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Background: Length of stay (LOS) in the hospital following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) has decreased over the past decade due to well-defined postoperative clinical pathways, earlier mobilization, and improved pain control methods. Historically, liberal use of parenteral and oral opioids for pain control caused side effects, resulting in delayed discharge. Intraoperative intrathecal morphine (ITM) has been posited to reduce the need for postoperative opioids and to expedite the discharge process. This study examines the relationship between the use of ITM with average required postoperative opioid usage and with average LOS. Methods: This IRB-approved retrospective cohort study examined 105 patients with AIS who received PSF with instrumentation split into two cohorts. One cohort underwent PSF via standard surgical protocol (n=40) while the other cohort received intraoperative ITM with the standard surgical protocol (n=65). Power analysis demonstrated a study power of 0.8. LOS and total postoperative opioid analgesic medication (morphine milligram equivalent, MME) data were collected. Age at surgery, gender, number of spinal levels fused, estimated intraoperative blood loss (EBL), preoperative Cobb angle, and any complications related to the use of ITM were also recorded. Continuous variables were analyzed with Student's t-test and categorical variables were analyzed with chi-square independent-sample tests using SAS 9.4 (α = 0.05). Results: Patients who were treated with ITM displayed shorter LOS (p<0.0001) and reduced postoperative analgesic requirement (p<0.0001). Patients who received ITM spent an average of 1.8 fewer midnights in the hospital and received an average of 221.2 MME less than patients who received standard protocol (57% decrease). There were no significant differences between the two groups for any other variable. Conclusion: Intraoperative ITM is a simple and effective treatment for scoliosis surgeons to better control postoperative pain in patients, reduce the risk of dependency, and achieve earlier discharge from the hospital. Shortened LOS reduces the overall cost of care, benefitting patients, hospitals, and insurance companies. Based on the results of this study and several earlier studies, the authors recommended that scoliosis surgeons consider incorporating use of ITM into their standard operative protocols. Level of Evidence: IV.

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A radial tear of the meniscus can lead to significant loss of meniscus function, resulting in deleterious cartilage changes. Repair of radial meniscus tears has several challenges, including suture pull-out, which can reduce healing success. We present an arthroscopic repair technique in a complete radial lateral meniscus tear using vertical reinforced bars (rebar) of suture tapes to reduce suture pull-out and approximate the radial tear.

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The use of 3-dimensional (3D) printing in orthopedics is developing rapidly and impacting the areas of preoperative planning, surgical guides, and simulation. As this technology continues to improve, the greatest impact of 3D printing may be in low- and middle-income countries where surgical items are in short supply. This study investigated sterility of 3D-printed ankle fracture fixation plates and cortical screws. The hypothesis was that the process of heated extrusion in fused deposition modeling printing would create sterile prints in a timely fashion that would not require postproduction sterilization. A free computer-assisted design program was used to design the implant models. One control group and 8 study groups were printed. Print construct, orientation, size, and postproduction sterilization differed among the groups. Sterility was assessed using thioglycollate broth cultures at 24 hours, 48 hours, and 7 days. Positive growth was speciated for aerobic and anaerobic bacteria. Print time and failed prints were recorded. Control samples were 100% positive for bacterial growth. All test samples remained sterile at all time points (100%). Speciation of control samples was obtained, and Staphylococcus was the most common species. Print times varied; however, no print time exceeded 6.75 minutes. Eighteen prints (17%) failed in the printing process. These findings demonstrate an intrinsic sterilization process associated with fused deposition modeling 3D printing and indicate the feasibility of 3D-printed surgical implants and equipment for orthopedic applications. With future research, 3D-printed implants may be a treatment modality to assist orthopedic surgeons in low- and middle-income countries. [Orthopedics. 2020; 43(1): 46-51.].

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Concentrations of polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) were determined in nearshore marine surficial sediments from three locations in Trinidad. Sediments were sampled at Sea Lots on the west coast, in south Port-of-Spain Harbor, south of Sea Lots at Caroni Lagoon National Park, and on Trinidad's east coast at Manzanilla. Total PCB concentrations in Sea Lots sediments ranged from 62 to 601ng/g (dry weight {dw}), which was higher than at Caroni and Manzanilla, 13 and 8ng/g dw, respectively. Total OCP concentrations at Sea Lots were ranged from 44.5 to 145ng/g dw, compared with 13.1 and 23.8n/g (dw), for Caroni and Manzanilla respectively. The concentrations of PCBs and of some OCPs in sediments from Sea Lots were above the Canadian interim sediment quality guidelines. To date, this data is the first report on the levels of PCBs and other organochlorine compounds from Trinidad and Tobago.

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Organochlorine compounds are a class of pollutants considered toxic to humans, fish and wildlife, and show great potential for accumulation and persistence in the environment. In May 1995, the United Nations Environmental Program (UNEP) Governing Council adopted Decision 18/32 (GC18/32) on persistent organic pollutants (POPs), the goal of which was to initiate an expeditious assessment process, initially beginning with twelve priority POPs: polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins (PCDDs or dioxins), polychlorinated dibenzofurans (PCDFs), aldrin, dieldrin, DDT, endrin, chlordane, hexachlorobenzene (HCB), mirex, toxaphene and heptachlor. In 1997, based on recommendations from the Intergovernmental Forum on Chemical Safety (IFCS), UNEP decided that immediate international action should be initiated to protect human health and the environment by reducing and/or eliminating emissions and discharges of the twelve persistent organic pollutants (the ‘dirty dozen’) specified by GC18/32. UNEP decision GC19/13C proposed a series of immediate action responses based on the IFCS recommendations: (1) general awareness of POPs; (2) information exchange between countries and organizations; and (3) improved availability of information and expertise on alternatives to POPs (UNEP, 2001 UNEP. 2001. The Stockholm Convention on Persistent Organic Pollutants. . English. PDF (accessed 29.09.08.).UNEP, 2001). In accordance with the mandates of UNEP GC18/32, GC19/13C and GC20/24, the first global legally binding instrument on POPs, ‘The Stockholm Convention’, was agreed upon. Trinidad and Tobago declared its accession to this in December 2002 and the Convention became legally binding in 2004 after France became the fiftieth country to ratify the agreement...

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