Medical Protective

Autoimmune gastritis (AIG) is an immune-mediated chronic atrophic gastritis, and anemia is common in AIG. This study aims to investigate the clinical characteristics of AIG patients with and without anemia. This was a single-center retrospective study. The diagnosis of AIG was based on endoscopic or pathologic findings combined with antiparietal cell antibody (PCA) and anti-intrinsic factor antibody (IFA) results. Anemia was defined as hemoglobin levels <110g/L for females or 120g/L for males. This study included 117 AIG patients. The median age was 53.6±10.5 years old, and 72.6% were female. Anemia was present in 39.3% patients, with 17.9% iron deficiency anemia (IDA) and 21.4% pernicious anemia (PA). AIG patients with anemia had a higher positive rate of IFA (34.8% vs. 18.3%, P=0.044) and a lower level of pepsinogen I (PG-I) [5.0 (3.3 to 10.4) vs. 8.0 (4.1 to 18.9)ng/mL, P=0.033]. However, no significant differences were observed in the age, sex, PCA positivity, gastrin levels, Helicobacter pylori (H. pylori) infection status or the concomitant diseases between patients with and without anemia. Compared with PA patients, IDA patients had a higher incidence of H. pylori infection (66.7% vs. 28.0%, P=0.009), as well as the levels of PG-I (P=0.001), PG-II (P=0.016) and PG-I/II ratio (P=0.007). Univariate and multivariate analyses revealed that IFA positivity (odds ratio=2.379, P=0.047) was a significant risk factor for anemia in AIG patients. AIG patients with IFA positivity are more prone to anemia, and IDA maybe associated with H. pylori infection.

Implant-implant impingement in total hip arthroplasty remains a primarily clinical diagnosis, with little technology available to demonstrate impingement radiographically. The purpose of this study was to determine the effectiveness of external rotation stress CT scans in evaluating for posterior impingement in patients with painful total hip prostheses. Sixty-seven patients presenting with CT IMA (implant movement analysis) scans previously used for evaluation of potential aseptic loosening were identified between May 2021 and May 2024. Plain radiographs were evaluated to assess for acetabular cup abduction. CT IMA scans in external rotation IMA protocol position were evaluated to measure acetabular implant version and the distance between the femoral and acetabular components. Patients were separated into impingement and nonimpingement groups based on whether a clinical or intraoperative diagnosis of impingement had been made. Cup version, abduction, and implant-implant distances on the external rotation CT were compared between the groups. A receiver operating characteristic curve was created, and the area under the curve was calculated to determine an optimal implant-implant distance for diagnosing impingement. Overall, 29 patients were diagnosed with impingement and 38 patients were diagnosed with other sources of hip pain. Linear regression showed a notable negative correlation (P = 0.004) of measured cup version versus implant-implant distance. Implant-implant distance was markedly smaller in the impingement group versus the non-impingement group (P < 0.0001). The receiver operating characteristic curve demonstrated 100% sensitivity and 89% specificity impingement when the implant-implant distance was <5 mm, with an area under the curve of 0.98 ± 0.02. External rotation stress CT scans used by the IMA protocol were 100% sensitive and 89% specific in identifying patients with posterior impingement when an implant-implant distance of <5 mm was considered. This technology may help clinicians objectively define a diagnosis of impingement in total hip prostheses in the absence of other clinically identifiable sources of pain.

Comparisons made between spine-trained neurosurgeons (Neuro) and orthopaedic surgeons (Ortho) can be a delicate matter. Considering most authors are spine surgeons, one may wonder if study results inappropriately favor authors' own specialties. The purpose of this study was to perform a bibliometric analysis of all studies comparing spine surgeons of each training pathway and to evaluate potential biases when reporting study results. A systematic review was conducted according to the PRISMA statement. All literature comparing Neuro and Ortho before May 2022 were identified. Included articles were categorized according to the training backgrounds of the first and last authors ("Neuro-Neuro," "Ortho-Ortho," or "Author Diverse"), evaluated for inclusion of both Neuro and Ortho authors from the total author list, and classified by journal type of publication ("Neuro Journal," "Ortho Journal," or "Combined Journal"). A Neuro and Ortho spine surgeon each independently reviewed a subset of articles evaluating postoperative outcomes, categorizing the articles' stated conclusions (Pro-Neuro, Pro-Ortho, Neutral). Student t -test and Chi-squared analyses were used when appropriate to test for significance. Alpha level was set at <0.05. A total of 80 studies were identified. Overall, 26 Neuro-Neuro articles, 34 Ortho-Ortho articles, and 20 Author Diverse articles were included. Neuro-Neuro authors were found to publish more in Neuro Journals ( P < 0.001). No differences were observed for inclusion of both Neuro and Ortho authors between studies published by the three different author types. Overall, there were 22 articles comparing postoperative outcomes: 15 articles (68%) reported no notable differences, whereas 3 (14%) found improved outcomes with Neuro, and 4 (18%) found improved outcomes with Ortho. No notable differences were found in outcomes when analyzed according to author type ( P = 0.531), journal type ( P = 0.962), and database used ( P = 0.636). The growing body of literature comparing Neuro and Ortho spine surgeons shows little differences in surgical outcomes and no evidence of bias. V.

The purpose of this study was to evaluate the incidence of new-onset anxiety and depression (NOAD) in younger patients undergoing common sports medicine procedures, determine risk factors associated with NOAD, and identify which treatments are used. A retrospective review of the PearlDiver national database was done. All patients included had no diagnosis of depression or anxiety before undergoing the following surgical procedures: anterior cruciate ligament reconstruction (ACLR), meniscus repair, hip arthroscopy (HA), shoulder instability repair, rotator cuff repair, or Achilles tendon repair. All patients were 25 years or younger and had ≥1-year follow-up. The primary outcome was development of NOAD within 1 year postoperatively. Multivariate regression was used to assess risk factors for NOAD. A total of 178,759 patients were included in this study. Overall, 8,900 (5.0%) of patients developed NOAD within 1 year postoperatively; HA patients had the highest rate of NOAD (8.43%). Logistic regression identified age (P < 0.001), female sex (P < 0.001), Charlson Comorbidity Index score (P < 0.001), alcohol disorders (P < 0.001), headaches/migraines (P < 0.001), obesity (P < 0.001), and tobacco use (P < 0.001) as predictors of NOAD. Compared with ALCR, HA patients (OR, 1.81; P < 0.001) had the greatest risk of developing NOAD. The incidence of NOAD in the first year after common sports medicine procedures was 5% for patients aged 25 years or younger. Increased age, substance use, comorbidities, and HA were identified as risk factors for NOAD. Additional study of both mental health and functional outcomes, prevention, and treatment strategies is required to elucidate the risk of NOAD.

Abstract Over the past decade, three overlapping trends have fundamentally reshaped and now characterize the global geopolitical order: the rise of emerging powers, increasing military conflicts, and growing international trade tensions. These features of the global order are deeply connected to global environmental politics (GEP) and governance, as a warming world spurs some aspects of geopolitical change, while the geopolitical dynamics themselves have far-reaching environmental consequences. Given this, we call on GEP researchers to bring geopolitics more fully back into their analyses to better explain the new dynamics of environmental politics and governance in a changing world. We identify four priority areas for future inquiry for GEP scholarship: the race for critical minerals, ecological dimensions of land conquests, the trade–environment nexus in the context of trade tensions and blocs, and the interplay of the rise of authoritarian populism and political polarization and global environmental change.

Postoperative stiffness is a common complication after total knee arthroplasty (TKA), leading to limited range of motion (ROM), pain, and reduced function. Direct oral anticoagulants (DOACs), such as factor Xa inhibitors, are commonly prescribed for venous thromboembolism (VTE) prophylaxis but may increase the risk of postoperative stiffness due to postoperative bleeding within the knee. This study seeks to evaluate the effect of postoperative VTE prophylaxis (factor Xa inhibitors vs. aspirin) on ROM outcomes in patients undergoing TKA. A total of 1,054 patients who underwent primary TKA by the senior author between November 2021 and May 2023 were retrospectively identified from an institutional database. Records were examined at preoperative, 2-week, 6-week, <1-year, and >1-year postoperative visits. Logistic regression models analyzed ROM outcomes, defining success as 90° flexion and 0° extension at 2 weeks and 125° flexion and 0° extension at 6 weeks. Manipulation under anesthesia (MUA) was recorded as a secondary end point. Factor Xa inhibitors (apixaban or rivaroxaban) did not significantly affect ROM success at 2 weeks (OR = 0.956, 95% confidence interval [CI, 0.866 to 1.054], P = 0.364) or 6 weeks (OR = 0.986, 95% CI [0.892 to 1.089], P = 0.778) postoperatively, compared with aspirin. VTE prophylaxis type was not found to be significantly associated with MUA likelihood. No association was found between postoperative ROM and VTE prophylaxis medication. Previous studies used lower ROM thresholds or focused solely on MUAs. Understanding the effects of DOACs on postoperative stiffness can help guide chemoprophylaxis decisions after TKA.