Recurrent implant fractures in total hip arthroplasty: a yes-you-yan case report.

This case report describes a single patient with recurrent implant fractures of his left total hip replacement. According to our knowledge this is the first patient in literature with recurrent implant fractures. This is a rare phenomenon as reason for revision. Risk factors for implant failure of total hip replacement include a lack of proximal support, a distally well fixed stem with proximal debonding, malalignment of the stem and raised BMI.

Enabling ultra-low-voltage switching in BaTiO3.

Single crystals of BaTiO3 exhibit small switching fields and energies, but thin-film performance is considerably worse, thus precluding their use in next-generation devices. Here, we demonstrate high-quality BaTiO3 thin films with nearly bulk-like properties. Thickness scaling provides access to the coercive voltages (<100 mV) and fields (<10 kV cm-1) required for future applications and results in a switching energy of <2 J cm-3 (corresponding to <2 aJ per bit in a 10 × 10 × 10 nm3 device). While reduction in film thickness reduces coercive voltage, it does so at the expense of remanent polarization. Depolarization fields impact polar state stability in thicker films but fortunately suppress the coercive field, thus driving a deviation from Janovec-Kay-Dunn scaling and enabling a constant coercive field for films <150 nm in thickness. Switching studies reveal fast speeds (switching times of ~2 ns for 25-nm-thick films with 5-µm-diameter capacitors) and a pathway to subnanosecond switching. Finally, integration of BaTiO3 thin films onto silicon substrates is shown. We also discuss what remains to be demonstrated to enable the use of these materials for next-generation devices.

Do Natural Portosystemic Shunts Need to Be Compulsorily Ligated in Living Donor Liver Transplantation?

BACKGROUND: Natural portosystemic shunt ligation practices in liver transplant vary widely across transplant centres and are frequently undertaken to prevent the serious consequence of portal steal phenomenon. No concrete indications have so far been convincingly identified for their management in living donor liver transplant. METHODS: We retrospectively studied the outcome of 89 cirrhotic patients who either did (n = 63) or did not (n = 25) undergo shunt ligation during living donor liver transplantation between 2017 and 2020. RESULTS: The incidence of early allograft dysfunction/nonfunction (P = 1.0) and portal venous complications (P = 0.555) were similar between the two groups. Although overall complications, biliary complications, and the composite of Grade III and IV complications were significantly higher in the nonligated group (P = 0.015, 0.052 and 0.035), 1- year graft and patient survival were comparable between them (P = 0.524). CONCLUSION: We conclude that shunt ligation in living donor liver transplantation may not always be necessary if adequate portal flow, good vascular reconstruction, and good graft quality have been ensured.

Living Donor Liver Transplant for Budd-Chiari Syndrome Without Caval Replacement: A Single-Center Study.

OBJECTIVES: Adequate venous outflow is one of the most important factors responsible for optimal graft function in liver transplantation. Thrombosis of the inferior vena cava in cases of Budd-Chiari syndrome poses a major challenge to a transplant surgeon in establishing proper graft outflow. In deceased donor liver transplant, this problem can be dealt with relative ease as the liver graft includes donor inferior vena cava. However, this is not the case in living donor liver transplant. We present our findings of living donor liver transplant for Budd-Chiari syndrome and discuss techniques that have helped overcome this unique problem without the need for complete inferior vena cava replacement. MATERIALS AND METHODS: Our retrospective analysis included living donor liver transplant recipients from November 2006 to March 2020 at our center and selected patients who underwent this transplant for Budd-Chiari syndrome. We studied the extent and severity of inferior vena cava involvement in these cases. We developed a classification that not only helped to stratify patterns of venacaval disease but also helped to plan the surgical technique. The role of interventional radiology combined with surgery in management of extensive inferior vena cava stenosis was studied. RESULTS: Among 2952 cases of liver transplant in our unit from November 2006 to March 2020, 36 patients had Budd-Chiari syndrome; 21 had significant level of inferior vena cava thrombosis, which was managed with inferior vena cava thrombectomy with either patchplasty (n = 20) or segmental replacement (n = 1). None of our patients showed recurrence of primary disease during the median follow-up of 36 months (range, 8-158 mo). CONCLUSIONS: Establishment of adequate venous ouflow in thrombosed inferior vena cava is possible with proper planning of surgical technique and timely involvement of interventional radiology-guided interventions in patients with Budd-Chiari syndrome.

Predicting the disaster - The role of CRP in acetabular surgery.

OBJECTIVES: Acetabular fractures represent a complex surgical challenge. Given the heterogenous fracture pattern, the patient characteristics and spectrum of complications demand individual solutions. Surgical site infections (SSI) threaten osteosynthesis, and early detection of them and treatment remain crucial. What is the value of postoperative C-reactive protein (CRP) in this group of patients as well as its normal course? DESIGN & METHODS: 115 patients with isolated fractures of the acetabulum were retrospectively evaluated. CRP, white blood cell count (WBC) and fracture patterns as well as patient characteristics were assessed for 20 days following operative fixation of the acetabular fracture (n = 71) and in fractures that were managed conservatively (n = 44). RESULTS: Twelve patients suffered an infectious complication. With a one-phase decay, 70.55% of the variance of postoperative CRP kinetics was predicted. To anticipate maximum CRP as well as an infection, the preoperative CRP represented the best prognostic parameter. To predict an infection, the single variable "peak CRP value above 100 mg/l" resulted in a sensitivity and specificity of 91.67% and 36.21%, respectively. Combining a second peak of CRP with maximum CRP and day 5 CRP value for receiver-operating characteristic (ROC) analysis resulted in 83.3% and 88.1%, respectively. CONCLUSIONS: Predicting surgical site infections after an acetabular fracture is most predictive when analyzing the maximum overall CRP, the second peak and the CRP after day 5. With a combination of these parameters, a sensitivity and specificity of 83.3% and 88.1% to detect an infection was achieved.

Systemic HDAC3 inhibition ameliorates impairments in synaptic plasticity caused by simulated galactic cosmic radiation exposure in male mice.

Deep space travel presents a number of measurable risks including exposure to a spectrum of radiations of varying qualities, termed galactic cosmic radiation (GCR) that are capable of penetrating the spacecraft, traversing through the body and impacting brain function. Using rodents, studies have reported that exposure to simulated GCR leads to cognitive impairments associated with changes in hippocampus function that can persist as long as one-year post exposure with no sign of recovery. Whether memory can be updated to incorporate new information in mice exposed to GCR is unknown. Further, mechanisms underlying long lasting impairments in cognitive function as a result of GCR exposure have yet to be defined. Here, we examined whether whole body exposure to simulated GCR using 6 ions and doses of 5 or 30 cGy interfered with the ability to update an existing memory or impact hippocampal synaptic plasticity, a cellular mechanism believed to underlie memory processes, by examining long term potentiation (LTP) in acute hippocampal slices from middle aged male mice 3.5-5 months after radiation exposure. Using a modified version of the hippocampus-dependent object location memory task developed by our lab termed "Objects in Updated Locations" (OUL) task we find that GCR exposure impaired hippocampus-dependent memory updating and hippocampal LTP 3.5-5 months after exposure. Further, we find that impairments in LTP are reversed through one-time systemic subcutaneous injection of the histone deacetylase 3 inhibitor RGFP 966 (10 mg/kg), suggesting that long lasting impairments in cognitive function may be mediated at least in part, through epigenetic mechanisms.

High rate capable and high energy supercapacitor performance of reduced graphene oxide/Al(OH)3/polyaniline nanocomposite.

The high rate capable, high energy (higher than the lead acid batteries & Nickel-cadmium batteries and comparable with Li-ion batteries) and long lasting supercapacitive performance was achieved from a ternary nanocomposite of rGO/Al(OH)3/PANI (5.88%:11.77%:82.85%) (GAlP82). The GAlP82 exhibited high cyclic stability till 47,500 cycles at 400 mV s-1, with increasing trend of specific capacitance (Cs) with increase in No. of energy storage/delivery cycles. After 41,500 cycles the GAlP82 exhibited a Cs of 490.19 F g-1, an energy density (E) of 98.03 W h kg-1 and a power density (P) of 2.2829 kW kg-1 at 1 A g-1. The GAlP82 exhibited a good rate capability by retaining 73% of Cs up to 10 A g-1 before cyclic stability study and 33% of Cs up to 23 A g-1 after 41,500 cycles; and all these impressive performances are achieved from the symmetric supercapacitor cell of GAlP82.

Management of gallbladder cancer in India.

Gallbladder cancer is a highly aggressive disease with variable prevalence across the globe. Particularly the Indo-Gangetic belt in Northern India has an incidence as high as 21/100,000. Majority of cases are detected either incidentally on pathological evaluation of cholecystectomy specimens or present with advanced disease. Radical surgery remains the mainstay of cure but only a small subset of patients is operable at presentation, and even with curative surgery recurrence rates remain high. Much debate surrounds the management of gallbladder cancer, with continuously evolving standards regarding the extent of hepatic resection and lymphadenectomy, curative resection in patients presenting with jaundice, routine excision of bile duct, and the role of neoadjuvant chemoradiotherapy. In this review we present a synopsis of currently available evidence and emerging approaches in the management of gallbladder cancer in India.

Achieving margin negative resection-doing less is justified: oncological outcomes of wedge excision of liver in gallbladder cancer (GBC) surgery.

BACKGROUND: The extent of liver resection for gallbladder cancer (GBC) is still debated. We evaluated the post-operative and oncological outcomes of patients with GBC who underwent liver wedge excision. METHODS: Patients who underwent an upfront radical cholecystectomy (with a liver wedge excision of 2.5- 3 centimetres) from June 2010 to December 2015 were retrospectively analysed. RESULTS: In total, 558 patients underwent surgery for GBC of which 97 cases of primary GBC who underwent upfront radical cholecystectomy were selected. At a median follow up of 47 months, 57.7% of patients were disease free where as 16.5% were alive with disease. Two (2.1%) patients died in postoperative period, 17 (17.5%) patients died of disease, and 6 (6.2%) died of unrelated causes. Eleven patients had loco-regional recurrence and 22 failed at distant sites. Only one patient recurred in the gall bladder bed. Three-year overall survival (OS) of stage II was 86.1% and of stage III was 59.6%. CONCLUSIONS: In our series surgical outcomes of radical cholecystectomy with wedge resection of the liver emphasizes its oncological equivalence compared to formal segment IVb/V excision. Our experience with wedge resection gains significance in the absence of any level I evidence and can prompt a multicentre randomised controlled trial (RCT) in future which may help in standardizing surgery for GBC.

Atypical Location of an Atrial Myxoma: A Case Report.

Here, we report a case of a right atrial myxoma attached to the lateral wall, which is seen in only 10% cases, impinging upon the tricuspid valve. A 57 year old male normotensive, non-diabetic, nonsmoker patient was presented to us on 5th of August 2018 with the complaints of cough, dyspnea and orthopnea for the last two years. This type of presentation is very rare. After excision of myxoma, there was a significant improvement in the signs and symptoms of the patient. In this report, we emphasize the rarity of myxoma in the Right Atrium, and its difficulty in diagnosis because of its uncommon location and atypical presentation, surgical management has shown to quickly alleviate the majority of symptom and expectant sequeale.

Posterior wall acetabular fracture fixation: A mechanical analysis of fixation methods.

Stable, anatomical fixation of acetabular fractures gives the best chance of successful outcome, while penetration of the acetabular articular surface with screws is associated with poor outcomes. Spring plates are an alternative to interfragmentary lag screws when penetration is a concern. A mechanical study comparing fracture stability and construct stiffness of three fixation methods for posterior wall acetabular fractures with transverse comminutions was performed. The three fixation methods tested were a posterior wall rim plate, a posterior wall buttress plate with separate lag screws and a posterior wall plate with two spring plates. Nine samples were tested, three for each fixation method. Two-dimensional motion analysis was used to measure fracture fragment displacement and construct stiffness. After two 6000 cycle-loading protocols, to a maximum 1.5 kN, the mean fracture displacement was 0.154 mm for the rim plate model, 0.326 mm for the buttress plate and 0.254 mm for the spring plate model. Mean maximum displacement was significantly less for the rim plate fixation than the buttress plate (p = 0.015) and spring plate fixation (p = 0.02). The rim plate was the stiffest construct 10,962 N/mm, followed by the spring plate model 5637 N/mm and the buttress plate model 4882 N/mm. Based on data obtained in this study, where possible a rim plate with interfragmentary lag screws should be used for isolated posterior wall fractures as this is the stiffest and most stable construct. When this method is not possible, spring plate fixation is a safe and a superior alternative to a posterior buttress plate method.

Right Atrial Myxoma: An Uncommon Presentation.

There are two types of tumors found in the cardiac chamber. These are divided into primary intra-cardiac tumors and secondary intra-cardiac tumors. Primary intra cardiac tumors are rare and among them 29% are myxomas. Majority of them are found in the left atrium. Here, we report a case of a myxoma in the right atrium with hepatomegaly and Hepatitis B virus infection. The coexistence of all these conditions is very rare. A 52 years old patient presented with history of shortness of breath on exertion along with fever and generalized weakness for 6 months which aggravated lately for last 2 months. He was then taken for better medical care and hospitalization. On cardiac evaluation he had soft S1 and S2 over the tricuspid region on the right lower parasternal region. He had bilateral mild pitting pedal edema. On further examination, it was revealed that he had mild tender hepatomegaly with jaundice. His blood analysis for HBsAg was positive. Echocardiogram showed right atrial myxoma of 14.3cm² almost completely occupying the right atrium and even protruding into the Inferior Venacava however not fully obstructing it. The inferior vena cava size was mildly dilated (22mm). Abdominal ultrasound report showed hepatomegaly (17.6cm) with coarse hepatic parenchyma. In this report, we emphasize the rarity of myxoma in the Right Atrium, its difficult diagnosis because of the location and the atypical presentation in the echocardiograph.

The use of an anterior pelvic internal fixator to treat disruptions of the anterior pelvic ring: a report of technique, indications and complications.

AIMS: The anterior pelvic internal fixator is increasingly used for the treatment of unstable, or displaced, injuries of the anterior pelvic ring. The evidence for its use, however, is limited. The aim of this paper is to describe the indications for its use, how it is applied and its complications. PATIENTS AND METHODS: We reviewed the case notes and radiographs of 50 patients treated with an anterior pelvic internal fixator between April 2010 and December 2015 at a major trauma centre in the United Kingdom. The median follow-up time was 38 months (interquartile range 24 to 51). RESULTS: Three patients were excluded from the analysis leaving 47 patients with complete follow-up data. Of the 47 patients, 46 achieved radiological union and one progressed to an asymptomatic nonunion. Of the remaining patients, 45 required supplementary posterior fixation with percutaneous iliosacral screws, 2 of which required sacral plating. The incidence of injury to the lateral femoral cutaneous nerve (LFCN) was 34%. The rate of infection was 2%. There were no other significant complications. Without this treatment, 44 patients (94%) would have needed unilateral or bilateral open reduction and plate fixation extending laterally to the hip joint. CONCLUSION: The anterior pelvic internal fixator reduces the need for extensive open surgery and is a useful addition to the armamentarium for the treatment of anterior pelvic injuries. It is associated with injury to the LFCN in a third of patients. Cite this article: Bone Joint J 2017;99-B.1232-6.

Changes in concentrations of trace minerals in lambs fed sericea lespedeza leaf meal pellets with or without dietary sodium molybdate.

Prolonged feeding of sericea lespedeza (SL) previously led to reduced serum concentrations of Mo, a cofactor in an enzyme complex that may be involved in weight gain. The current objective was to determine the effect of Mo supplementation on changes in serum, fecal, urine, and liver concentrations of trace minerals in lambs fed SL leaf meal pellets. Thirty ram lambs weaned in May (84 ± 1.5 d of age and 27 ± 1.1 kg; D 0) were blocked by BW, breed type (full or three-fourths Katahdin), and EBV of parasite resistance and randomly assigned to be fed 900 g/d of an alfalfa-based supplement (CON; = 10) or a SL-based supplement ( = 20) for 103 d. Supplements were formulated to be isonitrogenous and isocaloric and to meet trace mineral requirements. Within the SL group, individual lambs were administered either 5 mL water or 5 mL of water with 163.3 mg of sodium molybdate (SLMO). Serum was collected on d 28, 56, and 104; a liver sample was collected by biopsy on d 104 to determine concentrations of trace minerals. Data were analyzed using a mixed model and orthogonal contrasts. Serum concentrations of Mo increased in response to the drench and were greatest in SLMO lambs and then CON lambs and lowest in SL lambs ( < 0.001). Concentrations of Mo in the liver ( < 0.001) were similar between CON and SLMO lambs and were lower in SL lambs than other groups. Serum ( < 0.001) and liver ( = 0.013) concentrations of zinc (Zn) were reduced in both SL and SLMO lambs compared with CON lambs. Serum concentrations of cobalt (Co) increased in CON lambs compared with SL and SLMO lambs between d 0 and 56 but were similar on d 104 (diet × day, < 0.005) as with concentrations in the liver. Serum and liver concentrations of copper (Cu) were greatest ( < 0.001 and < 0.001, respectively) in CON lambs followed by SL lambs and then SLMO lambs. Serum concentrations of selenium (Se) tended ( = 0.10) to be reduced in SL lambs compared with CON and SLMO lambs, but concentrations in the liver were reduced in SL lambs compared with CON lambs and even more so in SLMO lambs ( < 0.003). Although the dietary Mo did increase stores of Mo in the animal and reduced copper, trace minerals associated with metalloproteins-Mo, copper, selenium, and zinc-were reduced in the liver of SL- and/or SLMO-fed lambs. These reductions could be associated with the lower weight gains previously observed after prolonged feeding of SL.

Examination of commercially available copper oxide wire particles in combination with albendazole for control of gastrointestinal nematodes in lambs.

Control of gastrointestinal nematodes (GIN) remains a critical issue due to the prevalence of anthelmintic resistance. The objective of the experiment was to determine the efficacy of copper oxide wire particles (COWP) from three commercial sources and a combination of COWP and albendazole to control GIN and/or Haemonchus contortus in lambs. Naturally infected Katahdin lambs in early June 2014 and 2015 were randomly assigned to receive no COWP (CON; n=9 and 12) or 2g COWP in a gel capsule as Copasure(®) (COP; n=4 and 17; Animax Ltd.), copper oxide-wire form (AUS; n=7 in 2014 only; Pharmplex), Ultracruz™ (ULT; n=8 and 15; Santa Cruz Animal Health™), no COWP and albendazole (CON+alb; n=10 in 2015 only; 15mg/kg BW; Valbazen(®); Zoetis Animal Health), or COWP+alb (n=7 and 11; in 2014, lambs were administered alb on day 3). Lambs grazed grass pastures as a group and were supplemented with 227g/lamb daily of a commercial grain mix (15% crude protein) and the same amount of alfalfa pellets. Feces were collected on days 0 (day of COWP treatment), 7, and 14 for determination of fecal egg counts (FEC). Pooled (2014) or pooled treatment group feces were cultured on days 0, 7, and 14 (2015 only) to determine GIN genera. Data were analyzed using repeated measures in a mixed model, and FEC were log transformed. The predominant GIN on day 0 was H. contortus (87%) in 2014, and there was a mixed population in 2015. The mean FEC was reduced by day 7 in AUS and ULT lambs (treatment×day, P=0.001), and all of the COWP products were similar. By day 14, the AUS FEC were lower than the CON and COP groups. When examining the combination of COWP and synthetic anthelmintic, the FEC of COWP+alb were reduced to nearly 0eggs/g (back-transformed) and lower than the other groups (treatment×day, P=0.001). The percentage of H. contortus in cultured feces was reduced to a greater extent in the COWP than CON or CON+alb groups of lambs. In a mixed GIN population, the COWP products appeared to be similar in efficacy and using a combination of COWP+alb increased the efficacy not only against H. contortus, but all GIN genera present, offering options in the face of resistance to benzimidazoles.

The Pattern of Injury and Workload Associated with Managing Patients After Suicide Attempt by Jumping from a Height.

PURPOSE: The aim of this study is to examine the pattern of injuries sustained and the hospital workload generated by patients who deliberately jump from height. METHOD: One regional trauma centre's admissions were scrutinized to find all patients who jumped, or were suspected of jumping from one storey or greater over a four year period. Patients who died prior to admission were excluded. RESULTS: 41 patients were included. Each patient suffered a mean of 3 injuries. The probability of calcaneal fracture was 0.32, of ankle injury 0.2, tibial fracture 0.2, femoral fracture 0.17, pelvic fracture 0.34, spinal injury 0.51, upper limb injury 0.26, head injury 0.2 and trunk injury 0.32. The mean length of inpatient stay was 7.9 days, rising to 17.9 for the 11 patients requiring intensive care. The average number of operations per patient was 1.5. CONCLUSION: Patients who jump from height generate large volumes of operative and inpatient workloads. Our data show that there may be a protective effect of limb trauma against lethal head, chest or pelvic injury. Injury to the upper limb is associated with a 4 times greater risk of head injury. The incidence of pelvic injury in this series is higher than in previous work. There was a high incidence of spinal fracture. Patients generated 64 surgical procedures and consumed a mean of 17.9 inpatient days, including prolonged stay in intensive care.