Successive traumatic brain injuries (TBIs) exacerbate neuroinflammation and oxidative stress. No therapeutics exist for populations at high risk of repetitive mild TBIs (rmTBIs). We explored the preventative therapeutic effects of Immunocal^®, a cysteine-rich whey protein supplement and glutathione (GSH) precursor, following rmTBI and repetitive mild-moderate TBI (rmmTBI). Populations that suffer rmTBIs largely go undiagnosed and untreated; therefore, we first examined the potential therapeutic effect of Immunocal^® long-term following rmTBI. Mice were treated with Immunocal^® prior to, during, and following rmTBI induced by controlled cortical impact until analysis at 2 weeks, 2 months, and 6 months following the last rmTBI. Astrogliosis and microgliosis were measured in cortex at each time point and edema and macrophage infiltration by MRI were analyzed at 2 months post-rmTBI. Immunocal^® significantly reduced astrogliosis at 2 weeks and 2 months post-rmTBI. Macrophage activation was observed at 2 months post-rmTBI but Immunocal^® had no significant effect on this endpoint. We did not observe significant microgliosis or edema after rmTBI. The dosing regimen was repeated in mice subjected to rmmTBI; however, using this experimental paradigm, we examined the preventative therapeutic effects of Immunocal^® at a much earlier timepoint because populations that suffer more severe rmmTBIs are more likely to receive acute diagnosis and treatment. Increases in astrogliosis, microgliosis, and serum neurofilament light (NfL), as well as reductions in the GSH:GSSG ratio, were observed 72 h post-rmmTBI. Immunocal^® only significantly reduced microgliosis after rmmTBI. In summary, we report that astrogliosis persists for 2 months post-rmTBI and that inflammation, neuronal damage, and altered redox homeostasis present acutely following rmmTBI. Immunocal^® significantly limited gliosis in these models; however, its neuroprotection was partially overwhelmed by repetitive injury. Treatments that modulate distinct aspects of TBI pathophysiology, used in combination with GSH precursors like Immunocal^®, may show more protection in these repetitive TBI models.

Background: Loss to follow-up is among the most important sources of bias in clinical research. Thus, the purpose of this study was to identify factors associated with a failure to complete a 2-year follow-up after shoulder surgery. We hypothesized that older patients would demonstrate higher follow-up rates and that patients who underwent instability surgery would have lower follow-up rates. Methods: A retrospective chart review was conducted on 1,028 consecutive patients who underwent shoulder surgery performed by a single surgeon between 2017 and 2022. All patients were contacted by the surgeon via telephone, text message, and email at 2 years postoperatively. Variables analyzed included demographic characteristics, insurance status, surgical procedure type, Social Deprivation Index (SDI), and distance from the surgical site to home. Multivariable logistic regression analysis was performed to determine which factors were associated with 2-year follow-up. Results: Of the 1,028 patients, 507 (49%) completed a 2-year follow-up. The mean patient age was 51 years, 585 patients (57%) were male, and 443 patients (43%) were female. Ninety-four percent of patients were White. Patients who completed follow-up were older (mean age, 53 compared with 49 years; p < 0.001), more likely to have undergone an arthroplasty, and more often insured by Medicare. Loss to follow-up was associated with instability surgery, Medicaid or Workers’ Compensation insurance, and missing preoperative visual analog scale (VAS) pain scores. SDI scores and distance from the surgical site were not significant predictors. Age was a covariate of both surgery type and insurance status. In the multivariable model, younger age (odds ratio [OR], 0.99; p < 0.001) and missing VAS scores (OR, 1.51; p = 0.001) independently predicted loss to follow-up, whereas current alcohol use (OR, 0.74; p = 0.024) was associated with lower odds of loss to follow-up. Conclusions: Older age emerged as the most significant predictor of follow-up adherence. Older patients, often undergoing arthroplasty and covered by Medicare, were more likely to complete follow-up. These findings highlight the need for targeted strategies to improve follow-up rates among younger patients, particularly those undergoing instability surgeries, as well as patients with Medicaid and Workers’ Compensation insurance. Level of Evidence: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Background/Objectives: The follow-up for pediatric elbow injuries often involves in-office visits to assess the range of motion (ROM). There is evidence for the use of telemedicine and digital assessments of elbow motion in adults but none in pediatrics. The aim of this study was to compare measurements of the joint range of motion and elbow alignment in children, taken in a doctor’s office, with those obtained from photographs and to evaluate the intra- and inter-observer reliability of these measurements. Methods: Fourteen children were prospectively included in this study during follow-ups after an arm fracture. Only the uninjured arm was evaluated: goniometric measurements performed in the office were compared with digital measurements obtained from photographs. For the uninjured arm, in-office goniometer measurements were compared to picture-based digital measurements. Mean digital values were compared to in-office goniometer measurements using a paired t-test, and the intra- and inter-rater reliability of the digital measurements was calculated. Results: When comparing photograph-based digital measurements to in-office goniometer measurements, the mean absolute error (average absolute difference between observer measurements and goniometer) showed differences of 4.5° for extension, 7.4° for flexion, and 4.8° for the carrying angle. The accuracy bias (average difference between observer measurements and goniometer) showed an overestimation of photographs for extension by 1.2°, an overestimation of photographs for flexion by 5.5°, and an underestimation of photographs for a carrying angle of 3.5°. Intra- and inter-rater reliability correlations were all within the good (0.75–0.9) to excellent (>0.9) ranges. The intra-rater intraclass correlation coefficient (ICC) was 0.91 for extension, 0.87 for flexion, and 0.87 for the carrying angle. The inter-rater ICC was 0.98 for extension, 0.93 for flexion, and 0.96 for the carrying angle. Conclusions: Photograph-based digital measurements appear to be an acceptable alternative compared to in-office goniometer measurements in pediatric patients.