A New Dressing System Reduces the Number of Dressing Changes in the Primary Total Knee Arthroplasty: A Randomized Controlled Trial

A Comparison of Incisional Dressings and Negative-Pressure Wound Therapy for the Prevention of Infection and Wound Complications After Primary Total Hip and Knee Arthroplasty: A Network Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Incisional dressings may decrease wound complications and joint infection after total hip and knee arthroplasties (THA; TKA). However, there is no consensus on the superiority of a particular product. This study compared infection and wound complications among randomized controlled trials (RCTs) across various dressing types after primary THA and TKA.

METHODS

Scopus, Ovid/MEDLINE, PubMed, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials were queried in May 2024. A frequentist model network meta-analysis of eligible prospective RCTs compared minor and major wound complications and dressing changes using P-scores.

RESULTS

Of 3,067 compiled studies, 12 RCTs of 1,939 patients with median (interquartile range) follow-up of 42 (382) days undergoing primary THA (n = 880, 45.4%) or TKA (n = 1,059, 54.6%) with alginate (n = 208; 10.7%), absorbent (n = 236; 12.2%), gauze (n = 474; 24.4%), or hydrofiber (n = 683; 35.2%) dressings or negative-pressure wound therapy (NPWT; n = 338; 17.4%) were included for meta-analysis. Compared with gauze, alginate and hydrofiber dressings were associated with fewer postoperative changes (mean difference [MD], -12.1; 95% confidence interval [CI], -15.08 to -9.09, p < 0.001; MD, -3.5; 95% CI, -6.30 to -0.74, p = 0.013, respectively). In a subanalysis, silver-ion hydrofiber also was associated with fewer changes (MD, -5.0; 95% CI, -5.70 to -4.39; p < 0.001). Overall, there was no statistically significant risk of increased minor nor major wound complications including superficial and deep infections among all dressing types and NPWT compared with gauze.

CONCLUSION

Despite no association between wound complications nor infection risk among various incisional dressings and NPWT vs. gauze, the alginate, hydrofiber, and silver hydrofiber dressings had statistically fewer mean postoperative changes. Future studies are required to assess whether these dressings confer reduced infection risk.

LEVEL OF EVIDENCE

Therapeutic, Level I. See Instructions for Authors for a complete description of levels of evidence.

Unlocking Wearable Microbial Fuel Cells for Advanced Wound Infection Treatment

Better infection control will accelerate wound healing and alleviate associated healthcare burdens. Traditional antibacterial dressings often inadequately control infections, inadvertently promoting antibacterial resistance. Our research unveils a novel, dual-functional living dressing that autonomously generates antibacterial agents and delivers electrical stimulation, harnessing the power of spore-forming Bacillus subtilis. This dressing is built on an innovative wearable microbial fuel cell (MFC) framework, using B. subtilis endospores as a powerful, dormant biocatalyst. The endospores are resilient, reactivating in nutrient-rich wound exudate to produce electricity and antibacterial compounds. The combination allows B. subtilis to outcompete pathogens for food and other resources, thus fighting infections. The strategy is enhanced by the extracellular synthesis of tin oxide and copper oxide nanoparticles on the endospore surface, boosting antibacterial action, and electrical stimulation. Moreover, the MFC framework introduces a pioneering dressing design featuring a conductive hydrogel embedded within a paper-based substrate. The arrangement ensures cell stability and sustains a healing-friendly moist environment. Our approach has proven very effective against three key pathogens in biofilms: Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus demonstrating exceptional capabilities in both in vitro and ex vivo models. Our innovation marks a significant leap forward in wearable MFC-based wound care, offering a potent solution for treating infected wounds.

Association between Dietary total antioxidant capacity and knee osteoarthritis: a case-control study in the Iranian Population

AIM

Knee osteoarthritis (KOA) is a prevalent chronic condition associated with significant pain, disability, and healthcare costs, particularly among the elderly population. Despite the considerable burden of KOA, effective treatment options for managing the condition's underlying causes remain limited. This case-control study aims to investigate the relationship between dietary total antioxidant capacity (DTAC) and knee osteoarthritis.

METHODS

This case-control study was conducted on 105 patients with confirmed KOA and 210 controls. KOA was diagnosed based on the American College of Rheumatology criteria. Dietary total antioxidant capacity (DTAC) was calculated based on the ferric-reducing antioxidant power method.

RESULTS

The mean age and BMI of the participants were 53.6 ± 8.8 years old and 27.3 ± 2.7 kg/m2, respectively. The study participant's DTAC score ranged from 3.56 to 25.32 with a mean and SD of 12.46 ± 5.12. In the crude model, individuals in the highest quartile of DTAC score had 71% lower odds of having knee osteoarthritis compared to those in the first quartile (OR: 0.29, 95%CI: 0.15 to 0.58, P-trend < 0.001). These associations remained significant after adjustment for potential confounders including age, sex, energy intake, family history of osteoarthritis, vitamin D and calcium use, physical activity level, cigarette smoking and BMI. Although the odds of having knee osteoarthritis decreased with increasing quartiles of DTAC in both sexes, this relationship was stronger among males than females.

CONCLUSION

The results of this study showed that there was an inverse correlation between DTAC and KOA among the Iranian patients with KOA.

cGAS-STING pathway in pathogenesis and treatment of osteoarthritis and rheumatoid arthritis

Osteoarthritis (OA) and Rheumatoid Arthritis (RA) are significant health concerns with notable prevalence and economic impact. RA, affecting 0.5% to 1.0% of the global population, leads to chronic joint damage and comorbidities. OA, primarily afflicting the elderly, results in joint degradation and severe pain. Both conditions incur substantial healthcare expenses and productivity losses. The cGAS-STING pathway, consisting of cyclic GMP-AMP synthase (cGAS) and stimulator of interferon genes (STING), is a crucial component of mammalian immunity. This pathway is responsible for detecting foreign DNA, particularly double-stranded DNA (dsDNA), triggering innate immune defense responses. When cGAS recognizes dsDNA, it catalyzes the synthesis of cyclic GMP-AMP (cGAMP), which then binds to and activates STING. Activated STING, in turn, initiates downstream signaling events leading to the production of interferons and other immune mediators. The cGAS-STING pathway is essential for defending against viral infections and maintaining cellular balance. Dysregulation of this pathway has been implicated in various inflammatory diseases, including arthritis, making it a target for potential therapeutic interventions. Understanding the intricate molecular signaling network of cGAS-STING in these arthritis forms offers potential avenues for targeted therapies. Addressing these challenges through improved early detection, comprehensive management, and interventions targeting the cGAS-STING pathway is crucial for alleviating the impact of OA and RA on individuals and healthcare systems. This review offers an up-to-date comprehension of the cGAS-STING pathway's role in the development and therapeutic approaches for these arthritis types.

Advancements in health informatics: finite element insights into medial open-wedge high tibial osteotomy and lateral meniscal tears

Knee medial compartment osteoarthritis is effectively treated by a medial open-wedge high tibial osteotomy (MOWHTO). The feasibility and safety of MOWHTO for mild lateral meniscal tears are unknown. This study examined the feasibility and safety of knee joint weight-bearing line ratio (WBLr) adjustment during MOWHTO with lateral meniscal injuries. We used a healthy adult male's lower extremities computed tomography scans and knee joint magnetic resonance imaging images to create a normal fine element (FE) model. Based on this model, we generated nine FE models for the MOWHTO operation (WBLr: 40-80%) and 15 models for various lateral meniscal injuries. A compressive load of 650N was applied to all cases to calculate the von Mises stress (VMS), and the intact lateral meniscus' maximal VMS at 77.5% WBLr was accepted as the corrective upper limit stress. Our experimental results show that mild lateral meniscal tears can withstand MOWHTO, while severe tears cannot. Our findings expand the use of MOWHTO and provide a theoretical direction for practical decisions in patients with lateral meniscal injuries.

Synergistic impact of Gui Zhi Shao Yao Zhi Mu Decoction and leflunomide on gut microbiota in rheumatoid arthritis: insights from 16S rDNA sequencing

BACKGROUND

Rheumatoid arthritis (RA) is a chronic autoimmune disease with complex pathogenesis, including alterations in the gut microbiota. Gui Zhi Shao Yao Zhi Mu Decoction (GSZD), a traditional Chinese herbal formula, has shown efficacy in RA treatment, but its impact on intestinal microflora remains unclear. This study aimed to investigate the effects of GSZD combined with leflunomide on the gut microbiota of RA patients.

METHODS

The study enrolled 48 RA patients who were randomly assigned to either a control group receiving leflunomide or a treatment group receiving GSZD combined with leflunomide for 12 weeks. Gut microbiota composition was analyzed pre- and post-intervention using 16S rDNA sequencing. Changes in microbial diversity, abundance, and metabolic functions were assessed.

RESULTS

Post-treatment, both groups exhibited significant alterations in gut microbiota composition. GSZD combined with leflunomide led to an increased Bacteroidetes/Firmicutes ratio and a reduction in Actinobacteria compared to leflunomide alone. This was associated with beneficial shifts in microbial genera and metabolic pathways, suggesting improved gut health and systemic immune modulation.

CONCLUSION

GSZD combined with leflunomide significantly modulates the gut microbiota in RA patients. This study provides insights into the mechanisms underlying the therapeutic effects of GSZD and highlights the potential of integrating traditional Chinese medicine with conventional treatments in managing RA.

Implemented classification techniques for osteoporosis using deep learning from the perspective of healthcare analytics

BACKGROUND

Osteoporosis is a medical disorder that causes bone tissue to deteriorate and lose density, increasing the risk of fractures. Applying Neural Networks (NN) to analyze medical imaging data and detect the presence or severity of osteoporosis in patients is known as osteoporosis classification using Deep Learning (DL) algorithms. DL algorithms can extract relevant information from bone images and discover intricate patterns that could indicate osteoporosis.

OBJECTIVE

DCNN biases must be initialized carefully, much like their weights. Biases that are initialized incorrectly might affect the network's learning dynamics and hinder the model's ability to converge to an ideal solution. In this research, Deep Convolutional Neural Networks (DCNNs) are used, which have several benefits over conventional ML techniques for image processing.

METHOD

One of the key benefits of DCNNs is the ability to automatically Feature Extraction (FE) from raw data. Feature learning is a time-consuming procedure in conventional ML algorithms. During the training phase of DCNNs, the network learns to recognize relevant characteristics straight from the data. The Squirrel Search Algorithm (SSA) makes use of a combination of Local Search (LS) and Random Search (RS) techniques that are inspired by the foraging habits of squirrels.

RESULTS

The method made it possible to efficiently explore the search space to find prospective values while using promising areas to refine and improve the solutions. Effectively recognizing optimum or nearly optimal solutions depends on balancing exploration and exploitation. The weight in the DCNN is optimized with the help of SSA, which enhances the performance of the classification.

CONCLUSION

The comparative analysis with state-of-the-art techniques shows that the proposed SSA-based DCNN is highly accurate, with 96.57% accuracy.