Radiofrequency-Induced Heating of Amalgam Restorations and Dental Implants during 1.5T Magnetic Resonance Imaging.

Objectives: This study aimed to evaluate radiofrequency-induced heating of different amalgam restorations and dental implants during 1.5T magnetic resonance imaging (MRI). Materials and Methods: Standardized class I cavities (5 mm long, 3 mm wide, and 3 mm deep) were prepared on the occlusal surface of 45 extracted human third molars. The samples were restored by three different types of amalgam including Cinalux amalgam (non-gamma-2, spherical), GS-80 (non-gamma-2, admix), and GK-110 amalgam (non-gamma-2, admix in silver). As a separate intervention group (G4), five titanium mini drive-lock implants with 2mm diameter and 10mm length were also selected and mounted to the base of the Eppendorf tube with 3mm of the implants extending above the mounting putty. The box containing the specimens was placed parallel to the long axis of the standard head and neck coil of the MRI device (64MHz radio-frequency energy with 25kW amplifier, 1.5T). Temperature fluctuations of the metallic materials in each group were monitored during MRI scans using a calibrated thermometer. One-way ANOVA was used to compare temperature changes among the amalgam groups (P<0.05). Results: Temperature elevations ranged from 0.21°C to 0.70°C in amalgam restorations and from 0.35 to 0.47°C in dental implants. The temperature changes among the three amalgam agents were not statistically significant. Conclusion: According to our findings, the radiofrequency-induced heating of amalgam restorations and dental implants during MRI examination can be considered within acceptable ranges. Therefore, amalgam restorations and dental implants can be categorized as "MR safe" in terms of radiofrequency-induced heating during 1.5 T MRI.

Explainable artificial intelligence (XAI) for predicting the need for intubation in methanol-poisoned patients: a study comparing deep and machine learning models.

The need for intubation in methanol-poisoned patients, if not predicted in time, can lead to irreparable complications and even death. Artificial intelligence (AI) techniques like machine learning (ML) and deep learning (DL) greatly aid in accurately predicting intubation needs for methanol-poisoned patients. So, our study aims to assess Explainable Artificial Intelligence (XAI) for predicting intubation necessity in methanol-poisoned patients, comparing deep learning and machine learning models. This study analyzed a dataset of 897 patient records from Loghman Hakim Hospital in Tehran, Iran, encompassing cases of methanol poisoning, including those requiring intubation (202 cases) and those not requiring it (695 cases). Eight established ML (SVM, XGB, DT, RF) and DL (DNN, FNN, LSTM, CNN) models were used. Techniques such as tenfold cross-validation and hyperparameter tuning were applied to prevent overfitting. The study also focused on interpretability through SHAP and LIME methods. Model performance was evaluated based on accuracy, specificity, sensitivity, F1-score, and ROC curve metrics. Among DL models, LSTM showed superior performance in accuracy (94.0%), sensitivity (99.0%), specificity (94.0%), and F1-score (97.0%). CNN led in ROC with 78.0%. For ML models, RF excelled in accuracy (97.0%) and specificity (100%), followed by XGB with sensitivity (99.37%), F1-score (98.27%), and ROC (96.08%). Overall, RF and XGB outperformed other models, with accuracy (97.0%) and specificity (100%) for RF, and sensitivity (99.37%), F1-score (98.27%), and ROC (96.08%) for XGB. ML models surpassed DL models across all metrics, with accuracies from 93.0% to 97.0% for DL and 93.0% to 99.0% for ML. Sensitivities ranged from 98.0% to 99.37% for DL and 93.0% to 99.0% for ML. DL models achieved specificities from 78.0% to 94.0%, while ML models ranged from 93.0% to 100%. F1-scores for DL were between 93.0% and 97.0%, and for ML between 96.0% and 98.27%. DL models scored ROC between 68.0% and 78.0%, while ML models ranged from 84.0% to 96.08%. Key features for predicting intubation necessity include GCS at admission, ICU admission, age, longer folic acid therapy duration, elevated BUN and AST levels, VBG_HCO3 at initial record, and hemodialysis presence. This study as the showcases XAI's effectiveness in predicting intubation necessity in methanol-poisoned patients. ML models, particularly RF and XGB, outperform DL counterparts, underscoring their potential for clinical decision-making.

Translation, cross-cultural adaptation, and validation of the Persian version of the Hospital for Special Surgery Anterior Cruciate Ligament Postoperative Satisfaction Survey.

PURPOSE: With over 140 million speakers spread across Iran, Afghanistan, and Tajikistan, Persian, also known as Farsi, is a pluri-centric language. The purpose of this study is to perform cross-cultural adaptation and examine the validity and reliability of the Persian translation of the Hospital for Special Surgery Anterior Cruciate Ligament Post-Operative Satisfaction Survey (HSS ACL-SS). METHODS: In this retrospective study, 102 anterior cruciate ligament reconstruction (ACLR) patients were asked to complete the Persian version of the HSS ACL-SS, Tegner scale, Lysholm score, the Single Assessment Numeric Evaluation (SANE) score, the Cincinnati Knee Rating System (CKRS), and the Visual Analogue Scale (VAS) for pain. Internal consistency was calculated via Cronbach's alpha coefficient. Validity was assessed with the correlations of Spearman's rho. 18 patients were included in the test-retest reliability assessment. The floor and ceiling effects of the examined content validity of HSS ACL-SS. RESULTS: The Cronbach's alpha coefficient was computed at 0.959, showing outstanding internal consistency. The intra-class correlation coefficient (ICC) demonstrated excellent results (0.986, P-value < 0.001). Insignificant ceiling effects (2.9%) and floor effects (3.9%) were detected. The Persian version of the HSS ACL-SS score significantly correlated with the SANE (r = 0.730, p < 0.001), Lysholm score (r = 0.622, p < 0.001), and CKRS (r = 0.741, p < 0.001). CONCLUSION: The overall performance of the Persian HSS ACL-SS was more than excellent in terms of reliability and validity. To conclude, Persian HSS ACL-SS may be used to assist patients in having a better perception of post-operative satisfaction.

Conversion Total Hip Arthroplasty in Patients With Osteopetrosis: Insights From Two Unique Cases.

CASE: Two patients with osteopetrosis underwent conversion total hip arthroplasty (THA) after failure of internal fixation due to hip fractures. We experienced challenges, including difficulty of hardware removal, remaining of previous broken screws in the canal, difficulty in finding the femoral canal, and an intraoperative acetabulum fracture. Despite complications, both patients achieved satisfactory functional outcome after surgery at the latest follow-up. CONCLUSION: Our cases showed that previous hip fracture and failed internal fixation make conversion THA more complex and unpredictable in patients with osteopetrosis. This in turn underscores the critical need for advanced preoperative planning, intraoperative flexibility, and meticulous postoperative care.

Sequential radiation exposure: uncovering the potential of low dose ionizing radiation in mitigating high dose effects on immune cells.

PURPOSE: The radioadaptive response refers to a phenomenon wherein exposure to a low dose of ionizing radiation (LDIR) can induce a protective response in cells or organisms, reducing the adverse effects of a subsequent higher dose of ionizing radiation (HDIR). However, it is possible to administer the low dose after the challenge dose. This study was conducted to determine the potential mitigating effect of LDIR administered after HDIR on mice immune cells. MATERIALS AND METHODS: Alongside the conventional adaptive response setting, one group of mice was initially exposed to HDIR and subsequently treated with LDIR. Neutrophil activation was done using DHR-reducing assay and cell proliferation was evaluated through CFSE-dilution assay in helper (CD4+) and cytotoxic (CD8+) T cells. Cytokine production by these T cell subsets was also assessed by intracellular staining using flow cytometry. RESULTS: The results of this study revealed no change in neutrophil function between any of the mice groups compared to the untreated control group. Although significant changes were not detected in the proliferation of CD4+ T cells, decreased proliferation was observed in stimulated CD8+ T cells in the HDIR group. In contrast to IFN-É£, which showed no evident change in either of the T cell subsets after stimulation, IL-4 was rigorously dropped in stimulated CD4+ T cells in the HDIR group. CONCLUSIONS: In summary, the results of this study indicated that the administration of LDIR to mice before HDIR was not able to reduce the detrimental effects of HDIR in our experimental setting. Instead, we observed a mitigating effect of LDIR when administered after the challenge dose. This suggests that not only the dose and duration but also the order of LDIR relative to HDIR affects its efficacy.

Total Hip Arthroplasty in Patients Who Have Crowe Type IV Developmental Dysplasia of the Hip: A Systematic Review.

BACKGROUND: Developmental dysplasia of the hip (DDH) is one of the principal causes of secondary hip osteoarthritis, giving rise to considerable pain, impaired mobility, and a reduced quality of life. The optimal approach to managing individuals who have Crowe type IV DDH remains controversial. This study aimed to review the existing literature on the application of total hip arthroplasty (THA) as a treatment modality for Crowe type IV DDH, assessing its efficacy in addressing this severe hip deformity. METHODS: A comprehensive search across the PubMed, Scopus, and Web of Science databases identified relevant studies. Inclusion criteria encompassed investigations reporting outcomes of THA in Crowe type IV DDH patients. Data extraction and quality assessment were performed independently by 2 reviewers. Utilizing R software, the prevalence of THA complications was analyzed through proportion analysis, employing the inverse variance method. RESULTS: In this systematic review, a total of 74 studies were included, comprising a collective sample size of 2,829 patients (3,356 hips) diagnosed with Crowe type IV DDH. The posterior or posterolateral approach was the most commonly utilized surgical approach, followed by the lateral Hardinge and direct lateral approaches. The majority of studies have employed subtrochanteric osteotomies. Notably, post-THA, leg length discrepancy decreased, Trendelenburg sign resolved, and back pain was reduced. Patient-reported outcome measures like the Harris Hip Score improved significantly. The pooled prevalence rates of major postoperative complications were also assessed, including dislocation (7.2%), revision (8.7%), intraoperative fractures (10.5%), loosening (5.7%), nerve paralysis (5.6%), deep vein thrombosis (3.6%), infection (3.8%), heterotopic ossification grade 2 and above (6.1%), and a complicated patient rate of 11.0%. CONCLUSIONS: Synthesizing diverse study data, an overview of THAs performance emerges, demonstrating significant enhancements in function, pain reduction, quality of life, and the correction of substantial leg length discrepancy. While THA has shown positive outcomes, instances of complications have been reported. The decision to undergo THA should involve a collaborative assessment between the surgeon and the patient, considering potential benefits and complications.

Vascular injury during lateral close-wedge distal femoral osteotomy: A case report and review of surgical principles.

INTRODUCTION: Knee malalignment can increase the risk of osteoarthritis. Osteotomies can correct limb deformities, but they come with the risk of complications such as cortical hinge fracture, hardware failure, pain syndrome, and infection. Vascular injury is rare, but it can lead to bleeding, limb ischemia, and swelling. If revascularization is delayed for over 12 h, it can result in poor outcomes. The work has been reported in line with the SCARE criteria. CASE: A 41-year-old female underwent a lateral close-wedge distal femoral osteotomy. Postoperatively, no distal pulse was detected. An emergency vascular surgery consultation revealed popliteal vein penetration and popliteal artery thrombosis, probably during pin penetration. Revascularization was performed, and the patient was discharged without complications. At the three-year follow-up, the patient was in good health and without complications. DISCUSSION: Knowledge of the femoral artery and vein's proximity to the apex of the wedge is crucial in lateral close wedge distal femoral osteotomy. Despite vascular injury with an oscillating saw, it can happen during guide pin insertion. Although Intraoperative massive bleeding can show vascular injury, lack of it was not a protective factor. CONCLUSION: During the process of pin insertion, it is important to ensure that the pin's orientation is directly lateral to the medial. This should be checked using the C-Arm by obtaining AP, Lat, and Oblique views. To check for intraoperative bleeding, the tourniquet should be deflated. Once the procedure is complete, it is important to check for any vascular injury by examining distal pulses and limb perfusion carefully, particularly in the recovery room.

A mechanistic simulation of induced DNA damage in a bacterial cell by X- and gamma rays: a parameter study.

Mechanistic Monte Carlo simulations calculating DNA damage caused by ionizing radiation are highly dependent on the simulation parameters. In the present study, using the Geant4-DNA toolkit, the impact of different parameters on DNA damage induced in a bacterial cell by X- and gamma-ray irradiation was investigated. Three geometry configurations, including the simple (without DNA details), the random (a random multiplication of identical DNA segments), and the fractal (a regular replication of DNA segments using fractal Hilbert curves), were simulated. Also, three physics constructors implemented in Geant4-DNA, i.e., G4EmDNAPhysics_option2, G4EmDNAPhysics_option4, and G4EmDNAPhysics_option6, with two energy thresholds of 17.5 eV and 5-37.5 eV were compared for direct DNA damage calculations. Finally, a previously developed mathematical model of cell repair called MEDRAS (Mechanistic DNA Repair and Survival) was employed to compare the impact of physics constructors on the cell survival curve. The simple geometry leads to undesirable results compared to the random and fractal ones, highlighting the importance of simulating complex DNA structures in mechanistic simulation studies. Under the same conditions, the DNA damage calculated in the fractal geometry was more consistent with the experimental data. All physics constructors can be used alternatively with the fractal geometry, provided that an energy threshold of 17.5 eV is considered for recording direct DNA damage. All physics constructors represent a similar behavior in generating cell survival curves, although the slopes of the curves are different. Since the inverse of the slope of a bacterial cell survival curve (i.e., the D10-value) is highly sensitive to the simulation parameters, it is not logical to determine an optimal set of parameters for calculating the D10-value by Monte Carlo simulation.

Digital Screen Time and the Risk of Female Breast Cancer: A Retrospective Matched Case-Control Study.

Background: As the use of electronic devices such as mobile phones, tablets, and computers continues to rise globally, concerns have been raised about their potential impact on human health. Exposure to high energy visible (HEV) blue light, emitted from digital screens, particularly the so-called artificial light at night (ALAN), has been associated with adverse health effects, ranging from disruption of circadian rhythms to cancer. Breast cancer incidence rates are also increasing worldwide. Objective: This study aimed at finding a correlation between breast cancer and exposure to blue light from mobile phone. Material and Methods: In this retrospective matched case-control study, we aimed to investigate whether exposure to blue light from mobile phone screens is associated with an increased risk of female breast cancer. We interviewed 301 breast cancer patients (cases) and 294 controls using a standard questionnaire and performed multivariate analysis, chi-square, and Fisher's exact tests for data analysis. Results: Although heavy users in the case group of our study had a statistically significant higher mean 10-year cumulative exposure to digital screens compared to the control group (7089±14985 vs 4052±12515 hours, respectively, P=0.038), our study did not find a strong relationship between exposure to HEV and development of breast cancer. Conclusion: Our findings suggest that heavy exposure to HEV blue light emitted from mobile phone screens at night might constitute a risk factor for promoting the development of breast cancer, but further large-scale cohort studies are warranted.

Do blue light filter applications improve sleep outcomes? A study of smartphone users' sleep quality in an observational setting.

Exposure to blue light at bedtime, suppresses melatonin secretion, postponing the sleep onset and interrupting the sleep process. Some smartphone manufacturers have introduced night-mode functions, which have been claimed to aid in improving sleep quality. In this study, we evaluate the impact of blue light filter application on decreasing blue light emissions and improving sleep quality. Participants in this study recorded the pattern of using their mobile phones through a questionnaire. In order to evaluate sleep quality, we used a PSQI questionnaire. Blue light filters were used by 9.7% of respondents, 9.7% occasionally, and 80% never. The mean score of PSQI was more than 5 in 54.10% of the participants and less than 5 in 45.90%. ANOVA test was performed to assess the relationship between using blue light filter applications and sleep quality (p-value = 0.925). The findings of this study indicate a connection between the use of blue light filter apps and habitual sleep efficiency in the 31-40 age group. However, our results align only to some extent with prior research, as we did not observe sustained positive effects on all parameters of sleep quality from the long-term use of blue light filtering apps. Several studies have found that blue light exposure can suppress melatonin secretion, exacerbating sleep problems. Some studies have reported that physical blue light filters, such as lenses, can affect melatonin secretion and improve sleep quality. However, the impact of blue light filtering applications remains unclear and debatable.

Using smartphones before bedtime and being exposed to its blue light can make it harder to fall asleep and disrupt your sleep. Some smartphone makers have introduced a night mode feature claiming it can help improve your sleep. In this study, we wanted to find out if using these blue light filters on smartphones really makes a difference. We asked people how often they used blue light filters on their phones and also had them fill out a questionnaire about their sleep quality. Only about 10% of people said they used blue light filters regularly, another 10% used them occasionally, and the majority, around 80%, never used them. When we looked at the results, more than half of the participants had sleep scores higher than 5, indicating they might have sleep problems. Less than half had sleep scores lower than 5, suggesting better sleep quality. We used some statistical tests to see if using blue light filters had any link to sleep quality, and the results showed that there was only a connection between the use of blue light filter apps and habitual sleep efficiency in the 31­40 age group. Our findings matched what other studies have found before, that using blue light filters on smartphones may not significantly help improve sleep. So, while it might be a good idea to limit smartphone use before bed, using a blue light filter app may not be the magic solution for better sleep.

Prediction of acute methanol poisoning prognosis using machine learning techniques.

Methanol poisoning is a global public health concern, especially prevalent in developing nations. This study focuses on predicting the severity of methanol intoxication using machine learning techniques, aiming to improve early identification and prognosis assessment. The study, conducted at Loghman Hakim Hospital in Tehran, Iran. The data pertaining to individuals afflicted with methanol poisoning was retrieved retrospectively and divided into training and test groups at a ratio of 70:30. The selected features were then inputted into various machine learning methods. The models were implemented using the Scikit-learn library in the Python programming language. Ultimately, the efficacy of the developed models was assessed through ten-fold cross-validation techniques and specific evaluation criteria, with a confidence level of 95%. A total number of 897 patients were included and divided in three groups including without sequel (n = 573), with sequel (n = 234), and patients who died (n = 90). The two-step feature selection was yielded 43 features in first step and 23 features in second step. In best model (Gradient Boosting Classifier) test dataset metric by 32 features younger age, higher methanol ingestion, respiratory symptoms, lower GCS scores, type of visual symptom, duration of therapeutic intervention, ICU admission, and elevated CPK levels were among the most important features predicting the prognosis of methanol poisoning. The Gradient Boosting Classifier demonstrated the highest predictive capability, achieving AUC values of 0.947 and 0.943 in the test dataset with 43 and 23 features, respectively. This research introduces a machine learning-driven prognostic model for methanol poisoning, demonstrating superior predictive capabilities compared to traditional statistical methods. The identified features provide valuable insights for early intervention and personalized treatment strategies.

Latent infections in conversion total hip arthroplasty following internal fixation of femoral neck fractures: a systematic review and meta-analysis of diagnostic methods.

BACKGROUND: Accurate diagnosis of latent infections prior to conversion total hip arthroplasty (THA) following internal fixation of femoral neck fractures is crucial for successful surgical outcomes. This systematic review aimed to provide a comprehensive evaluation of the current literature regarding the diagnosis of latent infections before conversion THA. METHODS: Systematic search of PubMed, EMBASE, and Cochrane (CENTRAL) databases was conducted, and the diagnostic accuracy of various markers and techniques was assessed. The quality of the included studies was evaluated using the QUADAS-2 instrument. RESULTS: Five studies comprising 661 patients were included in the review. Pooled analysis using C-reactive protein (CRP) as a diagnostic marker resulted in a sensitivity and specificity of 72% and 76%, respectively, while using erythrocyte sedimentation rate (ESR) yielded a sensitivity and specificity of 75% and 78%, respectively. Fibrinogen and platelet count showed lower sensitivity and specificity compared to CRP and ESR. The best combined markers were CRP and serum platelet count, with a sensitivity of 76% and specificity of 86% based on one study. CONCLUSION: Our review underscored the limitations and inconsistencies present in current diagnostic methods for latent infections in conversion surgery. Future research needs to focus on standardizing threshold values, exploring the potential of synovial fluid analysis, imaging techniques, and molecular methods, as well as developing tailored diagnostic algorithms. PROSPERO: CRD42023394757.

Concurrent Learning Approach for Estimation of Pelvic Tilt from Anterior-Posterior Radiograph.

Accurate and reliable estimation of the pelvic tilt is one of the essential pre-planning factors for total hip arthroplasty to prevent common post-operative complications such as implant impingement and dislocation. Inspired by the latest advances in deep learning-based systems, our focus in this paper has been to present an innovative and accurate method for estimating the functional pelvic tilt (PT) from a standing anterior-posterior (AP) radiography image. We introduce an encoder-decoder-style network based on a concurrent learning approach called VGG-UNET (VGG embedded in U-NET), where a deep fully convolutional network known as VGG is embedded at the encoder part of an image segmentation network, i.e., U-NET. In the bottleneck of the VGG-UNET, in addition to the decoder path, we use another path utilizing light-weight convolutional and fully connected layers to combine all extracted feature maps from the final convolution layer of VGG and thus regress PT. In the test phase, we exclude the decoder path and consider only a single target task i.e., PT estimation. The absolute errors obtained using VGG-UNET, VGG, and Mask R-CNN are 3.04 ± 2.49, 3.92 ± 2.92, and 4.97 ± 3.87, respectively. It is observed that the VGG-UNET leads to a more accurate prediction with a lower standard deviation (STD). Our experimental results demonstrate that the proposed multi-task network leads to a significantly improved performance compared to the best-reported results based on cascaded networks.

Simultaneous Tunnel Grafting and Anterior Cruciate Ligament Reconstructions Revision Using Double Suspensory Fixation: A Single-Stage Solution.

The anterior cruciate ligament (ACL) is often vulnerable to sports-related injuries, leading to numerous ACL reconstructions (ACLRs) annually in the United States. Although largely successful, these procedures face the risk of recurrent instability due to graft failure. ACLR failures are typically attributed to technical errors and patient-related factors, with improper positioning of the tibial and femoral tunnels as the most common technical mistake. Current 2-stage revision techniques involve primary bone grafting followed by secondary tendon graft placement, resulting in increased costs and extended rehabilitation times. This article proposes a single-stage revision strategy involving simultaneous tunnel grafting and ACLR revision. The method employs double suspensory fixation by adjustable loop buttons, thereby eliminating the dependence on metaphyseal bone stock for stable graft fixation. This new procedure may offer a more efficient and cost-effective approach, reducing the need for a second surgery and potentially allowing patients to return to normal activities more quickly.

Evaluation of core decompression outcome in systemic lupus erythematosus with hip osteonecrosis: a retrospective cohort study.

BACKGROUND: Osteonecrosis is a major cause of morbidity for patients with systemic lupus erythematosus (SLE). Although core decompression is an approved and trusted technique to prevent further joint deterioration, this surgical method seems to be less beneficial for SLE patients. We aimed to evaluate the outcomes of core decompression in SLE patients with primary stages of femoral head osteonecrosis. METHODS: In this study, 23 patients (39 affected hip joints) with osteonecrosis of the femoral head with stage II of the disease, based on the Ficat-Arlet classification system, underwent core decompression. Also, patients demographic characteristics, clinical data, medication history, comorbidities, immunological findings, hip plain radiographs, history of total hip arthroplasty after core decompression, and patients satisfaction with joint function according to the Oxford hip score questionnaire were obtained. RESULTS: In the study, 53.8% of affected joints showed signs of radiographic deterioration in follow-up imaging. Sixty-one and a half percent (61.5%) of patients had unsatisfactory joint performance. A third (33.3%) of affected hip joints underwent total hip arthroplasty up to 5 years from core decompression. SLE patients with a history of receiving bisphosphonate were 83.2% less dissatisfied with their joint function than patients without a history of bisphosphonate use (P < 0.02). Of the 23 studied cases, the mean cumulative dose of prednisolone before and after core decompression surgery was 46.41 mg and 14.74 mg respectively. Besides, one case (2.6%) that had a high anti-phospholipid antibodies level during follow-up did not have any radiographic deterioration, and 9 cases (23.1%) had some degrees of radiographic deterioration. CONCLUSIONS: The patients group that used bis-phosphonate, had a higher level of satisfaction with joint function after core decompression. Patients with high-level anti-phospholipid antibodies are related to a poor prognosis after core decompression.

Indirect effects of interference of two emerging environmental contaminants on cell health: Radiofrequency radiation and gold nanoparticles.

BACKGROUND: The global need for wireless technologies is growing rapidly. So, we have been exposed to a new type of environmental pollution: radiofrequency radiation (RFR). Recent studies have shown that RFR can cause not only direct effects but also indirect or non-targeted effects such as the bystander effect (BE). In this study, we investigated the BE induced by RFR in the present of gold nanoparticles (GNP). Moreover, we studied the expression of cyclooxygenase-2 (COX-2). METHODS: Non-toxic dose of 15-nm GNP was used to treat the Chinese Hamster Ovary (CHO) cells. After 48 h of incubation, cells were exposed to 900 MHz GSM RFR for 24 h. Then we collected the cell culture medium of these cells (conditioned culture medium, CCM) and transferred it to new cells (bystander cells). Cell deaths, DNA breaks, oxidative stress and COX-2 expression were analyzed in all groups. RESULTS: The results showed that RFR increased metabolic death in cells treated with GNP. Inversely, the colony formation ability was reduced in bystander cells and RFR exposed cells either in the presence or absence of GNP. Also, the level of reactive oxygen species (ROS) in GNP treated cells showed a significant reduction compared to those of untreated cells. However, RFR-induced DNA breaks and the frequencies of micronuclei (MN) were not significantly affected by GNP. The expression of COX-2 mRNA increased in RFR GNP treated cells, but the difference was not significant. CONCLUSION: Our results for the first time indicated that RFR induce indirect effects in the presence of GNP. However, the molecular mediators of these effects differ from those in the absence of GNP. Also, to our knowledge, this is the first study to show that COX-2 is not involved in the bystander effect induced by 900 MHz RFR.

The impact of retaining the femoral stem in revision total hip arthroplasty: a systematic review, meta-analysis, and meta-regression.

INTRODUCTION: The management of well-fixed femoral stems in revision total hip arthroplasty (rTHA) remains a subject of debate, with concerns over potential complications arising from stem retention. This study aimed to investigate the re-revision rates due to aseptic loosening of the stem, overall re-revision rates, dislocation rates, and factors influencing these outcomes in rTHA with a retained well-fixed femoral stem. MATERIALS AND METHODS: A systematic search was conducted across several databases including PubMed, EMBASE, and CENTRAL to identify pertinent publications from their inception through 2023. We specifically focused on studies that reported outcomes of rTHA with retained well-fixed femoral stems. The study designs incorporated in our research encompassed both cohort studies and case series studies. Thirty-five studies involving isolated acetabular revision and retaining the stem were included, representing a total of 3497 patients. Data extraction was tailored to the study questions. Meta-analyses, meta-regression, and subgroup analyses were conducted to evaluate the outcomes and their relationship with various factors. Pooled results, meta-regression, and subgroup analyses were performed using random-effects models. To assess and reduce bias, we employed Egger's test and the trim and fill method. RESULTS: The meta-analysis included 3497 patients with a mean follow-up of 9.28 years. The 10-year risk of re-revision after retaining femoral stem using highly cross-linked polyethylene was 1.7% (95% CI 1.1%-2.3%; I2: 60%) for stem aseptic loosening and 8.8% (95% CI 6.2%-11.4%; I2: 78%) overall re-revision. Dislocation risk was 5.7% (95% CI 4.1-7.0%; I2: 61%). Ceramic heads showed lower stem failure risk than metal heads in long-term follow-ups (P < 0.001). The posterolateral approach in revision surgery resulted in better long-term outcomes compared to the direct lateral approach (P < 0.001). Follow-up duration, timeline of study, Harris Hip Score, type of stem fixation, femoral head material, BMI, age, stem age, and surgical approach were evaluated as influential factors on these outcomes. CONCLUSION: The re-revision rate due to aseptic loosening of the retained stem during rTHA was found to be significantly low, supporting the idea of retaining well-fixed stems during rTHA. The overall re-revision and dislocation rates also presented comparable or better outcomes to prior studies. A range of factors, including the use of highly cross-linked polyethylene and ceramic femoral heads, was found to influence these outcomes. LEVEL OF EVIDENCE: IV. PROSPERO REGISTRATION NUMBER: CRD42022351157.

Evaluation of core decompression outcome in systemic lupus erythematosus with hip osteonecrosis: a retrospective cohort study

Abstract Background Osteonecrosis is a major cause of morbidity for patients with systemic lupus erythematosus (SLE). Although core decompression is an approved and trusted technique to prevent further joint deterioration, this surgical method seems to be less beneficial for SLE patients. We aimed to evaluate the outcomes of core decompression in SLE patients with primary stages of femoral head osteonecrosis. Methods In this study, 23 patients (39 affected hip joints) with osteonecrosis of the femoral head with stage II of the disease, based on the Ficat-Arlet classification system, underwent core decompression. Also, patients demographic characteristics, clinical data, medication history, comorbidities, immunological findings, hip plain radiographs, history of total hip arthroplasty after core decompression, and patients satisfaction with joint function according to the Oxford hip score questionnaire were obtained. Results In the study, 53.8% of affected joints showed signs of radiographic deterioration in follow-up imaging. Sixty-one and a half percent (61.5%) of patients had unsatisfactory joint performance. A third (33.3%) of affected hip joints underwent total hip arthroplasty up to 5 years from core decompression. SLE patients with a history of receiving bisphosphonate were 83.2% less dissatisfied with their joint function than patients without a history of bisphospho-nate use (P < 0.02). Of the 23 studied cases, the mean cumulative dose of prednisolone before and after core decompression surgery was 46.41 mg and 14.74 mg respectively. Besides, one case (2.6%) that had a high anti-phospholipid antibodies level during follow-up did not have any radiographic deterioration, and 9 cases (23.1%) had some degrees of radiographic deterioration. Conclusions The patients group that used bis-phosphonate, had a higher level of satisfaction with joint function after core decompression. Patients with high-level anti-phospholipid antibodies are related to a poor prognosis after core decompression.

Single-stage bilateral conversion arthroplasty for hip fusion via direct anterior approach in a patient with severe ankylosing spondylitis and kyphoscoliosis: a case report.

BACKGROUND: Severe ankylosing spondylitis (AS) frequently involves hip joints and, occasionally, presents with concurrent spinal deformities, such as kyphoscoliosis, creating complex challenges for surgical management. CASE PRESENTATION: We present a 26-year-old Persian male with a history of AS and severe kyphoscoliosis, leading to bilateral hip fusion and immobility. Following spinal deformity correction, a one-stage bilateral conversion to total hip arthroplasty (THA) was conducted through the direct anterior approach. CONCLUSION: Primary correction of spinal deformities allows for extended surgical procedures under general anesthesia. Single stage bilateral hip conversion arthroplasty via the direct anterior approach enhances postoperative mobilization, reduce the risk of re-ankylosis, and improve the overall quality of life for AS patients with this unique presentation.