Remplissage May Decrease the Redislocation Rate After Arthroscopic Bankart Repair in Patients With an Engaging Hill-Sachs Defect: A Systematic Review and Meta-analysis of Studies With Minimal 2-Year Follow-up

BACKGROUND

The redislocation rate after arthroscopic Bankart repair (BR) among patients with a Hill-Sachs lesion (HSL) may be reduced with the use of remplissage.

PURPOSE

To investigate the outcomes of adding remplissage to an arthroscopic BR in patients with concomitant HSL.

STUDY DESIGN

Meta-analysis; Level of evidence, 3.

METHODS

PubMed and ScienceDirect databases were searched between February 2022 and April 2023 with the terms "remplissage" and "shoulder instability" according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion criteria were formed using the population, intervention, control, and outcome method; the investigation included studies that compared BR with and without remplissage and had ≥24 months of follow-up.

RESULTS

From 802 articles found during the initial search, 7 studies with a total of 837 patients-558 receiving isolated BR (BR group) and 279 receiving BR with remplissage (BR+REMP)-were included. The probability of recurrence of instability among patients with an engaging HSL was significantly diminished in the BR+REMP group compared with the BR group (odds ratio, 0.11; 95% CI, 0.05 to 0.24; P < .001). Regarding shoulder range of motion, the BR+REMP group achieved increased forward flexion (mean difference [MD], 1.97°; 95% CI, 1.49° to 2.46°; P < .001) and decreased external rotation in adduction (MD, -1.43°; 95% CI, -2.40° to -0.46°; P = .004) compared with the BR group. Regarding patient-reported outcome measures, the BR+REMP group had Rowe (MD, 2.53; 95% CI, -1.48 to 6.54; P = .21) and Western Ontario Shoulder Instability Index (WOSI) (MD, -61.60; 95% CI, -148.03 to 24.82; P = .162) scores that were comparable with those of the BR group.

CONCLUSION

Remplissage resulted in a 9-fold decrease in the recurrence of instability after arthroscopic BR in patients with HSL. Remplissage not only led to an increase in forward flexion but also only slightly limited patients' external rotation in adduction. WOSI and Rowe scores after remplissage at the final 24-month follow-up were comparable with those obtained after isolated Bankart repair.

Different methods of eubiotic feed additive provision affect the health, performance, fermentation, and metabolic status of dairy calves during the preweaning period

Background

This study aimed to evaluate whether different methods of providing eubiotic feed additives to neonatal calves, during the preweaning period, can improve the calves’ health, performance, ruminal fermentation, and metabolic status. Forty-four (3-day-old) Holstein–Friesian dairy calves (22 female and 22 male) were divided into four treatment groups for the duration of the 8-week trial. The eubiotic feed additive consisted of a combination of probiotic Lactobacillus spp. (multiple-strains at a dose of 250 mg/calf/day) and phytobiotics containing rosmarinic acid, as the main bioactive compound (at a dose of 50 mg/calf/day). The groups were named: CON (control, without eubiotic in either the milk replacer or the starter feed), MR (eubiotic in the milk replacer), SF (eubiotic in the starter feed), MRS (eubiotic in both the milk replacer and the starter feed). The individual intake of starter feed and the fecal scores were measured daily, and body weight and biometric measurements were taken weekly until calves were 56 days of age. Blood samples were collected on day 3 and then every 14 days to determine concentrations of insulin-like-growth-factor-I, β-hydroxybutyrate, non-esterified fatty acids, and blood urea nitrogen. Ruminal fluid was collected on days 28 and 56 for short-chain fatty acids, NH₃-N, and pH measurements.

Results

The body weight of the calves of the MR treatment group was higher compared to all other groups on days 28 and 56. Including the eubiotic feed additive in the milk replacer increased average daily gain, starter intake, and total dry matter intake from day 29 to day 56 and the overall experimental period compared to the CON group. The calves with MR treatment had lower fecal scores from days 3 to 28, a number of parasite oocysts/cysts per gram of feces on day 28, and the occurrences of fecal consistency scores of 3 (mild diarrhea) and 4 (severe diarrhea) were 3.2 and 3.0 times lower, respectively, compared with the CON group. The MR group had higher ruminal concentrations of short-chain-fatty-acids, propionate, and butyrate on day 56 than the CON group. Adding eubiotics into milk replacer resulted in the highest concentrations of blood insulin-like-growth-factor-I and β-hydroxybutyrate from days 29 to 56 and the overall experimental period.

Conclusion

The addition of eubiotic feed additives into the milk replacer can improve health, performance, ruminal fermentation, and biochemical blood indices in dairy calves during the preweaning period.

Growth Performance, Gut Environment and Physiology of the Gastrointestinal Tract in Weaned Piglets Fed a Diet Supplemented with Raw and Fermented Narrow-Leafed Lupine Seeds

Simple Summary

Fermented feed in growing pig nutrition may influence microbiota of the gastrointestinal tract, improve utilization of nutrients from the diet, and reduce the level of excreted ammonia and phosphorus released into the environment. In the research, fermentation of narrow-leafed lupine seeds was provided and fermented seeds were added to the pigs’ diet. In the 28-day experiment, 24 male pigs were divided into three groups. The control group was fed a soybean meal diet, whereas in the experimental diets, 50% of soybean meal (SBM) protein was replaced by raw or fermented lupine seeds. The influence of fermentation on performance results, gut environment and physiology, and selected blood metabolic parameters in young pigs, were analyzed. Fermentation did not affect pigs’ performance, metabolic, microbial and most gastrointestinal tract parameters, but influenced crypt depth, concentrations of short chain fatty acids and p-cresole in the proximal colon segment, and significantly lowered the pH of the middle colon digesta and ammonia contents. Fermentation improved the chemical composition of seeds, but due to the lack of a significant improvement in the performance, the results may prove to be economically unviable.

Abstract

The aim of this study was to: (1) provide controlled fermentation of narrow-leafed lupine seeds; (2) monitor seed composition, and (3) determine the influence of fermentation on the performance, gut environment and physiology, and selected blood metabolic parameters, in young pigs. Firstly, the effect of 24 h lupine seed fermentation by bacteria and yeast on seed chemical composition was determined. It increased contents of crude protein, crude fiber and ash, but reduced nitrogen-free extractive levels. The amino acid profile of fermented lupine (FL) was similar to that of raw lupine (RL) seeds, whereas the contents of oligosaccharides and P-phytate decreased significantly, in contrast to alkaloids. In fermented feed, pH dropped from 5.5 to 3.9. In the 28-day experiment, 24 male pigs were divided into three groups. The control group was fed a soybean meal diet (SBM), whereas in the experimental diets, 50% of SBM protein was replaced by RL or FL. Afterwards, eight pigs from each group were euthanized and their digesta and blood samples were collected. The FL use did not affect pigs’ performance, nor their metabolic, microbial and most gastrointestinal tract parameters, but influenced crypt depth. Fermentation affected concentrations of short chain fatty acids and p-cresole in the proximal colon segment. In the small intestine, the levels of acetate and butyrate decreased, and, in the caecum, the propionate level decreased. Fermentation significantly lowered the pH of the middle colon digesta and ammonia contents compared to RL. A part of SBM may be successfully replaced by RL and FL in young pigs’ diets.

Association of Country-Specific Socioeconomic Factors With Survival of Patients Who Experience Severe Classic Acute Graft-vs.-Host Disease After Allogeneic Hematopoietic Cell Transplantation. An Analysis From the Transplant Complications Working Party of the EBMT

Acute graft-vs.-host disease (aGvHD) is one of the most frequent causes of transplant-related mortality (TRM) after allogeneic hematopoietic cell transplantation (alloHCT). Its treatment is complex and costly. The aim of this study was to retrospectively analyze the impact of country-specific socioeconomic factors on outcome of patients who experience severe aGvHD. Adults with hematological malignancies receiving alloHCT from either HLA-matched siblings (n = 1,328) or unrelated donors (n = 2,824) developing grade 3 or 4 aGvHD were included. In univariate analysis, the probability of TRM at 2 years was increased for countries with lower current Health Care Expenditure (HCE, p = 0.04), lower HCE as % of Gross Domestic Product per capita (p = 0.003) and lower values of the Human Development Index (p = 0.02). In a multivariate model, the risk of TRM was most strongly predicted by current HCE (HR = 0.76, p = 0.006). HCE >median was also associated with reduced risk of the overall mortality (HR 0.73, p = 0.0006) and reduced risk of treatment failure (either relapse or TRM; HR 0.77, p = 0.004). We conclude that country-specific socioeconomic factors, in particular current HCE, are strongly associated with survival of patients who experience severe aGvHD.

The effect of eubiotic feed additives on the performance of growing pigs and the activity of intestinal microflora

The aim of this study was to compare the effect of probiotic bacteria, prebiotics, phytobiotics and their combinations on performance and microbial activity in the digestive tract of growing pigs. The experiment was conducted over 28 d on 48 male pigs of about 12 kg body weight (BW), which were allocated to following treatments.: (1) Control Group (Con) without additive, (2) Group I, addition of a prebiotic (inulin), (3) Group Ph, a phytobiotic (herbal water extracts), (4) Group P, a probiotic composed of four strains of lactic acid bacteria, (5) Group PhP, phytobiotic and probiotic bacteria and (6) Group PhPI, a phytobiotic, probiotic bacteria and a prebiotic. Animal performance was recorded and at d 28 six pigs from each group were euthanised to collect digesta samples. In all groups except for Group I, diarrhoea incidents were observed. Groups Ph and P had significantly higher daily gains and final BW, and Group Ph utilised feed better than other groups. The pH of ileal digesta was significantly lower in Group PhPI. In the caecal digesta of Groups I, P and PhP, the pH level was lower than in the other groups but dry matter contents was significantly higher in Groups Con and I. The short-chain fatty acids and particular acid content differed significantly only in the colonic digesta. The yeast and mould numbers in caecal digesta was highest in Group Con. No treatment effects were observed for the number of lactic acid bacteria, coli group bacteria or Clostridium. However, the observed significantly higher number of total bacteria suggests that a multi-component eubiotic treatment changes the bacterial composition and distribution more effectively. Our findings indicated that all used additives changed the intestinal microflora, but the multi-component eubiotics were not beneficial as feed additives offered separately. Moreover, supplementation of phytobiotics and probiotic bacteria also improved the animal performance significantly.

The influence of narrow-leafed lupin seed fermentation on their chemical composition and ileal digestibility and microbiota in growing pigs

The aims of this study were to provide a controlled fermentation process of blue lupin seeds (Lupinus angustifolius, cv. Neptun), monitor the changes in seed composition and determine the influence of the fermentation on the apparent ileal digestibility (AID) of crude protein (CP) and amino acids in growing pigs, compared with raw lupin seeds. The fermentation with bacteria and yeast was conducted for 24 h at 25ºC under aerobic conditions. Seed fermentation increased the contents of CP, fibre, fat and ash and most of the analysed amino acids but reduced the levels of the nitrogen-free extractives. Furthermore, fermentation decreased the contents of raffinose family oligosaccharides and phytic acids but increased the alkaloid content. The AID was estimated on three barrows (mean initial body weight 25 kg), surgically fitted with a T-cannula in the distal ileum. The pigs received three diets, each for 6 d, within three experimental periods (3 × 3 Latin Square design). The diets contained soybean meal (Group SBM), raw lupin seeds (Group RL) or fermented lupin seeds (Group FL) as solely protein sources. Fermentation had a positive impact on the AID of CP and methionine, cysteine, isoleucine, leucine, phenylalanine and valine (p < 0.05). Feeding raw or fermented lupin seeds did not affect the microbial status of the ileal digesta. Moreover, ammonia content in the caecal digesta did not differ between Groups RL and FL, although it was significantly higher than in Group SBM. It can be concluded that the fermentation process modified the chemical composition of nutrients in seeds, which can influence the digestibility and utilisation of the fermentation product in animal diets compared to raw seeds.

The Effect of Dry Yeast Fermentation on Chemical Composition and Protein Characteristics of Blue Lupin Seeds

The effect of 24-hour fermentation of lupin seeds by different yeast strains on their chemical composition was determined. After fermentation, the mass fraction of proteins increased and their in vitro digestibility and biological activity significantly improved. The amino acid profile of fermented products was similar to that of raw lupin seeds. The significant reduction in the mass fraction of oligosaccharides and phytate, but not of alkaloids was found. The pH level of fermented products decreased as a consequence of the increase of lactic and propionic acid mass fractions. The most favourable changes in the chemical composition of blue lupin seeds were obtained in fermentation with Saccharomyces cerevisiae baker's yeast and Fermivin 7013 strain.

The Nutritional Value and Physiological Properties of Diets with Raw and Candida utilis-Fermented Lupin Seeds in Rats

The growth and physiological responses of the rats to diet supplemented with raw and Candida utilis-fermented yellow and blue lupin seeds were determined. The diets containing soya bean meal, raw and fermented blue and yellow lupin were administered to eight rats in each diet group for four weeks. Yellow lupin seeds in the diets of rats improved significantly (p<0.05) feed intake, protein digestibility, body mass gain and protein efficiency ratio in comparison with blue lupin seeds. On the contrary, blue lupin seeds affected significantly (p<0.05) gastrointestinal fermentation processes in comparison with yellow lupin seeds. Fermentation of lupin seeds increased crude protein content and reduced phytate and oligosaccharide content. In the fermented products, a higher number of lactic acid bacteria and yeasts but reduced number of coliform bacteria was found. Fermentation by Candida utilis positively (p<0.05) affected protein digestibility of feed, body mass gain and protein efficiency ratio of rats, as well as the activity of some bacterial enzymes and cholesterol concentrations in the blood serum.

Treating oral mucositis with a supersaturated calcium phosphate rinse: comparison with control in patients undergoing allogeneic hematopoietic stem cell transplantation

Purpose

Of patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT), 75 % or more experience oral mucositis, a painful acute complication that can delay discharge, interrupt treatment, and threaten life. To evaluate the efficacy of a supersaturated calcium phosphate rinse (SCPR), we compared it with customary care—topical mouth solutions—on measures of severity and consequent interventions and complications.

Methods

In this randomized controlled trial, 40 patients undergoing allogeneic HSCT were randomized: 20 to SCPR four times daily and 20 to solutions made with salvia leaf extract, iodine-povidine, and fluconazole. Treatment extended from initiation of conditioning treatment until the granulocyte count was ≥0.2 g/L. Mucositis severity was measured daily by a hematologist according to a World Health Organization (WHO) scale and self-assessed by patients. Need for interventions [analgesics, total parenteral nutrition (TPN), and granulocyte colony-stimulating factor] and complications (acute graft-versus-host disease and infections) were also assessed.

Results

In comparison with the control group, the SCPR group had significantly lower mean measures of WHO oral toxicity (0.9 vs. 1.8; P = 0.02), disease course (3.2 vs. 7.1 days; P = 0.02), and peak mouth pain (0.85 vs. 1.75; P = 0.005). Analgesic need was significantly shorter (1.1 vs. 3.4 days; P = 0.047) and the need for TPN significantly lower (0 vs. 6 patients; P = 0.02; 0 vs. 1.9 mean days; P = 0.009). Measures of complications were lower in the SCPR group, but not significantly so. Trial limitations include the impracticality of achieving double blinding with agents so different in appearance and in preadministration preparation.

Conclusions

Compared with the control group, the SCPR group had significantly lower mean measures of oral toxicity, peak mouth pain, and disease course duration. These results warrant confirmation in controlled, multicenter, randomized trials.

The influence of lupin seed germination on the chemical composition and standardized ileal digestibility of protein and amino acids in pigs

The germination process can modify the chemical composition of nutrients in seeds, which can influence the digestibility and utilization of sprouts in animal diets compared to raw seeds. The aims of research were to provide controlled germination process of lupin seeds, monitor the changes in seed composition and determine the influence of the germination on the coefficients of standardized ileal digestibility (SID) of crude protein and amino acids in growing pigs, compared to raw lupin seeds. The seeds of two lupin species were used: yellow (RYL) (Lupinus luteus, cv. Lord) and blue (RBL) (Lupinus angustifolius, cv. Graf). Germination was provided in the dark at 24°C for 4 days. Nutritional and antinutritional compositions of raw and germinated seeds (GYL and GBL, respectively) were analysed. Digestibility study was performed on pigs with an average body weight of 25 kg, and the pigs were surgically fitted with a T-cannula in the distal ileum, with chromic oxide as an indicator. Seed germination increased the crude protein and fibre concentrations, but reduced the levels of the ether extract, nitrogen-free extracts and all amino acids in protein. The content of alkaloids and raffinose family oligosaccharides decreased in both lupin species. Germination had no positive impact (p>0.05) on the SID of crude protein and amino acids. Germination of lupin seeds negatively influenced the SID of lysine and methionine (p<0.05). The results of the research revealed a decrease in the concentrations of antinutritional factors in the sprouts of yellow and blue lupins compared to raw seeds; however, no positive effect was observed on the coefficients of the standardized ileal apparent digestibility of protein and amino acids.

[The opportunities of the photodynamic therapy (PDT) in bones' tumours treatment]

The bones tumors represent in orthopedic surgery frequently affection. Among the most often diagnosed primary malignant bones tumors there are: osteosarcoma, chondrosarcoma, gigantocellular tumour of the bone, the Ewing sarcoma. Nearly 35% patients, who start their treatment, have unfortunately, disseminated neoplastic illness (metastases). The much bigger problem (25 times often find than primary neoplasms) are metastatic tumours direct to the bones. Inspite of accessible widespread therapeutic spectrum (multidrugs chemotherapy, surgical tumors' resection, radiotherapy, interferon, genic therapy) five years patients' survival are observed only in small percentage. Therefore, there is a requirement to find more effective and also less invasive method of treatment. The submission of this method seems to be photodynamic therapy (PDT). PDT based on the cytotoxic activity of the laser light and photosensitizer on the neoplastic tissue. Nowdays, there are accepted lines of conduction and closely characterized the indications to PDT in neoplastic diseases. Based on a high grade of efficiency, and also selectivity of PDT, it seems very purposeful to make the investigations about possibilities of PDT in the neoplastic tumours in orthopedics.

[PDT photodynamic therapy in orthopedic inflammatory conditions?]

The infections in orthopedic surgery and traumatology represents important medical problem. The results of treatment of motor-organs infections in high degree were improved by the introduction of antisepsis and asepsis in XIX century and the antibiotics' discovery in the beginning of XX century. However, widespread usage of antibiotics leaded to the rise of refractory tribes of bacteria on their activity, which caused higher percentage of fails in the therapy. Also the rapid civilization development, which flown on arising of a new invasive methods of operative trauma protection and stabilizations of fractures in motor-organs area increased the number of infectious complications during treatment. These facts gave a reason to look for a more effective therapeutic methods. It seems that photodynamic therapy gives us the new possibilities of infectious treatment, which avails oneself activity of therapeutic light laser with proper wave length on the human tissue with photosensitizer included. Indeed there are known until now splendid results of PDT in neoplasma treatment, however it seems, based on experimental investigations and publications in medical literature, that this method can be a chance of effectual and non-invasive treatment of the soft tissues and bones inflammations.

[Azoles. 18. Sulfonylindazole derivatives]

The nucleophilic substitution of hydrogen to synthesize the sulphonyl indazole derivatives 9-16 is described. The structures of the substitution products are discussed using H-NMR spectra. Chemical structural proof was given by steric hindrance observed in the process of chorination of 9-16. The compounds 3, 4, 7, 8, 14, and 16 are studied to find an inhibition on phospholipase-A2 and lipoxygenase-I.