications (7.29%, n = 69), and intimacy (6.0%, n = 57). Users frequently described a decrease in libido secondary to medications, particularly antidepressants and hormonal birth control. Many users discussed the challenges of navigating a relationship with low sexual desire and the resulting sexual distress. Posters described feelings of sadness, anxiety, and guilt due to their low desire. Additionally, users discussed the role that sex plays in relationships, whether as a way to develop intimacy between partners or to achieve orgasm. Finally, posters expressed dissatisfaction with health care addressing their concerns surrounding sexual desire.Clinical ImplicationsThe study findings-namely, the impact of medications on sexual health, the interaction of sexual desire and mental health, and cited examples of inadequate sexual health care-can help guide sexual well-being research, diagnosis, and public policy.Strengths and LimitationsUsing Reddit as a data source allowed for the analysis of women's experiences outside the preestablished concepts of female sexual desire. Limitations to the study include the potential for posts to be deleted by moderator guidelines, the young demographic distribution of Reddit users, and the popularity-based structure of subreddit threads.ConclusionOur results emphasize the psychosocial aspects of sexual desire and the need to redefine sexual problems to encompass the complex nature of female sexual well-being.

Objectives: Describe patient-reported pain and function within 24 months of a pelvic fracture treated with posterior screw fixation and identify factors associated with increased pain. Design: Prospective case series. Setting: Academic trauma center. Patients/Intervention: Eighty-eight patients with adult pelvic fracture treated with sacroiliac or transiliac screws. Main Outcome Measures: Average pain measured with the Brief Pain Inventory (BPI); function measured with the Majeed Pelvic Outcome Score from 6 to 24 months postinjury. Results: The mean pain from 6 to 24 months postinjury was 2.22 on the 10-point BPI scale (95% CI, 0.64-3.81). Sixty-nine patients (78.4%) reported mild to no pain at 6 months; 12 (13.6%) patients had severe pain. Two years after injury, 71 patients (80.6%) exhibited mild to no pain. Within 24 months of injury, the mean pelvic function was 71 on the 100-point Majeed scale (95% CI, 60-82). Half of the sample (n = 44) had good to excellent pelvis function by 6 months postinjury; 55 patients (62.5%) attained this level of function by 24 months. A history of chronic pain (1.31; 95% CI, 0.26-2.37; P = 0.02), initial fracture displacement (>= 5 mm) (0.99; 95% CI, 0.23-1.69; P = 0.01), and socioeconomic deprivation (0.28; 95% CI, 0.11-0.44; P < 0.01) were significantly associated with increased pain. Conclusion: Our findings suggest that most patients with unstable pelvic ring fractures treated with posterior screw fixation achieve minimal to no pelvis pain and good to excellent pelvic function 6-24 months after injury.

ABSTRACT Introduction Female sexual dysfunction (FSD) encompasses difficulties with sexual desire, libido, arousal, orgasm and pain. These medical problems are often multi-factorial in origin and can cause significant distress to patients. FSD can be a particularly sensitive topic to discuss, and patients may not feel comfortable seeking help from healthcare providers. Objective We aimed to evaluate the experience of women with low libido on Reddit, an anonymous forum-based platform that allows users to interact with a global audience, to gain a better understanding of how FSD affects patients. Methods The subreddit “TwoXChromosomes” was queried using the Reddit Application Programming Interface (API) for posts using the keywords “libido” and “sex drive”. Posts that were deleted, archived or unrelated to themes of FSD were excluded. Threads were qualitatively analyzed using the grounded theory approach. Five independent researchers read and coded each thread identifying dominant themes and emergent concepts. Results Qualitative analysis of eighty five threads and approximately 2,900 comments resulted in 5 preliminary themes: medications effects on libido, the interplay between libido and relationships, the purpose of sex, the psychological impact of FSD, and challenges with healthcare. Users frequently described a decrease in libido secondary to medications, particularly antidepressants and hormonal birth control, with resolution upon stopping or switching medications. Users with low libido also reported positive sexual/romantic relationships, suggesting that their sexual dysfunction is unrelated to their partner; however, many posters discussed the challenges navigating a relationship with mismatched libido. Users discussed the role sex plays in relationships, whether as way to develop intimacy between partners or to achieve orgasm. Additionally, users described feeling distressed and anxious about their FSD. Finally, posters expressed dissatisfaction with healthcare providers and the healthcare system when trying to address their concerns. Conclusions Reddit serves as a resource and support group for users experiencing FSD. Posters share their experiences with low libido and its effect on their relationships. Many women discussed various psychological consequences of FSD, which suggests that a patient-centered approach is critical in managing FSD. Similarly, our research demonstrates a gap between provider based sexual health care concerns and patient concerns, emphasizing the need for greater awareness of and improved provider education about FSD. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout (Raliegh, NC), Absorption Pharmaceuticals, Urovant Sciences, Inc.

Fibrosis and adipogenesis can occur within the associated muscles of injured or diseased tendons. While these degenerative changes can have a significant impact on clinical outcomes, there are no therapies that reduce these changes and enhance native tissue regeneration. The purpose of this review is to summarize the biological mechanisms involved in fibroadipogeneis and identify potential therapeutic targets for future research. Fibrosis and adipogenesis are mediated by a PDGFRα+ stem cell population in both skeletal muscle and tendon. Macrophages play a role in recruitment and proliferation of these cells to the injury site. In tendon stem cells, adipogenesis results from activation of various signaling pathways with downstream effects on PPARγ and C/EBPα. PDGFRα signaling and stem cells may be therapeutic targets to reduce fibroadipogenesis and improve healing in damaged tendons. Further research should determine the exact mechanisms through which stem cells promote these degenerative changes.