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Campagner A, Milella F, Banfi G, Cabitza F. Second opinion machine learning for fast-track pathway assignment in hip and knee replacement surgery: the use of patient-reported outcome measures. BMC Med Inform Decis Mak 2024; 24:203. [PMID: 39044277 PMCID: PMC11267678 DOI: 10.1186/s12911-024-02602-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 07/09/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND The frequency of hip and knee arthroplasty surgeries has been rising steadily in recent decades. This trend is attributed to an aging population, leading to increased demands on healthcare systems. Fast Track (FT) surgical protocols, perioperative procedures designed to expedite patient recovery and early mobilization, have demonstrated efficacy in reducing hospital stays, convalescence periods, and associated costs. However, the criteria for selecting patients for FT procedures have not fully capitalized on the available patient data, including patient-reported outcome measures (PROMs). METHODS Our study focused on developing machine learning (ML) models to support decision making in assigning patients to FT procedures, utilizing data from patients' self-reported health status. These models are specifically designed to predict the potential health status improvement in patients initially selected for FT. Our approach focused on techniques inspired by the concept of controllable AI. This includes eXplainable AI (XAI), which aims to make the model's recommendations comprehensible to clinicians, and cautious prediction, a method used to alert clinicians about potential control losses, thereby enhancing the models' trustworthiness and reliability. RESULTS Our models were trained and tested using a dataset comprising 899 records from individual patients admitted to the FT program at IRCCS Ospedale Galeazzi-Sant'Ambrogio. After training and selecting hyper-parameters, the models were assessed using a separate internal test set. The interpretable models demonstrated performance on par or even better than the most effective 'black-box' model (Random Forest). These models achieved sensitivity, specificity, and positive predictive value (PPV) exceeding 70%, with an area under the curve (AUC) greater than 80%. The cautious prediction models exhibited enhanced performance while maintaining satisfactory coverage (over 50%). Further, when externally validated on a separate cohort from the same hospital-comprising patients from a subsequent time period-the models showed no pragmatically notable decline in performance. CONCLUSIONS Our results demonstrate the effectiveness of utilizing PROMs as basis to develop ML models for planning assignments to FT procedures. Notably, the application of controllable AI techniques, particularly those based on XAI and cautious prediction, emerges as a promising approach. These techniques provide reliable and interpretable support, essential for informed decision-making in clinical processes.
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Affiliation(s)
| | - Frida Milella
- Department of Computer Science, Systems and Communication, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Banfi
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Faculty of Medicine and Surgery, Universitá Vita-Salute San Raffaele, Milan, Italy
| | - Federico Cabitza
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Computer Science, Systems and Communication, University of Milano-Bicocca, Milan, Italy
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Fouhy LE, Lai CQ, Parnell LD, Tucker KL, Ordovás JM, Noel SE. Genome-wide association study of osteoporosis identifies genetic risk and interactions with Dietary Approaches to Stop Hypertension diet and sugar-sweetened beverages in a Hispanic cohort of older adults. J Bone Miner Res 2024; 39:697-706. [PMID: 38484114 DOI: 10.1093/jbmr/zjae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/02/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
Osteoporosis (OP) and low bone mass can be debilitating and costly conditions if not acted on quickly. This disease is also difficult to diagnose as the symptoms develop unnoticed until fracture occurs. Therefore, gaining understanding of the genetic risk associated with these conditions could be beneficial for health-care professionals in early detection and prevention. The Boston Puerto Rican Osteoporosis (BPROS) study, an ancillary study to the Boston Puerto Rican Health Study (BPRHS), collected information regarding bone and bone health. All bone measurements were taken during regular BPROS visits using dual-energy X-ray absorptiometry. The OP was defined as T-score ≤ -2.5 (≥2.5 SDs below peak bone mass). Dietary variables were collected at the second wave of the BPRHS via a food frequency questionnaire. We conducted genome-wide associations with bone outcomes, including BMD and OP for 978 participants. We also examined the interactions with dietary quality on the relationships between genotype and bone outcomes. We further tested if candidate genetic variants described in previous GWAS on OP and BMD contribute to OP risk in this population. Four variants were associated with OP: rs114829316 (IQ motif containing J gene), rs76603051, rs12214684 (melanin-concentrating hormone receptor 2 gene), and rs77303493 (Ras and Rab interactor 2 gene), and 2 variants were associated with BMD of lumbar spine (rs11855618, cingulin-like 1 gene) and hip (rs73480593, NTRK2), reaching the genome-wide significance threshold of P ≤ 5E-08. In a gene-diet interaction analysis, we found that 1 SNP showed a significant interaction with the overall Dietary Approaches to Stop Hypertension (DASH) score, and 7 SNPs with sugar-sweetened beverages (SSBs), a major contributor to the DASH score. This study identifies new genetic markers related to OP and BMD in older Hispanic adults. Additionally, we uncovered unique genetic markers that interact with dietary quality, specifically SSBs, in relation to bone health. These findings may be useful to guide early detection and preventative care.
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Affiliation(s)
- Liam E Fouhy
- Department of Biomedical and Nutritional Sciences and Center for Population Health, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Chao-Qiang Lai
- JM-US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, USDA ARS, Nutrition and Genomics Laboratory, Boston, MA 02111, USA
| | - Laurence D Parnell
- JM-US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, USDA ARS, Nutrition and Genomics Laboratory, Boston, MA 02111, USA
| | - Katherine L Tucker
- Department of Biomedical and Nutritional Sciences and Center for Population Health, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - José M Ordovás
- Nutrition and Genomics Laboratory, JM-USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111, USA
- IMDEA-Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
| | - Sabrina E Noel
- Department of Biomedical and Nutritional Sciences and Center for Population Health, University of Massachusetts Lowell, Lowell, MA 01854, USA
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Buckley JG, Frost SS, Hartley S, Rodacki ALF, Barrett BT. Moving from stable standing to single-limb stance or an up-on-the-toes position: The importance of vision to dynamic balance control. PLoS One 2024; 19:e0307365. [PMID: 39042648 PMCID: PMC11265682 DOI: 10.1371/journal.pone.0307365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/03/2024] [Indexed: 07/25/2024] Open
Abstract
Understanding the contribution vision has to dynamic balance control may help in understanding where/why loss of balance occurs during everyday locomotion. The current study determined how body-centre-of-mass (BCoM) dynamics and postural stability when moving to and holding a single-limb-stance (SS) or an up-on-the-toes (UTT) position were affected by visual occlusion. From standing on a force platform, 18 adults (mean (SD) 26.7 (4.8) years; 1.73 (0.08) m; 84.0 (22.9) kg; 7 females) completed repeated trials (x3) with and without vision in which they moved to either a SS or an UTT position (order countered-balanced), and attempted to hold that position for 2 (SS) or 5 (UTT) seconds before returning to standing. UTT trials were also repeated at a fast speed, and SS trials were repeated using both the dominant and non-dominant limb. BCoM dynamics were assessed by analysing the displacement and peak velocity of the centre-of-pressure (CoP) when moving to and from the SS and UTT positions. Balance stability was the variability in the CoP displacement/velocity when holding these positions. Results indicate that under visual occlusion, the peak CoP velocity when moving to the SS or UTT position was reduced (ES, 0.67 and 0.68, respectively), suggesting greater caution. Both the variability in the CoP displacement/velocity when holding these positions and the peak CoP velocity when returning to flat-standing increased (SS: ES, 1.0 and 0.86, respectively; UTT: ES 1.26 and 0.66, respectively), suggesting, respectively, greater instability and poorer control. The poorer control in SS trials, occurred when returning to standing from the SS position held on the non-dominant limb, and correspondingly, the reduction in SS duration when vision was occluded was greater for the non-dominant limb trails (limb-vision interaction; p = 0.042). This suggests that movements initiated/controlled by the non-dominant limb are more reliant on visual feedback than those initiated/controlled by the dominant limb.
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Affiliation(s)
- John G Buckley
- School of Engineering, University of Bradford, Bradford, United Kingdom
| | | | - Shaun Hartley
- School of Engineering, University of Bradford, Bradford, United Kingdom
| | - Andre L F Rodacki
- Department of Physical Education, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Brendan T Barrett
- School of Optometry and Vision Science, University of Bradford, Bradford, United Kingdom
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Al Zein M, Akomolafe AF, Mahmood FR, Khrayzat A, Sahebkar A, Pintus G, Kobeissy F, Eid AH. Leptin is a potential biomarker of childhood obesity and an indicator of the effectiveness of weight-loss interventions. Obes Rev 2024:e13807. [PMID: 39044542 DOI: 10.1111/obr.13807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 05/12/2024] [Accepted: 07/02/2024] [Indexed: 07/25/2024]
Abstract
Childhood obesity represents a significant public health concern, imposing a substantial burden on the healthcare system. Furthermore, weight-loss programs often exhibit reduced effectiveness in adults who have a history of childhood obesity. Therefore, early intervention against childhood obesity is imperative. Presently, the primary method for diagnosing childhood obesity relies on body mass index (BMI), yet this approach has inherent limitations. Leptin, a satiety hormone produced by adipocytes, holds promise as a superior tool for predicting both childhood and subsequent adulthood obesity. In this review, we elucidate the tools employed for assessing obesity in children, delve into the biological functions of leptin, and examine the factors governing its expression. Additionally, we discuss maternal and infantile leptin levels as predictors of childhood obesity. By exploring the relationship between leptin levels and weight loss, we present leptin as a potential indicator of the effectiveness of obesity interventions.
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Affiliation(s)
- Mohammad Al Zein
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | | | - Fathima R Mahmood
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Ali Khrayzat
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gianfranco Pintus
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | | | - Ali H Eid
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
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Dietz N, Alkin V, Agarwal N, Bjurström MF, Ugiliweneza B, Wang D, Sharma M, Drazin D, Boakye M. Polypharmacy in spinal cord injury: Matched cohort analysis comparing drug classes, medical complications, and healthcare utilization metrics with 24-month follow-up. J Spinal Cord Med 2024:1-10. [PMID: 39037335 DOI: 10.1080/10790268.2024.2375892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVE Polypharmacy in spinal cord injury (SCI) is common and predisposes patients to increased risk of adverse events. Evaluation of long-term health consequences and economic burden of polypharmacy in patients with SCI is explored. DESIGN Retrospective cohort. METHODS The IBM Marketscan Research Databases claims-based dataset was queried to search for adult patients with SCI with a 2-year follow-up. PARTICIPANTS Two matched cohorts were analyzed: those with and without polypharmacy, analyzing index hospitalization, readmissions, payments, and health outcomes. RESULTS A total of 11 569 individuals with SCI were included, of which 7235 (63%) were in the polypharmacy group who took a median of 11 separate drugs over two years. Opioid analgesics were the most common medication, present in 57% of patients with SCI meeting the criteria of polypharmacy, followed by antidepressant medications (46%) and muscle relaxants (40%). Risk of pneumonia was increased for the polypharmacy group (58%) compared to the non-polypharmacy group (45%), as were urinary tract infection (79% versus 63%), wound infection (30% versus 21%), depression (76% versus 57%), and adverse drug events (24% versus 15%) at 2 years. Combined median healthcare payments were higher in polypharmacy at 2 years ($44 333 vs. $10 937, P < .0001). CONCLUSION Majority of individuals with SCI met the criteria for polypharmacy with nearly 60% of those prescribed opioids and taking drugs from high-risk side effect profiles. Polypharmacy in SCI was associated with a greater risk of pneumonia, depression, urinary tract infections, adverse drug events, and emergency room visits over two years with four times higher overall healthcare payments at 1-year post-injury.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Victoria Alkin
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Nitin Agarwal
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Doniel Drazin
- Department of Neurosurgery, Pacific Northwest University of Health Sciences, Yakima, Washington, USA
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
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Aubert T, Gerard P, Galanzino G, Marmor S. In silico analysis of the patient-specific acetabular cup anteversion safe zone. Orthop Traumatol Surg Res 2024:103940. [PMID: 39043498 DOI: 10.1016/j.otsr.2024.103940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Various computer-assisted surgical systems claim to improve the accuracy of cup placement in total hip arthroplasties after assessing spinopelvic mobility to prevent prosthetic impingement. However, no study has yet analyzed the extent of the patient-specific cup anteversion safe zones. HYPOTHESIS We hypothesized that most patients have a safe zone >10 °, except those with abnormal spinopelvic mobility, who have a much narrower safe zone. MATERIALS AND METHODS We simulated the risks of prosthetic impingement using the planned cup anteversion. The consecutive cohort included 341 patients who underwent total hip arthroplasty. Our primary endpoint was the patient-specific impingement-free zone for cup anteversion, which was then divided into four subgroups: 0 °, 1 ° to 5 °, 6 ° to 10 °, and >10 °. This data was then secondarily analyzed for abnormal spinopelvic mobility (the difference in the spinopelvic tilt [ΔSPT] from a standing to a flexed seated position >20 °). RESULTS The mean anteversion safe zone was 22.8 ° with 82.4% (281/341) of patients with a zone strictly >10 °. The mean safe zone was 8.9 ° (+/- 9 °) in patients with an ΔSPT ≥20 ° (18.2%), with 37.1% of these patients having a zone of 0 °, 16.13% a zone between 1 ° and 5 °, 8.06% a zone between 6 ° and 10 ° and 38.71% a zone >10 °. The mean safe zone was 25.9 ° (+/- 9 °) in patients with an ΔSPT <20 ° (81.8%), and the proportion of cases in each zone was 2.51%, 1.08%, 4.3%, and 92.11%, respectively (p < 0.001). CONCLUSION The safe zone for anteversion appears to be fairly wide in most patients. However, identifying patients at risk of abnormal spinopelvic mobility seems necessary to identify the two-thirds of patients with a narrow safe zone. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Thomas Aubert
- Orthopedic Department, Croix St Simon Hospital 125 rue d'Avron, 75020 Paris, France.
| | - Philippe Gerard
- Orthopedic Department, Croix St Simon Hospital 125 rue d'Avron, 75020 Paris, France
| | - Giacomo Galanzino
- Orthopedic Department, Croix St Simon Hospital 125 rue d'Avron, 75020 Paris, France
| | - Simon Marmor
- Orthopedic Department, Croix St Simon Hospital 125 rue d'Avron, 75020 Paris, France
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Bouché PA, Corsia S, Auberger G, Descamps J, Anract P, Hamadouche M. Validation of mediCAD® software for fully digital preoperative planning of total hip arthroplasty: a retrospective study. Orthop Traumatol Surg Res 2024:103941. [PMID: 39043497 DOI: 10.1016/j.otsr.2024.103941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 03/11/2024] [Accepted: 04/09/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION The planning step that precedes a total hip arthroplasty (THA) procedure is crucial. Digital planning software programs are being increasingly used, although few studies have reported on the reliability of such tools. Furthermore, no studies have been conducted on the mediCAD® software, despite it being widely used in France. This led us to conduct a retrospective study to: (1) assess the accuracy of this planning software, (2) determine the intra- and inter-rater reliability, (3) determine how obesity affects the accuracy of planning. HYPOTHESIS THA planning is accurate and reliable when using the mediCAD® software. PATIENTS AND METHODS This was a single center, retrospective study. One hundred one consecutive cases performed by a single experienced surgeon were planned retrospectively by two blinded surgeons on two separate occasions. The acetabular cup was cemented in 90 hips (89%), cementless in 11 hips (11%). A dual mobility cup was used in 21 hips (21%). The femoral stem was cemented in 60 hips (59%). The endpoint was the number of exact plans, defined as the same size as the actual implants. An acceptable match was defined as a difference of one size. The match was unacceptable if the planned and implanted size differed by more than 2 for the acetabular cup or by more than 1 size for the femoral stem. The intra-rater and inter-rater reliability were calculated using the intraclass correlation coefficient (ICC) with 95% confidence intervals (CI). RESULTS Exact agreement was found by the first rater for 15 planned acetabular cups (15%) and for 45 planned femoral stems (45%) relative to the implants used. The second rater reached exact agreement for 20 planned acetabular cups (20%) and 50 planned femoral stems (50%). The intra-rater reliability for the acetabular cup was average (ICC = 0.57; 95%CI [0.43-0.69]) and poor (ICC = 0.38 95%CI [0.20-054]) for the 1st and 2nd rater, respectively. The intra-rater reliability for the femoral stem was poor for the 1st rater (ICC = 0.47 95%CI [0.30-0.61]) and the 2nd rater (ICC = 0.45 95%CI [0.29-0.60]). The interobserver reliability was low for the planned acetabular cup (ICC = 0.39 95%CI [0.21-0.54]) and the planned femoral stem (ICC = 0.42 95%CI [0.24-0.57]). Overall, when combining the two raters, exact prediction of the acetabular cup was achieved in 31 hips (19%) in non-obese patients and in 7 hips (21%) in obese patients (p = 0.62). DISCUSSION This study found acceptable reliability of the mediCAD® software. Experience level, radiograph magnification affected the planning outcome in this study, but obesity did not. We currently do not have the ability to incorporate a reliable radiological scale for two-dimensional templating. Some surgeons prefer using a CT scan, but this costs more than conventional radiographs and exposes the patient to more radiation. This study shows that the mediCAD® software can provide satisfactory output for the preoperative planning of THA. LEVEL OF EVIDENCE III; retrospective, diagnostic, comparative study.
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Affiliation(s)
- Pierre-Alban Bouché
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Lariboisière, 2 rue Ambroise Paré 75010 Paris, France.
| | - Simon Corsia
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques 75014 Paris, France
| | - Guillaume Auberger
- Service de Chirurgie Orthopédique et Traumatologique, Groupe Hospitalier Diaconesses Croix St-Simon, 125 rue d'Avron, 75020 Paris, France
| | - Jules Descamps
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Lariboisière, 2 rue Ambroise Paré 75010 Paris, France
| | - Philippe Anract
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques 75014 Paris, France
| | - Moussa Hamadouche
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques 75014 Paris, France
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Kimmeyer M, Rapp K, Rentschler V, Schieffer C, Schmalzl J, Christian G, Lars-Johannes L. Comparative study of two different horizontal stabilisation methods in arthroscopically assisted coracoclavicular stabilisation for acute acromioclavicular joint dislocations-Good clinical outcome and no correlation to recurrent anteroposterior instability. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39033339 DOI: 10.1002/ksa.12374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE The hypothesis of this study was that acromioclavicular K-wire transfixation is noninferior to horizontal FiberTape cerclage in terms of vertical and horizontal stability in the short follow-up period of acute acromioclavicular joint (ACJ) dislocations fixed with an arthroscopically assisted coracoclavicular single bundle endobutton cerclage system. The secondary aim was to investigate the impact of postoperative recurrent instability on clinical outcomes in these populations. METHODS In this consecutive clinical trial, all patients who underwent surgery for acute AC joint dislocation between January 2017 and December 2021 were included. Two groups were formed according to the additional AC stabilisation technique (K-wire group, cerclage group). Clinical examination and bilateral radiologic analysis (Zanca stress view, Alexander view) were performed with a follow-up period of at least 12 months. Satisfaction, return to sports, active range of motion, global shoulder scores and specific shoulder scores including constant score, disabilities of the arm, shoulder and hand (DASH) score and ACJ instability score (ACJI) were evaluated. Complications, including recurrent instability, and revision rate were assessed. RESULTS Included were 59 patients (32 K-wire group, 27 cerclage group, 92% male, median follow-up 33 months). No significant differences were found in the clinical outcome parameters between the different techniques, except for the DASH value (superior in the K-wire group). Recurrent anteroposterior instability was radiographically detected in 27% of patients. No correlation was found between anteroposterior instability and clinical outcome parameters. There was no revision surgery due to chronic ACJ instability. CONCLUSION Horizontal ACJ stabilisation with temporary K-wire transfixation does not appear to be inferior to a FiberTape cerclage technique in acute ACJ dislocations stabilised in an arthroscopically assisted single bundle DogBone technique. Recurrent ACJ instability detected radiographically does not necessarily correlate with the functional outcome and can be well compensated. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Michael Kimmeyer
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Karlsruhe, Germany
| | - Katharina Rapp
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Karlsruhe, Germany
| | - Verena Rentschler
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Karlsruhe, Germany
| | - Christian Schieffer
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Karlsruhe, Germany
| | - Jonas Schmalzl
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Würzburg, Germany
| | - Gerhardt Christian
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Karlsruhe, Germany
| | - Lehmann Lars-Johannes
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Karlsruhe, Germany
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Gollapalli S, Sharma V, Al Ghazwi A, Heskin L. Smart Glasses in Surgery: The Theatre and Beyond. Surg Innov 2024:15533506241265274. [PMID: 39033416 DOI: 10.1177/15533506241265274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
AIMS & OBJECTIVES The primary aim of this paper is to determine whether smart glasses or head-mounted displays improve efficiency in a procedural or theatre setting without compromising the quality of the procedure performed. Additionally, this paper aims to qualitatively explore applications in surgical education, whilst on-call, consulting and patient observation. DESIGN This paper is a systematic review of the literature available on the topic of smart glasses or head-mounted displays in surgical or procedural settings. METHODS A search of Pubmed, Cochrane and the Wiley Online Library was performed in accordance with the PRISMA guidelines. Procedural times and adverse outcomes were compared between the smart glass and non-smart glass groups in each of the quantitative studies. A literature review of studies, including those not satisfying the primary aim was conducted and is included in this paper. RESULTS 32 studies were identified that complied with the inclusion criteria of this paper. 8 of these studies focused on procedural times and adverse outcomes, with and without smart glass usage. Procedural time was reduced when smart glass technology was used, without an increase in adverse patient outcomes. CONCLUSIONS Surgeons should consider whether the relatively short reduction in procedural time is worth the high cost, privacy issues, battery complaints and user discomfort involved with these devices. There are promising applications of this technology in the areas of surgical education and consultation. However, more trials are necessary to assess the value of using smart glasses in these settings.
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Affiliation(s)
- Syama Gollapalli
- Royal College of Surgeons in Ireland Faculty of Medicine and Health Sciences, Dublin, Ireland
| | - Vidushi Sharma
- Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Adel Al Ghazwi
- Royal College of Surgeons in Ireland Faculty of Medicine and Health Sciences, Dublin, Ireland
| | - Leonie Heskin
- Royal College of Surgeons in Ireland Faculty of Medicine and Health Sciences, Dublin, Ireland
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Nayak D, Ray R, Anand C, Baruah TD, Goyal A. Protocolized Foot Exercises Help in Improvement of Diabetic Foot Ulcers and Quality of Life When Added to Standard Therapy-A Randomized Clinical Trial. INT J LOW EXTR WOUND 2024:15347346241262591. [PMID: 39034105 DOI: 10.1177/15347346241262591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
CONTEXT Diabetic foot disease is the major cause of nontraumatic limb amputations worldwide causing a high socioeconomic and psychological toll and a huge burden to the healthcare system. Currently, standard treatment of diabetic foot ulcer is through multidisciplinary therapy. Foot exercises have been shown to improve healing in diabetic ulcers although evidence is limited and applicability is non-uniform. Our study aimed to generate more evidence regarding the benefit of addition of protocolized foot exercises so that it can be instituted as a standard of care. METHODS AND MATERIAL It was an open label Randomized controlled trial with seventy-two patients and study duration of one and half years Patients with diabetic foot ulcers were randomized into two groups. Both groups received standard therapy for diabetic foot ulcer. The intervention group in addition received three months of protocolized foot exercises. At the end of three months ulcer healing and quality of life were m compared among both the groups. RESULTS Regular exercises for three months caused significant reduction in ulcer area compared to the non-intervention group [100% versus 45.22%, 95% CI =36.30(16.04-56.56), P-value = 0.001]. Quality of life analyzed by SF-36 score showed significant improvement in components like physical function [69.4 ± 8.9 versus 63.7 ± 11.0, 95% CI = 5.73 (0.97-10.48), P-value = 0.01], emotional well-being [65.2 ± 7.6 versus 60.8 ± 7.9, 95% CI = 4.44 (0.79-8.10), P-value = 0.01], and pain components [55.4 ± 18.5 versus 47.5 ± 14.5, 95% CI = 7.99 (0.16-15.81), P-value = 0.04) at 3 months although change in social functioning, physical health limitation, health change, energy and general health improvement were not significant. CONCLUSIONS Addition of protocolized foot exercises are beneficial for patients of diabetic foot ulcers in terms of ulcer healing as well as improvement of quality of life provided compliance to exercises can be ensured.
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Affiliation(s)
- Deepak Nayak
- Department of General Surgery, All India Institute of Medical Sciences Raipur, Raipur, India
| | - Rubik Ray
- Department of General Surgery, All India Institute of Medical Sciences Raipur, Raipur, India
| | - Chetan Anand
- Department of General Surgery, All India Institute of Medical Sciences Raipur, Raipur, India
| | - Tridip Dutta Baruah
- Department of General Surgery, All India Institute of Medical Sciences Raipur, Raipur, India
| | - Ashok Goyal
- Department of General Surgery, All India Institute of Medical Sciences Raipur, Raipur, India
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Sergi GG, Borja VR, Jesus C, Pedro H, Joan Carles M, Xavier P. Antibiotic-loaded bone cement is associated with a reduction of the risk of revision of total knee arthroplasty: Analysis of the Catalan Arthroplasty Register. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39033344 DOI: 10.1002/ksa.12361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 07/06/2024] [Accepted: 07/06/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE The purpose of this study was to analyse the impact on peri-prosthetic joint infection (PJI) rate and prosthetic survival using antibiotic-loaded bone cement (ALBC) versus plain cement during total knee arthroplasty (TKA). METHODS A retrospective cohort study was conducted. The main data source was the Catalan Arthroplasty Register (RACat). TKAs with surgery date between 1 January 2011 and 31 December 2020 were analysed and followed up until 31 December 2023. The main variable of interest was the type of cement (ALBC vs. plain cement), and several endpoints (septic revision, aseptic revision, and all-cause revision) were considered. The analysed outcomes were revision rates, survival rates and risk factors' hazard ratios (HR). RESULTS A total of 22,781 TKAs were analysed, 13,125 (57.6%) of them with plain cement and 9656 (42.4%) with ALBC. The septic revision rate was lower in the ALBC group after 3 months of follow-up (0.52% vs. 0.78%, p value = 0.04). Prosthetic survival with respect to the aseptic revision endpoint was also higher for the ALBC group during the whole follow-up period (~158 months). Regarding risk factors for infection, ALBC showed a protective effect, HR: 0.53 (0.44, 0.63), while sex (being male) and the analysed comorbidities increased the risk. CONCLUSIONS ALBC is associated with a reduction in both the septic revision and the aseptic revision rate after TKA, and thus with higher prosthetic survival. LEVEL OF EVIDENCE Level III, Therapeutic, retrospective.
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Affiliation(s)
- Gil-Gonzalez Sergi
- Institut d'investigació i Innovació Parc Taulí (I3PT-CERCA), Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Velasco-Regúlez Borja
- Data and Artificial Intelligence, Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain
- Learning systems, Artificial Intelligence Research Institute (IIIA-CSIC), Bellaterra, Spain
| | - Cerquides Jesus
- Learning systems, Artificial Intelligence Research Institute (IIIA-CSIC), Bellaterra, Spain
| | - Hinarejos Pedro
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Monllau Joan Carles
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pelfort Xavier
- Institut d'investigació i Innovació Parc Taulí (I3PT-CERCA), Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell, Spain
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Ismiarto YD, Phandu M, Handoko HK, Prasetiyo GT, Kamaris FR, Telaumbanua TT. Surgical management of bilateral preaxial and postaxial polydactyly with syndactyly: A case report. Int J Surg Case Rep 2024; 122:110064. [PMID: 39043096 DOI: 10.1016/j.ijscr.2024.110064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 07/13/2024] [Accepted: 07/19/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Polydactyly is the most common congenital malformation in the limbs. However, it is rare for a patient to exhibit concomitant preaxial and postaxial polydactyly alongside syndactyly in both limbs, and there are limited recommendations for such conditions. This report presents a case of bilateral preaxial and postaxial polydactyly with syndactyly of the feet. PRESENTATION OF CASE A 2-year-old girl was presented with an excess number of toes on both feet and an abnormal connection between the second and third toes. After a physical examination and plain radiography, the patient was diagnosed with bilateral preaxial and postaxial polydactyly with syndactyly. We performed a one-stage surgical correction consisting of ablation at the extra digit of bilateral great and little toes, followed by syndactyly release using z-plasty. The surgery was uneventful, and the parents were satisfied with the result. DISCUSSION A plain radiograph is necessary for pre-operative planning. We discarded the excess digits for cosmetics and soft and hard tissue for optimal function. It is necessary to preserve the soft tissues, remove the auxiliary digit, realign the digit, and restore the ligaments to preserve digit stability. CONCLUSION The complexity of this case required a meticulous surgical approach to address the structural abnormalities, restore functionality, and improve cosmetic appearance. In this case, the surgery can be performed in one procedure to minimize patient morbidity.
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Affiliation(s)
- Yoyos Dias Ismiarto
- Division of Pediatrics Orthopaedic Surgery, Department of Orthopaedics and Traumatology, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Mirna Phandu
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Hans Kristian Handoko
- Department of Orthopaedics and Traumatology, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.
| | - Gregorius Thomas Prasetiyo
- Department of Orthopaedics and Traumatology, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Fajri Rozi Kamaris
- Department of Orthopaedics and Traumatology, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
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Massarotti C, Cimadomo D, Spadoni V, Conforti A, Zacà C, Carosso AR, Vaiarelli A, Venturella R, Vitagliano A, Busnelli A, Cozzolino M, Borini A. Female fertility preservation for family planning: a position statement of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR). J Assist Reprod Genet 2024:10.1007/s10815-024-03197-4. [PMID: 39030346 DOI: 10.1007/s10815-024-03197-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/03/2024] [Indexed: 07/21/2024] Open
Abstract
PURPOSE This position statement by the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR) aims to establish an optimal framework for fertility preservation outside the standard before oncological therapies. Key topics include the role of fertility units in comprehensive fertility assessment, factors impacting ovarian potential, available preservation methods, and appropriate criteria for offering such interventions. METHODS The SIFES-MR writing group comprises Italian reproductive physicians, embryologists, and scientists. The consensus emerged after a six-month period of meetings, including extensive literature review, dialogue among authors and input from society members. Final approval was granted by the SIFES-MR governing council. RESULTS Fertility counselling transitions from urgent to long-term care, emphasizing family planning. Age, along with ovarian reserve markers, is the primary predictor of female fertility. Various factors, including gynecological conditions, autoimmune disorders, and prior gonadotoxic therapies, may impact ovarian reserve. Oocyte cryopreservation should be the preferred method. Women 30-34 years old and 35-39 years old, without known pathologies impacting the ovarian reserve, should cryopreserve at least 12-13 and 15-20 oocytes to achieve the same chance of a spontaneous live birth they would have if they tried to conceive at the age of cryopreservation (63% and 52%, respectively in the two age groups). CONCLUSIONS Optimal fertility counselling necessitates a long-term approach, that nurtures an understanding of fertility, facilitates timely evaluation of factors that may affect fertility, and explores fertility preservation choices at opportune intervals.
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Affiliation(s)
- Claudia Massarotti
- Physiopathology of Human Reproduction, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi, 10, 16132, Genova, Italy.
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI Department), University of Genova, Genova, Italy.
| | - Danilo Cimadomo
- IVIRMA Global Reseach Alliance, Genera, Clinica Valle Giulia, Rome, Italy
| | | | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Carlotta Zacà
- IVIRMA Global Research Alliance, 9.Baby, Bologna, Italy
| | - Andrea Roberto Carosso
- Obstetrics and Gynecology 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, Sant'Anna Hospital Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy
| | - Alberto Vaiarelli
- IVIRMA Global Reseach Alliance, Genera, Clinica Valle Giulia, Rome, Italy
| | - Roberta Venturella
- Unit of Obstetrics and Gynecology, University of Catanzaro "Magna Grecia", Catanzaro, Italy
| | - Amerigo Vitagliano
- First Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Andrea Busnelli
- Department of Obstetrics and Gynecology, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Mauro Cozzolino
- IVIRMA Global Research Alliance, IVI Roma, Rome, Italy
- IVIRMA Global Research Alliance, Fundación IVI-IIS la Fe, Valencia, Spain
| | - Andrea Borini
- IVIRMA Global Research Alliance, 9.Baby, Bologna, Italy
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Liu B, Wang L, Li X, Chen Z, Hou G, Zhou F, Wang C, Tian Y. Applying 3D-printed prostheses to reconstruct critical-sized bone defects of tibial diaphysis (> 10 cm) caused by osteomyelitis and aseptic non-union. J Orthop Surg Res 2024; 19:418. [PMID: 39033286 PMCID: PMC11264997 DOI: 10.1186/s13018-024-04926-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Clinical repair of critical-sized bone defects (CBDs) in the tibial diaphysis presents numerous challenges, including inadequate soft tissue coverage, limited blood supply, high load-bearing demands, and potential deformities. This study aimed to investigate the clinical feasibility and efficacy of employing 3D-printed prostheses for repairing CBDs exceeding 10 cm in the tibial diaphysis. METHODS This retrospective study included 14 patients (11 males and 3 females) with an average age of 46.0 years. The etiologies of CBDs comprised chronic osteomyelitis (10 cases) and aseptic non-union (4 cases), with an average defect length of 16.9 cm. All patients underwent a two-stage surgical approach: (1) debridement, osteotomy, and cement spacer implantation; and (2) insertion of 3D-printed prostheses. The interval between the two stages ranged from 8 to 12 weeks, during which the 3D-printed prostheses and induced membranes were meticulously prepared. Subsequent to surgery, patients engaged in weight-bearing and functional exercises under specialized supervision. Follow-up assessments, including gross observation, imaging examinations, and administration of the Lower Extremity Functional Scale (LEFS), were conducted at 3, 6, and 12 months postoperatively, followed by annual evaluations thereafter. RESULTS The mean postoperative follow-up duration was 28.4 months, with an average waiting period between prosthesis implantation and weight-bearing of 10.4 days. At the latest follow-up, all patients demonstrated autonomous ambulation without assistance, and their LEFS scores exhibited a significant improvement compared to preoperative values (30.7 vs. 53.1, P < 0.001). Imaging assessments revealed progressive bone regeneration at the defect site, with new bone formation extending along the prosthesis. Complications included interlocking screw breakage in two patients, interlocking screw loosening in one patient, and nail breakage in another. CONCLUSIONS Utilization of 3D-printed prostheses facilitates prompt restoration of CBDs in the tibial diaphysis, enabling early initiation of weight-bearing activities and recovery of ambulatory function. This efficacious surgical approach holds promise for practical application.
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Affiliation(s)
- Bingchuan Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Liwei Wang
- Department of Anesthesiology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China
| | - Xingcai Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhuo Chen
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Guojin Hou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Fang Zhou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Caimei Wang
- Beijing AKEC Medical Co., Ltd, Beijing, China
| | - Yun Tian
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.
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Ma J, Wang XR, Zhou YX, Zhou WJ, Zhang JN, Sun CY. Navigating the gut-bone axis: The pivotal role of Coprococcus3 in osteoporosis prevention through Mendelian randomization. Medicine (Baltimore) 2024; 103:e38861. [PMID: 39029026 DOI: 10.1097/md.0000000000038861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
Osteoporosis (OP) constitutes a notable public health concern that significantly impacts the skeletal health of the global aging population. Its prevalence is steadily escalating, yet the intricacies of its diagnosis and treatment remain challenging. Recent investigations have illuminated a profound interlink between gut microbiota (GM) and bone metabolism, thereby opening new avenues for probing the causal relationship between GM and OP. Employing Mendelian randomization (MR) as the investigative tool, this study delves into the causal rapport between 211 varieties of GM and OP. The data are culled from genome-wide association studies (GWAS) conducted by the MiBioGen consortium, in tandem with OP genetic data gleaned from the UK Biobank, BioBank Japan Project, and the FinnGen database. A comprehensive repertoire of statistical methodologies, encompassing inverse-variance weighting, weighted median, Simple mode, Weighted mode, and MR-Egger regression techniques, was adroitly harnessed for meticulous analysis. The discernment emerged that the genus Coprococcus3 is inversely associated with OP, potentially serving as a deterrent against its onset. Additionally, 21 other gut microbial species exhibited a positive correlation with OP, potentially accentuating its proclivity and progression. Subsequent to rigorous scrutiny via heterogeneity and sensitivity analyses, these findings corroborate the causal nexus between GM and OP. Facilitated by MR, this study successfully elucidates the causal underpinning binding GM and OP, thereby endowing invaluable insights for deeper exploration into the pivotal role of GM in the pathogenesis of OP.
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Affiliation(s)
- Jun Ma
- Department of Orthopedics, 2nd Hospital of Mudanjiang People, Heilongjiang Province, China
| | - Xin-Ran Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Heilongjiang Province, China
| | - Yu-Xin Zhou
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Heilongjiang Province, China
| | - Wei-Jin Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, China
| | - Jian-Nan Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Heilongjiang Province, China
| | - Chong-Yi Sun
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, China
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Palee S, Yener U, Abd-Elsayed A, Wahezi SE. Is Chronic Tendon Pain Caused by Neuropathy? Exciting Breakthroughs may Direct Potential Treatment. Curr Pain Headache Rep 2024:10.1007/s11916-024-01299-3. [PMID: 39028489 DOI: 10.1007/s11916-024-01299-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Tendinopathy significantly impacts the quality of life and imposes a high economic burden, accounting for a large proportion of sports and musculoskeletal injuries. Traditionally considered a collagen-related inflammatory disorder, emerging evidence suggests a critical role of neuropathic processes in chronic tendon pain. OBJECTIVE This review aims to evaluate the neuropathic mechanisms in tendinopathy and discuss innovative treatments targeting these pathways. METHODS We analyze recent studies highlighting the tendon innervation, pathological nerve sprouting neuronal ingrowth in tendinopathy, and the associated increase in pain and neuronal mediators. RESULTS Chronic tendinopathy exhibits nociceptive sprouting from paratenon into the fibrous tendon proper. Innovative treatments such as Percutaneous Ultrasound-Guided Tenotomy (PUT) or high-frequency ultrasound interventions show promise in targeting these neuropathic components by paratenon separation. These approaches focus on disrupting the pathological innervation cycle. CONCLUSION Chronic tendon pain may be predominantly neuropathic, driven by pathologic neuronal ingrowth from paratenon into the tendon proper. Interventions that accurately target and disrupt these nerve pathways could revolutionize the treatment of tendinopathy. Further research is required to validate these findings and refine treatment modalities to ensure safety and efficacy.
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Affiliation(s)
- Suwannika Palee
- Department of Rehabilitation Medicine, Faculty of Medicine, Naresuan University, Mueng Phitsanulok, Thailand
| | - Ugur Yener
- Department of Physical Medicine & Rehabilitation, Montefiore Medical Center, 1250 Waters Place, Tower #2 8th Floor, Bronx, NY, 10461, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Sayed Emal Wahezi
- Department of Physical Medicine & Rehabilitation, Montefiore Medical Center, 1250 Waters Place, Tower #2 8th Floor, Bronx, NY, 10461, USA.
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Xu S, Li K, Jin L, Dong Y, Liang Y, Liu C, Wang P, Zhao Z, Wang Y, Guo C, Wang Z, Liu H. Distribution of scoliosis in 2.22 million adolescents in mainland China: A population-wide analysis. J Glob Health 2024; 14:04117. [PMID: 39026457 PMCID: PMC11258535 DOI: 10.7189/jogh.14.04117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
Background The characteristics of scoliosis afflicting school children and adolescents in mainland China are still unclear. Therefore, we conducted a systematic review to estimate scoliosis's prevalence and characterise its distribution in China. Methods We screened PubMed, Scopus, WanFang, China National Knowledge Infrastructure, National Science and Technology Library, and WeiPu databases for mainland China articles published between 1 January 1980 and 31 October 2022. Among them, we identified population-wide scoliosis studies in school children and adolescents. The main outcomes were the positive rate of primary screening and the prevalence of final screening. Primary screening mainly included general examination with/without the forward bending test in school. The final screening entailed clinical diagnosis by Röntgen radiation in a hospital (based on primary screening). A meta-analysis of scoliosis distribution by gender was performed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs). Further, we analysed the distributions of scoliosis by age, region, aetiological type, and severity of curvature, in addition to the correlation between its prevalence and altitude or latitude. Results 77 studies with 2 224 320 participants were included. The positive rate through primary screening was 3.97%, whereas the prevalence of scoliosis at final screening was 1.20%. Analysing the data revealed a higher prevalence of scoliosis in girls (OR = 1.57; 95% CI = 1.38-1.81). The age-wise peak rate of scoliosis was 15-16 years (1.07%) in boys and 13-14 years (1.42%) in girls. The mean prevalence of scoliosis was 1.07% in the western region, 1.54% in the central, and 1.35% in the eastern. Scoliosis prevalence was not correlated with either altitude or latitude. The prevalence of idiopathic and congenital scoliosis was 1.18 and 0.03%. Among all subjects with scoliosis, 79.10 and 16.80% had mild and medium disease severity. Conclusions According to this comprehensive study using data sets of scoliosis in adolescents across mainland China, the mean prevalence of scoliosis is 1.20%, yet 1.57 times higher in girls than boys, and is most prevalent in the middle region. Overall, scoliosis in adolescents could pose a burden to public health in mainland China. Registration PROSPERO CRD42021231987.
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Affiliation(s)
- Shuai Xu
- Department of Spinal Surgery, Peking University People’s Hospital, Peking University, Beijing, China
| | - Kexin Li
- Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Linyu Jin
- Department of Spinal Surgery, Peking University People’s Hospital, Peking University, Beijing, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Yan Liang
- Department of Spinal Surgery, Peking University People’s Hospital, Peking University, Beijing, China
| | - Chenjun Liu
- Department of Spinal Surgery, Peking University People’s Hospital, Peking University, Beijing, China
| | - Peihan Wang
- Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Zhuran Zhao
- Department of Paediatrics, Peking University People’s Hospital, Peking University, Beijing, China
| | - Yixuan Wang
- Department of Pain Medicine Centre, Peking University Third Hospital, Peking University, Beijing, China
| | - Chen Guo
- Department of Spinal Surgery, Peking University People’s Hospital, Peking University, Beijing, China
| | - Zhenbo Wang
- Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Haiying Liu
- Department of Spinal Surgery, Peking University People’s Hospital, Peking University, Beijing, China
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Moon JM, Kwon KE, Lee JW, Minn KR, Kim K, Seo J, Shin SY, Jung SY, Choi CH. Risk of avascular necrosis in patients with inflammatory bowel disease: Insights from a nationwide cohort study and the impact of corticosteroid use. Dig Liver Dis 2024:S1590-8658(24)00870-3. [PMID: 39033076 DOI: 10.1016/j.dld.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 06/30/2024] [Accepted: 07/03/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND AND AIM Corticosteroid use is a risk factor for avascular necrosis (AVN) and inflammatory bowel disease (IBD) patients are often exposed to higher corticosteroid usage. We investigated the epidemiology and risk factors of AVN in a nationwide population-based cohort of IBD patients. METHODS Patients newly diagnosed with IBD were identified, and sex- and age-matched participants from the general population were selected in a 1:3 IBD:non-IBD ratio. We investigated newly diagnosed AVN and assessed the incidence rates and risk of AVN with multivariate Cox regression models. RESULTS During the median follow-up period of 7.22±3.85 years, 357 (0.62 %) were newly diagnosed with AVN. The risk of AVN was higher in IBD (aHR = 1.42, 95 % CI: 1.25-1.62). Ulcerative colitis (UC) patients showed a particularly elevated risk of developing AVN. IBD patients with higher cumulative corticosteroid intake and exposed to a mean prednisolone-equivalent daily dose>20 mg for >1 month were at higher risk of AVN. In Crohn's disease (CD), longer exposure time to >20 mg prednisolone-equivalent presented a trend in increased risk. CONCLUSION AVN risk was higher in IBD than in those without, particularly in UC and corticosteroid use in IBD could pose a crucial role. These underscore the importance of considering the AVN etiological factors, particularly corticosteroid use.
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Affiliation(s)
- Jung Min Moon
- Chung-Ang University College of Medicine, Department of Internal Medicine, Seoul, Republic of Korea
| | | | - Ju Won Lee
- College of Pharmacy, Chung-Ang University, Seoul, Korea
| | - Kyung Rok Minn
- Chung-Ang University College of Medicine, Department of Internal Medicine, Seoul, Republic of Korea
| | - Kyuwon Kim
- Chung-Ang University College of Medicine, Department of Internal Medicine, Seoul, Republic of Korea
| | - Jeongkuk Seo
- Chung-Ang University College of Medicine, Department of Internal Medicine, Seoul, Republic of Korea
| | - Seung Yong Shin
- Chung-Ang University College of Medicine, Department of Internal Medicine, Seoul, Republic of Korea
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, Korea.
| | - Chang Hwan Choi
- Chung-Ang University College of Medicine, Department of Internal Medicine, Seoul, Republic of Korea.
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Peters MCWM, Pronk Y, Brinkman JM. Eight of ten patients return to daily activities, work, and sports after total knee arthroplasty. World J Orthop 2024; 15:608-617. [DOI: 10.5312/wjo.v15.i7.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/13/2024] [Accepted: 05/29/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Besides return to work (RTW) and return to sports (RTS), patients also prefer to return to daily activities (RTA) such as walking, sleeping, grocery shopping, and domestic work following total knee arthroplasty (TKA). However, evidence on the timelines and probability of patients’ RTA is sparse.
AIM To assess the percentage of patients able to RTA, RTW, and RTS after TKA, as well as the timeframe and influencing factors of this return.
METHODS A retrospective cohort study with prospectively collected data was conducted at a medium-sized Dutch orthopedic hospital. Assessments of RTA, RTW, and RTS were performed at 3 mo and/or 6 mo following TKA. Investigated factors encompassed patient characteristics, surgical characteristics, and preoperative patient-reported outcomes.
RESULTS TKA patients [n = 2063; 66 years old (interquartile range [IQR]: 7 years); 47% male; 28 kg/m2 (IQR: 4 kg/m2)] showed RTA ranging from 28% for kneeling to 94% for grocery shopping, with 20 d (IQR: 27 d) spent for putting on shoes to 74 d (IQR: 57 d) for kneeling. RTW rates varied from 62% for medium-impact work to 87% for low-impact work, taking 33 d (IQR: 29 d) to 78 d (IQR: 55 d). RTS ranged from 48% for medium-impact sports to 90% for low-impact sports, occurring within 43 d (IQR: 24 d) to 90 d (IQR: 60 d). One or more of the investigated factors influenced the return to each of the 14 activities examined, with R² values ranging from 0.013 to 0.127.
CONCLUSION Approximately 80% of patients can RTA, RTW, and RTS within 6 mo after TKA. Return is not consistently influenced by predictive factors. Results help set realistic pre- and postoperative expectations.
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Affiliation(s)
| | - Yvette Pronk
- Department of Research, Kliniek ViaSana, Mill 5451 AA, Netherlands
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70
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Remy K, Raasveld FV, Saqr H, Khouri KS, Hwang CD, Austen WG, Valerio IL, Eberlin KR, Gfrerer L. The neuroma map: A systematic review of the anatomic distribution, etiologies, and surgical treatment of painful traumatic neuromas. Surgery 2024:S0039-6060(24)00368-4. [PMID: 39025690 DOI: 10.1016/j.surg.2024.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/01/2024] [Accepted: 05/24/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND This study analyzed all reported cases of painful traumatic neuromas to better understand their anatomic distribution, etiologies, and surgical treatment. METHODS PubMed, Embase, Cochrane, and Web of Science were searched in October 2023 for articles describing painful traumatic neuromas. RESULTS In total, 414 articles reporting 5,562 neuromas were included and categorized into head/neck, trunk, upper extremity, lower extremity, and autonomic nerves. Distribution was as follows: Head/neck: 82 articles reported on 393 neuromas (93.2% iatrogenic) most frequently involving the lingual (44.3%), cervical plexus (14.9%), great auricular (8.5%), inferior/superior alveolar (8.3%), and occipital (7.2%) nerves. Trunk: 47 articles reported on 554 neuromas (92.9% iatrogenic) most commonly involving the intercostal (35.4%), genitofemoral (14.3%), and pudendal (12.9%) nerves. Upper extremity: 159 articles reported on 2079 neuromas (53.3% after amputation) most frequently involving the digital (46.9%), superficial radial (18.3%), and median (7.0%) nerves. Lower extremity: 128 articles reported on 2,531 neuromas (53.0% after amputation) most commonly involving the sural (17.9%), superficial peroneal (17.3%), and saphenous (16.0%) nerves. Autonomic nerves: 15 articles reported on 53 neuromas (100% iatrogenic) most frequently involving the biliary tract (73.9%) and vagus nerve (14.9%). Compared with the extremities, neuromas in the head/neck and trunk had significantly longer symptom duration before surgical treatment and the nerve end was significantly less frequently reconstructed after neuroma excision. CONCLUSION Painful neuromas are predominantly reported in the extremities yet may occur throughout the body primarily after iatrogenic injury. Knowledge of their anatomic distribution from head to toe will encourage awareness to avoid injury and expedite diagnosis to prevent treatment delay.
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Affiliation(s)
- Katya Remy
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Floris V Raasveld
- Hand and Arm Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Hazem Saqr
- Division of Plastic and Reconstructive Surgery, University of Pittsburgh, PA
| | - Kimberly S Khouri
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Charles D Hwang
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - William G Austen
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ian L Valerio
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kyle R Eberlin
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Hand and Arm Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Lisa Gfrerer
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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Villarreal-Espinosa JB, Berreta RS, Boden SA, Khan ZA, Carter AJ, Cole BJ, Verma NN. The Application of Interpositional (Bone-Tendon Interface) Scaffolds in Tendon Healing Augmentation for Rotator Cuff Repair. Arthroscopy 2024:S0749-8063(24)00499-7. [PMID: 39029812 DOI: 10.1016/j.arthro.2024.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/21/2024]
Abstract
PURPOSE To investigate outcomes of inlay positioned scaffolds for rotator cuff healing and regeneration of native enthesis following augmentation of rotator cuff tendon repairs in preclinical studies. METHODS A literature search was performed using PubMed, Embase, and CINAHL databases according to PRISMA guidelines. Preclinical studies reporting on outcomes after inlay tendon augmentation in rotator cuff repair were included. Preclinical study quality was assessed using an adapted version of the Gold Standard Publication Checklist (GSPC) for animal studies. Level of evidence was defined based on the inclusion of (A) clinical, (B) biomechanical, (C) biochemical, (D) semiquantitive, and (E) qualitative histological analyses. RESULTS Thirteen preclinical studies met the inclusion criteria. Quality assessment and level of evidence scores ranged from 4-8 points and B-E, respectively. Sheep and ewes were the main animal rotator cuff tear models utilized (n=7). Demineralized bone matrix or demineralized cortical bone were the most commonly investigated scaffolds (n=6). The majority of the pre-clinical evidence (n=10) demonstrated qualitative or quantitative differences regarding histological, biomechanical, and biochemical outcomes in favor of interpositional scaffold augmentation of cuff repairs in comparison to controls. CONCLUSION Inlay scaffold positioning in preclinical studies has been shown to enhance the healing biology of the enthesis while providing histological similarities to its native 4-zone configuration. CLINICAL RELEVANCE Although onlay positioned grafts and scaffolds have demonstrated mixed results in preclinical and early clinical studies, inlay scaffolds may provide enhanced healing and structural support in comparison due to the ability to integrate with the bone-tendon interface.
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Affiliation(s)
| | | | - Stephanie A Boden
- Department of Orthopaedics, Rush University Medical Center, Chicago, IL
| | | | - Andrew J Carter
- Prince of Wales Clinical School, UNSW Medicine at the University of New South Wales (UNSW), Australia
| | - Brian J Cole
- Department of Orthopaedics, Rush University Medical Center, Chicago, IL
| | - Nikhil N Verma
- Department of Orthopaedics, Rush University Medical Center, Chicago, IL.
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Jiang K, Xie Y, Zhang X, Zhang X, Zhou B, Li M, Chen Y, Hu J, Zhang Z, Chen S, Yu K, Qiu C, Zhang X. Fully and Weakly Supervised Deep Learning for Meniscal Injury Classification, and Location Based on MRI. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01198-4. [PMID: 39020156 DOI: 10.1007/s10278-024-01198-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 06/14/2024] [Accepted: 07/08/2024] [Indexed: 07/19/2024]
Abstract
Meniscal injury is a common cause of knee joint pain and a precursor to knee osteoarthritis (KOA). The purpose of this study is to develop an automatic pipeline for meniscal injury classification and localization using fully and weakly supervised networks based on MRI images. In this retrospective study, data were from the osteoarthritis initiative (OAI). The MR images were reconstructed using a sagittal intermediate-weighted fat-suppressed turbo spin-echo sequence. (1) We used 130 knees from the OAI to develop the LGSA-UNet model which fuses the features of adjacent slices and adjusts the blocks in Siam to enable the central slice to obtain rich contextual information. (2) One thousand seven hundred and fifty-six knees from the OAI were included to establish segmentation and classification models. The segmentation model achieved a DICE coefficient ranging from 0.84 to 0.93. The AUC values ranged from 0.85 to 0.95 in the binary models. The accuracy for the three types of menisci (normal, tear, and maceration) ranged from 0.60 to 0.88. Furthermore, 206 knees from the orthopedic hospital were used as an external validation data set to evaluate the performance of the model. The segmentation and classification models still performed well on the external validation set. To compare the diagnostic performances between the deep learning (DL) models and radiologists, the external validation sets were sent to two radiologists. The binary classification model outperformed the diagnostic performance of the junior radiologist (0.82-0.87 versus 0.74-0.88). This study highlights the potential of DL in knee meniscus segmentation and injury classification which can help improve diagnostic efficiency.
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Affiliation(s)
- Kexin Jiang
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University (Academy of Orthopedics Guangdong Province), 183 Zhongshan Ave W, Guangzhou, 510630, China
| | - Yuhan Xie
- School of Electronics and Communication Engineering, Sun Yat-sen University, Guangzhou, China
| | - Xintao Zhang
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University (Academy of Orthopedics Guangdong Province), 183 Zhongshan Ave W, Guangzhou, 510630, China
| | - Xinru Zhang
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University (Academy of Orthopedics Guangdong Province), 183 Zhongshan Ave W, Guangzhou, 510630, China
| | - Beibei Zhou
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University (Academy of Orthopedics Guangdong Province), 183 Zhongshan Ave W, Guangzhou, 510630, China
| | - Mianwen Li
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University (Academy of Orthopedics Guangdong Province), 183 Zhongshan Ave W, Guangzhou, 510630, China
| | - Yanjun Chen
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University (Academy of Orthopedics Guangdong Province), 183 Zhongshan Ave W, Guangzhou, 510630, China
| | - Jiaping Hu
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University (Academy of Orthopedics Guangdong Province), 183 Zhongshan Ave W, Guangzhou, 510630, China
| | - Zhiyong Zhang
- School of Electronics and Communication Engineering, Sun Yat-sen University, Guangzhou, China
| | - Shaolong Chen
- School of Electronics and Communication Engineering, Sun Yat-sen University, Guangzhou, China
| | - Keyan Yu
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University (Academy of Orthopedics Guangdong Province), 183 Zhongshan Ave W, Guangzhou, 510630, China
| | - Changzhen Qiu
- School of Electronics and Communication Engineering, Sun Yat-sen University, Guangzhou, China.
| | - Xiaodong Zhang
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University (Academy of Orthopedics Guangdong Province), 183 Zhongshan Ave W, Guangzhou, 510630, China.
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Mackay G, Allen J. Platelet Rich plasma injection of the vocal folds in benign vocal pathologies. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08824-5. [PMID: 39014252 DOI: 10.1007/s00405-024-08824-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 07/01/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE There are few options for treatment of dysphonia secondary to vocal pathology related to lamina propria scar, atrophy, sulcus, or inflammatory disorders. Platelet rich plasma (PRP) may provide anti-inflammatory and regenerative properties seen with other tissue engineering therapies without the risks associated with these treatments. We evaluated vocal fold (VF) injection of PRP for feasibility, phonatory effects, patient satisfaction and durability. METHODS Patients with dysphonia secondary to vocal fold scar, atrophy, sulcus and inflammatory lesions were included. PRP injections were administered in office, to bilateral vocal folds. Patients were followed up at 1 week, 1 month, 3 months and 6 months to assess outcomes (GRBAS scale, maximum phonation time, vocal fatigue index (VFI), voice handicap index (VHI-10) and stroboscopy). RESULTS 75 intracordal PRP injections were administered to 48 patients. All injections were completed, and no adverse reactions were experienced. Improvements in VHI-10 scores at 1,3,6 months were seen (mean VHI 21.73 at baseline, 15.62 at six months, p < 0.001). 72.3% rated improvement at 7 or above on Likert scale. 95.7% of patients would consider a future PRP injection. Secondary outcomes VFI, MPT, and GRBAS also demonstrated significant improvements over time. Patients receiving a single PRP injection (n = 26) still demonstrated significant VHI-10 improvements at 1,3 and 6 months. CONCLUSIONS VF office PRP injections are feasible and safe and can provide phonatory benefit and reduce vocal effort in benign VF disorders. A single PRP injection is sufficient to provide sustained benefit in some cases. LEVEL OF EVIDENCE Level III: prospective cohort study.
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Affiliation(s)
- Georgia Mackay
- Department of Surgery, University of Auckland, Private Bag 91019, Grafton Auckland, New Zealand
| | - Jacqui Allen
- Department of Surgery, University of Auckland, Private Bag 91019, Grafton Auckland, New Zealand.
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74
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Kraus R, Schneidmueller D. [Incorrectly healed supracondylar humerus fracture : That will grow out later on?!]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00113-024-01462-w. [PMID: 39020090 DOI: 10.1007/s00113-024-01462-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2024] [Indexed: 07/19/2024]
Abstract
The supracondylar humerus fracture is the most frequent fracture of the elbow region during the growth period. The peak age is around 5 years. Extension fractures predominate. The clinical diagnostics are supplemented by X‑ray images in two projections. Growth-associated spontaneous corrections of posttraumatic deformities rarely occur. The goal of treatment is therefore the active transformation of every displaced fracture into a nondisplaced stably fixed fracture.If this is not successful, the consequences of healing in a malalignment can be, e.g., restriction of elbow flexion due to remaining antecurvation or cubitus varus. Combinations are often present. The causes include technical problems with reduction and retention but also misjudgement of the X‑ray findings, ignorance of the growth prognosis or inadequate verification of whether the treatment goal has been achieved.Unsatisfactory treatment results should be corrected as early as possible. This can be done primarily before bony healing is completed or secondarily as a corrective osteotomy at any later point in time. The earlier the correction of the malalignment is performed, the greater the chances of a complete restoration to the original condition. Depending on the type and extent of the deformity various techniques for corrective osteotomy are suggested in the literature.
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Affiliation(s)
- Ralf Kraus
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Gießen und Marburg, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland.
| | - Dorien Schneidmueller
- BG Unfallklinik Murnau, Abteilung für Kindertraumatologie und Kinderorthopädie, Murnau am Staffelsee, Deutschland
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75
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Thahakoya R. Editorial for "Deep Learning Assisted Classification of T1ρ-MR Based Intervertebral Disc Degeneration Phases". J Magn Reson Imaging 2024. [PMID: 39016471 DOI: 10.1002/jmri.29509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 07/18/2024] Open
Affiliation(s)
- Rafeek Thahakoya
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
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Rakhshankhah N, Abbaszadeh M, Kazemi A, Rezaei SS, Roozpeykar S, Arabfard M. Deep learning approach to femoral AVN detection in digital radiography: differentiating patients and pre-collapse stages. BMC Musculoskelet Disord 2024; 25:547. [PMID: 39010001 PMCID: PMC11251364 DOI: 10.1186/s12891-024-07669-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 07/08/2024] [Indexed: 07/17/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate a new deep-learning model for diagnosing avascular necrosis of the femoral head (AVNFH) by analyzing pelvic anteroposterior digital radiography. METHODS The study sample included 1167 hips. The radiographs were independently classified into 6 stages by a radiologist using their simultaneous MRIs. After that, the radiographs were given to train and test the deep learning models of the project including SVM and ANFIS layer using the Python programming language and TensorFlow library. In the last step, the test set of hip radiographs was provided to two independent radiologists with different work experiences to compare their diagnosis performance to the deep learning models' performance using the F1 score and Mcnemar test analysis. RESULTS The performance of SVM for AVNFH detection (AUC = 82.88%) was slightly higher than less experienced radiologists (79.68%) and slightly lower than experienced radiologists (88.4%) without reaching significance (p-value > 0.05). Evaluation of the performance of SVM for pre-collapse AVNFH detection with an AUC of 73.58% showed significantly higher performance than less experienced radiologists (AUC = 60.70%, p-value < 0.001). On the other hand, no significant difference is noted between experienced radiologists and SVM for pre-collapse detection. ANFIS algorithm for AVNFH detection with an AUC of 86.60% showed significantly higher performance than less experienced radiologists (AUC = 79.68%, p-value = 0.04). Although reaching less performance compared to experienced radiologists statistically not significant (AUC = 88.40%, p-value = 0.20). CONCLUSIONS Our study has shed light on the remarkable capabilities of SVM and ANFIS as diagnostic tools for AVNFH detection in radiography. Their ability to achieve high accuracy with remarkable efficiency makes them promising candidates for early detection and intervention, ultimately contributing to improved patient outcomes.
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Affiliation(s)
- Nima Rakhshankhah
- Department of Radiology and Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mahdi Abbaszadeh
- Department of Orthopedic Surgery, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Atefeh Kazemi
- Department of Radiology and Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Soroush Soltan Rezaei
- Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Saeid Roozpeykar
- Department of Radiology and Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Masoud Arabfard
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Troop LD, Puetzer JL. Intermittent cyclic stretch of engineered ligaments drives hierarchical collagen fiber maturation in a dose- and organizational-dependent manner. Acta Biomater 2024:S1742-7061(24)00397-0. [PMID: 39025395 DOI: 10.1016/j.actbio.2024.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
Hierarchical collagen fibers are the primary source of strength in tendons and ligaments; however, these fibers largely do not regenerate after injury or with repair, resulting in limited treatment options. We previously developed a static culture system that guides ACL fibroblasts to produce native-sized fibers and early fascicles by 6 weeks. These constructs are promising ligament replacements, but further maturation is needed. Mechanical cues are critical for development in vivo and in engineered tissues; however, the effect on larger fiber and fascicle formation is largely unknown. Our objective was to investigate whether intermittent cyclic stretch, mimicking rapid muscle activity, drives further maturation in our system to create stronger engineered replacements and to explore whether cyclic loading has differential effects on cells at different degrees of collagen organization to better inform engineered tissue maturation protocols. Constructs were loaded with an established intermittent cyclic loading regime at 5 or 10 % strain for up to 6 weeks and compared to static controls. Cyclic loading drove cells to increase hierarchical collagen organization, collagen crimp, and tissue tensile properties, ultimately producing constructs that matched or exceeded immature ACL properties. Further, the effect of loading on cells varied depending on degree of organization. Specifically, 10 % load drove early improvements in tensile properties and composition, while 5 % load was more beneficial later in culture, suggesting a shift in mechanotransduction. This study provides new insight into how cyclic loading affects cell-driven hierarchical fiber formation and maturation, which will help to develop better rehabilitation protocols and engineer stronger replacements. STATEMENT OF SIGNIFICANCE: Collagen fibers are the primary source of strength and function in tendons and ligaments throughout the body. These fibers have limited regenerate after injury, with repair, and in engineered replacements, reducing treatment options. Cyclic load has been shown to improve fibril level alignment, but its effect at the larger fiber and fascicle length-scale is largely unknown. Here, we demonstrate intermittent cyclic loading increases cell-driven hierarchical fiber formation and tissue mechanics, producing engineered replacements with similar organization and mechanics as immature ACLs. This study provides new insight into how cyclic loading affects cell-driven fiber maturation. A better understanding of how mechanical cues regulate fiber formation will help to develop better engineered replacements and rehabilitation protocols to drive repair after injury.
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Affiliation(s)
- Leia D Troop
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA 23284, United States
| | - Jennifer L Puetzer
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA 23284, United States; Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA 23284, United States.
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Guo Y, Jiang S, Li H, Xie G, Pavel V, Zhang Q, Li Y, Huang C. Obesity induces osteoimmunology imbalance: Molecular mechanisms and clinical implications. Biomed Pharmacother 2024; 177:117139. [PMID: 39018871 DOI: 10.1016/j.biopha.2024.117139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 07/01/2024] [Accepted: 07/10/2024] [Indexed: 07/19/2024] Open
Abstract
The notion that obesity can be a protective factor for bone health is a topic of ongoing debate. Increased body weight may have a positive impact on bone health due to its mechanical effects and the production of estrogen by adipose tissue. However, recent studies have found a higher risk of bone fracture and delayed bone healing in elderly obese patients, which may be attributed to the heightened risk of bone immune regulation disruption associated with obesity. The balanced functions of bone cells such as osteoclasts, osteoblasts, and osteocytes, would be subverted by aberrant and prolonged immune responses under obese conditions. This review aims to explore the intricate relationship between obesity and bone health from the perspective of osteoimmunology, elucidate the impact of disturbances in bone immune regulation on the functioning of bone cells, including osteoclasts, osteoblasts, and osteocytes, highlighting the deleterious effects of obesity on various diseases development such as rheumatoid arthritis (RA), osteoarthritis (AS), bone fracture, periodontitis. On the one hand, weight loss may achieve significant therapeutic effects on the aforementioned diseases. On the other hand, for patients who have difficulty in losing weight, the osteoimmunological therapies could potentially serve as a viable approach in halting the progression of these disease. Additional research in the field of osteoimmunology is necessary to ascertain the optimal equilibrium between body weight and bone health.
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Affiliation(s)
- Yating Guo
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Xiangya School of Medicine, Central South University, Changsha, Hunan 410083, China
| | - Shide Jiang
- The Central Hospital of Yongzhou, Yongzhou 425000, China
| | - Hengzhen Li
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Guangyang Xie
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Xiangya School of Medicine, Central South University, Changsha, Hunan 410083, China
| | - Volotovski Pavel
- Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk 220024, Belarus
| | - Qidong Zhang
- Department of Orthopeadics, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Yusheng Li
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
| | - Cheng Huang
- Department of Orthopeadics, China-Japan Friendship Hospital, Beijing 100029, China.
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Parikh HB, Ewing B, Tseng CC, Yoshida R, Kulber DA, Kuschner SH. Orthopaedic Surgery and Indusry: What our Potential Patients Believe. J Am Acad Orthop Surg 2024:00124635-990000000-01047. [PMID: 39018577 DOI: 10.5435/jaaos-d-24-00164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/23/2024] [Indexed: 07/19/2024] Open
Abstract
PURPOSE Physician and surgeon involvement in industry has received considerable attention in recent decades. In this study, we outline the perspective of the general US population regarding (1) disclosure, (2) ownership, and (3) compensation between physicians/surgeons and industry. We hypothesize that the general population would be largely supportive of the physician/surgeon-industry relationship. METHODS An online, survey-based, descriptive study was conducted through a crowdsourcing platform, Amazon Mechanical Turk. Survey respondents were presented with a seven-item questionnaire inquiring about the physician/surgeon and industry relationship. An "attention check" question was included; those who failed this question were excluded. Descriptive statistics were used to assess the data and a McNemar chi-squared test for paired, dichotomous data. RESULTS A total of 993 respondents were included. Survey responses are summarized in Table 1. 70.6% of respondents stated that it was "important" or "extremely important" to disclose that the patient be informed whether implants used in surgery had been developed by the operating surgeon. 71.1% of respondents reported that it was "important" or "extremely important" to disclose partial ownership within industry. Seventy-one percent of respondents stated it was "important" or "extremely important" to disclose royalty payments pertaining to surgical implants. 95.6% of respondents suggested that it was acceptable for surgeons to accept free airfare and lodging, and 95.2% of respondents stated that it was acceptable for the surgeon to be compensated for time away from practice to learn about new equipment. DISCUSSION In our survey of 993 respondents, we found that relationships with industry are considered acceptable if appropriate disclosure is given to patients. We also found that although respondents suggested that physicians and surgeons may be influenced by a free meal, compensation for trips to try new equipment and time spent away from practice is considered appropriate. LEVEL OF EVIDENCE 2c, Ecological studies.
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Affiliation(s)
- Harin B Parikh
- From the Department of Hand Surgery, Cedars-Sinai Medical Center (Parikh, Yoshida, Kulber, and Kuschner), the Department of Orthopaedic Surgery, Cedars-Sinai Medical Center (Ewing), and the Department of Outpatient Rehabilitation, University of Southern California, Los Angeles, CA (Tseng)
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Lee N, Fisher MH, McNamara CT, Greyson MA, Hogan CA, Iorio ML. A Systematic Review of Clinical Outcomes of Pedicled Flap Repairs of the Knee Extensor Mechanism. J Reconstr Microsurg 2024. [PMID: 38936419 DOI: 10.1055/a-2355-4073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
BACKGROUND Rupture of the extensor mechanism of the knee has severe functional morbidity, and repair can be complicated by infection, allograft degeneration, and recurrent rupture. Techniques of autologous tissue repair utilizing pedicled flaps such as the gastrocnemius offer vascularized methods of reconstruction, with potentially diminished complication rates. The goal of this study was to evaluate the functional outcomes and complications associated with pedicled flap repair of the knee extensor mechanism. METHODS A systematic review was conducted following the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. Publications that focused on local myocutaneous flaps as a means for reconstruction were included. Causes for knee extensor mechanism deficit, flap characteristics, ambulation rate, changes in range of motion pre- and postoperation, and postoperative complications were analyzed. Technique reports including primary suture repairs, synthetic mesh, and allograft use were excluded. RESULTS An initial 119 studies were identified, with final review of 22 observational studies encompassing 128 cases of pedicled flap reconstructions. The gastrocnemius (88.2%, n = 113), quadriceps (6.3%, n = 8), and a combination of the vastus and gastrocnemius flaps (5.5%, n = 7), were the most frequently utilized flaps. Functional outcomes were favorable with 87.2% of patients achieving ambulation without external support. Variability in range of motion outcomes across different flap may be secondary to the patient characteristics as well as extent of initial injury. CONCLUSIONS Autologous pedicle flap reconstruction of the knee extensor mechanism emerges as a viable option for cases characterized by extensive defects and insufficient soft tissue coverage, which are not amenable to direct suture repairs or allografts. Postoperative assessments revealed that the majority of patients experienced improved ambulation status, with no instances of deterioration noted among the patients.
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Affiliation(s)
- Nayun Lee
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Marlie H Fisher
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Colin T McNamara
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Mark A Greyson
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Craig A Hogan
- Department of Orthopedic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Matthew L Iorio
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Scarcella NR, Mills FB, Seidelman JL, Jiranek WA. The Effect of Nutritional Status in the Treatment of Periprosthetic Joint Infections in Total Hip Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00641-7. [PMID: 39019411 DOI: 10.1016/j.arth.2024.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Periprosthetic joint infections (PJIs) continue to be a complication that plagues arthroplasty. Albumin is a surrogate marker for nutrition as well as chronic inflammation, and hypoalbuminemia increases the risk of complications in arthroplasty. Patients with PJI are at increased risk for malnutrition and complications. This study's objective was to analyze patients who underwent treatment of PJI following total hip arthroplasty and investigate the outcome with regards to albumin levels. METHODS Overall, 48 patients who underwent surgery for a total hip PJI at 1 institution were reviewed. Albumin and C-reactive protein were recorded preoperatively and 2 to 3 weeks postoperatively. Treatment failure was determined by further surgical treatment for PJI or repeat infection, as determined by Musculoskeletal Infection Society guidelines. RESULTS A debridement, antibiotics, and implant retention procedure was performed in 39 patients, and explant with the placement of an antibiotic spacer was performed in 9. Preoperative mean albumin levels were significantly decreased in patients who failed to clear their infection compared to patients who remained infection-free (2.5 versus 3.3, P < .001). Postoperative albumin levels decreased in this same population (2.6 versus 3.8, P < .001). C-reactive protein was elevated in patients who failed to clear their infection preoperatively (19.9 versus 7.5, P < .001) and postoperatively (7.0 versus 1.7, P < .001). The average time to repeat surgical treatment for their PJI was 9 months CONCLUSIONS: Lower albumin levels are observed in patients with PJI who failed to remain infection-free after surgery. Albumin is a surrogate marker for nutrition, and low albumin is associated with poor immune function. Hypoalbuminemia is found with chronic inflammation as well as malnutrition. Nutritional reserves are diverted to the acute inflammatory response during an infection, which can lead to a deficient state. Further research may develop treatments to alter this modifiable risk factor. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Nicholas R Scarcella
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Frederic B Mills
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jessica L Seidelman
- Department of Infectious Disease, Duke University Medical Center, Durham, North Carolina
| | - William A Jiranek
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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Bhattarai M, Shigemoto Y, Huang YC, Islam MT, Sorenson M. Mindfulness for health and wellbeing in adults with spinal cord injury: A scoping review. J Spinal Cord Med 2024:1-15. [PMID: 39007686 DOI: 10.1080/10790268.2024.2374130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/16/2024] Open
Abstract
CONTEXT Individuals with spinal cord injury (SCI) require resources to prevent or self-manage complications in order to maintain optimum functioning and well-being. Rehabilitation literature suggests that mindfulness as an internal psychological resource can play a crucial role in promoting self-management and improving health and well-being. OBJECTIVES We sought to identify and synthesize existing evidence on the role of mindfulness and mindfulness-based interventions in health and well-being outcomes among adults with SCI. METHODS We conducted a scoping review, searching evidence across four electronic databases, CINAHL, PubMed, PsycINFO, and Web of Science, for articles published between 2000 and 2023. Additional articles were searched from the reference list of identified articles. RESULTS Of 354 articles identified in the search, 20 were included in the scoping review. Thirteen studies were interventional in design, while the other seven included cross-sectional and qualitative designs. Some interventional studies examined mindfulness as the major component of the interventions, whereas other studies integrated mindfulness as one component of the intervention program. Overall, mindfulness and mindfulness-based interventions were associated with a range of health and well-being outcomes among individuals with SCI. CONCLUSIONS Mindfulness and mindfulness-based interventions appear to positively impact health and well-being in adults with SCI. However, mindfulness interventions were inconsistent in terms of content, delivery frequency, and duration. It is essential to develop multifaceted, tailored mindfulness interventions utilizing a consumer-based approach and established theories of mindfulness and mindfulness-based practices for adults with SCI.
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Affiliation(s)
- Muna Bhattarai
- College of Nursing, Texas A&M University, College Station, TX, USA
| | - Yuki Shigemoto
- Department of Psychology, Prairie View A&M University, Prairie View, TX, USA
| | - Ya-Ching Huang
- College of Nursing, Texas A&M University, College Station, TX, USA
| | | | - Matthew Sorenson
- College of Nursing, Texas A&M University, College Station, TX, USA
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Kettlewell J, Radford K, Timmons S, Jones T, Fallon S, Westley R, White S, Kendrick D. What affects implementation of the UK major trauma rehabilitation prescription? A survey informed by the behaviour change wheel. Injury 2024:111722. [PMID: 39019749 DOI: 10.1016/j.injury.2024.111722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/26/2024] [Accepted: 07/05/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVE Major trauma 'Rehabilitation Prescriptions' aim to facilitate continuity of care and describe patient needs following discharge from UK Major Trauma Centre (MTCs), however research suggests rehabilitation prescriptions are not being implemented as intended. We aimed to identify factors influencing completion and use of rehabilitation prescriptions using the Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF). DESIGN Online survey informed by the TDF and BCW. SETTING UK trauma rehabilitation pathway. POPULATION Rehabilitation and trauma service providers involved in completing and/or using rehabilitation prescriptions (n = 78). ANALYSIS Mean scores were calculated for TDF behavioural domains, identifying facilitators (score ≥5) and barriers (≤3.5) to rehabilitation prescription implementation. Thematic analysis of free text data informed by the BCW/TDF identified further facilitators and barriers, plus potential behaviour change strategies. RESULTS Most respondents worked in UK MTCs (n = 63) and were physiotherapists (n = 34), trauma rehabilitation coordinators (n = 16) or occupational therapists (n = 15). 'Social/professional role and identity', 'knowledge' and 'emotion' (the highest-scoring TDF domains) were facilitators to implementing rehabilitation prescriptions. Qualitative data identified barriers to rehabilitation prescription completion, including 'seen as tick-box exercise','not a priority', lack of resources (IT and workforce), poor inter-service communication, limited knowledge/training. Facilitators included therapist buy-in, standardised training, easy inter-service rehabilitation prescription transfer, usefulness for sharing patient needs. CONCLUSIONS Although rehabilitation prescriptions are valued by some service providers, their effectiveness is hindered by negative attitudes, limited knowledge and poor communication. Uncertainties exist about whether rehabilitation prescriptions achieve their goals, particularly in documenting patient needs, engaging patients in rehabilitation, and informing onward referrals following MTC discharge. Improving IT systems, empowering patients, redirecting funding, and providing training might improve their usage. Further research should explore service provider and patient perspectives, and prospective long-term follow-up on outcomes of rehabilitation prescription recommendations.
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Affiliation(s)
- Jade Kettlewell
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, UK.
| | - Kate Radford
- Centre for Rehabilitation & Ageing Research, School of Medicine, University of Nottingham, UK
| | - Stephen Timmons
- Nottingham University Business School, University of Nottingham, UK
| | - Trevor Jones
- School of Medicine, University of Nottingham, UK
| | | | - Ryan Westley
- School of Medicine, University of Nottingham, UK
| | - Susan White
- School of Medicine, University of Nottingham, UK
| | - Denise Kendrick
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, UK
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Rios F, Elsebaie HB, Shahidi B, Ames R, Monjazeb B, Kerr W, Pahys JM, Hwang SW, Samdani AF, Andras LM, Oetgen ME, Newton PO, Yaszay B, Mundis GM, Akbarnia BA. Proximal foundation anchor variations and their correlation with unplanned return to the operating room (UPROR) in children with EOS treated with magnetically controlled growing rods (MCGR). Spine Deform 2024:10.1007/s43390-024-00921-z. [PMID: 38997612 DOI: 10.1007/s43390-024-00921-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/16/2024] [Indexed: 07/14/2024]
Abstract
INTRODUCTION The evolution of MCGR technique has led to modifications in the configuration of the proximal construct to decrease the incidence of implant-related complications (IRC) and revision surgeries. However, there is no data characterizing the performance of the most used configurations reducing the risk of complications. METHODS 487 patients were identified from an international multicenter EOS database. INCLUSION CRITERIA EOS patients, primary dual MCGR, complete radiographs, and minimum of 2-year follow-up. 76 patients had incomplete X-rays, 5 had apical fusions, and 18 had inconclusive complications, leaving 388 patients for review. A digital spine template was created to document UIV; number of levels; number, type, and location of anchors; as well as implant configuration. First available postoperative and latest follow-up radiographs were reviewed by two senior surgeons and two spine fellows. UPROR due to IRC was defined as any change in proximal anchors between the postoperative and final follow-up radiographs. RESULTS The most common proximal construct configuration: UIV at T2 (50.0%) with 17.5% UPROR, followed by T3 (34.0%) with 12.1% UPROR; number of levels was three (57.1%) with 16.8% UPROR and two (26.0%) with 17.0% UPROR; number of proximal anchors was six (49.9%) with 14.1% UPROR and four (27.0%) with 18.3% UPROR. The most common anchors were all screws (42.0%) with 9.9% UPROR, and all hooks (26.4%) with 31.4% UPROR (P < 0.001). The construct with the lowest rate of UPROR was a UIV at T2, with six anchors (all screws) across three levels (42 cases), with 0% UPROR. Other construct combinations that yielded 0% UPROR rates were UIV of T3, six anchors (all screws) across three levels (25 cases), and a UIV of T3 with six anchors (screws and hooks) across three3 levels (9 cases). CONCLUSION Proximal anchor configuration impacts the incidence of UPROR due to IRC in MCGR. UIV at T2 and T3 compared to T4, and the use of all screws or combination of screws and hooks compared to all hooks were associated with a lower UPROR rate. The most common construct configuration was T2 UIV, three levels, six anchors, and all screws. The use of a combination of six anchors (screws or screws and hooks) across three levels with a UIV at T2 or T3 was associated with a lower UPROR rate. Additional research is needed to further evaluate the variables contributing to configuration selection and their association with IRC.
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Affiliation(s)
- Fernando Rios
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
| | - Hazem B Elsebaie
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
| | - Bahar Shahidi
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
- University of California, San Diego, CA, USA
| | - Robert Ames
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
| | - Bailee Monjazeb
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
| | - William Kerr
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
| | | | | | | | | | | | | | - Burt Yaszay
- Seattle Children's Hospital, Seattle, WA, USA
| | - Gregory M Mundis
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA
- Scripps Clinic, La Jolla, CA, USA
| | - Behrooz A Akbarnia
- San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA.
- University of California, San Diego, CA, USA.
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85
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Zhang D, Litvak A, Lin N, Pirkle S, Strelzow J, Hynes K. Current Trends in the Surgical Treatment of Fibular Fractures: A National Database Study of Intramedullary vs. Plate Fixation Practice Patterns, Complications, and Cost. Adv Orthop 2024; 2024:7506557. [PMID: 39036541 PMCID: PMC11260212 DOI: 10.1155/2024/7506557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/14/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024] Open
Abstract
Existing primary evidence comparing fibular intramedullary fixation (IMF) with traditional plate fixation (PF) for the treatment of distal fibular fractures remains limited by modest sample sizes. Using a large national database, this study aims to compare use rates, fracture patterns, patient characteristics, time to surgery, complication rates, and cost between fibular IMF and PF within the United States. Adults treated with fibular IMF or PF between October 2015 and October 2021 were identified within the PearlDiver Database. The ratio of IMF-treated to PF-treated patients was tracked temporally to compare use rates. Fracture patterns were determined using fracture diagnoses within one-month preceding surgery. Further comparisons of IMF- and PF-treated groups only included patients with at least 12 months of follow-up, and patients with upper tibia or tibia shaft fractures were excluded. An analysis of cohorts matched at a 1 : 4 (IMF: PF) ratio to control for risk factors was performed to compare time to surgery, complication rates (infection, nonunion, malunion, revision, hardware removal, pulmonary embolism, and deep vein thrombosis), and cost. 39329 patients (2294 IMF and 37035 PF) were identified. IMF use trended upwards relative to PF use over time. Tibia and fibula shaft fractures were the most common injuries in IMF patients versus bimalleolar and trimalleolar fractures in PF patients. A higher proportion of IMF patients had open fractures. IMF patients were younger, with higher mean ECI, fewer female patients, and higher rates of CKD. Percutaneous approaches were more common among IMF patients. There were no significant differences in time to surgery or complication rates. IMF was less costly. The popularity of IMF trended upwards across the study period. IMF was used more commonly in injuries involving higher energy trauma and soft tissue disruption. Overall, IMF patients were younger with more comorbidities. When used in similar populations, IMF appears to be a cost-effective alternative to PF.
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Affiliation(s)
- Douglas Zhang
- The University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Audrey Litvak
- The University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Nicholas Lin
- The University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Sean Pirkle
- Department of Orthopaedics and Sports MedicineUniversity of Washington, Seattle, WA 98195, USA
| | - Jason Strelzow
- Department of Orthopaedic Surgery and Rehabilitation MedicineUniversity of Chicago Medicine, Chicago, IL 60637, USA
| | - Kelly Hynes
- Department of Orthopaedic Surgery and Rehabilitation MedicineUniversity of Chicago Medicine, Chicago, IL 60637, USA
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86
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Mohess JS, Lee H, Uzlaşir S, Wikstrom EA. The Effects of Augmenting Balance Training with Stroboscopic Goggles on Postural Control in Chronic Ankle Instability Patients: A Critically Appraised Topic. J Sport Rehabil 2024:1-6. [PMID: 38996448 DOI: 10.1123/jsr.2023-0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 07/14/2024]
Abstract
CLINICAL SCENARIO Individuals with chronic ankle instability (CAI) typically complete balance training protocols to improve postural control and reduce recurrent injury risk. However, the presence of CAI persists after traditional balance training protocols suggesting that such programs may be missing elements that could be beneficial to patients. Visual occlusion modalities, such as stroboscopic goggles, may be able to augment balance training exercises to further enhance postural control gains in those with CAI. However, a cumulative review of the existing evidence has yet to be conducted. FOCUSED CLINICAL QUESTION Does wearing stroboscopic goggles during balance training result in greater improvements to postural control than balance training alone in those with CAI? SUMMARY OF KEY FINDINGS All 3 studies indicated that the stroboscopic goggles group had statistically significant improvements in either a measure of static or dynamic postural control relative to the standard balance training group. However, significant improvements were not consistent across all postural control outcomes assessed in the included studies. CLINICAL BOTTOM LINE Postural control may improve more in those with CAI when stroboscopic goggles were worn while completing balance training exercises relative to completing balance training exercises alone. STRENGTH OF RECOMMENDATION Overall, consistent moderate- to high-quality evidence was present in the 3 studies, suggesting grade C evidence for the use of stroboscopic goggles during balance training in those with CAI.
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Affiliation(s)
- Joshua S Mohess
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hyunwook Lee
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Erik A Wikstrom
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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87
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Chen G, Scully MM, Huang J, Sergeev A, Yang J, Wei C, Monday P, Cohen L, Cheng X, Liu S, Wang J, Zhou S. Computational biomechanics for a standing human body: Modal analysis and simulation. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024:e3841. [PMID: 38992952 DOI: 10.1002/cnm.3841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 05/09/2024] [Accepted: 06/18/2024] [Indexed: 07/13/2024]
Abstract
We develop computational mechanical modeling and methods for the analysis and simulation of the motions of a human body. This type of work is crucial in many aspects of human life, ranging from comfort in riding, the motion of aged persons, sports performance and injuries, and many ergonomic issues. A prevailing approach for human motion studies is through lumped parameter models containing discrete masses for the parts of the human body with empirically determined spring, mass, damping coefficients. Such models have been effective to some extent; however, a much more faithful modeling method is to model the human body as it is, namely, as a continuum. We present this approach, and for comparison, we choose two digital CAD models of mannequins for a standing human body, one from the versatile software package LS-DYNA and another from open resources with some of our own adaptations. Our basic view in this paper is to regard human motion as a perturbation and vibration from an equilibrium position which is upright standing. A linear elastodynamic model is chosen for modal analysis, but a full nonlinear viscoelastoplastic extension is possible for full-body simulation. The motion and vibration of these two mannequin models is analyzed by modal analysis, where the normal vibration modes are determined. LS-DYNA is used as the supercomputing and simulation platform. Four sets of low-frequency modes are tabulated, discussed, visualized, and compared. Higher frequency modes are also selectively displayed. We have found that these modes of motion and vibration form intrinsic basic modes of biomechanical motion of the human body. This view is supported by our finding of the upright walking motion as a low-frequency mode in modal analysis. Such a "walking mode" shows the in-phase and out-of-phase movements between the legs and arms on the left and right sides of a human body, implying that this walking motion is spontaneous, likely not requiring any directives from the brain. Dynamic motions of CAD mannequins are also simulated by drop tests for comparisons and the validity of the models is discussed through Fourier frequency analysis. All computed modes of motion are collected in several sets of video animations for ease of visualization. Samples of LS-DYNA computer codes are also included for possible use by other researchers.
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Affiliation(s)
- Goong Chen
- Department of Mathematics, Texas A&M University, College Station, Texas, USA
- Institute for Quantum Science and Engineering, Texas A&M University, College Station, Texas, USA
- Hsinchu Branch, National Center for Theoretical Sciences, National Tsing Hua University, Hsinchu, Taiwan, ROC
| | - Matthew M Scully
- Department of Mathematics, Texas A&M University, College Station, Texas, USA
| | - Jingtong Huang
- Department of Mathematics, Texas A&M University, College Station, Texas, USA
| | - Alexey Sergeev
- Department of Mathematics, Texas A&M University, College Station, Texas, USA
| | - Jing Yang
- School of Mathematics and Statistics, Beijing Institute of Technology, Beijing, China
| | - Chunqiu Wei
- Department of Mathematics and Data Science, Beijing University of Civil Engineering and Architecture, Beijing, China
| | - Patrick Monday
- Department of Mathematics, Texas A&M University, College Station, Texas, USA
- Department of Naval Science, Texas A&M University, College Station, Texas, USA
| | - Leon Cohen
- Department of Physics and Astronomy, Hunter College, The City University of New York, New York City, New York, USA
| | - Xingong Cheng
- School of Electrical Engineering, University of Jinan, Jinan, China
| | - Sanyang Liu
- School of Mathematics, Xidian University, Xian, China
| | - Junmin Wang
- School of Mathematics and Statistics, Beijing Institute of Technology, Beijing, China
| | - Shuqin Zhou
- Department of Mathematics, Texas A&M University, College Station, Texas, USA
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88
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Amin H, Tapp A, Kailes B, Sheean A, Bulysheva A, Francis MP. Multiaxial filament winding of biopolymer microfibers with a collagen resin binder for orthobiologic medical device biomanufacturing. Biomed Mater 2024; 19:055013. [PMID: 38815607 DOI: 10.1088/1748-605x/ad5243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/30/2024] [Indexed: 06/01/2024]
Abstract
Multiaxial filament winding is an additive manufacturing technique used extensively in large industrial and military manufacturing yet unexplored for biomedical uses. This study adapts filament winding to biomanufacture scalable, strong, three-dimensional microfiber (3DMF) medical device implants for potential orthopedic applications. Polylactide microfiber filaments were wound through a collagen 'resin' bath to create organized, stable orthobiologic implants, which are sized for common ligament (e.g. anterior cruciate ligament) and tendon (e.g. rotator cuff) injuries and can be manufactured at industrial scale using a small footprint, economical, high-output benchtop system. Ethylene oxide or electron beam sterilized 3DMF samples were analyzed by scanning electron microscopy (SEM), underwent ASTM1635-based degradation testing, tensile testing, ISO 10993-based cytocompatibility, and biocompatibility testing, quantified for human platelet-rich plasma (PRP) absorption kinetics, and examined for adhesion of bioceramics and lyophilized collagen after coating. 3DMF implants had consistent fiber size and high alignment by SEM. Negligible mass and strength loss were noted over 4 months in culture. 3DMF implants initially exceeded 1000 N hydrated tensile strength and retained over 70% strength through 4 months in culture, significantly stronger than conventionally produced implants made by fused fiber deposition 3D printing. 3DMF implants absorbed over 3xtheir weight in PRP within 5 min, were cytocompatible and biocompatible in vivo in rabbits, and could readily bind tricalcium phosphate and calcium carbonate coatings discretely on implant ends for further orthobiologic material functionalization. The additive manufacturing process further enabled engineering implants with suture-shuttling passages for facile arthroscopic surgical delivery. This accessible, facile, economical, and rapid microfiber manufacturing platform presents a new method to engineer high-strength, flexible, low-cost, bio-based implants for orthopedic and extended medical device applications.
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Affiliation(s)
- Heather Amin
- Asante Bio, Tampa, FL 33612, United States of America
| | - Austin Tapp
- Asante Bio, Tampa, FL 33612, United States of America
- National Institutes of Health, Bethesda, MD 20892, United States of America
| | - Benjamin Kailes
- Department of Medical Engineering, University of South Florida, Tampa, FL 33612, United States of America
| | - Andrew Sheean
- San Antonio Military Medical Center, Department of Orthopedic Surgery, San Antonio, TX, United States of America
| | - Anna Bulysheva
- Department of Medical Engineering, University of South Florida, Tampa, FL 33612, United States of America
| | - Michael P Francis
- Asante Bio, Tampa, FL 33612, United States of America
- Department of Orthopaedic Surgery, University of South Florida Morsani College of Medicine, Tampa, FL 33612, United States of America
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Sadaak MM, AbdElMageed SF, Ibrahim MM. Effect of aquatic versus conventional physical therapy program on ankle sprain grade III in elite athletes: randomized controlled trial. J Orthop Surg Res 2024; 19:400. [PMID: 38992731 PMCID: PMC11238378 DOI: 10.1186/s13018-024-04855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/15/2024] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION Ankle sprains are the second most common sports injury after knee injuries, with about 85% of them affecting the lateral ankle ligaments. These injuries are particularly prevalent in sports like basketball and volleyball. PURPOSE To investigate the effect of Aquatic therapy as an early rehabilitation protocol for elite athletes with acute lateral ankle sprain grade III on back-to-sport time, dynamic balance, pain, Athletic performance, and muscle power compared to land-based exercise training. METHODS Thirty elite athletes have ankle sprain grade III with sprain onset from 1 to 7 days, their age ranges from 18-30 years old were recruited. All participants are professional athletes; mainly participating in above-head sports such as volleyball and basketball. The patients were randomly allocated into two treatment groups: Group I (control group): 15 patients received a conventional physical therapy program of structured therapeutic exercise program, manual therapy and land-based exercises, in addition to external support, and Group II (Aquatic therapy group): 15 patients received aquatic training. Visual Analog Scale (VAS) was used to measure the pain intensity, while the dynamic balance was measured by the Star Excursion Balance Test. Athletic performance was measured by HOP Tests (Single, Triple, 6-m, and Cross-over hops) aided by the Agility T-Test (ATT) and Illinois Agility Test (IAT). Muscle power was tested by a Single Leg Press. Finally, back to sports time was recorded for each participant in both groups. RESULTS There was a significant interaction effect of Aquatic therapy and time for VAS (p < 0.001), single hop (p < 0.001), triple hop (p < 0.001), cross-over hop (p < 0.001), IAT (p = 0.019) and ATT (p < 0.001) of both affected and nonaffected. There was no significant interaction effect of Aquatic therapy and time for 6-MHT of affected (p = 0.923), and nonaffected (p = 0.140). There was a significant main effect of time for all dependent variables (p < 0.001) except for 6-MHT of affected (p = 0.939), nonaffected (p = 0.109), and IAT (p = 0.099). The Star excursion dynamic balance test (SEBT) and Single leg press revealed a significant difference between groups on affected and non-affected sides (p < 0.001*). Lastly and most importantly the back-to-sport time revealed a significant difference in the return-to-sport time in favor of the Aquatic therapy group who returned faster than the control group (p < 0.001*). CONCLUSION Aquatic therapy is more effective than traditional protocols regarding early rehabilitation of acute ankle sprain grade III in Elite professional athletes for reducing pain intensity, improving dynamic balance and athletic performance and power and accelerating their return to sports time. Because aquatic therapy produces better outcomes, it is advised to be included in the rehabilitation programs of athletic patients with acute ankle sprains grade III.
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Affiliation(s)
| | - Salwa Fadl AbdElMageed
- Department of Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Mona Mohamed Ibrahim
- Department of Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
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Dawod MS, Alswerki MN, Ar Altamimi A, Abu Hilal M, Albadaineh A, Saber Y, Alisi MS, Al-Ajlouni J. Comparative analysis of geriatric hip fracture management outcomes in teaching and nonteaching hospitals in Jordan. Sci Rep 2024; 14:16053. [PMID: 38992060 PMCID: PMC11239659 DOI: 10.1038/s41598-024-66016-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024] Open
Abstract
Hip fractures are common orthopedic injuries that have significant impacts on patients and healthcare systems. Previous studies have shown varying outcomes for hip fracture management in different settings, with diverse postoperative outcomes and complications. While teaching hospital settings have been investigated, no studies have specifically examined hip fracture outcomes in teaching hospitals in Jordan or the broader Middle East region. Therefore, the aim of this study was to investigate this important outcome. A cohort comprising 1268 patients who underwent hip fracture fixation from 2017 to 2020 was analyzed for nine distinct outcomes. These outcomes encompassed time to surgery, ICU admissions, perioperative hemoglobin levels, length of hospital stay, readmission rates, revision procedures, and mortality rates at three time points: in-hospital, at 6-months, and at 1-year post-surgery. The analysis of 1268 patients (616 in teaching hospitals, 652 in non-teaching hospitals) showed shorter mean time to surgery in teaching hospitals (2.2 days vs. 3.6 days, p < 0.01), higher ICU admissions (17% vs. 2.6%, p < 0.01), and more postoperative blood transfusions (40.3% vs. 12.1%, p < 0.01). In-hospital mortality rates were similar between groups (2.4% vs. 2.1%, p = 0.72), as were rates at 6-months (3.1% vs. 3.5%, p = 0.65) and 1-year post-surgery (3.7% vs. 3.7%, p = 0.96). Geriatric hip fracture patients in teaching hospitals have shorter surgery times, more ICU admissions, and higher postoperative blood transfusion rates. However, there are no significant differences in readmission rates, hospital stays, or mortality rates at various intervals.
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Affiliation(s)
- Moh'd S Dawod
- Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Mohammad N Alswerki
- Department of Orthopedic Surgery, Jordan University Hospital, P.O. Box: 13046, Amman, 11942, Jordan.
| | - Anas Ar Altamimi
- Head of Special Surgery Department, Hashemite University, Amman, Jordan
| | | | - Ashraf Albadaineh
- Al-Karak Governmental Hospital, Jordanian Ministry of Health, Amman, Jordan
| | | | - Mohammed S Alisi
- Islamic University of Gaza, Palestinian Ministry of Health, Gaza, Palestine
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91
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Kułakowski M, Elster K, Szymczak M, Ślęczka P, Baumgart M, Królikowska A, Reichert P. Comparison of the effect of combined usage of povidone-iodine irrigation and topical vancomycin powder to the use of povidone-iodine irrigation alone on the periprosthetic joint infection incidence rate in patients undergoing primary total hip and knee arthroplasty: a protocol for multicenter prospective randomized clinical trial. Trials 2024; 25:468. [PMID: 38987786 PMCID: PMC11234679 DOI: 10.1186/s13063-024-08306-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND With the increasing number of joint replacement surgeries, periprosthetic joint infection (PJI) has become a significant concern in orthopedic practice, making research on PJI prevention paramount. Therefore, the study will aim to compare the effect of combined usage of povidone-iodine and topical vancomycin powder to the use of povidone-iodine alone on the PJI incidence rate in patients undergoing primary total hip (THA) and total knee arthroplasty (TKA). METHODS The prospective randomized clinical trial will be conducted in two independent voivodeship hospitals with extensive experience in lower limb arthroplasties. The studied material will comprise 840 patients referred to hospitals for primary THA or TKA. The patients will be randomly allocated to two equal groups, receiving two different interventions during joint replacement. In group I, povidone-iodine irrigation and consecutively topical vancomycin powder will be used before wound closure. In group II, only povidone-iodine lavage irrigation will be used before wound closure. The primary outcome will be the incidence rate of PJI based on the number of patients with PJI occurrence within 90 days after arthroplasty. The occurrence will be determined using a combined approach, including reviewing hospital records for readmissions and follow-up phone interviews with patients. The infection will be diagnosed based on Musculoskeletal Infection Society criteria. The chi-square test will be used to compare the infection rates between the two studied groups. Risk and odds ratios for the between-groups comparison purposes will also be estimated. Medical cost analysis will also be performed. DISCUSSION A randomized clinical trial comparing the effect of combined usage of povidone-iodine irrigation and vancomycin powder to the use of povidone-iodine irrigation alone in preventing PJIs after primary arthroplasty is crucial to advancing knowledge in orthopedic surgery, improving patient outcomes, and guiding evidence-based clinical practices. TRIAL REGISTRATION ClinicalTrials.gov NCT05972603 . Registered on 2 August 2023.
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Affiliation(s)
- Michał Kułakowski
- Orthopaedic and Trauma Surgery Department, Independent Public Healthcare Center in Rypin, Rypin, Poland
| | - Karol Elster
- Orthopaedic and Trauma Surgery Department, Independent Public Healthcare Center in Rypin, Rypin, Poland
| | - Mateusz Szymczak
- Orthopaedic and Trauma Surgery Department, Independent Public Healthcare Center in Rypin, Rypin, Poland
| | - Paweł Ślęczka
- Trauma and Orthopedic Surgery Department, Independent Public Healthcare Center in Myslenice, Myslenice, Poland
| | - Mariusz Baumgart
- Department of Normal Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Aleksandra Królikowska
- Ergonomics and Biomedical Monitoring Laboratory, Department of Physiotherapy, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland.
| | - Paweł Reichert
- Department of Orthopedics, Traumatology and Hand Surgery, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
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Ge Y, Xie Y, Chai J, Ji W, Lou X, Tian K, Bao R, Wu C, Ruan H. Augmented Cornus officinalis Levels in Liuwei Dihuang Decoction Inhibits Nucleus Pulposus Cell Pyroptosis to Enhance Therapeutic Efficacy Against Intervertebral Disc Degeneration. J Inflamm Res 2024; 17:4453-4465. [PMID: 39006498 PMCID: PMC11246628 DOI: 10.2147/jir.s465690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 07/03/2024] [Indexed: 07/16/2024] Open
Abstract
Background Intervertebral disc (IVD) degeneration (IVDD) is highly prevalent among the elderly population and stands as a leading cause of low back pain. Our prior studies have highlighted the therapeutic potential of Liuwei Dihuang decoction (LWDHD) and its component Cornus officinalis (CO)-derived compounds in alleviating IVDD and osteoarthritis, suggesting beneficial effects of CO in treating degenerative osteoarthropathies. However, uncertainty remains regarding the optimal CO dosage within LWDHD and its potential mechanism for effectively treating IVDD. Objective To ascertain the optimal dosage of CO within LWDHD for enhancing its therapeutic efficacy in treating IVDD, through a comparison of its effects across varied dosages using a mouse IVDD model. Methods Eight-week-old male C57BL/6J mice were subjected to a lumbar spine instability surgery to induce an IVDD model and received a modified LWDHD formulation containing varied dosages of CO (original dose of CO, or 5- or 10-time dose of CO (referred to as 1 × CO, 5 × CO, and 10 × CO)) for 8 weeks. The therapeutic efficacy on IVDD was evaluated through changes in lumbar spine function, histopathological morphology, extracellular matrix metabolism, nucleus pulposus cell viability, sensory nerve ingrowth, and nucleus pulposus (NP) cell pyroptosis. Results Augmenting CO levels in LWDHD led to a dose-dependent increase in the levels of CO-sourced active compounds in the plasma of mice. The modified LWDHD formulations, particularly the 5 × CO, exhibited a favorable pharmacological effect on lumbar function, structural integrity, ECM composition, NP cell viability, and sensory nerve ingrowth. Importantly, all 3 formulations notably mitigated NP cell pyroptosis by activating NRF2/KEAP1 pathway, with the 5 × CO formulation exhibiting superior efficacy. Additionally, a comprehensive score analysis indicated that 5 × CO formulation achieved the highest score. Conclusion These data underscore that elevating the dosage of CO to a specific threshold can enhance the effectiveness of LWDHD in treating IVDD.
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Affiliation(s)
- Yuying Ge
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, People's Republic of China
| | - Yuepeng Xie
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Junlei Chai
- Hangzhou Fuyang Hospital of TCM Orthopedics and Traumatology, Hangzhou, People's Republic of China
| | - Weifeng Ji
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Xiulong Lou
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, People's Republic of China
| | - Kun Tian
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Ronghua Bao
- Hangzhou Fuyang Hospital of TCM Orthopedics and Traumatology, Hangzhou, People's Republic of China
| | - Chengliang Wu
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, People's Republic of China
| | - Hongfeng Ruan
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, People's Republic of China
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93
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Chen X, Jing S, Xue C, Guan X. Progress in the Application of Hydrogels in Intervertebral Disc Repair: A Comprehensive Review. Curr Pain Headache Rep 2024:10.1007/s11916-024-01296-6. [PMID: 38985414 DOI: 10.1007/s11916-024-01296-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE OF REVIEW Intervertebral disc degeneration (IVDD) is a common orthopaedic disease and an important cause of lower back pain, which seriously affects the work and life of patients and causes a large economic burden to society. The traditional treatment of IVDD mainly involves early pain relief and late surgical intervention, but it cannot reverse the pathological course of IVDD. Current studies suggest that IVDD is related to the imbalance between the anabolic and catabolic functions of the extracellular matrix (ECM). Anti-inflammatory drugs, bioactive substances, and stem cells have all been shown to improve ECM, but traditional injection methods face short half-life and leakage problems. RECENT FINDINGS The good biocompatibility and slow-release function of polymer hydrogels are being noticed and explored to combine with drugs or bioactive substances to treat IVDD. This paper introduces the pathophysiological mechanism of IVDD, and discusses the advantages, disadvantages and development prospects of hydrogels for the treatment of IVDD, so as to provide guidance for future breakthroughs in the treatment of IVDD.
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Affiliation(s)
- Xin Chen
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Shaoze Jing
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
- Department of Orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
| | - Chenhui Xue
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Xiaoming Guan
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China.
- Department of Orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.
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94
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Guo H, Xiao K, Zheng Y, Zong J. Integrating bioinformatics and multiple machine learning to identify mitophagy-related targets for the diagnosis and treatment of diabetic foot ulcers: evidence from transcriptome analysis and drug docking. Front Mol Biosci 2024; 11:1420136. [PMID: 39044840 PMCID: PMC11263085 DOI: 10.3389/fmolb.2024.1420136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/20/2024] [Indexed: 07/25/2024] Open
Abstract
Background Diabetic foot ulcers are the most common and serious complication of diabetes mellitus, the high morbidity, mortality, and disability of which greatly diminish the quality of life of patients and impose a heavy socioeconomic burden. Thus, it is urgent to identify potential biomarkers and targeted drugs for diabetic foot ulcers. Methods In this study, we downloaded datasets related to diabetic foot ulcers from gene expression omnibus. Dysregulation of mitophagy-related genes was identified by differential analysis and weighted gene co-expression network analysis. Multiple machine algorithms were utilized to identify hub mitophagy-related genes, and a novel artificial neural network model for assisting in the diagnosis of diabetic foot ulcers was constructed based on their transcriptome expression patterns. Finally, potential drugs that can target hub mitophagy-related genes were identified using the Enrichr platform and molecular docking methods. Results In this study, we identified 702 differentially expressed genes related to diabetic foot ulcers, and enrichment analysis showed that these genes were associated with mitochondria and energy metabolism. Subsequently, we identified hexokinase-2, small ribosomal subunit protein us3, and l-lactate dehydrogenase A chain as hub mitophagy-related genes of diabetic foot ulcers using multiple machine learning algorithms and validated their diagnostic performance in a validation cohort independent of the present study (The areas under roc curve of hexokinase-2, small ribosomal subunit protein us3, and l-lactate dehydrogenase A chain are 0.671, 0.870, and 0.739, respectively). Next, we constructed a novel artificial neural network model for the molecular diagnosis of diabetic foot ulcers, and the diagnostic performance of the training cohort and validation cohort was good, with areas under roc curve of 0.924 and 0.840, respectively. Finally, we identified retinoic acid and estradiol as promising anti-diabetic foot ulcers by targeting hexokinase-2 (-6.6 and -7.2 kcal/mol), small ribosomal subunit protein us3 (-7.5 and -8.3 kcal/mol), and l-lactate dehydrogenase A chain (-7.6 and -8.5 kcal/mol). Conclusion The present study identified hexokinase-2, small ribosomal subunit protein us3 and l-lactate dehydrogenase A chain, and emphasized their critical roles in the diagnosis and treatment of diabetic foot ulcers through multiple dimensions, providing promising diagnostic biomarkers and targeted drugs for diabetic foot ulcers.
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Affiliation(s)
- Hui Guo
- Department of Emergency, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Kui Xiao
- Department of Plastic Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Yanhua Zheng
- Department of Critical Medicine, Wusong Hospital, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianchun Zong
- Department of Emergency, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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95
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Aydın A, Baydar M, Ünkar EA, Erbaş A, Üçpunar H, Yapıcı F, Gür V, Öztürk K. Evaluation of the effect of vascularized fibula graft harvesting on coronal plane alignment and functional outcomes of the lower limb. Sci Rep 2024; 14:15820. [PMID: 38982162 PMCID: PMC11233678 DOI: 10.1038/s41598-024-66847-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/04/2024] [Indexed: 07/11/2024] Open
Abstract
Recent studies on fibular osteotomy for varus gonarthrosis and possible subsequent biomechanical changes have attracted increasing attention to the topic. Existing studies have focused mainly on proximal fibular osteotomy with short follow-up periods. The aim of this study was to investigate changes in the alignment of the coronal plane of the ankle and knee joints in patients who underwent vascularized fibula graft harvest (VFGH). The evaluation was based on functional outcomes and radiological measurements.In the comparison between the VFGH side and the contralateral side, no significant differences in the knee inclination (KI) or talar inclination (TI) angle, knee medial clear space (K-MCS) or ankle medial clear space (A-MCS) distance were noted. However, a significant difference in the hip knee (HKA) angle was observed between the operated and nonoperated sides (0.3° ± 1.8° and 1.5° ± 1.9°, respectively [p = 0.019]). Statistically significant differences in both the knee society score (KSS) and the AOFAS scores were found between the ipsilateral donor limb and the contralateral healthy limb. Although the contralateral healthy side had better clinical scores than the VFGH side, the outcomes of the VFGH side were still satisfactory or excellent.
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Affiliation(s)
- Abdurrahman Aydın
- Department of Orthopedics and Traumatology, Düzce Akçakoca State Hospital, Cumhuriyet Mh, Park Cd. No: 20, 81650, Akçakoca, Düzce, Turkey.
| | - Mehmet Baydar
- Hand Surgery Clinic, University of Health Sciences Turkey MS Baltalimani Bone Diseases Teaching and Research Hospital, Istanbul, Turkey
| | - Ethem Ayhan Ünkar
- Hand Surgery Clinic, University of Health Sciences Turkey MS Baltalimani Bone Diseases Teaching and Research Hospital, Istanbul, Turkey
| | - Anıl Erbaş
- Department of Orthopedics and Traumatology, University of Health Sciences Turkey MS Baltalimani Bone Diseases Teaching and Research Hospital, Istanbul, Turkey
| | - Hanifi Üçpunar
- Department of Orthopedics and Traumatology, University of Health Sciences Turkey MS Baltalimani Bone Diseases Teaching and Research Hospital, Istanbul, Turkey
| | - Furkan Yapıcı
- Department of Orthopedics and Traumatology, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Volkan Gür
- Department of Orthopedics and Traumatology, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Kahraman Öztürk
- Hand Surgery Clinic, University of Health Sciences Turkey MS Baltalimani Bone Diseases Teaching and Research Hospital, Istanbul, Turkey
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Long T, Vemaganti K, Hawes JE, Lin CY. An experimental study of the heterogeneity and anisotropy of porcine meniscal ultimate tensile strength. J Mech Behav Biomed Mater 2024; 157:106649. [PMID: 39024732 DOI: 10.1016/j.jmbbm.2024.106649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/19/2024] [Accepted: 07/01/2024] [Indexed: 07/20/2024]
Abstract
Characterizing the ultimate tensile strength (UTS) of the meniscus is critical in studying knee damage and pathology. This study aims to determine the UTS of the meniscus with an emphasis on its heterogeneity and anisotropy. We performed tensile tests to failure on the menisci of six month old Yorkshire pigs at a low strain rate. Specimens from the anterior, middle and posterior regions of the meniscus were tested in the radial and circumferential directions. Then the UTS was obtained for each specimen and the data were analyzed statistically, leading to a comprehensive view of the variations in porcine meniscal strength. The middle region has the highest average strength in the circumferential (43.3 ± 4.7 MPa) and radial (12.6 ± 2.2 MPa) directions. This is followed by the anterior and posterior regions, which present similar average values (about 34.0MPa) in circumferential direction. The average strength of each region in the radial direction is approximately one-fourth to one-third of the value in the circumferential direction. This study is novel as it is the first work to focus on the experimental methods to investigate the heterogeneity and anisotropy only for porcine meniscus.
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Affiliation(s)
- Teng Long
- Department of Mechanical and Materials Engineering, College of Engineering and Applied Science, University of Cincinnati, 2901 Woodside Drive, Cincinnati, 45221-0072, OH, USA
| | - Kumar Vemaganti
- Sandia National Laboratories, 1515 Eubank Blvd. SE, Albuquerque, 87123, NM, USA
| | - James Edward Hawes
- Department of Biomedical Engineering, College of Engineering and Applied Science, University of Cincinnati, 2901 Woodside Drive, Cincinnati, 45221-0012, OH, USA
| | - Chia-Ying Lin
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, 45267-0212, OH, USA.
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Ardebol J, Gonzalez-Morgado D, Noble MB, Galasso LA, Menendez ME, Denard PJ. Home-Based or Supervised Physical Therapy Show Similar Functional Outcomes and Healing After Massive Rotator Cuff Repair. Arthroscopy 2024:S0749-8063(24)00485-7. [PMID: 38986853 DOI: 10.1016/j.arthro.2024.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/06/2024] [Accepted: 06/18/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE This study aimed to compare postoperative clinical outcomes at the 3-month, 6-month, 12-month, and latest follow-up in patients undergoing supervised physical therapy (PT) or a home-based exercise program after arthroscopic repair (ARCR) of massive rotator cuff tears (MRCTs). METHODS A retrospective review was conducted on a prospectively maintained database of patients who underwent either supervised PT or home-based therapy after ARCR of MRCTs between January 2015 and December 2018 at a single center with a minimum 24-month follow-up. At their 2-week postoperative routine follow-up, patients are allowed to choose between home-based and supervised PT. Patient-reported outcomes (PROs) and range of motion (ROM) were collected and compared between cohorts preoperatively and at the 3-month, 6-month, 12-month, and latest follow-up. The percentage of patients reaching or exceeding the minimal clinically important difference (MCID) and patient accepted symptomatic state (PASS) for visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeon score (ASES), and Subjective Shoulder Value (SSV) were recorded for both cohorts at each time point. Complications, healing, satisfaction, and return to work were reported. Healing was evaluated via ultrasound at the latest follow-up. RESULTS Ninety-nine patients met the study criteria: 61 in the supervised PT cohort, and 38 in the home-based cohort. The supervised PT and home-based cohorts returned to clinic for their most recent follow-up at 53±20 and 55±16 months (p=0.496) after surgery, respectively. There was no difference when comparing tendon involvement (SS, p=0.574; IS, p=0.288; SSc p=0.592), tear retraction (p=0.603), or high-grade fatty infiltration (SS, p=0.684; IS, p-0.397; SSc p=0.473) based on preoperative MRI assessment and surgery-related factors, including anterior (p=0.473) or posterior (p=0.386) slides, fixation constructs (p=0.829), or complete repair (p=0.912). Both cohorts showed similar PROs and ROM at baseline. Postoperative PROs and ROM were similar among groups at the 3-month, 6-month, 12-month, and latest follow-up. However, ASES (71.4 vs 61.2; p = 0.013) and FF (135° vs 118°; p = 0.023) were significantly higher at 3-month follow-up in the home-based cohort. Both groups comparably achieved MCID and PASS for PROs at the 3-month, 6-month, and12-month follow-up. At the latest follow-up, the supervised PT and home-based cohort achieved MCID and PASS for VAS (75% vs 81%, p=0.573; 70% vs 72%, p=0.911), ASES (76% vs 74%, p=0.777; 72% vs 72%, p=0.873), and SSV (82% vs 84%, p=0.734; 72% vs 66%, p=0.489), respectively. Satisfaction, healing, complication, and return to work rates were similar. CONCLUSION Patients undergoing rehabilitation using a home-based protocol showed largely similar functional scores and healing to those with supervised PT after ARCR of MRCTs at the latest follow-up. Although patients with home-based therapy achieved higher FF and ASES at the 3-month follow-up, these became comparable starting at the 6-month postoperative mark. MCID and PASS were achieved similarly for PROs at each time point.
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Affiliation(s)
| | - Diego Gonzalez-Morgado
- Oregon Shoulder Institute, Medford, OR, USA; Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
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Deng K, Hu DX, Zhang WJ. Application of cell transplantation in the treatment of neuropathic pain. Neuroscience 2024; 554:43-51. [PMID: 38986736 DOI: 10.1016/j.neuroscience.2024.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/15/2024] [Accepted: 06/30/2024] [Indexed: 07/12/2024]
Abstract
Nerve injury can not only lead to sensory and motor dysfunction, but also be complicated with neuropathic pain (NPP), which brings great psychosomatic injury to patients. At present, there is no effective treatment for NPP. Based on the functional characteristics of cell transplantation in nerve regeneration and injury repair, cell therapy has been used in the exploratory treatment of NPP and has become a promising treatment of NPP. In this article, we discuss the current mainstream cell types for the treatment of NPP, including Schwann cells, olfactory ensheathing cells, neural stem cells and mesenchymal stem cells in the treatment of NPP. These bioactive cells transplanted into the host have pharmacological properties of decreasing pain threshold and relieving NPP by exerting nutritional support, neuroprotection, immune regulation, promoting axonal regeneration, and remyelination. Cell transplantation can also change the microenvironment around the nerve injury, which is conducive to the survival of neurons. It can effectively relieve pain by repairing the injured nerve and rebuilding the nerve function. At present, some preclinical and clinical studies have shown that some encouraging results have been achieved in NPP treatment based on cell transplantation. Therefore, we discussed the feasible strategy of cell transplantation as a treatment of NPP and the problems and challenges that need to be solved in the current application of cell transplantation in NPP therapy.
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Affiliation(s)
- Kan Deng
- Rehabilitation Medicine Department, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang City, Jiangxi Province, China; Ji an College, Ji an City, Jiangxi Province, China
| | - Dong-Xia Hu
- Rehabilitation Medicine Department, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Wen-Jun Zhang
- Rehabilitation Medicine Department, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang City, Jiangxi Province, China.
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99
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Bsoul N, Ning L, Cai L, Mazmanyan D, Porter D. Evidence-based clinical practice guidelines for the management of acute ankle injuries according to: a PRISMA systematic review and quality appraisal with AGREE II. BMC Musculoskelet Disord 2024; 25:523. [PMID: 38978052 PMCID: PMC11229291 DOI: 10.1186/s12891-024-07655-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Acute ankle injuries are commonly seen in emergency rooms, with significant social impact and potentially devastating consequences. While several clinical practice guidelines (CPGs) related to ankle injuries have been developed by various organizations, there is a lack of critical appraisal of them. The purpose of this systematic review is to identify and critically appraise evidence-based clinical practice guidelines (EB-CPGs) related to acute ankle injuries in adults. METHOD We conducted searches in the Cochrane Library, MEDLINE, EMBASE databases, WHO, and reviewed 98 worldwide orthopedic association websites up until early 2023. Two authors independently applied the inclusion and exclusion criteria, and each evidence-based clinical practice guideline (EB-CPG) underwent independent critical appraisal of its content by all four authors using the Appraisal of Guidelines for REsearch and Evaluation (AGREE II) instrument. AGREE II scores for each domain were then calculated. RESULTS This review included five evidence-based clinical practice guidelines. The mean scores for all six domains were as follows: Scope and Purpose (87.8%), Stakeholder Involvement (69.2%), Rigour of Development (72.5%), Clarity of Presentation (86.9%), Applicability (45.6%), and Editorial Independence (53.3%). CONCLUSION The number of EB-CPGs related to ankle injuries are limited and the overall quality of the existing evidence-based clinical practice guidelines (EB-CPGs) for ankle injuries is not strong, with three of them being outdated. However, valuable guidance related to Ottawa rules, manual therapy, cryotherapy, functional supports, early ambulation, and rehabilitation has been highlighted. Challenges remain in areas such as monitoring and/or auditing criteria, consideration of the target population's views and preferences, and ensuring editorial independence. Future guidelines should prioritize improvements in these domains to enhance the quality and relevance of ankle injury management. SYSTEMATIC REVIEW Systematic review.
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Affiliation(s)
- Najeeb Bsoul
- Tsinghua University, Beijing, China
- First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Liang Ning
- Tsinghua University, Beijing, China.
- First Affiliated Hospital of Tsinghua University, Beijing, China.
| | - Leyi Cai
- Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Davit Mazmanyan
- Tsinghua University, Beijing, China
- First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Daniel Porter
- Tsinghua University, Beijing, China
- First Affiliated Hospital of Tsinghua University, Beijing, China
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100
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Triantafyllou G, Koptas K, Zielinska N, Piagkou M, Olewnik Ł. The brachioradialis longus: an unreported accessory form of the brachioradialis muscle. Anat Sci Int 2024:10.1007/s12565-024-00787-1. [PMID: 38972022 DOI: 10.1007/s12565-024-00787-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/03/2024] [Indexed: 07/08/2024]
Abstract
The brachioradialis muscle (BR) belongs to the lateral forearm muscle. Typically, the radial nerve innervates it. BR morphological variability, such as split muscular belly, split tendon, or accessory BR (ABR), has been described in the current literature. A 68-year-old female donated cadaver was routinely dissected for research and educational purposes. A variant muscle was identified extending at the right arm's lateral and forearm compartments. It originated from the humerus lateral surface between the deltoid and the triceps brachii lateral head, joined the second muscular head from the brachialis muscle, and inserted into the radius styloid process. According to its origin, course, and insertion, the variant muscle probably corresponded to the BR accessory form. However, in the current literature, the ABR morphology corresponds to an accessory muscle originating adjacent to the typical BR and inserted into the radial tuberosity. At the same time, it was defined as "brachioradialis brevis." In the current case, the variant muscle differed significantly from the current literature due to the origin, insertion, length, and relationship with the typical BR; therefore, the term "brachioradialis longus" seemed adequate to describe this variant muscle.
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Affiliation(s)
- George Triantafyllou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527, Athens, Greece.
| | - Krzysztof Koptas
- Department of Anatomical Dissection and Donation, Medical University of Łódź, Łódź, Poland
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Łódź, Łódź, Poland
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527, Athens, Greece
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Łódź, Łódź, Poland
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