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Impact of Ischemia-reperfusion on Outcomes after Open Mesenteric Bypass for Chronic Mesenteric Ischemia.

J Vasc Surg 2021 Apr 19. Epub 2021 Apr 19.

Division of Vascular Surgery & Endovascular Therapy, University of Florida, Gainesville.

Objective: Significant physiologic perturbations can occur in patients with chronic mesenteric ischemia (CMI) undergoing open mesenteric bypass (OMB). These events are frequently attributed to ischemia-reperfusion(I/R) events and are directly implicated in multiple organ dysfunction (MOD). Scoring systems [MOD and Sequential Organ Failure Assessment (SOFA)] have been derived within critical care literature to provide a composite metric for these pathophysiologic changes. Read More

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Experience With Ventriculoperitoneal and Lumboperitoneal Shunting for the Treatment of Idiopathic Intracranial Hypertension: A Single Institution Series.

Oper Neurosurg (Hagerstown) 2021 Apr 22. Epub 2021 Apr 22.

Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.

Background: CSF shunting is among the most widely utilized interventions in patients with idiopathic intracranial hypertension (IIH). Ventriculoperitoneal shunting (VPS) and lumboperitoneal shunting (LPS) are 2 possible treatment modalities.

Objective: To evaluate and compare complications, malfunction, infection, and revision rates associated with VPS compared to LPS. Read More

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Improvements Of 111In Spect Images Reconstructed with Sparsely Acquired Projections by Deep Learning Generated Synthetic Projections.

Radiat Prot Dosimetry 2021 Apr 22. Epub 2021 Apr 22.

Department of Medical Physics and Bioengineering, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden.

The aim was to improve single-photon emission computed tomography (SPECT) quality for sparsely acquired 111In projections by adding deep learning generated synthetic intermediate projections (SIPs). Method: The recently constructed deep convolutional network for generating synthetic intermediate projections (CUSIP) was used for improving 20 sparsely acquired 111In-octreotide SPECTs. Reconstruction was performed with 120 (120P) or 30 (30P) projections, or 120 projections with 90 SIPs generated from 30 projections (30-120SIP). Read More

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Clinical outcome of pediatric and young adult subclinical varicoceles: a single-institution experience.

Asian J Androl 2021 Apr 20. Epub 2021 Apr 20.

Department of Urology, Boston Children's Hospital, Boston, MA 02115, USA.

Subclinical varicocele represents an abnormality of veins of the pampiniform plexus on scrotal ultrasound (US) without a clinically palpable varicocele. Its significance remains unclear. While guidelines do not recommend surgical intervention, clinical management is variable. Read More

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Venoarterial extra corporeal membrane oxygenation and blood component usage in pediatric patients undergoing cardiac surgery: Single centre experience.

Ann Card Anaesth 2021 Apr-Jun;24(2):203-208

Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India.

Background: Extra Corporeal Membrane Oxygenation (ECMO) is a well-known tool for providing life-saving support in patients developing post cardiotomy cardiogenic shock in post cardiac surgeries. The current study was designed to evaluate blood transfusion requirements and its relation to mortality in neonate and pediatric cardiac patients requiring venoarterial cardiac ECMO during post-operative period following cardiac surgery.

Materials And Methods: Overall 24 pediatric patients (including neonates) who underwent VA ECMO in post cardiac surgery at our institute from January 2016 to October 2017 were included in the study. Read More

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Perioperative management and considerations in pediatric patients with connective tissue disorders undergoing cardiac surgery.

Paediatr Anaesth 2021 Apr 21. Epub 2021 Apr 21.

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine.

Background: Marfan syndrome and Loeys-Dietz syndrome (LDS) are connective tissue disorders associated with cardiac and vascular disease. Patients often require surgical repair, but limited data exist to describe their perioperative management.

Aims: Our goals were to review the perioperative features of patients with Marfan and Loeys-Dietz syndrome that may affect anesthesia care and to describe the differences in pre-operative clinical characteristics and intra-operative anesthetic management. Read More

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Pyomyositis and Infectious Myositis: A Comprehensive, Single-Center Retrospective Study.

Open Forum Infect Dis 2021 Apr 4;8(4):ofab098. Epub 2021 Mar 4.

Yale University School of Medicine, New Haven, Connecticut, USA.

Background: Pyomyositis is a bacterial infection of skeletal muscle that classically leads to abscess formation. A related, but distinct, entity is infectious myositis. The epidemiology of these infections has changed in recent years. Read More

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Factors that Influence Door-to-Needle Administration for Acute Stroke Patients in the Emergency Department.

J Neurosci Nurs 2021 Apr 20. Epub 2021 Apr 20.

Questions or comments about this article may be directed to Nicolle W. Davis, PhD RN SCRN ASC-BC, at N.W.D. is Stroke Program Coordinator, UF Health Shands Hospital, Gainesville, FL. Meghan Bailey, MSN RN CCRN, is Stroke Program Coordinator, UF Health Shands Hospital, Gainesville, FL. Natalie Buchwald, MD, is Neurology Resident, Department of Neurology, University of Florida, Gainesville, FL. Amreen Farooqui, MD, is Neurology Resident, Department of Neurology, University of Florida, Gainesville, FL. Anna Khanna, MD, is Assistant Professor and Stroke Program Medical Director, University of Florida, Gainesville, FL.

Abstract: BACKGROUND: There is growing importance on discovering factors that delay time to intervention for acute ischemic stroke (AIS) patients, as rapid intervention is essential for better patient outcomes. The management of these patients involves a multidisciplinary effort and quality improvement initiatives to safely increase treatment with intravenous (IV) thrombolytic. The objective of this pilot study is to evaluate factors of acute stroke care in the emergency department (ED) and their impact on IV alteplase administration. Read More

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Effects of prior exposure to a visual airway cognitive aid on decision-making in a simulated airway emergency: A randomised controlled study.

Eur J Anaesthesiol 2021 Apr 20. Epub 2021 Apr 20.

From the Departments of Anesthesia (FB-Z, M-M, E-W, KE-YT), Family Medicine-Emergency Medicine (VS-P), MiCcare Research Centre, Mount Sinai Hospital-Sinai Health System, University of Toronto, Toronto, Ontario, Canada (XY-Y), The Wilson Centre and Post-MD Education, Toronto, Ontario, Canada (W-T).

Background: Decision-making deficits in airway emergencies have led to adverse patient outcomes. A cognitive aid would assist clinicians through critical decision-making steps, preventing key actions omission.

Objective: We aimed to investigate the effects of a visual airway cognitive aid on decision-making in a simulated airway emergency scenario. Read More

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Reconstructive Management of Gunshot Wounds to the Frontal Sinus: An Urban Trauma Center's Perspective.

Ann Plast Surg 2021 Apr 21. Epub 2021 Apr 21.

From the University of Alabama at Birmingham, School of Medicine, Birmingham, AL Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, AL Ford Plastic and Reconstructive Surgery, Baton Rouge, LA Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL.

Introduction: In the last decade, we have seen a steady increase in the incidence of frontal sinus trauma due to gunshot wounds and a decrease in motor vehicle trauma. Penetrating gunshot wounds to the frontal sinus present a unique challenge to the reconstructive surgeon because they require careful consideration of the management principles of plastic surgery. Despite previous reviews on frontal sinus trauma, there are no studies examining the management techniques of frontal sinus fractures due specifically to gunshot wounds. Read More

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Low suction on digital drainage devices promptly improves post-operative air leaks following lung resection operations: a retrospective study.

J Cardiothorac Surg 2021 Apr 21;16(1):105. Epub 2021 Apr 21.

Department of Thoracic Surgery, Akashi Medical Center, 743-33 Okubocho Yagi, Akashi, Hyogo, 674-0063, Japan.

Background: We investigated the most effective suction pressure for preventing or promptly improving postoperative air leaks on digital drainage devices after lung resection.

Methods: We retrospectively analyzed the postoperative data of 242 patients who were monitored with a digital drainage system after pulmonary resection in our institution between December 2017 and June 2020. We divided the patients into three groups according to the suction pressure used: A (low-pressure suction group: - 5 cm HO), B (intermediate-pressure group: - 10 cm HO), and C (high-pressure suction group: - 20 cm HO). Read More

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Prognostic Value of Positive Lymph Nodes in Patients with Renal Cell Carcinoma and Tumor Thrombus Undergoing Nephrectomy and Thrombectomy.

Urol Int 2021 Apr 21:1-9. Epub 2021 Apr 21.

Department of Urology, Peking University Third Hospital, Beijing, China.

Introductions: The objective of this study was to determine the prognostic value of positive lymph nodes (LNs) in patients with renal cell carcinoma (RCC) and tumor thrombus (TT) and to explore risk factors predicting LNs metastasis.

Methods: We retrospectively analyzed 216 patients with RCC and TT treated at a single institution from January 2015 to December 2019. Overall survival (OS) and progression-free survival (PFS) was estimated using the Kaplan-Meier curves divided by pathological LN status. Read More

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Endoscopic cardial constriction with band ligation in the treatment of refractory gastroesophageal reflux disease: a preliminary feasibility study.

Surg Endosc 2021 Apr 21. Epub 2021 Apr 21.

School of Basic Medical Science, Zhengzhou University, Zhengzhou, 450001, Henan Province, People's Republic of China.

Background: Gastroesophageal reflux disease (GERD) is a common digestive disease, could cause extra-esophageal symptoms. Peroral endoscopic cardial constriction with band ligation (PECC-b) is a minimally invasive method for the treatment of GERD in recent years. The goals of this study were to evaluate the clinical efficacy of PECC-b to treat gastroesophageal reflux-related symptoms. Read More

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Urinary peptides in heart failure: a link to molecular pathophysiology.

Eur J Heart Fail 2021 Apr 21. Epub 2021 Apr 21.

Mosaiques Diagnostics GmbH, Hannover, Germany.

Aims: Heart failure (HF) is a major public health concern worldwide. The diversity of HF makes it challenging to decipher the underlying complex pathological processes using single biomarkers. We examined the association between urinary peptides and HF with reduced (HFrEF), mid-range (HFmrEF) and preserved (HFpEF) ejection fraction, defined based on European Society of Cardiology guidelines, and the links between these peptide biomarkers and molecular pathophysiology. Read More

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Pharmacist-led interventions to reduce adverse drug events in older people living in residential aged care facilities: A systematic review.

Br J Clin Pharmacol 2021 Apr 20. Epub 2021 Apr 20.

School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, 7005, Australia.

Aims: We aimed to investigate the efficacy and effectiveness of pharmacist-led interventions to reduce adverse drug events (ADEs) in older people living in residential aged care facilities (RACFs).

Methods: We systematically searched MEDLINE via PubMed, Embase, Cochrane Central Register of Controlled Trials and PsycINFO from their inceptions to July 2020. We investigated experimental study designs that employed a control group, or quasi-experimental studies conducted in RACFs. Read More

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Family History of GERD Does Not Predict Anti-Reflux Surgery Outcomes.

JSLS 2021 Jan-Mar;25(1)

Division of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX.

Background And Objectives: Gastroesophageal reflux disease is a common disease and there is little known about the role family history plays in its disease process and incidence. Our study was designed to compare the patients with first degree relatives with and without the disease and see if there was any difference in patients needing antireflux surgery, the outcomes after antireflux surgery, and whether they needed redo surgery.

Methods: An institutional review board approved registry for patients undergoing antireflux surgery at a single institution was used. Read More

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Laparoscopic Ventral Hernia Repair with Poly-4-Hydroxybutyrate Absorbable Barrier Composite Mesh.

JSLS 2021 Jan-Mar;25(1)

Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Background: Repair of ventral and incisional hernias (VIHR) is a common procedure, newly introduced resorbable mesh biomaterials provide an attractive option to reduce the use of permanent synthetic mesh in hernia surgery and reduce its complications. However, data on the use of slowly resorbable mesh materials remains scarce, this study aims to evaluate the use of poly-4-hydroxybutyrate/absorbable barrier composite mesh (P4HB/ABCM) in laparoscopic repair of VIHR.

Methods: This is a retrospective study of a sequential cohort of patients undergoing laparoscopic VIHR utilizing a P4HB/ABCM mesh. Read More

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Low levels of anti-cyclic citrullinated peptide (CCP) 3.1 associated with diseases other than rheumatoid arthritis.

Medicine (Baltimore) 2021 Apr;100(16):e25558

Cedars-Sinai Medical Center, Division of Rheumatology, Los Angeles, CA.

Abstract: Our aim was to investigate the newest generation anti-cyclic citrullinated peptide (CCP) antibody 3.1 assay in diagnosing rheumatoid arthritis (RA) compared with other autoimmune and non-autoimmune diseases. We performed a retrospective observational chart review of patients with a positive CCP level over a one-year period at a single academic institution and assessed the associated diagnoses after at least six-months of follow-up. Read More

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Personalised virtual gene panels reduce interpretation workload and maintain diagnostic rates of proband-only clinical exome sequencing for rare disorders.

J Med Genet 2021 Apr 20. Epub 2021 Apr 20.

North West Genomic Laboratory Hub, Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK.

Purpose: The increased adoption of genomic strategies in the clinic makes it imperative for diagnostic laboratories to improve the efficiency of variant interpretation. Clinical exome sequencing (CES) is becoming a valuable diagnostic tool, capable of meeting the diagnostic demand imposed by the vast array of different rare monogenic disorders. We have assessed a clinician-led and phenotype-based approach for virtual gene panel generation for analysis of targeted CES in patients with rare disease in a single institution. Read More

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Acquired Idiopathic Stiffness After Contemporary Total Knee Arthroplasty: Incidence, Risk Factors, and Results Over 25 Years.

J Arthroplasty 2021 Apr 1. Epub 2021 Apr 1.

Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.

Background: Acquired idiopathic stiffness (AIS) remains a common failure mode of contemporary total knee arthroplasties (TKAs). The present study investigated the incidence of AIS and manipulation under anesthesia (MUA) at a single institution over time, determined outcomes of MUAs, and identified risk factors associated with AIS and MUA.

Methods: We identified 9771 patients (12,735 knees) who underwent primary TKAs with cemented, modular metal-backed, posterior-stabilized implants from 2000 to 2016 using our institutional total joint registry. Read More

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Overall health information exposure, its barriers and impacts on attitude toward healthcare among cancer patients. The long-term aftermath of the 2011 triple disaster in Fukushima, Japan: A single institution cross-sectional study.

Health Informatics J 2021 Apr-Jun;27(2):1460458221996420

Minamisoma Municipal General Hospital, Japan.

Disasters can hinder access to health information among cancer patients. However, little is known regarding overall health information exposure (HIE), its barriers and its impacts on attitudes toward healthcare among cancer patients in the long-term aftermath of disasters. The aims of this study were threefold: assess the extent of HIE; identify associations between family composition and a non-engagement with HIE; and examine the effects of HIE on attitudes toward healthcare among local cancer patients-5 years after the 2011 triple disaster (earthquake, tsunami, and nuclear disaster) in Fukushima, Japan. Read More

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Latency Period after Preterm Premature Rupture of Membranes: Singletons versus Twins.

Am J Perinatol 2021 Apr 20. Epub 2021 Apr 20.

Department of Obstetrics and Gynecology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York.

Objective:  Several studies have evaluated the differences in duration of latency and clinical outcomes between singleton and twin pregnancies after preterm premature rupture of membranes (PPROM); however, these data are limited to single-institution analyses and based on small sample sizes. The aim of this study was to assess differences in latency and clinical outcomes in singletons versus twin gestations affected by PPROM in a large, diverse cohort of women.

Study Design:  This is a secondary analysis of a multicenter trial of magnesium for neuroprotection in women at high risk of preterm birth. Read More

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Opioid prescribing practices in academic otolaryngology: A single institutional survey.

Am J Otolaryngol 2021 Apr 15;42(5):103038. Epub 2021 Apr 15.

Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.

Objectives: Opioids are highly addictive medications and otolaryngologists have a responsibility to practice opioid stewardship. We investigated postoperative opioid prescribing patterns among resident and attending physicians as an educational platform to underscore the importance of conscientious opioid prescribing.

Methods: This quality improvement study was designed as a cross-sectional electronic survey. Read More

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Medical Student Attitudes Toward Blood Donation in Times of Increased Need.

Am Surg 2021 Apr 20:31348211011083. Epub 2021 Apr 20.

Division of Trauma, Acute Care and Critical Care Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.

Background: In situations of increased need, such as mass casualty incidents (MCIs) and COVID-19, donated blood products are in shortage across the United States. Medical students are a potential pool for blood donors. The aim of this study was to determine overall attitudes of medical students at a single academic institution toward blood donation during times of increased need. Read More

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Opioid Prescribing at Discharge in Opioid-Naïve Trauma Patients.

Am Surg 2021 Apr 20:31348211011105. Epub 2021 Apr 20.

Department of Pharmacy, 6473St. Joseph's University Medical Center, Paterson, NJ, USA.

Background: Opioid analgesics remain mainstay of treatment for trauma-related pain despite growing concerns for opioid dependency or misuse. The purpose of this study was to evaluate opioid prescribing at hospital discharge after traumatic injury.

Methods: This is a single-center, retrospective analysis of patients ≥18 years of age admitted for ≥24 hours with a primary diagnosis of traumatic injury. Read More

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Above the Clavicle: A Simplified Screening Method for Asymptomatic Blunt Cerebral Vascular Injury.

Am Surg 2021 Apr 20:31348211011141. Epub 2021 Apr 20.

Department of Surgery, 12279Wake Forest University School of Medicine, Winston-Salem, NC, USA.

Introduction: Blunt cerebrovascular injury (BCVI) is an increasingly detected pattern in trauma with significant morbidity, putting patients at risk for subsequent stoke. Complex screening protocols exist to determine who should undergo CT angiography of the neck (CTAN) to evaluate for BCVI. Once identified, stroke incidence may be reduced with appropriate treatment across grades. Read More

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Solid Pseudopapillary Neoplasms of the Pancreas: a Single-Center Experience and Review of the Literature.

J Gastrointest Cancer 2021 Apr 20. Epub 2021 Apr 20.

Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK.

Purpose: Pancreatic solid pseudopapillary neoplasms (SPNs) are rare borderline tumours mainly affecting young female patients. The number of patients diagnosed with SPNs has increased significantly in the last decades owing to the increased use of cross-sectional imaging investigating different abdominal symptoms, whilst a significant proportion are incidentally discovered during the process of evaluating other pathologies. We herein present our institutional experience of patients with SPN who underwent curative resection focusing on clinical, pathological features, and the long-term outcomes. Read More

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Pathogenic Mutations and Atypical Flow Cytometric Findings Characterize the Majority of Unclassifiable Myelodysplastic/Myeloproliferative Neoplasms.

Am J Clin Pathol 2021 Apr 20. Epub 2021 Apr 20.

Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OHUSA.

Objectives: Myelodysplastic/myeloproliferative neoplasms (MDS/MPN) are a group of rare and heterogeneous hematopoietic disorders that frequently present a diagnostic challenge. Here we present our institutional experience with next-generation sequencing (NGS), together with morphologic, flow cytometric, and cytogenetic evaluation, in the diagnosis of MDS/MPN, with particular emphasis on MDS/MPN unclassifiable (MPN-U).

Methods: We evaluated the morphologic, flow cytometric, cytogenetic, and molecular characteristics of all MDS/MPN cases that underwent NGS at our institution between April 2016 and February 2019. Read More

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Long-term Outcome of Microscopic Transsphenoidal Surgery for Prolactinomas as an Alternative to Dopamine Agonists.

J Korean Med Sci 2021 Apr 19;36(15):e97. Epub 2021 Apr 19.

Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.

Background: Although long-term dopamine agonist (DA) therapy is recommended as a first-line treatment for prolactinoma, some patients may prefer surgical treatment because of the potential adverse effects of long-term medication, or the desire to become pregnant. This study aimed to determine whether surgical treatment of prolactinomas could be an alternative to DA therapy.

Methods: In this retrospective study, 96 consecutive patients (74 female, 22 male) underwent primary pituitary surgery without long-term DA treatment for prolactinomas at a single institution from 1990 to 2010. Read More

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The Cost of Hip and Knee Revision Arthroplasty by Diagnosis-Related Groups: Comparing Time-Driven Activity-Based Costing and Traditional Accounting.

J Arthroplasty 2021 Mar 20. Epub 2021 Mar 20.

Department of Orthopedic Surgery, New England Baptist Hospital, Boston, MA.

Background: Traditional hospital cost accounting (TA) has innate disadvantages that limit the ability to meaningfully measure care pathways and quality improvement. Time-driven activity-based costing (TDABC) allows a meticulous account of costs in primary total joint arthroplasty (TJA). However, differences between TA and TDABC have not been examined in revision hip and knee TJA (rTJA). Read More

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