Short-term clinical outcomes of transarterial embolization for symptomatic hand osteoarthritis refractory to conservative treatment

PURPOSE

The present study aims to assess the short-term clinical outcomes and safety of transarterial embolization (TAE) for symptomatic hand osteoarthritis (OA) refractory to conservative treatment.

METHODS

The present retrospective cohort pilot study included nine patients who underwent TAE for symptomatic OA-associated hand pain in a single tertiary center between November 2022 and January 2023. The baseline and post-procedural OA-associated hand pain and function were assessed using the visual analog scale (VAS) and the Australian Canadian Hand Osteoarthritis Index (AUSCAN). The use of conservative treatment and pain medications was also recorded. Post-procedural adverse events were evaluated according to the Society of Interventional Radiology classification.

RESULTS

Compared with the baseline, the overall VAS scores were significantly decreased at 1-week, 1-month, 3-months, and 6-months after TAE (76 ± 15 mm versus 34 ± 18 mm, P < 0.001; 32 ± 11 mm, P < 0.001; 21 ± 15 mm, P < 0.001; 18 ± 19 mm, P = 0.002). Similarly, improvement in the mean total AUSCAN scores (22.0 ± 10.0 versus 13.2 ± 6.6, P = 0.007; 14.11 ± 7.3, P = 0.004; 9.8 ± 6.8, P = 0.004; 9.3 ± 7.4, P = 0.011) were documented. The use of other conservative treatment methods also gradually decreased. There were no severe adverse events reported during the follow-up period.

CONCLUSION

TAE is a feasible and safe treatment method for symptomatic hand OA refractory to conservative treatment. This minimally invasive procedure effectively relieves debilitating OA-associated joint pain and restores hand function with a durable treatment effect.

The Differential Systemic Biological Effects between Computer Navigation and Conventional Total Knee Arthroplasty (TKA) Surgeries: A Prospective Study

Distal femur reaming-free total knee arthroplasty (TKA) was reported to possess lower risk of acute myocardial infarction (AMI) or venous thromboembolism (VTE) than conventional TKA in a retrospective population-based study. We tried to offer prospective biological evidence by comparing the levels of AMI and VTE serum surrogate markers among the patients undertaking navigation and conventional TKAs to support these observations. Thirty-four participants undertaking navigation TKA and 34 patients receiving conventional TKA were recruited between February 2013 and December 2015. Blood samples were drawn from all participants before TKA, and 24 and 72 h after TKA, to assess the concentration of soluble P-selectin, matrix metalloproteinase-9 (MMP-9), C-reactive protein (CRP), and interleukin-8 (IL-8) between the participants undergoing navigation and conventional TKAs. We showed that significantly lower serum levels of soluble P-selectin 24 h after, as well as CRP 24 and 72 h after TKA could be observed in the navigation cohort. The more prominent surge of serum soluble P-selectin and CRP were perceived 24 and 72 h after TKA among the participants undergoing conventional TKA. Based upon our prospective biological evidence, the merits of navigation TKA are strengthened by lower levels of AMI and VTE serum surrogate markers.

Decreased Expression of Leptin among Patients with Shoulder Stiffness

Shoulder stiffness (SS) is a disease that is fibroblastic and inflammatory in nature. Leptin is an adipokine-mediating the fibroblastic and inflammatory processes of various diseases. Our study tried to investigate the role of leptin in SS pathogenesis. Subacromial bursa from stiff and non-stiff shoulders were obtained for reverse transcription-polymerase chain reaction (RT-PCR) analysis and immunoblotting. Subacromial fluid was obtained for enzyme-linked immunosorbent assay. We showed that the expression level of leptin was lower in the subacromial bursae from the stiff shoulders in RT-PCR analysis (p < 0.001) and immunoblotting (p < 0.001). The concentration of leptin was also lower in the subacromial fluid derived from stiff shoulders. The leptin level in the subacromial fluid was positively associated with the constant score, total range of motion, flexion, abduction, and external rotation. The synovial fibroblasts derived from stiff shoulder-retrieved subacromial bursa were treated by 0, 1, and 3 μM leptin. Under RT-qPCR analysis, leptin was shown to dose-dependently decrease the transcription of IL-6, IL-10, and IL-13, but without impact on IL-1β and IL-4 (p < 0.001, p = 0.001, p = 0.001, p = 0.137, and p = 0.883 by ANOVA test, respectively). These results shed light on the role of leptin in orchestrating the disease processes of SS.

Shoulder and Elbow Injuries in Elite Taiwanese High School Baseball Pitchers From 2016 to 2017

Background

Numerous studies have discussed the risk factors for shoulder and elbow injuries in high school baseball players worldwide.

Purpose

To determine the risk factors for pitching-related shoulder and elbow injuries in Taiwanese high school pitchers.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

Included in the study were 144 pitchers from 11 top-ranked Taiwanese high school baseball teams between 2016 and 2017 high school baseball season. The participants answered a 55-item questionnaire concerning physical characteristics, pitching activities, injury history, and off-season activities. Univariate analyses were conducted separately for participants with and those without a pitching-related injury in the 12-month study period. The chi-square test or Fisher exact test was applied to categorical variables, and the F test or t test was applied to continuous variables. A stepwise multivariate logistic regression analysis was used to identify factors related to pitching-related injuries, and those results were calculated as odds ratios (ORs).

Results

Having a pitching-related injury was significantly related to the number of pitches per week in the past 12 months (OR, 1.01; P = .006), pain over the shoulder and/or elbow in the past 12 months (OR, 3.56; P = .008), pitching competitive baseball for more than 8 of the past 12 months (OR, 2.53; P = .036), throwing sliders (OR, 2.97; P = .026), and lack of participating in other over-the-shoulder activities (0.03-0.11 fewer odds; P ≤ .010).

Conclusion

For elite high school pitchers in Taiwan, pitching-related shoulder and elbow injuries were related to the number of pitches per week, pitching competitive baseball for more than 8 of the past 12 months, pain over the shoulder and/or elbow in the past 12 months, throwing sliders, and a lack of participation in other sports with over-the-shoulder activities.

Automated coronary artery calcium scoring using nested U-Net and focal loss

Coronary artery calcium (CAC) is a great risk predictor of the atherosclerotic cardiovascular disease and CAC scores can be used to stratify the risk of heart disease. Current clinical analysis of CAC is performed using onsite semiautomated software. This semiautomated CAC analysis requires experienced radiologists and radiologic technologists and is both demanding and time-consuming. The purpose of this study is to develop a fully automated CAC detection model that can quantify CAC scores. A total of 1,811 cases of cardiac examinations involving contrast-free multidetector computed tomography were retrospectively collected. We divided the database into the Training Data Set, Validation Data Set, Testing Data Set 1, and Testing Data Set 2. The Training, Validation, and Testing Data Set 1 contained cases with clinically detected CAC; Testing Data Set 2 contained those without detected calcium. The intraclass correlation coefficients between the overall standard and model-predicted scores were 1.00 for both the Training Data Set and Testing Data Set 1. In Testing Data Set 2, the model was able to detect clinically undetected cases of mild calcium. The results suggested that the proposed model’s automated detection of CAC was highly consistent with clinical semiautomated CAC analysis. The proposed model demonstrated potential for clinical applications that can improve the quality of CAC risk stratification.

Superior training efficacy of beginning movement load training for the baseball throwers

Background

Superior shoulder motion with rotator cuff activation are essential for the performance of the throwing athletes. The present study compared the novel beginning movement load training (BMLT) and popular throwers ten program regarding the training efficacy of baseball throwers. We hypothesized that the BMLT contributed the superior training efficacy than popular throwers ten program.

Methods

Forty adult baseball players were randomized into study group and control group equally. In study group, the cyclic shoulder motion was repeatedly operated 3 days in a week and lasted for 6 weeks using three different BMLT training machines. As for control group, three popular cyclic training in the throwers ten program were adopted for the shoulder trainings as the same protocol in study group. The evaluations before and after training included the static range of motion (ROM), the maximal voluntary isometric contraction (MVICs) of the target muscle (pectoralis major, middle deltoid and supraspinatus) and throwing velocity.

Result

After 6-week course, study group had significant wider static ROM in saggital adduction (p = 0.002), coronal internal rotation (p = 0.018) and external rotation (p = 0.044) than in control group. The maximal voluntary isometric contraction (MVIC) ratio of middle deltoid/supraspinatus was significant lower in study group (Study:Control = 1.14 ± 0.76:3.56 ± 5.57, p = 0.049) which indicated the enhanced supraspinatus maximal contraction in the study group after training. In addition, the study group had significant improvement in throwing speed (117 ± 10 vs. 109 ± 10 km/h, p = 0.040).

Conclusion

The BMLT contributed the superiority in range of motion, recruitment of supraspinatus and throwing velocity than the popular thrower’s ten program. It could be a favourable training for the overhead activity.

Surface Analysis of Perovskite Oxynitride Thin Films as Photoelectrodes for Solar Water Splitting

Perovskite oxynitride semiconductors have attracted huge interest recently as promising photoelectrode materials for photoelectrochemical (PEC) water splitting. Depicted by, the extensive studies of the PEC activity of oxynitride powder-based photoelectrodes and/or deposited thin-film electrodes. High-crystalline-quality, oxynitride thin films grown by physical vapor deposition are ideal model systems to study the fundamental physical and chemical properties of the surface of these materials, including their evolution. In this work, using a combination of high-sensitivity low-energy ion scattering (LEIS) and X-ray photoelectron spectroscopy (XPS), we monitor surface evolution of LaTiO_xN_y (LTON) and CaNbO_xN_y (CNON) thin films before and after the PEC characterizations. The as-prepared epitaxial LTON films show a preferential LaO termination at the surface layers, followed by a Ti-enriched subsurface. Whereas, the polycrystalline CNON thin films exhibit a non-uniform surface, with a mixed surface termination and a significant Ca-segregated subsurface. After the PEC characterizations, additional precipitated LaO species are found on the outer surface of the LTON epitaxial films. However, no significant surface change is observed on the polycrystalline CNON films by LEIS. The XPS analysis shows, an increase of the oxidized Ti and Nb cations (Ti⁴⁺ and Nb⁵⁺) after the PEC reaction in the LTON and CNON films, respectively. The initial drops in photocurrent for the LTON and CNON films are attributed to the changes in the surface chemical status. This work provides insight into the surface characteristics and evolution of LTON and CNON oxynitride thin films as photoelectrodes for PEC applications.

Predicting the surgical reparability of large-to-massive rotator cuff tears by B-mode ultrasonography: a cross-sectional study

PURPOSE

This study aimed to compare the ability of B-mode ultrasonography and magnetic resonance imaging (MRI) to predict the repairability of large-to-massive rotator cuff tears (RCTs).

METHODS

This cross-sectional study included participants with large-to-massive RCTs who underwent arthroscopic repair. B-mode ultrasonography and MRI were conducted prior to arthroscopic repair. B-mode ultrasonography was used to evaluate the echogenicity of the rotator cuff muscle using the Heckmatt scale. Intra-rater and inter-rater reliabilities were examined for two independent physicians. MRI was used to evaluate the degrees of tendon retraction, fatty infiltration of rotator cuff muscles, and muscle atrophy. Finally, two experienced orthopedic surgeons performed surgery and decided whether the torn stump could be completely repaired intraoperatively.

RESULTS

Fifty participants were included, and 32 complete repairs and 18 partial repairs were performed. B-mode ultrasonography showed good intra-rater reliability and inter-rater reliability for assessment of the muscle echogenicity of the supraspinatus and infraspinatus muscles. The correlation coefficients between B-mode ultrasound findings and MRI findings showed medium to large effect sizes (r=0.4-0.8). The Goutallier classification of the infraspinatus muscles was the MRI predictor with the best discriminative power for surgical reparability (area under the curve [AUC], 0.89; 95% confidence interval [CI], 0.81 to 0.98), while the Heckmatt scale for infraspinatus muscles was the most accurate ultrasound predictor (AUC, 0.85; 95% CI, 0.74 to 0.96). No significant differences in AUCs among the MRI and ultrasound predictors were found.

CONCLUSION

B-mode ultrasonography was a reliable examination tool and had a similar ability to predict surgical reparability to that of MRI among patients with large-to-massive RCTs.

Is coracoclavicular reconstruction necessary in hook plate fixation for acute unstable acromioclavicular dislocation?

Background

Acromioclavicular joint (ACJ) dislocation is a relatively common shoulder injury. For the treatment of cases of severe ACJ dislocation (Rockwood type III–V), hook plate fixation is an easy-to-master and minimally-invasive approach to surgical intervention. Over stress on the acromion following hook plate fixation often leads to acromial complications such as osteolysis and loss of reduction. We hypothesized that suspensory reconstruction alongside hook plate fixation might provide a superior stability and reduce complications as compared with hook plate fixation alone. The purpose of the study was to assess the clinical and radiographic outcomes of these two surgical modalities.

Methods

We retrospectively enrolled 49 patients with acute ACJ dislocation from May 2010 to December 2018. Among them, 19 patients received hook plate fixation only (HP group), and 19 underwent concomitant hook plate fixation and loop suspension fixation with two mersilene sutures (HM group). The demographic data of the patients were recorded and analyzed. All patients underwent a shoulder X-ray initially, immediately postoperatively, and at 1, 3, 6 and 12 months to measure the relative coracoclavicular distance (rCCD). Clinical assessment of shoulder function outcome was conducted using the Constant Murley Score (CMS); the University of California at Los Angeles (UCLA) Shoulder Score was also measured at the latest follow-up.

Results

There were no significant differences in the demographic data between the two groups. With regards to the CMS and the UCLA score, the HM group and HP group both had excellent outcomes, and no significant differences in scores were observed between groups (CMS: 93.90 ± 6.16 versus 94.47 ± 7.26, p = 0.47; UCLA score: 32.84 ± 2.91 versus 34.32 ± 1.16, p = 0.07). However, the HM group demonstrated substantial superiority in terms of maintenance of the rCCD over the HP group (91.47 ± 27.47 versus 100.75 ± 48.70, p = 0.015). In addition, there was less subacromial osteolysis in the HM group than the HP group (52.6% versus 15.8%, p = 0.038).

Conclusion

Both fixations yielded excellent functional outcomes. However, concomitant hook plate fixation with loop suspensory reconstruction demonstrated the fewer acromion complications and statistical differences in reduction maintenance with less clinical significance.

Phase transformation and room temperature stabilization of various Bi2O3 nano-polymorphs: effect of oxygen-vacancy defects and reduced surface energy due to adsorbed carbon species

We report the grain growth from the nanoscale to microscale and a transformation sequence from Bi →β-Bi₂O₃→γ-Bi₂O₃→α-Bi₂O₃ with the increase of annealing temperature. The room temperature (RT) stabilization of β-Bi₂O₃ nanoparticles (NPs) was attributed to the effect of reduced surface energy due to adsorbed carbon species, and oxygen vacancy defects may have played a significant role in the RT stabilization of γ-Bi₂O₃ NPs. An enhanced red emission band was evident from all the samples attributed to oxygen-vacancy defects formed during the growth process in contrast with the observed white emission band from the air annealed Bi ingots. Based on our experimental findings, the air annealing induced oxidation of Bi NPs and transformation mechanism within various Bi₂O₃ nano-polymorphs are presented. The outcome of this study suggests that oxygen vacancy defects at the nanoscale play a significant role in both structural stabilization and phase transformation within various Bi₂O₃ nano-polymorphs, which is significant from theoretical consideration.

Use sonoelastography to predict the reparability of large-to-massive rotator cuff tears

INTRODUCTION

Most symptomatic large-to-massive rotator cuff tears (RCTs) should be operated, but the surgical reparability depended on the degree of rotator cuff muscle atrophy or fatty infiltration. The orthopedic surgeons will decide whether the teared stump is reparable during the surgery, but preoperative evaluation can be done by some assessment tools. Magnetic resonance imaging (MRI) was used in recent studies to predict the reparability of large-to-massive RCTs, but the clinical availability was not as good as ultrasound. We hypothesize that the ultrasound elastography can predict the reparability of large-to-massive RCTs.

METHODS

This is a prospective observational study and participants with large-to-massive RCTs who are going to have surgeries will be included. Out investigators will evaluate the shoulder passive range of motion (ROM) and strength of all participants. Participants' degree of shoulder pain and activities of daily living (ADLs) will be assessed by American Shoulder and Elbow Surgeons (ASES) score. The ultrasound elastography will be used to evaluate the tissue quality of supraspinatus muscle and infraspinatus muscle. To test the reliability of the ultrasound elastography, two physicians will perform the ultrasound elastography independently and twenty participants will be selected for the reliability test. Besides, MRI will be used to evaluate the size of tear, the degree of tendon retraction, fatty infiltration of rotator cuff muscles, and muscle atrophy. Finally, the orthopedic surgeons will perform surgeries and decide whether the teared stump can be completely repaired intraoperatively. The primary analysis is the predictive validity of ultrasound elastography for the reparability of large-to-massive RCTs. Before the predictive validity of ultrasound elastography is measured, our investigators will assess the reliability of ultrasound elastography when administered to cases with large-to-massive RCTs, and we will check the correlations between the findings of ultrasound elastography and MRI.

DISCUSSION

The outcome will provide the evidence of ultrasound elastography for preoperative evaluation of large-to-massive RCTs. The relationships between the findings of ultrasound elastography and MRI will also be examined for further analysis.

TRIAL REGISTRATION

Clinicaltrials.gov NCT03682679. Date of Registration: 25 September 2018, https://clinicaltrials.gov/ct2/show/NCT03682679?cond=rotator+cuff&cntry=TW&draw=2&rank=1.

Comparative Effectiveness of Different Nonsurgical Treatments for Patellar Tendinopathy: A Systematic Review and Network Meta-analysis

PURPOSE

To investigate the functional improvement and pain reduction of different nonsurgical treatments for patellar tendinopathy (PT), a systematic review with network meta-analysis was performed.

METHODS

Studies were comprehensively searched for without language restrictions in the CENTRAL, MEDLINE, EMBASE, Web of Science, Physiotherapy Evidence Database, and SPORTDiscus databases from inception to May 2018. Randomized controlled trials about nonsurgical treatments for PT were included. The outcome measurements were the Victorian Institute of Sports Assessment (VISA) scale and pain scores (such as the visual analog scale or Numerical Rating Scale). Study quality was evaluated using the Physiotherapy Evidence Database score. Direct comparisons were performed using pairwise meta-analysis, whereas network meta-analysis was performed using a frequentist method in a multivariate random-effects model.

RESULTS

Eleven studies with 430 affected patellar tendons were included in the systematic review. The summary mean difference of improvement in the VISA scale versus the control group for corticosteroid injection was -23.00 (95% confidence interval [CI] -36.73 to -9.27), for leukocyte-rich platelet-rich plasma (LR-PRP) was 13.22 (95% CI 2.37-24.07), for focused extracorporeal shockwave therapy (ESWT) was -1.28 (95% CI -6.25 to 3.68), for radial ESWT was -6.68 (95% CI -20.20 to 6.84), for ultrasound was -0.70 (95% CI -11.23 to 9.83), for autologous blood injection was -0.60 (95% CI -9.30 to 8.10), for dry needling was 17.51 (95% CI -2.57 to 37.60), for topical glyceryl trinitrate was -0.90 (95% CI -13.07 to 11.27), and for skin-derived tendon-like cells was 10.40 (95% CI -1.59 to 22.39). LR-PRP (Surface Under the Cumulative Ranking curve [SUCRA] = 87.5%) or dry needling (SUCRA = 90.5%) was most likely to be ranked the best in terms of improvement on the VISA scale. Compared with the control group, the summary mean difference of the change in pain score for corticosteroid injection was 0.80 (95% CI -3.48 to 5.08), for LR-PRP was -1.87 (95% CI -3.28 to -0.46), for focused ESWT was 0.13 (95% CI -0.68 to 0.93), for radial ESWT was 0.03 (95% CI -1.92 to 1.98), for ultrasound was -0.20 (95% CI -1.49 to 1.09), for autologous blood injection was 0.60 (95% CI -0.73 to 1.93), for dry needling was -0.37 (95% CI -2.71 to 1.97), and for topical glyceryl trinitrate was -0.50 (95% CI -2.55 to 1.55). The treatment most likely to be ranked the best in terms of change in pain score was LR-PRP (SUCRA = 94.9%).

CONCLUSIONS

The network meta-analysis demonstrated that LR-PRP has the greatest functional improvement and pain reduction for PT compared with other treatment options. However, the treatment effect estimates can be biased by the possible intransitivity and should not be overestimated.

LEVEL OF EVIDENCE

Level I, meta-analysis of Level I studies.

Inferior outcome of rotator cuff repair in chronic hemodialytic patients

BACKGROUND

Repair of rotator cuff tears has yielded excellent functional outcomes in recent decades; however, poor outcomes and dissatisfaction have been noted in specific groups. Spontaneous tendon rupture has been reported in patients receiving long-term hemodialysis owing to alteration of tendon structure, which might impede functional recovery after rotator cuff repair. The purpose of the present study was to compare the clinical outcomes between hemodialysis and non-hemodialysis patients after rotator cuff repair.

METHODS

We retrospectively reviewed patients who underwent mini-open rotator cuff repair from Jan 2013 to Jan 2017. A total of 14 patients under chronic hemodialysis (HD) were matched to non-hemodialysis (NHD) patients at a 1:2 ratio according to age, gender, tear size, severity of fatty infiltration and history of diabetes. Pre- and post-operative functional outcome was assessed using the simple shoulder test (SST), American Shoulder and Elbow Surgeons (ASES), Shoulder Rating Scale of the University of California at Los Angeles (UCLA) and visual analog scale (VAS) scores. Clinical functional outcome at the last follow-up was adopted for comparison of the HD and NHD groups.

RESULTS

A total of 42 patients were enrolled in this comparative study, with a mean age of 66.64 ± 1.68 years in the HD group and 65.71 ± 5.40 years in the NHD group. At the final clinical assessment, the post-operative functional outcome was significantly improved in both groups (p < 0.001). However, the functional outcome of the HD group was significantly inferior to that of the NHD group in terms of the SST score (6.50 ± 2.24 vs 9.39 ± 1.87, p < 0.001), ASES score (63.17 ± 15.93 vs 86.96 ± 11.43, p < 0.001), UCLA score (20.14 ± 7.71 vs 29.82 ± 5.08, p < 0.001) and VAS score (3.00 ± 0.96 vs 1.21 ± 1.03, p < 0.001).

CONCLUSION

The improvement of pain and functional improvement of long-term hemodialysis patients were inferior to those of patients without hemodialysis after mini-open rotator cuff repair.

Outcomes and factors of elbow arthroscopy upon returning to sports for throwing athletes with osteoarthritis

Background

Elbow arthroscopy had good functional outcome for throwing athletes. Returning to sports is a major concern for all athletes, but only a few reports have investigated the clinical factors related to the duration of returning to sports. The present study evaluates the efficacy of elbow arthroscopic surgery on throwing elbows with osteoarthritis and defines the clinical factors related to the duration of the returning to sports.

Methods

This was a retrospective study with fifteen active baseball throwing athletes with elbow osteoarthritis who were treated with elbow arthroscopy. Perioperative clinical factors were analyzed for functional outcomes. A multiple linear regression analysis was used to analyze the clinical factors associated with the duration of returning to training and sports.

Results

The 15 patients’ mean age was 27 years. The mean follow-up time was 2.6 years. The mean procedural complexity was 3.1 ± 1.6 (range 1–6). The elbow total range of motion (ROM) improved significantly from 100.7 ± 28.7° to 125.7 ± 18.5° (p = 0.001). The terminal flexion range of the elbow increased significantly from 116.0 ± 22.6° to 130.0 ± 13.2° (p = 0.001), and the terminal extension range improved from 15.3 ± 11.1° to 4.3 ± 5.9° (p = 0.001). Before the operation, the average subjective patient outcome for return to sports (SPORTS) score was 3.4 ± 1.5, which increased significantly to 9.67 ± 0.45 (p = 0.003) at the last follow-up. The multiple linear regression analysis revealed that higher procedural complexity hinders the athletes from returning to competition.

Conclusions

Elbow arthroscopy offered highly satisfactory results in the throwing elbows of elite athletes and significantly improved the range of motion and SPORTS score. The procedural complexity was significantly related to the duration of returning to competition. Early and aggressive arthroscopic intervention is recommended for elite throwing athletes with elbow osteoarthritis who fail to respond to conservative treatment.

Relationship between the social support and self-efficacy for function ability in patients undergoing primary hip replacement

Background

The World Health Organization (WHO) reported that nearly 25% of people will suffer from physical disability owing to the bone and joint problems until 2050. The condition of patients with this type of difficulty could be improved by increasing positive self-efficacy and instigating suitable medical treatment to implement self-efficacy for functional ability (SEFA) and physical functional ability self-care. In this study, we aim to evaluate the influence of social support on SEFA in patients after total hip arthroplasty.

Methods

This cross-sectional study used structural questionnaires, telephone appointments, and data collection to obtain patient characteristics, such as gender, age, educational level, and marital status. Questionnaires about social support and self-efficacy for functional ability (SEFA) were sent to 200 patients at 3 months following a primary total hip replacement from September 2011 to December 2014. Factor analysis was used to categorize the dimensions of social support; the t test, analysis of variance (ANOVA), and correlation analysis were applied to screen factors influencing SEFA. Multiple regression analysis was employed to ascertain the relationships between patient characteristics, social support, and SEFA.

Results

In total, 134 patients responded to the questionnaires. Lower SEFA scores were observed in patients of an older age, unmarried patients, and those with a low level of education. Correlation analysis showed that emotional information and appraisal support, instrumental support, and SEFA were positively correlated. Multiple regression analysis was applied to ascertain the relationships between patient characteristics, social support, and SEFA. We identified significant coefficient values of − 0.187 for age, 5.344 for emotional information and appraisal support, and 1.653 for instrumental support.

Conclusion

The results of this study demonstrated that in patients undergoing primary hip replacement, positive impacts on SEFA were observed in relation to emotional information, appraisal support and instrumental support. The results indicated that enhancing emotional information and appraisal support could improve a patient’s self-efficacy for functional ability.

Isolated revision of the acetabular component using alumina-on-alumina bearings without a metal sleeve: A preliminary study

INTRODUCTION

There has been a debate on the use of ceramic-on-ceramic coupling with the retained femoral stem in isolated acetabular revision. The purpose of this study was to retrospectively review the results and complications of isolated revision of the acetabular component using alumina-on-alumina bearings.

METHODS

Between August 2010 and December 2013, 22 patients (23 hips) with a mean age of 60.74 years (40-73) underwent isolated revision of the acetabular component from metal-on-polyethylene to alumina-on-alumina bearings without using a metal sleeve on the undamaged trunnion. All patients completed clinical and radiographic evaluation.

RESULTS

At a mean follow-up of 3 years (2-5.5), all patients had a significant improvement in the clinical outcome, including Harris Hip Score (84.9 vs. 43, p < 0.001), West Ontario McMaster University Osteoarthritis Index Score (14.4 vs. 49.2, p < 0.001), and visual analogue pain score (1.42 vs. 6.63, p < 0.001). Complications included one aseptic loosening of the acetabular component and three noisy hips (click only). No fracture of the ceramic bearings, dislocation, infection, or squeaking noise were observed in any of the patients.

CONCLUSION

Isolated revision of the acetabular component to alumina-on-alumina bearings on the undamaged trunnion may be considered if there is no available titanium sleeves. Our study showed a satisfactory early outcome with minimal complications. However, a longer term follow-up study is necessary.

Nanodiamond for intracellular imaging in the microorganisms in vivo

Nanodiamond (ND) has great potential for bio labeling and drug delivery. In this work, the biocompatibility and bio labeling of ND are demonstrated via the interaction with cells and microorganisms, protists microorganisms Paramecium caudatum and Tetrahymena thermophile, in vitro and in vivo. We found the microorganism's living functions are not significantly affected by ND. The NDs were found entering the food vacuoles and later excreted by the microorganisms. The 5 nm ND was found more toxic compared to 100 nm ND, presumably due to the surface disordered carbons. Our results demonstrated nanodiamond can be used in bio imaging and matter delivery.

Particle size and magnetic field-induced optical properties of magnetic fluid nanoparticles

Magnetite nanoparticles with diameters of 7, 9, and 12 nm have been prepared by a chemical coprecipitation method. The transmission of light through magnetic fluid containing these nanoparticles has been investigated as a function of film thickness with wavelength between 400 and 750 nm, and applied magnetic fields up to 275 Oe. The transmission threshold shifts to the lower wavelength side with decreasing magnetic fluid film thickness as well as the particle size. For a given film thickness, the transmittance increases with increasing magnetic field for films with a particle size of 7 and 9 nm, but decreases in the 12-nm film. This is attributed to the competition between the van der Waals and dipole-dipole interaction.

Antioxidant properties of methanolic extracts from several ear mushrooms

Five kinds of ear mushrooms are commercially available in Taiwan, including black, red, jin, snow, and silver ears. Methanolic extracts were prepared from these ear mushrooms, and their antioxidant properties were studied. For all methanolic extracts from ear mushrooms, the antioxidant activities in the 1,3-diethyl-2-thiobarbituric acid method were moderate (38.6 approximately 74.6%) at 1.0-5.0 mg/mL. Methanolic extracts from red, jin, and snow ears showed excellent antioxidant activities in the conjugated diene method at 5.0 mg/mL. At 5.0 mg/mL, reducing powers of methanolic extracts were in the descending order of snow > black approximately red approximately jin > silver ears. The scavenging effect of methanolic extracts from ear mushrooms on 1,1-diphenyl-2-picrylhydrazyl radicals was excellent except for that from silver ears. Ear mushroom extracts were not good scavengers for hydroxyl free radicals but were good chelators for ferrous ions. Naturally occurring antioxidants, including ascorbic acid, tocopherols, and total phenols, were found in the methanolic extracts. However, beta-carotene was not detected. Total antioxidant components were 15.69, 30.09, 27.83, 49.17, and 31.70 mg/g for black, red, jin, snow, and silver ears, respectively.

Factors associated with the transition to nonprone sleep positions of infants in the United States: the National Infant Sleep Position Study

CONTEXT

Studies have demonstrated strong associations between the prone sleep position (on the stomach) and sudden infant death syndrome (SIDS). In 1992, the American Academy of Pediatrics recommended that infants be placed to sleep laterally (on their side) or supine (on their back) to reduce SIDS risk, and in 1994, the national public education campaign "Back to Sleep" was launched.

OBJECTIVE

To determine the typical sleep position of infants younger than 8 months in the United States, the changes that occurred after these recommendations, and the factors associated with the placement of infants prone or supine.

DESIGN

Annual nationally representative telephone surveys.

SETTING

The 48 contiguous states of the United States.

PARTICIPANTS

Nighttime caregivers of infants born within the last 7 months between 1992 and 1996. Approximately 1000 interviews were conducted per year.

MAIN OUTCOME MEASURES

The position the infant was usually placed in for sleep, and the position the infant was most commonly found in when checked during the night's sleep.

RESULTS

Ninety-seven percent of respondents in each wave of the survey usually placed their infant to sleep in a specific position. Infants were placed in the prone position by 70% of caregivers in 1992, prior to the campaign, but only 24% in 1996. Supine and lateral placements increased during this time period, from 13% in 1992 to 35% in 1996 and from 15% in 1992 to 39% in 1996, respectively. Significant predictors of prone placement included maternal race reported as black (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.68-3.26), mother's age 20 to 29 years (OR, 1.28; 95% CI, 1.09-1.50), region reported as the mid-Atlantic (OR, 1.41; 95% CI, 1.12-1.78) or southern states (OR, 1.47; 95% CI, 1.22-1.70), mothers with a previous child (OR, 1.68; 95% CI, 1.43-1.97), and infants younger than 8 weeks (OR, 0.63; 95% CI, 0.46-0.85). Infants aged 8 to 15 weeks were significantly more likely to be placed nonprone over time compared with the other age groups. Most of the risk factors for prone were significantly related in the opposite direction to supine placement.

CONCLUSIONS

The prevalence of infants placed in the prone sleep position declined by 66% between 1992 and 1996. Although causality cannot be proved, SIDS rates declined approximately 38% during this period. To achieve further reduction in prone sleeping, efforts to promote the supine sleep position should be aimed at groups at high risk for prone placement.

Planned early neck dissection before radiation for persistent neck nodes after induction chemotherapy

Optimal management of advanced neck metastases as part of an organ preservation treatment approach for head and neck squamous carcinoma (HNSC) is unclear. Since 1989, our management paradigm for patients on organ preservation was modified to incorporate planned early neck dissection before radiation therapy for patients who did not achieve a complete response (CR) of neck nodes after induction chemotherapy (IC). The purpose of this study was to determine if planned early neck dissection is a safe and effective approach in the management of advanced nodal disease as part of organ preservation. Fifty-eight consecutive patients with advanced HNSC who were entered in organ preservation trials using induction chemotherapy and radiation with surgical salvage were studied. Median follow-up was 26 months. Of the 58 patients, 71% were stage IV. Patients were grouped by nodal response to chemotherapy and N class, and were analyzed with respect to patterns of recurrence, complications, and survival. Overall, the rate of CR of neck nodes was 49%. Fifty-one percent had less than a complete response of neck nodes after IC and required planned early neck dissection. There were no significant differences in patterns of recurrence, complications, interval time to start of radiation, recurrence, or survival rates between the CR and less than CR groups. These data suggest that planned early neck dissection for patients with less than CR in the neck after IC is not detrimental with respect to neck relapse or overall survival. We believe that planned early neck dissection can be safely incorporated into future organ preservation treatment protocols for patients with advanced head and neck carcinoma.

Ureteropelvic fungal bezoar causing oliguric renal failure in a premature infant

Systemic candidiasis with renal involvement is a relatively rare infectious process in young infants. The mortality rate in the cases reported to date has been lower after aggressive surgical and medical management. This report concerns a three-month-old, prematurely born infant with a fatal systemic candidiasis and acute renal failure. Renal pelvic fungal balls caused ureteropelvic junction obstruction in this patient. Renal ultrasonography demonstrated bilateral obstructive uropathy. Treatment consisted of surgical removal of the bezoar, together with open placement of nephrostomy tubes, parenteral amphotericin B therapy and peritoneal dialysis. This case emphasizes the need for a highly suspicion of renal obstruction by fungal balls in any high risk infant with systemic candidiasis and renal dysfunction.

Determination of methylglyoxal-bis(guanylhydrazone) in body fluids by ion-pair chromatography

Methylglyoxal-bis(guanylhydrazone), Methyl-G, is a potent antineoplastic agent currently undergoing Phase l clinical trials. Serum, ascitic and pleural fluids, and urine are deproteinized with methanol, supernatant is evaporated, residue is redissolved in the eluent, lipids are removed with carbon tetrachloride, and an aliquot of the aqueous layer injected into the chromatograph. Ethylglyoxal-bis(guanylhydrazone) (Ethyl-G) is the internal standard. The mobile phase is a mixture of an aqueous buffer (containing 0.004 M heptane and pentane sulfonic acid, 90%:10%, buffered to pH 3.5) and methanol (68%:32%). The ion-pair complex is retained on a micro Bondapak C18 column, eluted with a flow of 2.0 mL/min. Absorbance is measured at 280 nm. Detectability: 30 ng/mL (0.11 micro M) in serum, ascitic and pleural fluids, 300 ng/mL (1.1 micro M) in urine. Calibration curves (peak height ratios of Methyl-G/Ethyl-G plotted against known drug concentrations) were linear in the 0.1-30 microg/mL range. Correlation coefficinets were 0.999; coefficients of variation for reproducibility were less than 5%. Residual blood levels of Methyl-G persist for several days. Methyl-G was found to pass into ascitic fluid.

Predilection of occlusive disease for the left iliac artery

Eighty-six consecutive patients operated on for atherosclerotic occlusion of the aortoiliac segment were examined regarding the severity of the disease in the left or right iliac arteries. Sixty-nine percent of 78 patients were found to have predominantly more severe lesions on the left side. A study of the geometric anatomy of the aortoiliac region in 14 male and 12 female cadavers revealed that the right common iliac take-off angle was wider than the left and the radius of curvature of the right osculating circle at the aortoiliac bifurcation was smaller than the left, with the asymmetry of the region being much more marked in males than in females. The predilection of occlusive disease for the left iliac artery is explained on the basis of these differences in local geometric anatomy and their effect on the local hemodynamics.

Hepatitis with Australia antigenemia following renal transplantation

Over a seven-year period 18 of 125 patients who underwent renal transplantation developed hepatitis. Acute hepatic necrosis occurred in two, chronic aggressive hepatitis progressing to posthepatitic cirrhosis in eight, chronic persistent hepatitis in five, acute hepatitis with recovery in two and cholestatic hepatitis in one. Hepatic failure was the cause of death in four and a major contributing factor in three. Fifteen of the 18 were of blood Group A. After renal transplantation Australia antigen (Au) was present in the blood of 12 of the 15 patients with hepatitis who were tested and in one of 38 patients without clinical evidence of liver disease. Once present, Au persisted in all patients but one. Particles measuring 210 to 250 A, characteristic of Au, were seen in liver cells by electronmicroscopy in nine of the 10 patients examined who had hepatitis with Australia antigenemia, but they were not seen in the two patients studied with Au-negative hepatitis.