Toxicological Impact and in Vivo Tracing of Rhodamine Functionalised ZIF-8 Nanoparticles.

Metal Organic Frameworks (MOFs) are extensively used for a wide range of applications due to their exceptionally high surface area. MOF particles are conventionally in micron size, but the nanosized MOFs show good transportation/mobility due to their small size, and when combined with the high surface area of MOFs, it makes MOF nanoparticles an ideal candidate to study for environmental remediation. Therefore, it is important to study the ecotoxicological impact of these MOFs. In this study, we developed rhodamine labelled nanoparticles of zinc imidazolate metal organic framework (ZIF-8 MOFs) as a means of in vivo tracing the MOF translocation in C. elegans. Rhodamine B isothiocyanate functionalized ZIF-8 MOFs nanoparticles (RBITC@ZIF-8 MOF nanoparticles; size 44 ± 7 nm) were fed to the worms naturally within a concentration range of 0.16-16.4 µg mg-1. Fluorescence was detected in the pharyngeal and gut lumen regions of the worms after 4 h of treatment, for exposure concentrations >0.163 µg mg-1. A higher intensity of fluorescence was observed at the end of 24 h for all exposure concentrations. Worms treated with RBITC@ZIF-8 MOF concentrations of ≥1.63 µg mg-1 for 24 h showed a bright stable fluorescence signal at the tail region. The uptake of RBITC@ZIF-8 MOF for an exposure concentration of 0.163, 1.63, and 8.2 µg mg-1 was found to be 52.1, 11.4 and 28.6%, respectively. Through this study, we showed that RBITC@ZIF-8 MOFs can be exposed to C. elegans and imaged at low concentrations of ∼0.16 µg mg-1.

Patients' perspectives on the extent of resident participation in the operating room for total hip oxr knee arthroplasty.

INTRODUCTION: Previous work suggests that patients do not understand the extent of resident involvement in their care and are also uncomfortable with resident involvement. METHODS: We recruited 202 English speaking patients with previous or planned total joint arthroplasty of the lower limb for a prospective survey trial. We assessed participant's knowledge of resident level of education and confidence of resident involvement in their surgery as a function of supervision. RESULTS: Participants' mean level of confidence in the consultant surgeon was 4.30 (SD±1.13) on a 5-point Likert scale. Confidence in residents was significantly less, regardless of experience (p < 0.05). 11.1% of participants did not want residents involved in their treatment. 60.6% would like to know more about the education level of the trainee. Less than half of participants correctly identified the education level of residents and fellows. CONCLUSION: Patient confidence in residents performing part or all of their surgery increases with resident experience and supervision. Compared with attending surgeons, patients have significantly less confidence in residents performing their surgery, including while supervised. Most patients do not understand the educational progression of medical trainees and would like to know more about the education level of the resident involved in their care. Further work should explore how we can help patients better understand resident involvement in their surgical care.

CONTEXTE: Des travaux antérieurs suggèrent que les patients ne comprennent pas le degré de participation des stagiaires dans leurs soins et que cette participation les rend mal à l'aise. MÉTHODES: Nous avons recruté 202 patients anglophones qui ont eu ou qui vont avoir une arthroplastie totale du membre inférieur pour un essai prospectif par sondage. Nous avons évalué les connaissances des participants sur le niveau de formation des résidents et leur confiance dans la participation des stagiaires dans l'intervention en fonction de la supervision dont ils font l'objet. RÉSULTATS: Le niveau moyen de confiance des participants dans le chirurgien consultant était de 4,30 (SD±1,13) sur une échelle de Likert à 5 points. Le degré de confiance dans les résidents était bien inférieur, quelle que soit l'expérience du résident (p < 0,05). Parmi les participants, 11,1 % ne voulaient pas que les résidents interviennent dans leur traitement et 60,6 % souhaitaient en savoir plus sur leur niveau de formation. Moins de la moitié des participants ont correctement identifié le niveau de formation des résidents et des fellows. CONCLUSION: La confiance des patients par rapport au fait que les stagiaires effectuent une partie ou la totalité de l'intervention chirurgicale augmente avec l'expérience et la supervision des résidents. La plupart des patients ne comprennent pas les niveaux de formation des stagiaires en médecine et voudraient en savoir plus sur celui du médecin en formation qui intervient dans leurs soins. Des études plus poussées s'imposent sur la manière d'aider les patients à mieux comprendre la participation des stagiaires dans les soins chirurgicaux.

Ion exchange based approach for rapid and selective Pb(II) removal using iron oxide decorated metal organic framework hybrid.

Polyacrylic acid capped Fe3O4 - Cu-MOF (i-MOF) hybrid was prepared for rapid and selective lead removal, with 93% removal efficiency, exceptional selectivity, and adsorption capacity of 610 mg/g and 91% of i-MOF hybrid could be easily separated from the contaminated water using magnetic separation. The adsorption process followed a pseudo-second-order model and the adsorption efficiency decreased from 93% to 83% on raising the temperature from 25 °C to 40 °C. The change in equilibrium adsorption capacity with respect to equilibrium adsorbate concentration followed the Langmuir isotherm model. i-MOF had a high selectivity coefficient and removal efficiency for lead ions even when exposed simultaneously with naturally abundant cations (Na(I), Ca(II), Mg(II)). Release of Cu(II) ions from the i-MOF after Pb(II) removal suggested suggested ion-exchange to be the dominant removal mechanism. This new finding for Pb(II) removal with excellent adsorption performance using i-MOF through ion exchange based approach is a viable option for treating lead contaminated water.

Intramedullary Insertion of the Patellar Tendon, a Rare Anatomical Variant, Its Sequelae, and Surgical Management: A Case Report.

CASE: We report a rare cause of patella baja in a 25-year-old man presenting with right knee pain. He was found to have patella baja and a genu recurvatum deformity. Imaging revealed an extremely unusual variant of the patellar tendon-identified to have an intramedullary tibial insertion. A patellar tendon reconstructive procedure was performed. CONCLUSIONS: An intramedullary insertion of the patellar tendon is a fascinating and rare cause of patella baja with subsequent altered biomechanics of the extensor mechanism. We believe this is the first case report to describe its surgical presentation and an operative approach to its management.

Change in Acetabular Cup Orientation From Supine to Standing Position and Its Effect on Wear of Highly Crosslinked Polyethylene.

BACKGROUND: The purpose of this study is to measure acetabular cup position and wear of the highly crosslinked polyethylene liner in the supine and standing position for patients at a minimum of 10 years after the operation. METHODS: A total of 38 patients were recruited at a mean of 12.5 years after the operation. All patients received a single acetabular cup design with a highly crosslinked liner and a 28-mm cobalt-chromium femoral head. Patients underwent supine and standing radiostereometric examinations in which the X-ray sources and detectors were positioned to obtain an anterior-posterior and cross-table lateral radiograph. Acetabular cup position and the three-dimensional wear rate were measured from the radiographs, and outcome scores were recorded for each patient. RESULTS: Anteversion significantly increased (P < .0001) a mean of 12° from supine (15.1° ± 10.4°) to standing (27.2° ± 10.5°) position. Inclination also significantly increased (P = .001) a mean of 2° from supine (44.4° ± 6.8°) to standing (46.3° ± 7.7°) position. There was no difference (P = .093) in wear rate between supine (0.067 ± 0.070 mm/y) and standing (0.073 ± 0.074 mm/y) positions. There were no correlations between cup orientation and wear rate in either position. CONCLUSION: Highly crosslinked polyethylene is a forgiving bearing material. Although adherence to the traditional acetabular position target zone is recommended, ensuring hip stability and consideration of the patient's functional position are also important objectives to consider for the acetabular position.

Effect of Acetabular Position on Polyethylene Liner Wear Measured Using Simultaneous Biplanar Acquisition.

BACKGROUND: Studies that have previously examined the relationship between acetabular component inclination angle and polyethylene wear have shown increased wear of conventional polyethylene with high inclination angles. To date, there are no long-term in vivo studies examining the correlation between cup position and polyethylene wear with highly crosslinked polyethylene. METHODS: An institutional arthroplasty database was used to identify patients who had metal-on-highly crosslinked polyethylene primary total hip arthroplasty using the same component design with a minimum follow-up of 10 years. A modified radiostereometric analysis examination setup was utilized, recreating standard anteroposterior and cross-table lateral examinations in a single stereo radiostereometric analysis acquisition. The same radiographs were used to measure inclination angle and anteversion. RESULTS: A total of 43 hips were included for analysis in this study. Average follow-up was 12.3 ± 1.2 years. The average linear wear rate was calculated to be 0.066 ± 0.066 mm/y. Inclination angle was not correlated with polyethylene wear rate (P = .82). Anteversion was also not correlated with polyethylene wear rate (P = .11). CONCLUSION: At long-term follow-up of >10 years, highly crosslinked polyethylene has a very low wear rate. This excellent tribology is independent of acetabular position. The low wear rate highlights the excellent results of metal on highly crosslinked polyethylene, and supports its use in total hip arthroplasty.

Effect of Acetabular Component Positioning on Functional Outcomes in Primary Total Hip Arthroplasty.

BACKGROUND: Acetabular component positioning is crucial to a successful total hip arthroplasty (THA). This study evaluated the effect of absolute acetabular component position as well as acetabular position relative to bony anatomy on patient-reported functional outcomes after primary THA. METHODS: Primary, press fit, hemispherical metal-on-polyethylene THA performed between 2003 and 2011 were analyzed. Western Ontario and McMaster Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), Short Form-12 scores, and radiographs between 2 and 3 years after the index procedure were assessed. RESULTS: Of the 1241 primary THA included, the mean abduction and anteversion angles were 44.4 ± 6.94 and 21.7 ± 11.9 degrees, respectively. The mean anterior and lateral overhang were 1.9 ± 3.6 and 2.5 ± 3.4 mm, respectively. There was no correlation between functional outcomes and acetabular inclination. A weak positive correlation between anteversion and HHS (P < .001) and WOMAC (P = .02) scores was found. For relative position, anterior overhang of the acetabular component beyond the bone resulted in inferior Short Form-12 physical function (P = .001), HHS (P = .004), and WOMAC (P < .001) scores compared to those with bony coverage. Mean HHS pain score was 41.20 ± 5.69 in patients with lateral overhang and 41.97 ± 5.04 in those who had bony coverage of the lateral edge of the acetabular component (P = .02). CONCLUSION: The tribology and biomechanics of acetabular component position have been extensively studied without examination of how it affects patient function. Although statistical significance was seen, clinical outcome scores were not sensitive enough to show a clinically significant effect of the absolute or relative position of the acetabular component.

Accuracy of the modified Hardinge approach in acetabular positioning.

BACKGROUND: The surgical approach chosen for total hip arthroplasty (THA) may affect the positioning of the acetabular component. The purpose of this study was to examine the accuracy in orienting the acetabular component using the modified Hardinge approach. METHODS: We used our institutional arthroplasty database to identify patients with primary, press-fit, hemispherical acetabular components of a metal-on-polyethylene THA performed between 2003 and 2011. Patients with radiographs obtained 1-3 years after the index procedure were included for measurement of anteversion and inclination angles. Acceptable values of anteversion and abduction angles were defined as 15° ± 10° and 40° ± 10°, respectively. RESULTS: We identified 1241 patients from the database, and the modified Hardinge approach was used in 1010 of the patients included in our analysis. The acetabular component was anteverted in the acceptable zone in 54.1% of patients. The abduction angle was within the defined range in 79.2% of patients. Combined anteversion and abduction angles within the defined zone were present in 43.6% of patients. CONCLUSION: Consistent with studies examining accuracy from other approaches, our study reveals that the modified Hardinge approach was only moderately accurate in positioning the acetabular component in the acceptable zone.

BACKGROUND: Les fractures de la clavicule sont fréquentes, et le choix du traitement optimal ne fait pas l'unanimité. Selon la littérature récente, la fixation chirurgicale des fractures du tiers médial déplacées (FTMD) aiguës raccourcies de plus de 2 cm donnerait de meilleurs résultats. Nous avons voulu établir une corrélation entre la mesure du déplacement obtenue par radiographie simple et par tomodensitométrie (TDM) et la fiabilité inter- et intra-observateur des mesures radiographiques répétées. BACKGROUND: La voie d'abord choisie pour une arthroplastie totale de la hanche (ATH) pourrait influer sur le positionnement du composant cotyloïdien. La présente étude portait sur la précision de l'orientation du composant dans les interventions empruntant la voie de Hardinge modifiée. METHODS: À partir de la base de données sur les arthroplasties de notre établissement, nous avons cherché puis retenu les patients ayant subi une ATH entre 2003 et 2011 et ayant alors reçu une première prothèse métal sur polyéthylène avec composant cotyloïdien hémisphérique ajusté à la presse. Nous avons inclus les patients ayant subi des radiographies de 1 à 3 ans après l'intervention afin de mesurer les angles d'antéversion et d'abduction. Les valeurs jugées acceptables étaient respectivement de 15° ± 10° et de 40° ± 10°. RESULTS: Nous avons retenu 1241 patients sélectionnés à partir de la base de données; la voie employée pour 1010 d'entre eux était la voie de Hardinge modifiée. L'angle d'antéversion du cotyle était dans les limites acceptables chez 54,1 % des patients, l'angle d'abduction se trouvait dans les limites définies dans 79,2 % des cas, et les valeurs cibles étaient respectées pour les 2 paramètres chez 43,6 % des patients. CONCLUSION: Nous avons conclu que la précision du positionnement du composant cotyloïdien par la voie de Hardinge modifiée est tout au plus modérée, ce qui concorde avec d'autres études visant à évaluer la précision d'autres techniques.

Mentored simulation training improves procedural skills in cardiac catheterization: a randomized, controlled pilot study.

BACKGROUND: Despite valuable supplemental training resources for surgical skill acquisition, utility of virtual reality simulators to improve skills relevant to performing cardiac catheterization has not been evaluated. METHODS AND RESULTS: Post baseline cardiac catheterization performance assessment, 27 cardiology trainees were randomized to either mentored training on a virtual reality simulator (n=12) or no simulator training (control; n=15). Cardiac catheterization performance was reassessed 1 week post baseline assessment. Performance scores at 1 week were compared with baseline within each group, and change in score from baseline to 1 week was compared between groups. Linear regression modeling was performed to assess the effect of simulator training as a function of baseline performance. Technical performance improved postintervention in the simulator group (24 versus 18; P=0.008) and changed marginally in the control group (20 versus 18; P=0.054). Improvement in technical performance was greater in the simulator group (6 versus 1; P=0.04). Global performance improved postintervention in both groups (simulator, 24 versus 17, P=0.01; control, 20 versus 18, P=0.02), with a trend toward greater improvement in the simulator group (5 versus 2; P=0.11). Lower scores at baseline were associated with larger differences in postintervention scores between the simulator and control groups (technical performance, P=0.0006; global performance, P<0.0001). CONCLUSIONS: Skills required to perform cardiac catheterization can be learned via mentored simulation training and are transferable to actual procedures in the catheterization laboratory. Less proficient operators derive greater benefit from simulator training than more proficient operators.