Purpose To compare clinical and magnetic resonance imaging results of patients who underwent superior capsule reconstruction with a 3 mm (Group 1) versus 6 mm (Group 2) human dermal allograft. Methods Between September 2014 and February 2022, patients who underwent superior capsule reconstruction at a single institution, with a minimum of 1‐year follow‐up, were included. Preoperative age, sex, and Hamada grade were recorded. Pre‐ and postoperative acromiohumeral distance, American Shoulder and Elbow Surgeons (ASES), Oxford, visual analog scale (VAS) for pain, and postoperative single‐assessment numeric evaluation score were recorded. Postoperative magnetic resonance image was routinely obtained regardless of symptoms. Results There were 39 shoulders in Group 1 and 22 shoulders in Group 2. There was no difference between in preoperative age ( P = .6412), acromiohumeral distance ( P = .7638), ASES ( P = .4612), and Oxford ( P = .55517). There was significant improvement in both groups in ASES, Oxford, and VAS ( P < .0001), but no difference in acromiohumeral distance for Group 1 ( P = .666) or Group 2 ( P = .1188). There was a significant difference between Group 1 and 2 in postoperative ASES (76.6 vs 94, P = .0002), Oxford (41.7 vs 47, P = .0005), VAS (2.2 vs 0.3, P = .0062), and single‐assessment numeric evaluation (75 vs 92.3, P = .0002). Group 2 had a lower graft tear rate (27.3% vs 64.1%, P = .0057). Group 2 also had a significantly lower lateral‐sided graft failure (0% vs 40%, P = .0099). In Group 1, 87% met minimal clinically important difference for ASES, 77% for Oxford, and 90% for VAS. In addition, 67% met substantial clinical benefit for ASES, 64% for Oxford, and 72% for VAS. In Group 2, 100% met minimal clinically important difference for ASES, Oxford, and VAS and 100% met SCB. Conclusions Patients who undergo superior capsule reconstruction with a 6 mm human dermal allograft have significantly lower lateral‐sided graft tears, leading to better functional outcomes compared with those with 3 mm grafts. Level of Evidence Level III, retrospective comparative study.

Background Shoulder arthroplasty is performed with increasing frequency, which has prompted greater attention to understand the drivers of procedural cost and surgical efficiency. While surgeon experience has been linked to improved outcomes in other orthopedic domains, its association with intraoperative cost and operative time in shoulder arthroplasty is unclear. Additionally, differences in intraoperative resource utilization between anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) are not well defined. Methods We conducted a retrospective cross-sectional study of 4,143 primary elective aTSA and rTSA procedures performed between 2018 and 2023 across 21 centers within an integrated healthcare system. Surgeon experience was evaluated using three metrics: annual case volume, total prior shoulder arthroplasties, and years in practice. Cost data were categorized as implant and supply cost; operative time was used to assess surgical efficiency. Nine multivariable generalized linear mixed models (three predictors × three outcomes) were used, adjusting for patient demographics, comorbidities, procedure type, and surgery year, with surgeon included as a random effect. Results Higher annual case volume (≥30 cases/year) was associated with 11% lower supply costs (p < .001) and 5% shorter operative times (p = .023). More years in practice (≥nine years) was associated with 6% shorter operative times (p < .001). Total prior arthroplasties were not associated with cost or operative time after adjustment. rTSA was associated with 36% higher implant costs, 8% lower supply costs, and 8% shorter operative times compared to aTSA (p < .001 for each). Conclusion Annual case volume and years in practice were associated with greater intraoperative efficiency in shoulder arthroplasty. rTSA demonstrated distinct resource utilization patterns compared to aTSA, highlighting the importance of procedure-specific benchmarking in optimizing surgical cost efficiency.

Background: Pain and loss of upper-limb function often occur together in people with partial supraspinatus tears.Treatment may reduce pain without fully restoring activity, so it is useful to examine whether improvement in painis accompanied by meaningful functional recovery. Functional exercise may offer an advantage because it trains theshoulder through coordinated movements that resemble daily tasks.Aim: To examine the pattern of pain reduction and functional recovery following traditional and functional exerciseprogrammes combined with Aerion Arthron Class IV laser therapy in patients with Grade I and II supraspinatustears.Methodology: Sixty adults aged 20–60 years were assigned equally to two treatment groups. Group A receivedtraditional shoulder exercises with Class IV laser therapy, while Group B received functional exercises with thesame laser intervention. Pain was measured using the Visual Analogue Scale and upper-limb disability was assessedusing QuickDASH before and after treatment. Within-group changes, between-group differences and therelationship between pain improvement and functional gain were analysed.Results: Both groups improved after treatment. Group A showed a mean VAS reduction of 2.257 ± 0.910 and amean QuickDASH improvement of 21.937 ± 8.410. Group B showed larger changes, with a VAS reduction of4.410 ± 0.779 and a QuickDASH improvement of 41.438 ± 7.629. Between-group differences favoured Group Bfor both pain and disability (p < 0.001). Pain reduction and functional improvement were positively related (r =0.58), indicating that participants who experienced greater pain relief generally regained more upper-limb function.Conclusion: Improvement in pain was accompanied by improvement in function in both groups, but the recoverypattern was stronger in participants who performed functional exercises. The findings suggest that task-based andkinetic-chain training may help convert pain relief into better use of the arm during everyday activity.

BACKGROUND:Benchmarking allows for measurements and comparisons of prostheses using agreed-upon standards so that surgeons may be informed on performance for clinical decision making. We sought to apply the Orthopaedic Data Evaluation Panel (ODEP) for Shoulders methodology to benchmark prostheses used for shoulder arthroplasty in a US integrated health care system. METHODS:Data from the Kaiser Permanente shoulder arthroplasty registry was used to identify 25,495 primary shoulder arthroplasties (2009-2024): 11,392 anatomic total shoulder arthroplasties (aTSAs), 1,204 elective hemiarthroplasties, 10,385 elective reverse total shoulder arthroplasties (rTSAs), 967 acute hemiarthroplasties, and 1,547 acute rTSAs. Cumulative percentage all-cause revision (CPR) and 95% confidence interval (CI) was calculated using 1 minus the Kaplan-Meier estimate. An A rating was given for implants where the upper bound of the 95% CI was less than 5.0%, 7.0%, 9.0%, or 12.0% at 3-, 5-, 7-, and 10-year follow-up; a B rating was where the lower bound of the 95% CI was less than 5.0%, 7.0%, 9.0%, or 12.0% at 3-, 5-, 7-, and 10-year follow-up, respectively. RESULTS:There were 16 and 21 unique glenoid and humeral stem components, respectively, that qualified for benchmarking, used in 95.1% and 94.6% of the aTSA cohort, respectively. Of the aTSA glenoid components, 8 received A ratings, 6 B ratings, and 2 failed to receive a benchmark; 13, 6, and 2 humeral stem components received A, B, or no ratings, respectively. Five hemiarthroplasty humeral stems received a B rating, whereas 3 received no benchmark. Thirty unique elective rTSA constructs were evaluated, used in 72.0% of procedures. Eleven, 12, and 7 of the elective rTSA constructs received A, B, or no ratings, respectively. Three acute hemiarthroplasty humeral stems received a B rating, and 3 received no benchmark. There were 8 unique rTSA constructs for fracture evaluated; 1 received an A rating whereas 7 received B ratings. CONCLUSIONS:We identified several prostheses that qualified for ratings using the ODEP benchmarking criteria. However, there was a larger proportion of prostheses used at too low a volume for benchmarking consideration. In terms of patients, 74.6% of the study sample received components and/or constructs receiving a rating, 10.3% received components and/or constructs that failed to receive a rating, and 15.1% of patients received components and/or constructs that did not meet the ODEP criteria for benchmarking. Registries are a valuable data source for postmarket evaluation of implant performance in a real-world setting that can be used to inform clinical, health care, and regulatory decision making on implant selection.

PURPOSE:We evaluated the safety outcomes of opioids alone versus opioids plus low-dose gabapentinoids in patients naïve to both opioids and gabapentinoids, after total joint arthroplasty (TJA) of the knee, hip, or shoulder. METHODS:This was a multicenter, population-based, retrospective cohort study based in a large, integrated health system. It included opioid-naïve and gabapentinoid-naïve patients who underwent TJA between 2018 and 2024. Patients were categorized into two groups: those dispensed opioids and low-dose gabapentinoids or those dispensed opioids alone postoperatively. The primary outcome was opioid-related overdose events. The secondary outcome was adverse events, including falls, fractures, neurologic/cognitive changes, sedation, and delirium. RESULTS:In total, 36,351 consecutive patients comprised the study cohort, including 29,009 (79.8%) in the opioids-alone group and 7,342 (20.2%) in the opioids plus gabapentinoids group. In total, there were 19 (0.05% total cohort) opioid-related overdose events. Fourteen of these (0.05%) were in the opioids-alone group, and five (0.07%) were in the opioids plus gabapentinoids group (P = 0.3). In addition, 233 patients (0.6%) experienced emergency department or hospital admission due to an adverse event, including 200 patients (0.69%) in the opioids-alone group and 33 patients (0.45%) in the opioids plus gabapentinoids group. No statistically significant difference in adverse event risk was identified between groups. CONCLUSION:Concurrent prescriptions for opioids and low-dose gabapentinoids after TJA were not associated with a statistically significant difference in risk of emergency department or hospital readmission due to opioid-related overdose or adverse events compared with opioids alone. However, the rarity of overdose events limits statistical power, and these findings should be interpreted cautiously.

Background Augmented glenoid implant usage in shoulder arthroplasty bone loss cases has increased over the past decade. While safe in the short term, there are insufficient studies on longer term survivorship data on the newer generation of implants. We sought to determine whether there was a difference in survivorship for patients treated with glenoid augmentation vs. those with traditional total shoulder arthroplasty (TSA). Method A retrospective cohort study was conducted using data from a US integrated health-care system's shoulder arthroplasty registry. Patients ≥18 years who underwent primary shoulder arthroplasty for arthritis, inflammatory arthritis, and rotator cuff tear were included (2018-2024). Augmented and nonaugmented glenoids were compared separately for anatomic (aTSA) and reverse (rTSA) TSA. All-cause, aseptic, and revision risk due to infection were evaluated through cause-specific Cox proportional hazard regression with confounder and operating surgeon adjustment. Reason for revision was recorded. Hazard ratios (HRs) and 95% confidence intervals (CIs) are presented, a P < .05 was considered statistically significant. Results Augmented glenoid implants were identified in 11.9% (n = 500) of aTSA and 55.8% (n = 2,641) of rTSA procedures. All-cause 5-year cumulative revision probability was 2.3% for rTSA and 2.6% aTSA. Average follow-up time for aTSA was 3.4 years (standard deviation [STD] = 2.0 years) and 2.6 years for rTSA (STD = 2.0 years). Mean time to first revision in aTSA was 2.1 years (STD = 1.8 years). The most common reason for aTSA revision was rotator cuff tear. We observed a 27% decreased risk of aseptic revision in aTSA patients with augmented glenoids (HR = 0.73, 95% CI = 0.56-0.93, P = .012) and no difference in all-cause or revision for infection (HR = 0.64, 95% CI = 0.32-1.29, P = .209 and HR = 0.79, 95% CI = 0.53-1.18, P = .253, respectively). The mean time to first revision in rTSA was 1.8 years (STD = 2.0 years). The most common reason for rTSA revision is chronic dislocation (instability). In rTSA, we failed to detect a difference in all-cause, aseptic, or revision for infection in augmented compared to nonaugmented glenoids (HR = 1.01, 95% CI = 0.80-1.28, P = .919, HR = 0.99, 95% CI = 0.78-1.26, P = .929, and HR = 0.98, 95% CI = 0.74-1.30, P = .885, respectively). Conclusions We found a lower 5-year risk of aseptic revision in aTSA and no-difference by augment status for rTSA. Augmented glenoid implants have several advantages when addressing glenoid wear, and our data support the use of these implants in the toolkit to address glenoid pathology.

The incidence and indications for shoulder arthroplasty are expanding. Although the procedure is generally successful, complications can occur. One of the most devastating is prosthetic joint infection of the shoulder. Efforts to prevent prosthetic joint infection of the shoulder vary from mechanical to pharmacologic. We review evidence-based prevention efforts ranging from preoperative optimization to pharmaceutical prophylaxis to draping techniques. Our paired review on diagnosis and treatment is also referenced.

The incidence of shoulder arthroplasty is increasing with rapidly expanding indications. Although the procedure is becoming increasingly successful, complications do occur. Prosthetic joint infection of the shoulder (PJIS) is a devastating complication that requires dedicated efforts for diagnosis and eradication. As a supplement to our accompanying article on the topic of PJIS prevention, we review the current approaches to diagnosing and treating PJIS.

Background: Studies to date of superior capsular reconstruction (SCR) comparing outcomes of healed grafts versus torn grafts do not separate graft tears based on location of the tear, rather they combine and report all tears as a single group. Purpose/Hypothesis: The purpose of this study was to correlate functional outcome with graft integrity and graft tear location after SCR with a dermal allograft. It was hypothesized that the functional outcomes of patients with an intact graft would be equivalent to those with graft tears leaving the tuberosity covered. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent SCR with an acellular dermal allograft at a single institution were included. Pre- and postoperative American Shoulder and Elbow Surgeons (ASES), Oxford Shoulder Score, visual analog scale (VAS) for pain, and postoperative Single Assessment Numeric Evaluation (SANE) scores were recorded. A magnetic resonance imaging scan was performed postoperatively to assess graft integrity. Results: A total of 39 patients met inclusion criteria. Mean age of patients was 60.4 8.7 years; mean follow-up was 53.3 +/- 25 months (range, 14-98 months). Magnetic resonance imaging performed at a mean of 17.5 months (range, 6-66 months) demonstrated an intact graft in 14 (36%); tear from the glenoid in 11 (28%), from midsubstance in 4 (10%), and from the tuberosity in 8 (21%); and complete graft absence in 2 (5%). Patients were divided into group 1 (intact graft), group 2 (tuberosity covered: tears from glenoid and midsubstance tears), and group 3 (tuberosity bare: tears from the tuberosity and dissolved or absent grafts). In group 1, there was significant improvement in ASES (37.9 to 88.5; P < .001), Oxford (25.2 to 46.2; P < .001), and VAS (6.8 to 0.9; P < .001). In group 2, there was significant improvement in ASES (32.2 to 86.1; P < .001), Oxford (23.4 to 44.2; P < .001), and VAS (7.3 to 1.3; P < .001). In group 3, there was no significant improvement in ASES (40.3 to 45.8; P = .50) or Oxford (33.5 to 31.4; P = .81), but there was a significant reduction in VAS (7.1 to 5.4; P = .03). There was no significant difference between group 1 and 2 in postoperative ASES (88.5 vs 86.1; P = .59), Oxford (46.2 vs 44.2; P = .07), VAS (0.9 vs 1.3, P = .42) and SANE (85.4 vs 83.2; P = .92) scores. However, group 3 had significantly lower ASES (45.8; P < .001), lower Oxford (31.4; P < .001), lower SANE (45.4; P < .001), and higher VAS (5.4; P < .001) scores than groups 1 and 2. There were no differences in outcomes based on sex (P = .72), previous surgery (P = .06), preoperative acromiohumeral distance (P = .57), and preoperative Goutallier stage of the supraspinatus (P = .16). Conclusion: Patients who underwent SCR with a dermal allograft and developed a graft tear leaving the tuberosity covered had equivalent functional outcomes to those with an intact graft.

Background: The supraspinatus is most frequently involved in rotator cuff tears, a common orthopaedic condition. However, the architecture of this muscle has been described only for the superficial, anterior, and posterior regions. Purpose: To determine the muscle architecture of the deep supraspinatus. Study Design: Descriptive laboratory study. Methods: Muscle architecture measurements were collected from 25 cadaveric supraspinatus specimens (13 intact [without tendon tears], 3 with partial-thickness tears, 9 with full-thickness tears). The muscle was divided into deep, superficial anterior, and superficial posterior regions. Pennation angle, raw and normalized fiber length, and sarcomere length and number were compared using repeated-measures analyses of variance. Results: First, mean architecture measurements were compared between regions using only the intact specimens (n = 13). The deep region had a lower mean pennation angle (3.3° ± 1.0°) compared with the posterior region (11.0° ± 3.9°; P < .0001), which in turn had a significantly higher pennation angle compared with the anterior region (7.6 ± 2.6°; P = .0005). Normalized fiber lengths in the deep region were 21.1% ( P = .0052) and 34.5% ( P < .0001) shorter than the posterior and anterior normalized fiber lengths, respectively. Sarcomere lengths in the deep region were longer (3.4 ± 0.2 μm) compared with the posterior (3.1 ± 0.2 μm; P = .0012) and anterior (3.2 ± 0.2 μm; P = .0390) regions. Sarcomere numbers also decreased in the deep region by 21.2% ( P = .0056) and 34.2% ( P < .0001) compared with the posterior and anterior regions, respectively. Conclusion: The deep supraspinatus had significantly lower pennation angles, shorter fiber lengths, and fewer but longer sarcomeres in series compared with other subregions within the muscle. These structural differences suggest a functionally unique “submuscle” within the supraspinatus. Clinical Relevance: Understanding the architecture of the supraspinatus muscle can provide insight into muscle function in health and disease. Specifically, this deep submuscle may play a different role in rotator cuff function than the rest of the muscle.

Background: Despite the importance of the deltoid to shoulder biomechanics, very few studies have quantified the three-dimensional shape, size, or quality of the deltoid muscle, and no studies have correlated these measurements to clinical outcomes after anatomic (aTSA) and/or reverse (rTSA) total shoulder arthroplasty in any statistically/scientifically relevant manner. Methods: Preoperative computer tomography (CT) images from 1057 patients (585 female, 469 male; 799 primary rTSA and 258 primary aTSA) of a single platform shoulder arthroplasty prosthesis (Equinoxe; Exactech, Inc., Gainesville, FL) were analyzed in this study. A machine learning (ML) framework was used to segment the deltoid muscle for 1057 patients and quantify 15 different muscle characteristics, including volumetric (size, shape, etc.) and intensity-based Hounsfield (HU) measurements. These deltoid measurements were correlated to postoperative clinical outcomes and utilized as inputs to train/test ML algorithms used to predict postoperative outcomes at multiple postoperative timepoints (1 year, 2–3 years, and 3–5 years) for aTSA and rTSA. Results: Numerous deltoid muscle measurements were demonstrated to significantly vary with age, gender, prosthesis type, and CT image kernel; notably, normalized deltoid volume and deltoid fatty infiltration were demonstrated to be relevant to preoperative and postoperative clinical outcomes after aTSA and rTSA. Incorporating deltoid image data into the ML models improved clinical outcome prediction accuracy relative to ML algorithms without image data, particularly for the prediction of abduction and forward elevation after aTSA and rTSA. Analyzing ML feature importance facilitated rank-ordering of the deltoid image measurements relevant to aTSA and rTSA clinical outcomes. Specifically, we identified that deltoid shape flatness, normalized deltoid volume, deltoid voxel skewness, and deltoid shape sphericity were the most predictive image-based features used to predict clinical outcomes after aTSA and rTSA. Many of these deltoid measurements were found to be more predictive of aTSA and rTSA postoperative outcomes than patient demographic data, comorbidity data, and diagnosis data. Conclusions: While future work is required to further refine the ML models, which include additional shoulder muscles, like the rotator cuff, our results show promise that the developed ML framework can be used to evolve traditional CT-based preoperative planning software into an evidence-based ML clinical decision support tool.

Pancreatic β-cell transplantation is an effective approach for the therapeutic treatment of type I diabetes. However, it has limitations due to the lack of human cadaveric pancreas donors. Stem cells provide an alternative source for the generation of surrogate pancreatic β-cells. Nonetheless, its clinical utility is restricted due to the unavailability of a robust culture system for the generation of large quantities of insulin-responsive pancreatic β-cells. In this study, we fabricated an MXene composite nanofibrous scaffold (PCL 25_Ti2C 5 nanofiber) for the development of a three-dimensional (3D) culture system that can enhance the proliferation and differentiation of stem cell-derived pancreatic β-cells. The fabricated MXene composite nanofibers exhibited a porous nanostructure and increased hydrophilicity due to a large number of hydrophilic functional groups. We assessed the biocompatibility and differentiation potential of human Wharton's jelly mesenchymal stem cells (hWJ-MSCs) on a fabricated MXene composite nanofibrous scaffold. MXene composite nanofibers significantly upregulated key pancreatic β-cell markers including PDX-1, MAFA, Insulin, Nkx6.1, and Nkx2.2 and also showed increased production and secretion of insulin in response to glucose stimulation when compared to control (PCL 25 nanofiber), suggesting enhanced differentiation of hWJ-MSCs into functional pancreatic β-cells. Overall, the results suggest that MXene nanofiber-based cell therapy has therapeutic potential for diabetes treatment.

Background: Radial head arthroplasty (RHA) is commonly used for the treatment of comminuted radial head fractures. Indications as well as implant types continue to evolve. RHA has had good outcomes with midterm longevity. The literature is limited to small case series with varying implant types, and larger studies are needed to determine the optimal implant type and radial head diameter. Methods: A retrospective analysis of RHA cases performed by 75 surgeons at 14 medical centers in an integrated health care system between 2006 and 2017 was completed. Patient demographics, comorbidities, implant type and head diameter, and indications for revi-sion were recorded. Patients' in-person clinical visit data were recorded. Patients were also contacted via telephone at a minimum of 2 years to obtain abbreviated Disabilities of the Arm, Shoulder, and Hand questionnaire and Oxford scores. Implant survivorship was also captured within our integrated system.Results: 405 cases met our inclusion criteria. Mean age was 51.5 +/- 15.5 years (range 16-88 years) and more common in females (62%). Chart review and telephone follow-up was performed at a mean of 68.9 +/- 31.5 months (range 24-146 months). Our study found that revision rate was positively correlated with increasing radial head diameter. A 26-mm head had 7.7 odds of revision compared to a size 18-mm head (95% con-fidence interval 1.2-150.1). More than 95% of revision cases were performed within the first 36 months of the index procedure. Obese patients had a significantly lower mean postoperative Oxford score (35.5) compared to controls (38.3) (P = .02). There was a significantly higher overall reoperation rate for terrible triad (18.4%) vs. isolated injuries (10.4%) (P =.04). There was no difference between Acumed Anatomic and Evolve radial head implants in overall reoperation, implant revision, postoperative range of motion, or patient-reported outcomes.Conclusions: Risk of revision is directly correlated with implanted radial head diameter. There were no differences in outcomes and com-plications between the 2 main implants used. Individuals who did not undergo a revision by 3 years' time tend to retain the implant. Terrible triad injuries had a higher all-cause reoperation rate than isolated radial head fractures, but no difference in the rate of RHA revision. These data reinforce the practice of downsizing radial head implant diameter.Level of evidence: Level IV; Case Series; Treatment Study (c) 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Capra hircus (goat) induced pluripotent stem cells (giPSCs) harbor enormous scientific value and contribute to cellular agriculture, animal cloning, etc. Conventional approaches to giPSC generation suffer from complexity and low preparation efficiency. In the present study, we introduced the episomal vectors carrying the human pluripotent genes in goat somatic cells to generate the giPSC-like colonies. Initially, a simple non-enzymatic method was used to isolate the goat dermal fibroblast cells and, further, a cell line was established. Later, goat fibroblast cells were transfected with commercially available episomal vectors carrying the human pluripotent genes and successfully generated the iPSC-like colonies which exhibited the expression of goat endogenous pluripotent genes and positive staining with alkaline phosphatase. Moreover, giPS-like cells formed embryoid bodies (EBs)-like aggregates and weekly expressed the marker genes of two germ layers. Reprogramming of goat fibroblast using episomal vectors carrying human pluripotent genes could lead to the development of an efficient and time- and cost-effective approach to giPSC generation.

Introduction: Rotator cuff tears are prevalent in the population above the age of 60. The disease progression leads to muscle atrophy, fibrosis, and fatty infiltration, which is not improved upon with surgical repair, highlighting the need to better understand the underlying biology impairing more favorable outcomes.Methods: In this study, we collected supraspinatus muscle tissue from 6 month old female rabbits who had undergone unilateral tenotomy for 8 weeks at 1, 2, 4, or 8 weeks post-repair (n = 4/group). RNA sequencing and enrichment analyses were performed to identify a transcriptional timeline of rotator cuff muscle adaptations and related morphological sequelae.Results: There were differentially expressed (DE) genes at 1 (819 up/210 down), 2 (776/120), and 4 (63/27) weeks post-repair, with none at 8 week post-repair. Of the time points with DE genes, there were 1092 unique DE genes and 442 shared genes, highlighting that there are changing processes in the muscle at each time point. Broadly, 1-week post-repair differentially expressed genes were significantly enriched in pathways of metabolism and energetic activity, binding, and regulation. Many were also significantly enriched at 2 weeks, with the addition of NIF/NF-kappaB signaling, transcription in response to hypoxia, and mRNA stability alongside many additional pathways. There was also a shift in transcriptional activity at 4 weeks post-repair with significantly enriched pathways for lipids, hormones, apoptosis, and cytokine activity, despite an overall decrease in the number of differentially expressed genes. At 8 weeks post-repair there were no DE genes when compared to control. These transcriptional profiles were correlated with the histological findings of increased fat, degeneration, and fibrosis. Specifically, correlated gene sets were enriched for fatty acid metabolism, TGF-B-related, and other pathways.Discussion: This study identifies the timeline of transcriptional changes in muscle after RC repair, which by itself, does not induce a growth/regenerative response as desired. Instead, it is predominately related to metabolism/energetics changes at 1 week post-repair, unclear or asynchronous transcriptional diversity at 2 weeks post-repair, increased adipogenesis at 4 weeks post-repair, and a low transcriptional steady state or a dysregulated stress response at 8 weeks post-repair.

Objectives: The supraspinatus (SSP) tendon is the most frequently involved in rotator cuff tears, a common orthopedic condition. Previous anatomical studies have described distinct anterior and posterior regions of the SSP muscle. The purpose of this study is to determine if the deep region of the supraspinatus muscle has significantly different architectural properties from the other regions. This could have implications on the mechanical and functional nature of the deep supraspinatus muscle. Methods: Architecture measurements were collected from 25 cadaver SSPs (Figure 1). There were 13 SSPs without a tear, 3 with partial tears, and 9 with full tears. The anterior to posterior dimension of the humeral head (APHH), musculotendinous junction length (MTJL), muscle mass and length were recorded. The muscle regions were demarcated as deep, [superficial] anterior, and [superficial] posterior. Raw and normalized fiber length, pennation angle, sarcomere length and number were analyzed for each region. Measurements were compared using repeated measures ANOVAs. The intact SSPs were analyzed first, and then a sub-analysis was performed based on presence of tear. Results: In 13 SSPs without tears (Figure 2), the deep region showed a lower mean pennation angle of 3.3±1.0° than the posterior region (11.0±3.9°, p<0.0001), which had a higher angle than the anterior region (7.6±2.6°, p=0.0005). Normalized fiber lengths in the deep region were 21.1% (p=0.0052) and 34.5% (p<0.0001) shorter than posterior and anterior, respectively. Deep region sarcomeres measured 3.4±0.2 µm compared to 3.1±0.2 µm (posterior, p=0.0012) and 3.2±0.2 µm (anterior, p=0.0390). Sarcomere number also decreased in the deep region by 21.2% (p=0.0056) and 34.2% (p<0.0001) compared to posterior and anterior regions, respectively. After including partial (n=3) and full (n=9) tears, all architecture measurements remained different in the deep region versus anterior or posterior. Finally, to help visualize the deep region of the SSP, diffusion tensor imaging with tractography was performed on a healthy volunteer’s MRI (Figure 3) to depict the tissue microstructure and muscle fiber orientation/length. Conclusions: The deep supraspinatus has lower pennation angles, shorter fiber lengths, and fewer but longer sarcomeres. These structural differences suggest a functionally unique ‘submuscle’ within the supraspinatus.

Type 1 diabetes (T1D) is a chronic autoimmune disease characterized by the destruction of pancreatic β-cells, leading to insulin deficiency. Insulin replacement therapy is the current standard of care for T1D, but it has significant limitations. However, stem cell-based replacement therapy has the potential to restore β-cell function and achieve glycaemic control eradicating the necessity for drugs or injecting insulin externally. While significant progress has been made in preclinical studies, the clinical translation of stem cell therapy for T1D is still in its early stages. In continuation, further research is essentially required to determine the safety and efficacy of stem cell therapies and to develop strategies to prevent immune rejection of stem cell-derived β-cells. The current review highlights the current state of cellular therapies for T1D including, different types of stem cell therapies, gene therapy, immunotherapy, artificial pancreas, and cell encapsulation being investigated, and their potential for clinical translation.

BACKGROUND:Same-day discharge for shoulder arthroplasty (SA) is well-supported in the literature; however, most studies have focused on healthier patients. Indications for same-day discharge SA have expanded to include patients with more comorbidities, but safety of same-day discharge in this population remains unknown. We sought to compare outcomes following same-day discharge vs. inpatient SA in a cohort of patients considered higher risk for adverse events, defined as an American Society of Anesthesiologists (ASA) classification of ≥3. METHODS:Data from Kaiser Permanente's SA registry were utilized to conduct a retrospective cohort study. All patients with an ASA classification of ≥3 who underwent primary elective anatomic or reverse SA in a hospital from 2018 to 2020 were included. The exposure of interest was in-hospital length of stay: same-day discharge vs. ≥1-night hospital inpatient stay. The likelihood of 90-day post-discharge events, including emergency department (ED) visit, readmission, cardiac complication, venous thromboembolism, and mortality, was evaluated using propensity score-weighted logistic regression with noninferiority testing using a margin of 1.10. RESULTS:The cohort included a total of 1814 SA patients, of whom 1005 (55.4%) had same-day discharge. In propensity score-weighted models, same-day discharge was not inferior to an inpatient stay SA regarding 90-day readmission (odds ratio [OR] = 0.64, one-sided 95% upper bound [UB] = 0.89) and overall complications (OR = 0.67, 95% UB = 1.00). We lacked evidence in support of noninferiority for 90-day ED visit (OR = 0.96, 95% UB = 1.18), cardiac event (OR = 0.68, 95% UB = 1.11), or venous thromboembolism (OR = 0.91, 95% UB = 2.15). Infections, revisions for instability, and mortality were too rare to evaluate using regression analysis. CONCLUSIONS:In a cohort of over 1800 patients with an ASA of ≥3, we found same-day discharge SA did not increase the likelihood of ED visits, readmissions, or complications compared with an inpatient stay, and same-day discharge was not inferior to an inpatient stay with regard to readmissions and overall complications. These findings suggest that it is possible to expand indications for same-day discharge SA in the hospital setting.

P¼0.70). OSPBT performed with one SSSA (21.70 mm) demonstrated significantly greater migration than ASPBT with IS (4.31mm, P<0.001) and OSPBT with IS (5.04 mm, P<0.001).Three patients (9.4%) who had OSPBT with one SSSA and one who had ASPBT with two SSSAs (3.8%), developed a Popeye deformity; none occurred in the IS groups.Mean 12-week bead migration in patients with versus without Popeye deformity was 60.8 mm and 11.2 mm, respectively (P<0.0001).PROMs did not differ at final follow-up.Conclusion: ASPBT and OSPBT with IS fixation demonstrated the least tendon migration, while OSPBT with one SSSA yielded the most.Compared to IS, fixation with one, but not two, SSSAs resulted in significantly greater migration.Average bead migration following a Popeye deformity was 6.1cm.To minimize migration when using SSSAs, at least 2 sutures should be used with an interlocking pattern within the tendon.

The selection of an appropriate scaffold is imperative for the successful development of alternative animal protein in the form of cultured meat or lab-grown meat. Decellularized tissues have been suggested as a potential scaffold for cultured meat production owing to their capacity to support an optimal environment and niche conducive to cell proliferation and growth. This approach facilitates the systematic development of 3D tissues in the laboratory. Decellularized scaffold biomaterials have characteristics of high biocompatibility, biodegradation, and various bioactivities, which could potentially address the limitations associated with synthetic bio-scaffold materials. The present study involved the derivation and characterization of a decellularized scaffold from mushroom tissue following subsequent assessment of the scaffold’s capacity to support myogenic differentiation. Mushroom sections were soaked in nuclease and detergent solution for 4 days. Furthermore, decellularization was confirmed by histology and DAPI staining, which showed the removal of cellular components and nuclei. Myoblast cells were seeded onto decellularized tissue, which exhibited excellent cytocompatibility and promoted myogenic growth and differentiation. The study’s findings can serve as a foreground for the generation of an edible and natural scaffold for producing a safe and disease-free source of alternative animal protein, potentially reducing the burden on the health sector caused by conventional animal protein production and consumption.