Long-term outcomes of conventional core decompression for osteonecrosis of the femoral head in systemic lupus erythematosus: a single-center retrospective study.

OBJECTIVE: Although the therapeutic efficacy of conventional core decompression (CD) for the early-stage osteonecrosis (ON) has been widely investigated in the literature, no study to date has specifically focused on its therapeutic effect on the long-term outcome of ON of the femoral head (ONFH) in systemic lupus erythematosus (SLE). This study aimed to provide a long-term survival analysis of all hips that underwent conventional CD for the management of ONFH in a consecutive case series of patients with SLE. PATIENTS AND METHODS: Sixteen hips of 10 consecutive SLE patients that underwent conventional CD for the management of ONFH in a single tertiary referral center were retrospectively identified and included in the study. After a retrospective chart review, several clinical and radiological data were recorded. RESULTS: All the hips treated with CD were stage I or IIA sclerotic and/or cystic based on the classification system of Ficat. Only the 2 hips of 1 patient (12.5%) survived both clinically and radiographically. The median overall survival for all hips after CD was 80 months (95% CI, 60-100). The 5-, 10-, and 15- year survival rates of hip joints following CD were 63%, 31%, and 12.5%, respectively (CI 95% 63.567 to 133.058 months). CONCLUSIONS: Conventional CD may not be effective in preventing the progression of pre-collapse ONFH to collapse and eventually end-stage osteoarthritis requiring arthroplasty in patients with SLE.

Ionized and non-ionized radiation effects on coronary stent implantation.

The purpose of this study is to examine the clinical radiation effects on patients with various stents. Several previous researches focused on the mechanical and physical features of the stents, but there have been few studies that focus on the interaction with radiological and clinical radiation. For stent material analysis, the ANSYS package program was employed. These materials and models are often built in three dimensions for three different types of stents made of three various materials. Estimates of blood pressure and thermal radiation were explored, as were the effects of non-ionizing radiation. Furthermore, the radiation attenuation characteristics of stent samples are investigated. The mass attenuation coefficient values are computed using MATLAB code over a large energy range of 0.015-15 MeV, and the findings are validated using theoretical WinXCom results. To determine the gamma-ray attenuation performances of the studied stent samples, variables such as the mass attenuation coefficient (MAC), half-value layer (HVL), tenth-value layer (TVL), mean free path (MFP), effective atomic number (Zeff), exposure build-up factor (EBF), and energy absorption build-up factor (EABF) are computed. Effective removal cross-sections (ΣR) of stent samples were acquired to determine the capacity of stent samples to stop fast neutrons. Finally, the ability of stent samples to stop charged alpha and proton particles was evaluated utilizing mass stopping power and projected range parameters. The discovery demonstrates that S3 has the best attenuation as well as the best proton, alpha, and gamma radiation attenuation capability.

Comparison of Monte Carlo simulations and theoretical calculations of nuclear shielding characteristics of various borate glasses including Bi, V, Fe, and Cd.

The aim of this study is to evaluate both buildup factors and photon attenuation effectiveness of some borate glasses doped by Cd, Fe, V, and Bi. The mass attenuation coefficients (µm) of these glass systems have been calculated via MCNP6 and GEANT4 computer simulation codes over 0.02-10 MeV energy range and compared with the theoretical results of WinXCOM program. And then, half-value layer, (HVL), mean free path (MFP), and effective atomic number (Zeff) for the different content based glasses have been determined. Through G-P fitting process, exposure buildup factors (EBF) have been found in the energy range of 0.015-15 MeV up to 40 mfp. It can be concluded that SrBiO20 glass is alternative material in terms of photon attenuation, respectively.

A comparison of external fixation and locked intramedullary nailing in the treatment of femoral diaphysis fractures from gunshot injuries.

INTRODUCTION: We studied the safety and incidence of complications from the treatment of gunshot-induced femur diaphysis fractures with locked intramedullary nailing in comparison to external fixation. METHODS: Patients who had femoral diaphysis fracture operations due to gunshot injuries (107 femurs of 99 patients) between 2003 and 2014 were retrospectively reviewed, and 66 femurs of 60 patients were place into two groups (Group A: intramedullary nailing-38 femurs of the 36 patients; Group B: external fixator-28 femurs of 24 patients). The mean follow-up was 76.3 months (22-131). The study outcomes were patient complications, infection rate, union time, need for secondary surgery, functional assessment with lower extremity functional scale, and radiological evaluation with orthoroentgenograms. RESULTS: The mean age of the patients was 37.3 ± 7.4 years in Group A and 39 ± 6.1 years in Group B. There was no significant difference between the two groups in age, gender or follow-up. There were two deep infections (5.2%) in Group A and one deep infection (3.5%) in Group B. Delayed union was observed in four patients (10.5%) in Group A and in two patients (7.1%) in Group B. There was one non-union (2.6%) and one non-union (3.5%) in Group A and Group B, respectively. There was no significant difference between the two groups in incidence of union, delayed union or deep infection. The mean union time was 3.1 ± 2.5 months in Group A and 5.8 ± 1.4 months in Group B. The union time was significantly lower in the intramedullary nailing group (p = 0.023). There were no significant differences between the two groups in regards to radiological and functional evaluation. DISCUSSION: This study showed similar complication rates and functional results both for external fixator and intramedullary nailing for the treatment of femoral diaphysis fractures due to gunshot injuries. LEVEL OF EVIDENCE: Level 3 retrospective comparative clinical study.

A realistic quantum capacitance model for quantum Hall edge state based Fabry-Pérot interferometers.

In this work, the classical and the quantum capacitances are calculated for a Fabry-Pérot interferometer operating in the integer quantized Hall regime. We first consider a rotationally symmetric electrostatic confinement potential and obtain the widths and the spatial distribution of the insulating (incompressible) circular strips using a charge density profile stemming from self-consistent calculations. Modelling the electrical circuit of capacitors composed of metallic gates and incompressible/compressible strips, we investigate the conditions to observe Aharonov-Bohm (quantum mechanical phase dependent) and Coulomb blockade (capacitive coupling dependent) effects reflected in conductance oscillations. In a last step, we solve the Schrödinger and the Poisson equations self-consistently in a numerical manner taking into account realistic experimental geometries. We find that, describing the conductance oscillations either by Aharanov-Bohm or Coulomb blockade strongly depends on sample properties also other than size, therefore, determining the origin of these oscillations requires further experimental and theoretical investigation.

Survival analysis of Y-90 radiosynovectomy in the treatment of haemophilic synovitis of the knee: a 10-year retrospective review.

Despite recent advances including new therapeutic options and availability of primary prophylaxis in haemophiliacs, haemophilic synovitis is still the major clinical problem in significant patient population worldwide. We retrospectively reviewed our 10-year experience with Y-90 radiosynovectomy to determine the outcome in the knee joints of patients with haemophilic synovitis. Between 2002 and 2012, 82 knee joints of 67 patients with haemophilic synovitis were treated with Y-90 radiosynovectomy. The mean age was 16.8 ± 7.8 years (range: 5-39 years). The mean follow-up period was 39.6 ± 25.6 months (range: 12-95 months). Failure of therapy represented re-bleeding after a radiosynovectomy was used as an end point in patient time to progression (TTP) analysis. The median TTP was calculated as 72.0 ± 3.6 months (95% CI 64.8-79.1 months) in Kaplan-Meier analysis. The 1, 3 and 5-year survival rates were 89%, 73% and 63% respectively. Longer TTP (hazard ratio for progression, 2.5; P = 0.00) was evident in patients who have greater reduction in bleeding frequency within 6 months after radiosynovectomy. We did not find a relationship between the TTP and the following variables: age, type and severity of haemophilia, the presence or absence of inhibitor, the radiological score, range of motion status of joints and the pretreatment bleeding frequency. We concluded that Y-90 radiosynovectomy in knee joint represents an important resource for the treatment of haemophilic synovitis, markedly reducing joint bleeding and long-term durability, irrespective of the radiographic stage and inhibitor status.

Long-term outcomes in haemophilic synovitis after radiosynovectomy using rhenium-186: a single-centre experience.

Radiosynovectomy has been performed successfully for more than 10 years in our hospital. This study investigated the long-term outcome in the context of time to progression (TTP) analysis and the factors influencing TTP following radiosynovectomy with Re-186 in patients with haemophilic synovitis. Radiosynovectomy performed in 165 joints (81 elbows, 74 ankles, 8 shoulder and 2 hip joints) of 106 patients (median age was 18.0 ± 7.5 years; 91 haemophilia A, 13 haemophilia B and 2 von Willebrand's disease between June 2001 and July 2011. The mean follow-up was 48 months (range: 9-120 months). This study revealed that patients' mean TTP after primary radiosynovectomy was satisfactory for both the ankle and elbow joints. There was no TTP differences between the ankle and elbow joint groups (67 vs. 72 months respectively; P = 0.22). We did not find a relationship between the TTP and the following variables: age, type and severity of haemophilia, the presence or absence of inhibitor, the radiological score, range of motion (ROM) status of joints and the pretreatment bleeding frequency. In this study, 18-20% of the treated joints had improved ROM and 82-79% of the treated joints had unchanged ROM after treatment both the ankle and elbow joints respectively. In this report including TTP analysis in the largest series with long-term follow-up, we demonstrated long-term effectiveness of Re-186 radiosynovectomy in haemophilic synovitis. In our experience, the main predictor of outcome following radiosynovectomy is the number of joint bleeding within 6 months after therapy.

Methylenetetrahydrofolate reductase C677T gene polymorphism in osteosarcoma and chondrosarcoma patients.

This study was designed to investigate the association of MTHFR C677T polymorphism and the risk of two common musculoskeletal sarcomas, osteosarcoma and chondrosarcoma. MTHFR genotypes were determined in 56 patients (44 osteosarcoma, 12 chondrosarcoma) and 44 controls using the PCR-RFLP technique. In the gender subgroup analysis, wild-type A allele frequency was higher in male osteosarcoma patients than in male control subjects (P = 0.064). Mutant V allele and mutant VV genotype were similar in the control group compared to the sarcoma groups (P > 0.05). No correlation could be proved between patient tumour site, presence of metastasis, and local tumour relapse and MTHFR polymorphism. The MTHFR C677T polymorphism may not be important in an individual's susceptibility to osteosarcoma and chondrosarcoma in Turkey and may not be a useful marker for identifying patients at high risk of developing sarcomas.

Monitoring the genotoxic effects of radiosynovectomy with Re-186 in paediatric age group undergoing therapy for haemophilic synovitis.

PURPOSE: The aim of this study was to investigate the genotoxic effect on the peripheral blood lymphocytes potentially induced by Re-186 in paediatric age group undergoing radiosynovectomy for haemophilic synovitis, by using chromosomal aberration analysis (CA) and the micronuclei (MN) assay for detecting chromosomal aberrations, as well as the sister chromatid exchanges (SCE) technique for assessing DNA damage. METHODS: Cytogenetic analyses were evaluated in 20 boys (mean age: 13.8 +/- 2.7 years) before, and 2 and 90 days after radiosynovectomy from the peripheral lymphocytes of the patients. Joint retention and extra-articular spread of the radionuclides were evaluated by using quantitative gamma camera imaging. RESULTS: Imaging after radiosynovectomy revealed local lymph node visualization in 8 (40%) patients and hepatosplenic visualization in 3 (15%) patients due to extra-articular leakage of radioactive material. The mean frequency of chromosome aberrations (0.2 +/- 0.4/1000 cells) determined prior to the onset of therapy was not significantly increased in comparison with control values obtained 2 days (0.4 +/- 0.5/1000 cells) and 90 days (0.2 +/- 0.4/1000 cells) after therapy (P = 0.754 and P = 1.0). In the analysis of MN and SCE, when we compare the baseline levels, the mean MN and SCE frequencies were slightly higher in the control analyses performed 2 and 90 days after radiosynovectomy but there were no significant differences between baseline and control levels (chi(2) = 2.621, P = 0.270 and F = 0.573, P = 0.569, respectively). CONCLUSION: The major finding of this study with relatively small sample is that, radiosynovectomy with Re-186 does not seem to induce early genotoxic effects on the peripheral blood lymphocytes in paediatric age group.

Muscular buttonholing: An unusual cause of irreducible knee dislocation.

In cases of irreducible knee dislocation, all the medial joint structures have been reported to be the obstructing tissue. The case presented, the first in the English-language literature, is buttonholing of the femoral condyle through the vastus medialis muscle. Entrapment of the muscle bundle was diagnosed preoperatively using magnetic resonance imaging scans. The joint could be reduced easily, following sectioning of the muscle bundle.

Modification of Bankart reconstruction with lateral capsulotomy and selective anatomic repair using suture anchors.

Twenty consecutive patients (17 male, 3 female) with a diagnosis of traumatic recurrent anterior instability of the shoulder were treated by a modified Bankart procedure using suture anchors. The technique consists of vertical incision of the capsule, just medial to the lateral insertion on the humerus and anatomic repair of the Bankart lesion. Humeral-based capsular shifting was performed in patients with anterior-inferior instability. The average age was 24 years (range: 14 to 39 years), and average follow-up period 68 months (range: 2 to 8 years). The average Bankart rating score was 92.5 (range: 70 to 100); with 16 (80%) excellent (score 90 to 100), 2 (10%) good (score 75 to 89), and 2 (10%) fair results. Failure in terms of recurrent dislocation was not reported. Eleven patients (55%) had a loss of 5 degrees to 10 degrees of external rotation either with the extremity at the side or at 90 degrees of abduction. Nine (45%) patients had external rotation equal to the contralateral side. We believe selective anatomic Bankart reconstruction by lateral capsulotomy and humeral-based capsular shifting in cases with marked inferior laxity is a more anatomic and physiologic technique.

Time-dependent reduction in load to failure of wedge-type polyglyconate suture anchors.

SUMMARY: Thirty-two absorbable (polyglyconate) and 24 nonabsorbable (polyacetal) wedge-type suture anchors (TAG; Acufex, Mansfield, MA) were implanted into sheep tibiae. Load to failure tests were performed on the day of insertion and at weeks 3, 6, and 12, followed by macroscopic examination. Failure type was suture breakage for nonabsorbable anchors in all groups, with average forces of 142.5 +/- 4.8 N on the first day, 138.0 +/- 6.6 N in week 6, and 135.6 +/- 2.9 N in week 12. In the absorbable group, suture breakage occurred on the first day with a mean force of 133.5 +/- 4. 2 N. In weeks 3, 6, and 12, suture cutout occurred with average forces of 33.75 +/- 5.0 N, 23.25 +/- 2.2 N, and 23.25 +/- 5.9 N, respectively. For absorbable anchors, results at weeks 3, 6, and 12 were significantly lower compared with initial results (P <.001). These results show that wedge-type polyglyconate anchors lose 75% of their initial pullout strength within the first 3 weeks and 84% in 6 weeks.

Ilizarov fixator for treatment of Legg-Calvé-Perthes disease.

Eleven hips of 11 patients (8 boys, 3 girls; mean age, 7.5 years) with a diagnosis of Perthes disease underwent distraction using an Ilizarov external fixator. All patients had one or more Catterall signs of poor prognosis, with four hips classified as Herring class B and seven as class C. Patients were followed for a mean of 36 months. Average time for wearing the fixator was 99 days (range, 40-150 days). After fixator removal, containment was lost in two more patients and was sustained in only four patients. The most common complication was pin track infection, which occurred in eight patients. The low rate of success found does not justify the routine use of this technique.