Angular stable plate versus reverse shoulder arthroplasty for proximal humeral fractures in elderly patient.

BACKGROUND: Treatment of complex proximal humeral fractures in the elderly is a challenge and reverse shoulder arthroplasty (RTSA) is now an important alternative to open reduction internal fixation (ORIF) with angular stable plate. The purpose of this study is to compare clinical and radiological outcomes of RTSA and ORIF in the elderly. METHODS: We retrospectively analyzed patients treated for three- or four-part displaced fractures of the proximal humerus. Range of motion, disabilities of the arm, shoulder and hand (DASH) and Constant scores were recorded. X-ray exam in three projections completed the clinical observation at follow-up. RESULTS: Forty-eight patients were enrolled after a mean follow-up of 37 months: 22 RTSA and 26 ORIF. Mean age at trauma was 74 years. Compared with RTSA patients, ORIF patients had significantly higher mean external rotation (28° vs. 14°) and better results in modal internal rotation (hand at D7 vs. hand at L5-S1). No significant differences were seen in DASH and Constant scores. Avascular necrosis and loss of reduction with varus dislocation of the humeral head were the most frequent causes of revision surgery in ORIF (34.6%) while the revision rate of the RTSA was 9.1%. CONCLUSION: In this study, both treatments showed good clinical outcomes, but RTSA resulted in lower revision rate than ORIF. Even if external and internal rotation in RTSA patients were worse than ORIF, they did not affect the patient's quality of life. So, the reverse arthroplasty seems to be a more reliable treatment.

Primary reverse shoulder arthroplasty for acute proximal humerus fractures: A 5-year long term retrospective study of elderly patients.

BACKGROUND: Reverse shoulder arthroplasty (RSA) in complex shoulder fractures is ever more frequently. This study compares clinical and radiologic results of patients with comminuted proximal humeral fractures (PHFs) treated with RSA, with and without tuberosities grafting. METHODS: Between January 2009 and June 2014, 55 patients aged ≥65 years with 3- and 4-part PHFs were treated surgically. Patients' files and the hospital's digital database were reviewed retrospectively with at least 5-year of follow up. We constituted three groups according to the tuberosity consolidation: patients in whom the tuberosities showed anatomic consolidation (Group I) and patients either with secondary displacement of the tuberosities (Group II) or without tuberosity repair (Group III). RESULTS: The 74% of the repaired tuberosities consolidated in anatomic position. Among range of motion (ROM), we reported that forward elevation, abduction and external rotation were significantly better in Group I than those in Group II-III. Furthermore, quick Dash score and Constant score showed more satisfied results in Group I. Regarding complications, not infection or instability were found in group I. On the other hand, in group II, we reported one patient with deep infection, leading to two steps surgery. In group III, we recorded two patients with instability required implant revision and one with deep infection treated by revision. CONCLUSION: RSA showed satisfied results even at 5 year follow up. Preservation of the tuberosities in anatomic position improves active forward elevation and external rotation as well as patient satisfaction with less complications.

Nanocomposite functionalized membranes based on silica nanoparticles cross-linked to electrospun nanofibrous support for arsenic(v) adsorption from contaminated underground water.

Nanocomposite functionalized membranes were synthesized using surface functionalized mesoporous silica nanoparticles (MCM-NH2 or MCM-PEI) cross-linked to a modified polyacrylonitrile (mPAN) nanofibrous substrate for the removal of 1 mg L-1 of As(v); a concentration much higher than what has been reported for underground water in Argentina. Adsorption studies were carried out in batch mode at pH 8 with nanoparticles in colloidal form, as well as the nanoparticles supported on the modified PAN membranes (mPAN/MCM-NH2 and mPAN/MCM-PEI). Results indicate a twenty-fold improvement in As(v) adsorption with supported nanoparticles (nanocomposite membranes) as opposed to their colloidal form. The adsorption efficiency could be further enhanced by modifying the nanocomposite membrane surface with Fe3+ (mPAN/MCM-NH2-Fe3+ and mPAN/MCM-PEI-Fe3+) which resulted in more than 95% arsenic being removed within the first 15 minutes and a specific arsenic adsorption capacity of 4.61 mg g-1 and 5.89 mg g-1 for mPAN/MCM-NH2-Fe3+ and mPAN/MCM-PEI-Fe3+ nanocomposite membranes, respectively. The adsorption characteristics were observed to follow a pseudo-first order behavior. The results suggest that the synthesized materials are excellent for quick and efficient reduction of As(v) concentrations below the WHO guidelines and show promise for future applications.

Orthopaedic Timing in Polytrauma in a Second Level Emergency Hospital. An Overrated Problem?

The main concern for orthopaedic treatment in polytrauma has always been the same for almost forty years, which also regards "where" and "when" to proceed; correct surgical timing and correct interpretation of the DCO concept are still being debated. In the last few years, several attempts have been made to classify patients based on their clinical presentation and by trying to figure out which vital parameters are able to predict the patient's outcome. This study evaluated all patients who presented with code red at the Emergency Department of our Hospital, a level II trauma center. For every patient, the following characteristics were noted: sex, age, day of hospitalization, orthopaedic trauma, time to surgery, presence of an associated surgical condition in the fields of general surgery, thoracic surgery, neurosurgery and vascular surgery, cardiac frequency, blood pressure, oxygen saturation, Glasgow Coma Scale and laboratory data. All patients included were divided into subgroups based on orthopaedic surgical timing. Two other subgroups were also identified and analyzed in detail: deceased and weekend traumas. A total of 208 patients were included. Our primary goal was to identify a correlation between the mortality and surgical timing of the orthopaedic procedures; our secondary goal was to recognize, if present, a statistically relevant association between historical, clinical and laboratory data, and mortality rate, defining any possible risk factor. A correlation between mortality and orthopaedic surgical timing was not found. Analyzing laboratory data revealed an interesting correlation between mortality and: blood pressure, platelet count, cardiac frequency, hematocrit, hemoglobin and age.

[Assessment of circadian rhythm in pain and stiffness in rheumatic diseases according the EMA (Ecologic Momentary Assessment) method: patient compliance with an electronic diary]. / Valutazione del ritmo circadiano del dolore e della rigidità nelle malattie reumatiche secondo la metodica EMA (Ecologic Momentary Assessment): compliance del paziente con un diario elettronico.

BACKGROUND: Many researchers have used paper diaries in an attempt to capture patient experience. However, patient non-compliance with written diary protocols is a serious problem for researchers. Electronic patient experience diaries (eDiary) facilitate Ecologic Momentary Assessment (EMA) study designs by allowing the researcher to administer flexible, programmable assessments and mark each record with a time and date stamp. OBJECTIVES: The objectives of the current study were to evaluate methodological issues associated with real-time pain reports (EMA) using electronic patient experience diaries, to quantify compliance (percentage of the total number of diary reports scheduled that were actually completed), and to examine the circadian rhythm in pain and stiffness of patients with rheumatic diseases in an ecologically valid manner. METHODS: In this cross-sectional study we examined 49 patients with rheumatic diseases (14 patients with rheumatoid arthritis, 18 with fibromyalgia and 17 with osteoarthritis of the knee), attending the care facilities of the Department of Rheumatology of Università Politecnica delle Marche. All patients fulfilling the American College of Rheumatology (ACR) criteria. The assessment of pain and stiffness in all patients were repeated seven times a day (8 A.M., 10 A.M., 12 A.M., 2 P.M., 4 P.M., 6 P.M. and 8 P.M.) on seven consecutive days using an electronic diary (DataLogger® - Pain Level Recorder). A datalogger is newly developed electronic instrument that records measurements of pain and stiffness over time. Dataloggers are small, battery-powered devices that are equipped with a microprocessor. Specific software is then used to select logging parameters (sampling intervals, start time, etc.) and view/analyse the collected data. Compliance is based on the time and date record that was automatically recorded by the devices. RESULTS: Using the data from the electronic diary, we determined that the average verified compliance rate for pain and stiffness were 93.8 and 93.6%, respectively. The two highest compliance rates were observed in patients with rheumatoid arthritis (95.6 and 95.2%, respectively). There were no statistically significant difference in compliance between females and males or patients above or below 60 years old. Significant circadian rhythms in patients with RA and OA of the knee were detected in pain and stiffness. No rhythm in pain or stiffness was observed in subjects with fibromyalgia. CONCLUSIONS: We conclude that collection of subjective data using electronic diary in rheumatologic setting is a feasible method than can be adopted with high compliance rates across a range of patient demographic subgroups. The identification of diurnal cycles of self-reported pain and stiffness, using EMA method, has important implications for patients with respect to planning their daily activities and in developing individual therapeutic programs with respect to diurnal variability, which therefore may be more effective.

In vivo-in vitro correlations with various aspirin formulations.

In vivo evaluation of gastric irritation as determined by gastric transmural potential difference (GPD) and in vitro characterization of four formulations have been made. The four formulations were: (A) highly buffered, (B) cytoprotective, (C) microencapsulated and (D) a plain tablet. The GPD results showed C to be much less irritating than A or D, and slightly less-irritating than B. The release from all formulations was well represented by dissolution efficiency (DE%) and mean time of dissolution. When correlation coefficients were calculated, significant relationships were found between DE% and the GPD parameters area under the baseline (AUB) and the Reiz Index (RI), and between the mean time of dissolution and the GPD parameters AUB, mean potential drop (MD) and RI.

Comparative gastric irritation by two buffered acetylsalicylic acid formulations and acetylsalicylic acid. A gastric potential difference analysis.

In a single dose clinical investigation two buffered acetylsalicylic acid formulations (Ascriptin and Ascriptin A/D) were shown to be significantly less irritating to the human gastric mucosa than acetylsalicylic acid, and no more irritating than a pharmacologically inert placebo. The measurements were taken using a minimally invasive method for recording transmural gastric potential difference changes versus time.

The subcellular distribution of 14C-lidamidine and its metabolites.

Examination of the subcellular distribution of 14C-lidamidine and its metabolites in rat liver showed that the majority of radioactivity appeared in the postmicrosomal supernatant fraction, with lysosomes and microsomes having the highest relative specific activity (RSA) of the particulate fractions. When the subcellular distribution pattern was corrected for cross-contamination, based on the distribution of subcellular fraction marker enzymes, there was a significant decrease in the lysosomal RSA with an attendant increase in the microsomal RSA. Thin-layer chromatography of subcellular fraction extracts revealed different distribution patterns for lidamidine and metabolites in each fraction. The whole homogenate and cytosol fraction contained mostly polar metabolites (76-91%), whereas the particulate fractions contained 37-50% of their radioactivity as polar metabolites. The highest percentages of unchanged lidamidine and its more pharmacologically active, demethylated metabolite were associated with the mitochondrial and microsomal fractions.

Histone modification in liver after administration of inducers of mixed function oxidase activity.

The phosphorylation and acetylation of rat liver histones in vivo were determined after administration of phenobarbital or 3-methylcholanthrene. No changes were observed in the phosphorylation profile of histones separated by gel electrophoresis after treatment with either of these two inducing agents. However, after 2h of treatment with either phenobarbital or 3-methylcholanthrene, a significant increase in acetylation of histones was noted, particularly in the F2a1 and (F3, F2b, F2a2) regions. It is suggested that this increase which precedes the enhancement in RNA synthesis may play a role in the alteration of transcription in liver.