Evaluation of Direct Anterior Approach for Revision Total Hip Arthroplasty: A Systematic Review / 대한고관절학회지

The direct anterior approach (DAA) is an established approach for total hip arthroplasty (THA) but has been sparingly tried for revisions. The purpose of this study was to examine the available literature in order to consolidate information available on revision THA using the DAA. A PubMed, Embase, and Scopus search was performed using relevant keywords. Studies reporting on patients undergoing revision THA using DAA were included for analysis. In a review of the literature, nine studies matched the pre-decided inclusion criteria with 319 hip joints undergoing revision THA. Mean follow-up of all included studies was 34 months. The indications of revision after primary THA in decreasing order were aseptic loosening (53%), prosthetic joint infection (20.7%), peri-prosthetic fracture (16.9%), dislocation (7.2%), psoas impingement (1.9%), polyethylene wear (1.2%), pain (0.6%), and instability (0.3%). Of the 319 revisions evaluated, 107 underwent a stem revision, 142 underwent cup revision, 49 underwent a combined revision, and 21 underwent isolated liner/head change. A statistically significant improvement in functional score (P<0.05) was observed for all studies reporting on functional outcomes. A low complication rate (51/319, 16.0%), which includes dislocation (12), infection (12), loosening of the acetabular shell (5), peri-prosthetic fractures (6), haematoma (4), and transient nerve palsy (6), was reported. Based on available level III-IV evidence, DAA appears to be a reliable alternative for revision of the failed hip arthroplasty with acceptable complication rates. Evidence of a higher quality is needed to further characterize its role in revision scenarios.

Preparation and characterization of double shell Fe3O4 cluster@nonporous SiO[2]@mesoporous SiO[2] nanocomposite spheres and investigation of their in vitro biocompatibility

Background: multifunctional core-shell magnetic nanocomposite particles with tunable characteristics have been paid much attention for biomedical applications in recent years. A rational design and suitable preparation method must be employed to be able to exploit attractive properties of magnetic nanocomposite particles

Objectives: herein, we report on a simple approach for the synthesis of magnetic mesoporous silica nanocomposite particles [MMSPs], consisted of a Fe[3]O[4] cluster core, a nonporous silica shell and a second shell of the mesoporous silica of suitable sizes for biomedical applications and evaluate their cytotoxicity effects on human cancer prostate cell lines

Materials and Methods: clusters of magnetite [Fe[3]O[4]] nanoparticles were coated by a layer of nonporous silica using Stober method. The coating step was completed by an outer layer of mesoporous silica via template-removing method. Structural properties of MMSPs were investigated by FTIR, HR-S[T]EM, BET, XRD techniques and magnetic properties of MMSPs by VSM instrument. MTT and LDH assays were employed to study the cytotoxicity of MMSPs

Results: obtained results revealed that decreasing the precursor concentration and the reaction time at the nonporous silica shell formation step decreases the thickness of the nonporous silica shell and consequently leads to the formation of smaller MMSPs. The as-prepared MMSPs have a desirable average size of 180 +/- 10 nm, an average pore size of 3.01 nm, a high surface area of 390.4 m[2].g[-1] and a large pore volume of 0.294 cm[3].g[-1]. In addition, the MMSPs exhibited a superparamagnetic behavior and a high magnetization saturation value of 21 +/- 0.5 emu/g. Furthermore, the viability tests of DU-145 cell lines exposed to various concentrations of these particles demonstrated negligible cytotoxicity effects of the asprepared Particles

Conclusions: these results demonstrate interesting properties of MMSPs prepared in this study for biomedical applications

Assessment of non-invasive models for liver fibrosis in chronic hepatitis B virus related liver disease patients in resource limited settings.

Context: A total of 350 million individuals are affected by chronic hepatitis B virus infection world-wide. Historically, liver biopsy has been instrumental in adequately assessing patients with chronic liver disease. A number of non-invasive models have been studied world-wide. Aim: The aim of this study is to assess the utility of non-invasive mathematical models of liver fi brosis in chronic hepatitis B (CHB). Indian patients in a resource limited setting using routinely performed non-invasive laboratory investigations. Settings and Design: A cross-sectional study carried out at a tertiary care center. Subjects and Methods: A total of 52 consecutive chronic liver disease patients who underwent percutaneous liver biopsy and 25 healthy controls were enrolled in the study. Routine laboratory investigations included serum aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Gama glutamyl transpeptidase (GGT), total bilirubin, total cholesterol, prothrombin time and platelet count. Three non-invasive models for namely aspartate aminotransferase to platelet ratio index (APRI), Fibrosis 4 (FIB-4) and Forn’s index were calculated. Outcomes were compared for the assessment of best predictor of fi brosis by calculating the sensitivity, specifi city, positive predictive value (PPV) and negative predictive value (NPV) of each index. Statistical Analysis Used: Medcalc online software and by Microsoft Excel Worksheet. Chi-square test was used for signifi cance. P value < 0.05 was taken as signifi cant. Results: While the serum levels of AST, ALT and GGT were signifi cantly higher in patients group as compare with the healthy controls (P < 0.01), the platelet counts were signifi cantly lower in patient group as compared to the control group (P < 0.01). Mean value of all 3 indices were signifi cantly higher in patients group as compare with the controls (P < 0.01). Conclusions: Out of the three indices, APRI index with a NPV of 95% appeared to be a better model for excluding signifi cant liver fi brosis while FIB-4 with a PPV of 61% showed fair correlation with signifi cant fi brosis. Thus, these two non-invasive models for predicting of liver fi brosis, namely APRI and FIB-4, can be utilized in combination as screening tools in monitoring of CHB patients, especially in resource limiting settings.

Thirty-day mortality and morbidity after total knee arthroplasty

<p><b>INTRODUCTION</b>Total knee arthroplasty (TKA) is one of the most successful orthopaedic procedures to date. It is estimated that over 130,000 of TKAs are performed in the United States every year. Whilst the procedure is safe, it nevertheless carries a risk of perioperative mortality and morbidity. This study aimed to report the mortality rate within 30 days after a TKA, as well as to assess the incidence of early postoperative morbidities.</p><p><b>MATERIALS AND METHODS</b>We reviewed a total of 2219 TKAs performed by multiple surgeons in our centre from 1998 to 2001. All mortalities within 30 days of a TKA were recorded. Morbidities such as infection, thromboembolic phenomenon, and any re-admissions within 30 days of operation or 15 days of discharge were recorded.</p><p><b>RESULTS</b>The mortality rate within 30 days of a TKA was 0.27% (6 of 2219 patients). The incidence of early postoperative infection was 1.8%, of which 1.44% were superficial and 0.36% were deep infections. There were 3 cases (0.13%) of pulmonary embolism and 22 cases (0.99%) of deep vein thrombosis.</p><p><b>CONCLUSIONS</b>The 30-day mortality rate, and the incidence of infection after TKA performed in our institution is comparable to other centres around the world, and further emphasises that TKA is a safe procedure. However, the small number of mortalities in this study does not allow us to identify a predominant cause of perioperative mortality.</p>