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1.
Sci Rep ; 13(1): 10643, 2023 06 30.
Article in English | MEDLINE | ID: mdl-37391465

ABSTRACT

Despite the transfer of COVID-19 from the pandemic to control, we are still in a state of uncertainty about long-term success. Therefore, there is a great need for rapid and sensitive diagnostics to sustain the control status. After several optimization trials, we developed lateral flow test (LFT) strips for rapid detection of SARS-CoV-2 spike 1 (S1) antigen in saliva samples. For signal enhancement of our developed strips, we applied dual gold conjugates. Gold-labeled anti-S1 nanobodies (Nbs) were employed as S1 detector conjugate, while gold-labeled angiotensin-converting enzyme 2 (ACE2) was used as S1 capturing conjugate. In a parallel strip design, we used an anti-S1 monoclonal antibody (mAb) as an antigen detector instead of anti-S1 Nbs. Saliva samples were collected from 320 symptomatic subjects (180 RT-PCR confirmed positive cases and 140 confirmed negative cases) and were tested with the developed strips. In early detection for positive samples with cycle threshold (Ct ≤ 30), Nbs-based LFT strips showed higher sensitivity (97.14%) and specificity (98.57%) than mAb-based strips which gave 90.04% sensitivity and 97.86% specificity. Moreover, the limit of detection (LoD) for virus particles was lower for Nbs-based LFT (0.4 × 104 copies/ml) than for the mAb-based test (1.6 × 104 copies/ml). Our results are in favor of the use of dual gold Nbs and ACE2 conjugates in LFT strips. These signal-enhanced strips offer a sensitive diagnostic tool for rapid screening of SARS-CoV-2 S1 antigen in the easily collected saliva samples.


Subject(s)
COVID-19 , Single-Domain Antibodies , Humans , SARS-CoV-2 , COVID-19/diagnosis , Angiotensin-Converting Enzyme 2 , Saliva , Antibodies, Monoclonal
2.
Exp Parasitol ; 242: 108390, 2022 Nov.
Article in English | MEDLINE | ID: mdl-36179853

ABSTRACT

This study was performed to evaluate the effect of two commercially available serum-free culture media; serum free medium (SFM) and chemically defined medium (CDM), on the growth rate, antibody productivity and post adaptation cryopreservation and revival reactivity of hybridoma cells compared to the conventional serum based medium (SBM). In addition, the diagnostic efficacy of MAbs secreted in each culture medium was evaluated by testing their performance in sandwich ELISA for antigen detection. Anti- Schistosoma mansoni soluble egg antigen hybridoma cell line (7A/8F) secreting previously characterized IgG Kappa mAbs, were retrieved and propagated in each of the three aforementioned media. Growth rate and viability were assessed post culturing in each media. The data collected from this study indicated that MAbs secreted from hybridoma cells cultured in SFM were the most abundant, easiest to purify, and the most effective in antigen detection by sandwich ELISA, in comparison to those produced in the other two media. Moreover, combination of fresh and conditioned medium with DMSO 7.5% was the most promising formulation for the cryopreservation of hybridoma cells cultivated in serum independent media (SFM or CDM).


Subject(s)
Antibodies, Monoclonal , Dimethyl Sulfoxide , Hybridomas , Culture Media, Serum-Free , Culture Media, Conditioned , Survival Rate , Cryopreservation , Immunoglobulin G
3.
Trop Med Infect Dis ; 7(6)2022 Jun 13.
Article in English | MEDLINE | ID: mdl-35736981

ABSTRACT

The development of sensitive, non-invasive tests for the detection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antigens is imperative, and it is still challenging to manage the extent of infection throughout the population. Here, we designed and optimized a sandwich enzyme-linked immunosorbent assay (ELISA) protocol for SARS-CoV-2 S1 antigen detection in saliva. Both saliva samples and nasopharyngeal swabs were collected from 220 real-time quantitative polymerase chain reaction (RT-qPCR)-confirmed positive and negative cases. S1 protein receptor-binding domain (RBD) nanobodies were efficiently conjugated with 40 nm gold nanoparticles (AuNPs) and employed as antigen detection probes in the developed system, while recombinant S1 monoclonal antibodies (S1mAbs) were employed as antigen capture probes. After checkerboard assays and system optimization, the clinical samples were tested. In saliva, the developed ELISA system showed the highest sensitivity (93.3) for samples with cycle threshold (Ct) values ≤ 30; interestingly, high sensitivity (87.5 and 86%) was also achieved for samples with Ct values ≤ 35 and ≤40, respectively, compared with 90, 80 and 88% sensitivity rates for nasopharyngeal swabs with the same categorized Ct values. However, the specificity was 100%, and no cross-reactions were detected with Middle East respiratory syndrome coronavirus (MERS-CoV) or SARS-CoV antigens. These results reveal that our protocol could be established as an efficient and sensitive, non-invasive diagnostic tool for the early detection of SARS-CoV-2 infection using easily collectable saliva samples.

4.
Exp Clin Transplant ; 17(2): 251-258, 2019 04.
Article in English | MEDLINE | ID: mdl-30346265

ABSTRACT

OBJECTIVES: Liver transplantation is the well-known treatment for chronic liver diseases; however, postoperative complications and lack of donors continue to be limitations with this treatment. Investigating new modalities for treatment of chronic liver illness is a must. In the present study, we aimed to clarify the effects of an in vitro hepatocyte-differentiated human unrestricted somatic stem cell transplant as a new cell-based therapy in an experimental model of chronic liver failure. MATERIALS AND METHODS: Human umbilical cord blood-derived unrestricted somatic stem cells were isolated, cultured, propagated, and characterized. Cells were directed to differentiate into hepatocyte-like cells. An animal model of carbon tetrachloride cirrhotic liver failure was prepared, and the human in vitro differentiated unrestricted somatic stem cells were transplanted into the experimental model. Animals that did not receive transplant served as the pathologic control group. Animals were euthanized 12 weeks after transplant, and liver functions and histopathology were assessed. RESULTS: Compared with the pathologic control group, the transplant group showed improvements in levels of alanine aminotransferase, aspartate aminotransferase, albumin, and bilirubin. Histopathologic examination of the transplant group also showed improvements in hydropic degeneration and fibrosis. CONCLUSIONS: The use of unrestricted somatic stem cells, isolated and propagated from cord blood and then differentiated into hepatocyte-like cells, improved both fibrosis and normal function of cirrhotic livers. These cells could be considered as a line of cell-based therapy in cases of chronic liver disease.


Subject(s)
Adult Stem Cells/transplantation , Chemical and Drug Induced Liver Injury/surgery , Cord Blood Stem Cell Transplantation/methods , Fetal Blood/cytology , Hepatocytes/transplantation , Liver Cirrhosis, Experimental/surgery , Liver Regeneration , Liver/pathology , Adult Stem Cells/metabolism , Animals , Biomarkers/metabolism , Carbon Tetrachloride , Cell Differentiation , Cell Proliferation , Cells, Cultured , Chemical and Drug Induced Liver Injury/metabolism , Chemical and Drug Induced Liver Injury/pathology , Hepatocytes/metabolism , Humans , Liver/metabolism , Liver Cirrhosis, Experimental/chemically induced , Liver Cirrhosis, Experimental/metabolism , Liver Cirrhosis, Experimental/pathology , Mice, Inbred BALB C , Phenotype , Time Factors
5.
Article in Chinese | WPRIM (Western Pacific) | ID: wpr-753247

ABSTRACT

Objective: To develop a new sandwich based lateral flow immunochromatographic strip for rapid detection of circulating Schistosoma mansoni antigen in serum and urine samples of patients with active schistosomiasis. Methods: This lateral flow immunochromatographic strip was prepared by using anti-Schistosoma mansoni soluble egg antigen monoclonal antibody conjugated gold nanoparticles (MAb-AuNPs) as antigen-detecting antibody, while crystalline material (MCM)-41-MAb bioconjugate was immobilized at the test line as antigen-capturing antibody. Both antigen capturing and detecting antibodies formed sandwich complexes with circulating Schistosoma mansoni antigen in the positive samples. Sandwich complexes immobilized at the test line gave distinct red color. The assay reliability was examined by using urine and serum samples of 60 Schistosoma mansoni infected patients, 20 patients infected with parasites other than Schistosoma, and 20 healthy individuals as negative controls. Results were compared with those obtained via sandwich enzyme linked immunosorbent assay (ELISA). Results: The detection limit of circulating Schistosoma mansoni antigen by lateral flow immunochromatographic strip was lower (3 ng/mL) than the detection limit by ELISA (30 ng/mL). The sensitivity and specificity of lateral flow immunochromatographic strip in urine samples were 98.3% and 97.5%, respectively compared to 93.5% and 90.0% by ELISA. In serum samples, they were 100.0% and 97.5%, respectively compared to 97.0% and 95.0% by ELISA. The strip test took approximately 10 min to complete. Conclusions: This new lateral flow immunochromatographic strip offers a sensitive, rapid, and field applicable technique for diagnosis of active schistosomiasis.

6.
Adv Clin Exp Med ; 27(10): 1329-1339, 2018 Oct.
Article in English | MEDLINE | ID: mdl-30048056

ABSTRACT

BACKGROUND: The liver is one of the major target organs for which cell-based therapies are very promising. The limitations of various cellular therapies, including bone marrow (BM)-derived mesenchymal stem cells (MSCs), urges the exploration of stem cell sources more suitable for transplantation. Human umbilical cord blood (HUCB) can overcome these drawbacks with a favorable reparative outcome. OBJECTIVES: The aim of this study was to evaluate the therapeutic potential of MSCs in 2 groups of chronic liver injury experimental models. MATERIAL AND METHODS: Propagation and characterization of MSCs isolated from cord blood (CB) samples were performed and differentiation into osteogenic, adipogenic and hepatogenic lineages was induced. The 1st experimental model group (80 mice) included a negative control, a pathological control and 60 mice infected with Schistosoma mansoni (S. mansoni) and transplanted with MSCs. The 2nd experimental model group (30 hamsters) included 10 healthy hamsters serving as a negative control and 20 hamsters injected with repeated doses of carbon tetrachloride (CCl4) to induce liver fibrosis; 10 of them were treated with an intrahepatic (IH) injection of 3 × 106 MSCs and the other 10 were untreated pathological controls. Mice and hamsters were sacrificed 12 weeks post-transplantation and their liver sections were stained immunohistochemically for the detection of human hepatocyte-like cells. Moreover, the sections were examined for the levels of fibrosis. RESULTS: In both models, the transplantation of CB-derived MSCs (CB-MSCs) resulted in the engraftment of the fibrotic livers with newly formed hepatocytes, as evidenced by positive immunohistochemistry staining with human Hepatocyte Paraffin 1 (Hep Par 1), alpha-fenoprotein (AFP), cytokeratin 18 (CK18), cytokeratin 7 (CK7), and OV6 monoclonal antibody. The transplanted liver sections showed markedly reduced hepatic fibrosis with a significantly lower fibrotic index, as well as significantly improved liver functions compared to the pathological control (p < 0.001). CONCLUSIONS: This data provides hope that human CB-MSCs can be utilized as multipotent stem cells with unlimited potentiality in regenerative medicine and supports the concept of cellular therapy for the cure of hepatic fibrosis.


Subject(s)
Cell Differentiation , Liver Cirrhosis/therapy , Mesenchymal Stem Cell Transplantation , Mesenchymal Stem Cells/cytology , Animals , Fetal Blood , Hepatocytes/metabolism , Humans , Liver , Mesenchymal Stem Cells/metabolism , Mice , Models, Theoretical
7.
Exp Clin Transplant ; 16(1): 81-89, 2018 02.
Article in English | MEDLINE | ID: mdl-28585911

ABSTRACT

OBJECTIVES: Liver transplant is the cornerstone line of treatment for chronic liver diseases; however, the long list of complications and obstacles stand against this operation. Searching for new modalities for treatment of chronic liver illness is a must. In the present research, we aimed to compare the effects of transplant of undifferentiated human mesenchymal stem cells, in vitro differentiated mesenchymal stem cells, and adult hepatocytes in an experimental model of chronic liver failure. MATERIALS AND METHODS: Undifferentiated human cord blood mesenchymal stem cells were isolated, pro-pagated, and characterized by morphology, gene expression analysis, and flow cytometry of surface markers and in vitro differentiated into hepatocyte-like cells. Rat hepatocytes were isolated by double perfusion technique. An animal model of chronic liver failure was developed, and undifferentiated human cord blood mesenchymal stem cells, in vitro hepato-genically differentiated mesenchymal stem cells, or freshly isolated rat hepatocytes were transplanted into a CCL4 cirrhotic experimental model. Animals were killed 3 months after transplant, and liver functions and histopathology were assessed. RESULTS: Compared with the cirrhotic control group, the 3 cell-treated groups showed improved alanine aminotransferase, aspartate aminotransferase, albumin, and bilirubin levels, with best results shown in the hepatocyte-treated group. Histopathologic examination of the treated groups showed improved fibrosis, with best results obtained in the undifferentiated mesenchymal stem cell-treated group. CONCLUSIONS: Both adult hepatocytes and cord blood mesenchymal stem cells proved to be promising candidates for cell-based therapy in liver regeneration on an experimental level. Improved liver function was evident in the hepatocyte-treated group, and fibrosis control was more evident in the undifferentiated mesenchymal stem cell-treated group.


Subject(s)
Cell Differentiation , Chemical and Drug Induced Liver Injury/surgery , Cord Blood Stem Cell Transplantation , End Stage Liver Disease/surgery , Hepatocytes/transplantation , Liver Cirrhosis, Experimental/surgery , Liver Transplantation/methods , Mesenchymal Stem Cell Transplantation , Mesenchymal Stem Cells , Animals , Biomarkers/metabolism , Carbon Tetrachloride , Cells, Cultured , Chemical and Drug Induced Liver Injury/etiology , Chemical and Drug Induced Liver Injury/pathology , Chemical and Drug Induced Liver Injury/physiopathology , End Stage Liver Disease/chemically induced , End Stage Liver Disease/pathology , End Stage Liver Disease/physiopathology , Hepatocytes/metabolism , Humans , Liver Cirrhosis, Experimental/chemically induced , Liver Cirrhosis, Experimental/pathology , Liver Cirrhosis, Experimental/physiopathology , Liver Regeneration , Male , Mesenchymal Stem Cells/metabolism , Mice, Inbred BALB C , Phenotype , Rats, Inbred Lew , Recovery of Function , Time Factors
8.
APMIS ; 119(1): 66-75, 2011 Jan.
Article in English | MEDLINE | ID: mdl-21143528

ABSTRACT

The in vivo angiogenic potential of transplanted human umbilical cord blood (UCB) CD133(+) stem cells in experimental chronic hepatic fibrosis induced by murine schistosomiasis was studied. Enriched cord blood-derived CD133(+) cells were cultured in primary medium for 3 weeks. Twenty-two weeks post-Schistosomiasis infection in mice, after reaching the chronic hepatic fibrotic stage, transplantation of stem cells was performed and mice were sacrificed 3 weeks later. Histopathology and electron microscopy showed an increase in newly formed blood vessels and a decrease in the fibrosis known for this stage of the disease. By immunohistochemical analysis the newly formed blood vessels showed positive expression of the human-specific angiogenic markers CD31, CD34 and von Willebrand factor. Few hepatocyte-like polygonal cells showed positive expression of human vascular endothelial growth factor and inducible nitric oxide synthase. The transplanted CD133(+) human stem cells primarily enhanced hepatic angiogenesis and neovascularization and contributed to repair in a paracrine manner by creating a permissive environment that enabled proliferation and survival of damaged cells rather than by direct differentiation to hepatocytes. A dual advantage of CD133(+) cell therapy in hepatic disease is suggested based on its capability of hematopoietic and endothelial differentiation.


Subject(s)
Antigens, CD/blood , Fetal Blood/physiology , Glycoproteins/blood , Liver Cirrhosis/immunology , Neovascularization, Physiologic/physiology , Peptides/blood , Stem Cells/physiology , AC133 Antigen , Adult , Animals , Antigens, CD/immunology , Female , Fetal Blood/cytology , Fetal Blood/immunology , Glycoproteins/immunology , Humans , Immunohistochemistry , Infant, Newborn , Liver Cirrhosis/blood , Mice , Microscopy, Electron , Neovascularization, Physiologic/immunology , Peptides/immunology , Stem Cell Transplantation , Stem Cells/cytology , Stem Cells/immunology , Young Adult
9.
Medscape J Med ; 10(6): 130, 2008 Jun 03.
Article in English | MEDLINE | ID: mdl-18679533

ABSTRACT

Apoptosis is central for control and elimination of viral infections. In chronic hepatitis C virus (HCV) infection, enhanced hepatocyte apoptosis and upregulation of the death-inducing ligands CD95/Fas occur. This study aimed to study the role of serum soluble Fas and hepatic Fas expression as early predictors of advancement of chronic hepatitis C disease. The current study included 50 cases of chronic hepatitis C (CHC) (and negative hepatitis B virus infection), 30 cases of liver cirrhosis (LC) and HCV, and 20 cases of hepatocellular carcinoma (HCC) and HCV admitted to Theodor Bilharz Research Institute, Giza, Egypt. Fifteen wedge liver biopsies, taken during laparoscopic cholecystectomy, were included in the study as normal controls. Assessment of serum soluble Fas level (sFas) and other laboratory investigations, including liver function tests, serologic markers for viral hepatitis, and serum alpha-fetoprotein level (alpha-FP), were determined for all cases. Histopathologic study and immunohistochemistry using monoclonal antibody for CD95 were also done. The sFas was significantly increased in CHC, LC, and HCC cases compared with normal controls (P < .01). The increase of sFas in HCC was also significantly higher than that of CHC (P < .01). However, positive hepatic expression of Fas antigen was higher in CHC than LC with no significant difference; meanwhile, it was significantly lower in HCC (P < .01) compared with CHC. In conclusion, circulating and hepatic Fas expression in chronic hepatitis C infection illustrate the mechanism of liver injury caused by death receptors throughout the multistep process of fibrosis/carcinogenesis. Not only the higher degree of hepatic fibrosis, but also the lower expression of Fas protein, are correlated with the increased incidence of HCC.


Subject(s)
Carcinoma, Hepatocellular/blood , Hepacivirus/metabolism , Hepatitis C, Chronic/blood , Liver Neoplasms/blood , fas Receptor/biosynthesis , fas Receptor/blood , Adult , Biomarkers/blood , Biomarkers/metabolism , Carcinoma, Hepatocellular/metabolism , Carcinoma, Hepatocellular/virology , Cross-Sectional Studies , Female , Follow-Up Studies , Gene Expression Regulation, Neoplastic/physiology , Hepatitis C, Chronic/metabolism , Hepatitis C, Chronic/virology , Humans , Liver Neoplasms/metabolism , Liver Neoplasms/virology , Male , Middle Aged , Young Adult , fas Receptor/genetics
10.
APMIS ; 114(7-8): 480-91, 2006.
Article in English | MEDLINE | ID: mdl-16907853

ABSTRACT

This work investigated the possible use of AdDP as adjuvant therapy to praziquantel (PZQ) in mice infected with PZQ-insusceptible Schistosoma mansoni isolate in a trial to increase the susceptibility of this isolate to the drug. Two batches of C57 BL/6 mice were infected with PZQ-susceptible and -insusceptible S. mansoni isolates, and each batch was divided into five groups. Seven weeks postinfection, the experimental group received AdDP (5 mg/kg) in addition to PZQ in reduced dose (3x100 mg/kg). Three of the remaining four groups were treated controls; they received AdDP, PZQ in reduced dose and in full dose (2x500 mg/kg), and the fourth group was infected untreated. In mice infected with PZQ-susceptible or -insusceptible S. mansoni isolate, praziquantel alone, and in addition to AdDP, reduced worm and egg loads and increased percentage dead eggs. Also, they improved the histopathological changes (reduction in granuloma diameter, percentage fibrotic area with increased percentage degenerated eggs). Inducible nitric oxide synthase (iNOS), nitric oxide (NO) in culture of peritoneal macrophages, and number of CD68-positive cells were decreased with improved alanine amino transaminase. In mice receiving combined therapy AdDP+PZQ, the antischistosomal efficacy and the reductions in the inflammatory granulomatous reactions, NO in cultured peritoneal macrophages, percentage fibrotic areas recorded, were comparable to that in mice receiving full dose of PZQ, with significantly higher reduction in CD68 cells denoting enhanced antischistosomal efficacy and healing of the inflammatory reactions in the liver.


Subject(s)
Adjuvants, Immunologic/administration & dosage , Amantadine/analogs & derivatives , Anthelmintics/administration & dosage , Dipeptides/administration & dosage , Praziquantel/administration & dosage , Schistosoma mansoni , Schistosomiasis mansoni/drug therapy , Administration, Oral , Amantadine/administration & dosage , Animals , Cells, Cultured , Fibrosis , Injections, Intraperitoneal , Male , Mice , Mice, Inbred C57BL , Schistosoma mansoni/drug effects , Schistosoma mansoni/immunology , Schistosoma mansoni/isolation & purification , Schistosomiasis mansoni/parasitology , Schistosomiasis mansoni/pathology
11.
Tunis Med ; 82(7): 648-55, 2004 Jul.
Article in French | MEDLINE | ID: mdl-15552022

ABSTRACT

From 1981 to 1999 Mitral bileaflet prosthesis was implanted to 90 patients. Doppler echocardiography was performed for these patients between January and March 2002 with a mean deadline of 111 months after the intervention. 36 were women (40%) and 54 were men (60%) the mean age was 41 years (20 - 70 years) The mitral bileaflet prosthesis was a Saint Jude in 65 cases, Jyros 8 cases, Carbomédics 7 cases, Sorin Bicarbon 7 cases, Edwards Duromédics 2 cases et an ON-X in one case. The maximal transprosthetic gradient was 15.7 mm Hg +/- 5.06 (6.25 mm Hg). The mean transprosthetic gradient was 5.6 mm Hg +/- 1.07 (39.5 mmHg). The mean prosthesis functional area 2.37 cm2 +/- 0.44 (1.75 cm2 et 3.60 cm2). Maximal gradient, mean gradient and prosthesis functional area are independent from kind mitral bileaflet prosthesis and from the prosthesis size.


Subject(s)
Echocardiography, Doppler , Heart Valve Prosthesis , Hemodynamics , Mitral Valve/diagnostic imaging , Mitral Valve/physiology , Adult , Aged , Female , Humans , Male , Middle Aged
12.
Tunis Med ; 82(3): 289-98, 2004 Mar.
Article in French | MEDLINE | ID: mdl-15382464

ABSTRACT

Between January 1981 and December 2000, we report 112 cases of mitral valvular replacement with bileaflet prothesis. Saint Jude prosthesis was implanted in 71% of cases. With a mean follow-up of 110 months we report a thromboembolic accident in 7 cases (6.2%). The linear rate of thromboembolic accident is 0.69% A/P. This complication was concerned 5 women and 5 men. The mean age is 54 years (43-65 years). An embolic accident without prosthesis thrombosis is noted in 6 cases. We report only one case of prosthesis occlusive thrombosis with urgent chirurgical intervention. Par rapport au RVM, l'ATE est survenue dans uns délai moyen de 129 months (86-168 months). Left atrium size, embolic antecedent, and bad anticoagulation are the predicted factors of thromboembolic accidents in our study. Patient age and sex, atrial fibrillation, type of bileaflet prosthesis don't influence the occurrence of thromboembolic accident.


Subject(s)
Heart Valve Prosthesis Implantation/adverse effects , Mitral Valve , Thromboembolism/etiology , Adult , Age Factors , Aged , Data Interpretation, Statistical , Echocardiography , Female , Follow-Up Studies , Heart Valve Prosthesis , Humans , Male , Middle Aged , Reoperation , Risk Factors , Sex Factors , Time Factors
13.
Tunis Med ; 81(6): 383-9, 2003 Jun.
Article in French | MEDLINE | ID: mdl-14567292

ABSTRACT

We report 112 cases of mitral valvular replacement with bileaflet prothesis. The mean age is 40 ans +/- 3.4 years (9-74 years). 71 (65%) are men and 45 (35%) are women, the main éthiology of mitral disease is rheumatic fever (94.74%). The Saint Jude prothesis is implanted in 70.4% cases. The early post operator mortality is 1.8% it is related on low cardiac output. With a mean follow-up of 110 months, the late mortality is 5.5%. The survey is 97% at 5 years and 94% at 10 years. The rates of thromboembolic and hemorrhagic complications are 6.3% and 9%. We report only one case of infective endocarditis. The rate of réintervention is 5%. By echocardiography the hemodynamic profile of bileaflet prothesis is excellent even with the small size.


Subject(s)
Heart Valve Prosthesis , Mitral Valve Insufficiency/surgery , Rheumatic Heart Disease/surgery , Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Prosthesis Design , Retrospective Studies , Treatment Outcome
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