No abstract

Background: Patients continue to utilize physician review websites (PRWs) to assist in their selection of a health care provider. Studies on PRWs and how they affect patient care have recently become popular in the literature. This study analyzes PRW ratings of a previously unexamined subspecialty, pediatric orthopaedic surgeons. Methods: Three hundred ninety-nine randomly selected Pediatric Orthopaedic Society of North America member's PRW ratings were examined from May 4, 2020 to July 18, 2020. Healthgrades. com, Vitals.com, RateMDs.com, and Google.com were reviewed. Number of ratings and average ratings (0 to 5.0) were recorded. Provider sex, years in practice (0 to 10, 11 to 20, and 21+), practice type (academic, private), geographic location (Northeast, Southeast, Midwest, Southwest, West), degree (Medical Doctor, Doctor of Osteopathic Medicine), and fellowship training (yes, no) were recorded. Kruskal-Wallis testing was performed to determine factors affecting positive surgeon ratings. Results: 98.5% (393) of Pediatric Orthopaedic Society of North America surgeons were rated on a PRW at least once and were highly rated with an average rating of 4.14 of 5.0. Surgeons in practice 1 to 10 years had higher ratings than those in practice 11 to 20 and 21+ years, on Healthgrades.com (P = 0.049) and RateMDs.com (P = 0.011). Academic surgeons were found to have higher ratings than those in private practice on Google.com (P = 0.007). Sex, region of practice, degree type, and fellowship training status did not have an effect on online ratings across all PRWs. Conclusions: Pediatric orthopaedic surgeons are frequently and highly rated, similar to other orthopaedic subspecialties. Surgeons in practice 1 to 10 years were found to have statistically higher ratings on some websites. Academic surgeons were found to have statistically higher ratings on some websites.

Background. In many resource-limited countries, children are routinely given intramuscular (IM) injections of medication to treat pain or illness. IM injections are suspected in the development of gluteal fibrosis (GF) in children, a condition that limits normal hip motion and function. The mechanism by which GF develops is not understood. Our study examines a commonly IM administered antimalarial in Uganda, quinine, to assess its ability to cause fibrogenesis of muscle fibro/adipogenic progenitors (FAPs), the cellular source of muscle fibrosis. The purpose was to evaluate if quinine itself could alter muscle cells and cause fibrosis. Methods. FAPs were isolated from skeletal muscle in wildtype C57BL/6 mouse with florescence-activated cell sorting (FACS). After sorting, the FAPs were cultured in standard media until they reached 80% confluence. The cells were then cultured in a series of quinine concentrations. Fibrogenesis of FAPs was determined with RT-qPCR of fibrogenic markers.Results. The RT-PCR results showed increased αSMA, vimentin and collagen-1 expression in quinine exposed cells. At lower quinine dosages, expression increased in stemness markers; Sox2, cMyc, Oct-4, and Nanog. Conversely, at higher dosages quinine decreased stemness marker expression. Lastly, quinine increased TGFβ1 and Ki67 and decreased BMP7. Conclusions. Our findings suggest that quinine induces FAP fibrogenesis and reduces FAP stemness. Further study is needed, but if confirmed that Quinine induces fibrogenesis, limiting the use of Quinine may be an effective public health intervention to reduce cases of gluteal fibrosis and resultant childhood disability.