No difference in clinical outcome, pain, and range of motion between fixed and mobile bearing Attune total knee arthroplasty: a prospective single-center trial.

BACKGROUND: Despite numerous scientific investigations, the tribological advantages of mobile bearing inserts have not been sustainably confirmed or refuted for modern knee prostheses in clinical studies. The purpose of this study was to compare fixed and mobile bearing inserts in order to draw conclusions regarding clinical benefits. METHODS: The present prospective single center cohort study of 2 non-randomized stratified groups consisted of 67 patients. All included patients received cemented total knee arthroplasty (Attune®) due to osteoarthritis. 34 patients were treated with a mobile and 33 patients with a fixed insert. The WOMAC score and the Visual Analogue Scale was used for the subjective assessment of success, while the Knee-Society-Score was used considering the Range of Motion for the objective assessment. The subjective and the clinical scores showed improvements for both compared groups postoperatively at 2 years of minimum follow-up. RESULTS: The overall postoperative results of the WOMAC score, the Knee-Society-Score and the Visual Analogue Scale presented no statistically difference between the compared groups (p > 0,05). The postoperative ROM showed a superior improvement of 13.2° ± 18.4° in the mobile-bearing group versus 4.9° ± 18.4° (p = 0.017) in the fixed-bearing group. The flexion of the knee joint was 114° ± 10.1° for the mobile-bearings and 109.2° ± 7.2° for fixed bearings (p = 0.012). CONCLUSION: According to the findings, both inserts showed overall promising postoperative results, in terms of objective as well as subjective parameters, without clinically relevant significant differences, except for ROM, which was superior in the mobile bearing group. The present clinical trial has been registered at the ISRCTN registry with the reverence number ISRCTN15117998 on 04/04/2022.

Mid-term results show no significant difference in postoperative clinical outcome, pain and range of motion between a well-established total knee arthroplasty design and its successor: a prospective, randomized, controlled trial.

PURPOSE: The purpose of this study was to compare the clinical and functional outcome scores following total knee arthroplasty (TKA) with two different systems. The hypothesis was that there is a difference between patients receiving the newer design than those receiving the predecessor. METHODS: Two hundred patients who underwent TKA were randomized into two groups: patients received either Attune TKA or PFC Sigma (both DePuy Synthes, Warsaw, IN). Clinically, the Knee Society Knee and Function Scores (KS and FS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Range of Motion (ROM) and Visual Analogue Scale (VAS) were evaluated and compared between the groups 2 years after surgery. 158 patients (80 in the Attune group and 78 in the PFC Sigma group) were available for follow-up. RESULTS: Through bivariate analysis using parametric and non-parametric statistical tests, no significant differences in postoperative KS, FS, WOMAC, ROM or VAS between the two groups were detected. Both groups significantly improved regarding all evaluated endpoints 2 years after surgery. CONCLUSIONS: In the current study population, no difference in clinical outcome between the two systems was found. The expected benefits of design modifications could not be observed in clinical outcome scores 2 years postoperatively. Both designs are effective options for improving pain and function in end-stage osteoarthritis. LEVEL OF EVIDENCE: I.

Malnutrition as predictor of poor outcome after total hip arthroplasty.

INTRODUCTION: The aim of this study was to assess the prevalence of protein energy malnutrition (PEM) and correlation with poor post-operative outcome in the elderly undergoing primary total hip arthroplasty (THA). HYPOTHESIS: Patients with PEM would have inferior post-operative outcome after THA. MATERIALS AND METHOD: We retrospectively evaluated the nutritional status of 220 hospitalized patients undergoing THA, 65 years and older. PEM was assessed using serum albumin and total lymphocyte count (TLC). Studied outcome parameters were length of pre-operative and post-operative stay, complications up to six months after surgery and 12-month mortality. Clinical and demographic data were retrieved from medical records from the hospital database. RESULTS: The prevalence of PEM among patients undergoing THA was 12.3% (27/220). Patients with PEM were significantly older (mean age 81.3 ± 7.0, p < 0.001), had a lower BMI (24.7 ± 4.1 kg/m 2, p = 0.022), and showed more comorbid conditions (mean CCI 2.8 ± 2.0, p = 0.002) compared with well-nourished patients (age 75.6 ± 6.2, BMI 26.8 ± 4.3 kg/m 2, CCI: 1.7 ± 1.7). Length of pre-operative stay differed significantly (p < 0.001) between PEM (median 7, range 1-36 days) and non PEM (median 1, range 1-22 days). In the PEM group, 12 (44.4%) patients had post-operative complications within six months after OP and 15 (7.8%) patients in the non PEM group (HR = 6.3, 95% CI 1.7-23.1). CONCLUSION: We observed a higher post-operative complication rate for malnourished patients undergoing elective THA. These results underline the importance of pre-operative nutritional assessment in the elderly. Therefore, serum albumin and TLC are valuable clinical markers of PEM and the post-operative outcome.

Excellent mid-term osseointegration and implant survival using metaphyseal sleeves in revision total knee arthroplasty.

PURPOSE: Metaphyseal fixation in revision total knee arthroplasty (RTKA) is a very promising treatment option for extended bone defects. Currently published mid-term results remain limited. The purpose was to analyse the implant durability, the clinical and the radiological mid-term results in RTKA when using metaphyseal sleeves. METHODS: Clinical and radiological follow-up examinations were performed in 92 patients (93 knees) with RTKA using hybrid fixation technique (cementless sleeves and stem). Radiographic measurements regarding osseointegration at the bone-sleeve interface were performed and the range of motion (ROM), a subjective satisfaction score (SSS), the American Knee Society Score (KSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as well as the SF-36 Health survey were examined. Bone defects were analysed using the Anderson Orthopaedic Research Institute (AORI) classification. RESULTS: No knee had to be revised due to aseptic loosening at the time of the follow-up (mean 6.3 years ± 2.3, minimum 2 years). Satisfactory radiographic osseointegration at the sleeve/bone interface was detected in 96.1% of cases. 17 knees (18.2%) had to be re-revised, 15 of them due to a recurrent infection and 2 due to aseptic reasons (mediolateral instability and a periprosthetic fracture). The median of the ROM (96°), SSS (8), KSS (87), WOMAC (9), SF-36 MCS (55) and SF-36 PCS (38) showed very satisfying results. CONCLUSION: No case of aseptic loosening was found in this large series of RTKA with extended bone defects using metaphyseal sleeve fixation. In this large retrospective series, it has been shown that this technique is an excellent treatment option for extended bone defects in RTKA surgery. LEVEL OF EVIDENCE: Retrospective cohort study, level III.

Similar revision rates in clinical studies and arthroplasty registers and no bias for developer publications in unicompartmental knee arthroplasty.

PURPOSE: Our aim was to assess the outcome with respect to cumulative revision rates of unicompartmental knee arthroplasty (UKA) by comparing published literature and arthroplasty registry data. Our hypothesis was that there is a superior outcome of UKA described in dependent clinical studies compared to independent studies or arthroplasty registers. METHODS: A systematic review of all clinical studies on UKA in the past decade was conducted with the main endpoint revision rate. Revision rate was calculated as "revision per 100 component years (CY)". The respective data were analysed with regard to a potential difference of the percentage of performed revision surgeries as described in dependent and independent clinical studies. Clinical data were further compared to arthroplasty registers in a systematic search algorithm. RESULTS: In total, 48 study cohorts fulfilled our inclusion criteria and revealed 1.11 revisions per 100 CY. This corresponds to a revision rate of 11.1% after 10 years. No deviations with regard to revision rates for UKA among dependent and independent clinical literature were detected. Data from four arthroplasty registers showed lower survival rates after 10 years compared to published literature without being significant. CONCLUSIONS: The outcomes of UKA in dependent and independent clinical studies do not differ significantly and are in line with arthroplasty register datasets. We cannot confirm biased results and the authors recommend the use of UKAs in properly selected patients by experts in their field.

Greater activity, better range of motion and higher quality of life following unicompartmental knee arthroplasty: a comparative case-control study.

PURPOSE: The purpose of this study was to provide a matched cohort comparison of clinical and functional outcome scores, range of motion and quality of life following unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). The hypothesis was that patients receiving UKA report better results than comparable patients who receive conventional TKA. METHODS: Clinical and functional results of 35 patients with medial end-stage osteoarthritis who had received a fixed-bearing UKA were compared with the results of 35 matched patients who had received a TKA from the same manufacturer by the same surgeon. Outcome scores were measured before surgery and at final follow-up using Tegner Activity Scale (TAS), range of motion (ROM) and Short Form 36 Health Survey (SF-36). The Knee Society Score (KSS) was assessed at final follow-up. The mean observation period was 2.3 years in both groups. RESULTS: The preoperative knee scores had no statistically significant differences between the two groups. Postoperatively, however, UKAs performed significantly better regarding TAS and ROM (4 vs. 3 and 118.4 vs. 103.7, respectively). The results of the SF-36 showed significantly better results for the UKA group in the mental component summary score and in the subscale of social function. CONCLUSIONS: The present study suggests that UKA is associated with higher activity level, higher quality of life, and greater ROM when compared with TKA on comparable patients. Prolonged clinical follow-up in a larger patient cohort with a randomised-controlled study design would be beneficial to confirm these findings. LEVEL OF EVIDENCE: III.

Septic Revision Total Knee Arthroplasty: Treatment of Metaphyseal Bone Defects Using Metaphyseal Sleeves.

BACKGROUND: Bone loss is a severe problem in septic revision total knee arthroplasty (RTKA). The use of porous coated metaphyseal sleeves is a promising treatment option for metaphyseal bone defects. The currently published midterm results remain limited and no study has been focused exclusively on septic cases. Our aim was to determine the implant survivorship (with special focus on osseointegration) and the clinical and radiological midterm outcome of metaphyseal sleeve fixation in septic RTKA surgery (minimum follow-up of 2 years). METHODS: We performed a clinical and radiographic examination of 56 patients with a history of prosthetic joint infection who underwent 2-stage RTKA with the use of porous coated metaphyseal sleeves. These examinations included evaluation of the American Knee Society Score, the Western Ontario and McMaster Universities Osteoarthritis Index, the Short Form (SF-36) Health survey as well as radiographic measurement to determine whether successful osseointegration had been achieved. RESULTS: Nine patients (16%) had to be re-revised at the time of follow-up (mean, 5.3 years; range, 2-11.2), all due to reinfection. We did not encounter any cases of aseptic loosening. The mean range of motion (92°, SD ± 21°), subjective satisfaction score (7, SD ± 2), American Knee Society Score (76, SD ± 19), Western Ontario and McMaster Universities Osteoarthritis Index (70, SD ± 20), SF-36 mental component summary (55, SD ± 14), and SF-36 physical component summary (35, SD ± 9) have shown satisfying results. CONCLUSION: Metaphyseal sleeves have shown very promising midterm results regarding clinical scores, osseointegration, and aseptic loosening. Our results are the first analyzing exclusively septic indications and indicate that they are a reliable fixation option in all bone defect types in septic RTKA patients.

MicroRNA-26 family is required for human adipogenesis and drives characteristics of brown adipocytes.

Adipose tissue contains thermogenic adipocytes (i.e., brown and brite/beige) that oxidize nutrients at exceptionally high rates via nonshivering thermogenesis. Its recent discovery in adult humans has opened up new avenues to fight obesity and related disorders such as diabetes. Here, we identified miR-26a and -26b as key regulators of human white and brite adipocyte differentiation. Both microRNAs are upregulated in early adipogenesis, and their inhibition prevented lipid accumulation while their overexpression accelerated it. Intriguingly, miR-26a significantly induced pathways related to energy dissipation, shifted mitochondrial morphology toward that seen in brown adipocytes, and promoted uncoupled respiration by markedly increasing the hallmark protein of brown fat, uncoupling protein 1. By combining in silico target prediction, transcriptomics, and an RNA interference screen, we identified the sheddase ADAM metallopeptidase domain 17 (ADAM17) as a direct target of miR-26 that mediated the observed effects on white and brite adipogenesis. These results point to a novel, critical role for the miR-26 family and its downstream effector ADAM17 in human adipocyte differentiation by promoting characteristics of energy-dissipating thermogenic adipocytes.

Health-related quality of life after TAPP repair for the sportsmen's groin.

BACKGROUND: Sportsmen's groin (SG) is a clinical diagnosis of chronic, painful musculotendinous injury to the medial inguinal floor in the absence of a groin hernia. Long-term results for laparoscopic inguinal hernia repair, especially data on health-related quality of life (HRQOL), are scant and there are no available data whatsoever on HRQOL after SG. The main goal of this study was to compare postoperative QOL data in the long term after transabdominal preperitoneal hernioplasty (TAPP) in groin hernia and SG patients with QOL data of a normal population. METHODS: This study included all patients (n = 559) who underwent TAPP repair between 2000 and 2005. Forty seven patients (8.4 %) were operated on for SG. We sent out the Short Form 36 Health Survey (SF-36) questionnaire for QOL evaluation. QOL data were compared with data from an age- and sex-matched normal population. RESULTS: Ultimately, 383 completed questionnaires were available for evaluation (69 % response rate). The mean follow-up time was 94 ± 20 months. In the SG group there were statistically significant differences in three subscales of the SF-36 and the mental component summary measure, showing better results for the SG group compared to the sex- and age-matched normal group data. There were no statistically significant differences between groin hernia patients and the sex- and age-matched normal population. CONCLUSION: TAPP repair for SG as well as groin hernia results in good HRQOL in the long term. Results for SG patients are comparable with QOL data of a normal population or even better.

Quality of life after volar locked plating: a 10-year follow-up study of patients with intra-articular distal radius fractures.

BACKGROUND: This study aimed to present functional results and patient's health related quality of life (HRQOL) data ten years after volar locked plate fixation (VPF) of unstable intra-articular distal radial fractures (DRF). METHODS: Thirty-nine patients with a mean age of sixty-one years were operatively treated with VPF after intra-articular distal radial fractures. They were evaluated two, six, and ten years postoperatively according to the Gartland and Werley score. For subjective evaluation the Short Form 36 (SF-36) and the Disability of Arm, Shoulder and Hand (DASH) questionnaires were adopted. RESULTS: Overall, wrist function did not differ significantly two, six and ten years after the operation. Over 90% patients achieved "good" or "excellent" results ten years after surgery according to the Gartland and Werley score. Ten years postoperatively the results of the SF 36 did not differ significantly from the two- and six-year follow-up. Overall findings from the SF-36 did not differ significantly from the data of Austrian and American norm populations. Only in the subscale of mental health (MH) the ten-year follow-up did show significantly poorer results (p = 0.045) compared to the Austrian norm population. The median DASH scores did not show significant differences during the ten-year follow-up period. CONCLUSION: The ten-year results of this single-center study suggest that operative treatment of intra-articular DRF with volar locked plates is a useful and satisfactory therapy option, both in terms of function and HRQOL.

Prosthetic joint infection following total hip replacement: results of one-stage versus two-stage exchange.

PURPOSE: Prosthetic hip joint infection remains a challenging socio-economic problem. Curative treatment is usually a one- or two-stage revision surgery, but neither of these options has yet emerged as the treatment of choice. The aim of this study was to evaluate which of these methods produced superior outcomes. METHODS: A retrospective study was performed including 92 patients with deep infections after implantation of primary total hip arthroplasty (THA) who had undergone either one-stage or two-stage revision surgery at a single centre. Infections were classified according to McPherson and we evaluated the rate of persisting infection or reinfection after surgical intervention. RESULTS: The two-stage revision surgery revealed superior outcomes for the analysed infection categories compared to the one-stage procedure except for the least serious category of infections (i.e. McPherson Stage I/A/1, early postoperative infection, no systemic comorbidities, local status uncompromised). Eradication of prosthetic infection was achieved in 94.5 % (n = 52) within the group of two-stage exchange, and 56.8 % (n = 21) of patients treated with a one-stage procedure. Outcome of patients following a one-stage or a two-stage exchange was overall significantly different with p < 0.001. Further deviations between the described two procedures were noted in the subgroups following the classification described by McPherson. CONCLUSIONS: Our results indicate superiority of two-stage revision surgery in case of serious infections. The authors believe that decisions on the surgical approach for the treatment of deep prosthesis infections should be made on the basis of standardized staging systems.

Increased Early Postoperative Complication Rate after Osteoporotic Hip Fracture in Patients with Low 25 (OH) Vitamin D Levels.

This study investigated the association of preoperative 25-hydroxy (25 (OH)) vitamin D levels with postoperative complications in osteoporotic hip fracture patients following surgery. We hypothesized that patients with low concentrations of 25 (OH) vitamin D might have an increased risk of developing adverse outcomes. Between January 2019 and December 2020, a retrospective observational study was conducted, including low-energy fragility fractures at the proximal femur. Regarding preoperative 25 (OH) vitamin D levels, patients were divided into two groups (<30 ng/mL and ≥30 ng/mL). Early and late postoperative complications were assessed and graded according to the Clavien-Dindo classification system. Logistic regression analysis was performed to demonstrate the association between preoperative 25 (OH) vitamin D levels (<30 ng/mL, ≥30 ng/mL) and postoperative complications after adjusting for age and sex. Of 314 patients, 222 patients (70.7%) had a 25 (OH) vitamin D level of <30 ng/mL. The mean serum 25 (OH) vitamin D level was 22.6 ng/mL (SD 13.2). In 116 patients (36.9%), postoperative complications were observed, with the most occurring in the short term (95 patients, 30.2%). Late postoperative complications were present in 21 patients (6.7%), most graded as Clavien I (57.1%). Logistic regression analysis identified a low vitamin D level (<30 ng/mL) as an independent risk factor for early postoperative complications (OR 2.06, 95% CI 1.14-3.73, p = 0.016), while no significant correlation was found in late complications (OR 1.08, 95% CI 0.40-2.95, p = 0.879). In conclusion, preoperative 25 (OH) vitamin D serum level might be an independent predictor for early postoperative complications. However, future studies are warranted to determine risk factors for long-term complications and establish appropriate intervention strategies.

Inter-patient heterogeneity in the hepatic ischemia-reperfusion injury transcriptome: Implications for research and diagnostics.

Cellular responses induced by surgical procedure or ischemia-reperfusion injury (IRI) may severely alter transcriptome profiles and complicate molecular diagnostics. To investigate this effect, we characterized such pre-analytical effects in 143 non-malignant liver samples obtained from 30 patients at different time points of ischemia during surgery from two individual cohorts treated either with the Pringle manoeuvre or total vascular exclusion. Transcriptomics profiles were analyzed by Affymetrix microarrays and expression of selected mRNAs was validated by RT-PCR. We found 179 mutually deregulated genes which point to elevated cytokine signaling with NFκB as a dominant pathway in ischemia responses. In contrast to ischemia, reperfusion induced pro-apoptotic and pro-inflammatory cascades involving TNF, NFκB and MAPK pathways. FOS and JUN were down-regulated in steatosis compared to their up-regulation in normal livers. Surprisingly, molecular signatures of underlying primary and secondary cancers were present in non-tumor tissue. The reported inter-patient variability might reflect differences in individual stress responses and impact of underlying disease conditions. Furthermore, we provide a set of 230 pre-analytically highly robust genes identified from histologically normal livers (<2% covariation across both cohorts) that might serve as reference genes and could be particularly suited for future diagnostic applications.

Effects of intra- and post-operative ischemia on the metabolic profile of clinical liver tissue specimens monitored by NMR.

Metabolomic profiles of tissues could greatly contribute to advancements in personalized medicine but are influenced by differences in adopted preanalytical procedures; nonhomogeneous pre- and post-excision ischemia times are potential sources of variability. In this study, we monitored the impact of ischemia on the metabolic profiles, acquired with high-resolution magic-angle-spinning (1)H NMR, of 162 human liver samples collected during and up to 6 h after routine surgery. The profiles changed significantly as a function of intraoperative warm ischemia (WI) and postresection cold ischemia (CI) time, with significant variations in the concentration of the same 16 metabolites. Therefore, a tight control of the preanalytical phase is essential for reliable metabolomic analyses of liver diseases. The NMR profiles provide a reliable "fingerprint" of ischemia and have predictive value: the best-performing predictive models are found to discriminate extreme time points of CI (0' vs 360 ') in the training set with cross-validation accuracy of ~90%; samples in the validation cohort can discriminate short (≤60') from long (≥180') CI with an accuracy of ~80%. For WI, the corresponding figures are 95.6 and 92%, respectively. Therefore, ischemia NMR profiles might become a tool for tissue quality control in biobanks.

Novel biomarkers to detect infection in revision hip and knee arthroplasties.

BACKGROUND: A periprosthetic joint infection is one of the most challenging complications associated with THA and TKA. In the diagnostic process for detecting a periprosthetic joint infection, one of the most important steps is analysis of laboratory infection biomarkers. QUESTIONS/PURPOSES: We investigated the sensitivity and specificity of the biomarkers procalcitonin, interleukin 6 (IL-6), and interferon α (IFN-α) as compared with conventional biomarkers (C-reactive protein [CRP], leukocyte level) for a periprosthetic joint infection associated with revision arthroplasties. METHODS: We prospectively included and analyzed 84 patients (124 revision arthroplasties). The blood parameters of interest were procalcitonin, IL-6, IFN-α, leukocyte level, and CRP. Samples were taken preoperatively and on the first, third, and seventh postoperative days. The sensitivity and specificity of these biomarkers then were calculated. RESULTS: Considering the preoperative values of 84 patients (124 operations), procalcitonin, IL-6, CRP, and leukocyte level correlated with periprosthetic joint infection, whereas IFN-α did not. A procalcitonin cut-off level of 0.35 ng/mL revealed a sensitivity of 80% and specificity of 37%. An IL-6 cut-off level of 2.55 pg/mL had a sensitivity of 92% and specificity of 59%. CONCLUSIONS: In this study procalcitonin and IL-6 were helpful for detecting periprosthetic joint infections in revision arthroplasties, although CRP generally was superior. Procalcitonin and IL-6 may be considered adjuvant tests when the diagnosis of a periprosthetic joint infection is in doubt. This study showed, in addition to conventional biomarkers such as CRP and leukocyte level, procalcitonin and IL-6 were helpful for detecting infections associated with revision arthroplasties.

[Sterile puncture of large joints]. / Sterile Punktion großer Gelenke.

OBJECTIVE: Puncture of large joints is performed for diagnostic purposes on the one hand and for the treatment of joint pathologies on the other. Puncture can be used for rapid pain relief by relieving effusions or intra-articular hematomas. The obtained puncture specimen allows immediate visual assessment and subsequent microscopic-cytological and microbiological evaluation in the laboratory. INDICATIONS: The indication for puncture of a large joint is for diagnosis and/or therapy of inflammatory, traumatic or postoperative joint problems. Diagnostic punctures are used to obtain punctate, to differentiate the location of pain or (rarely) to apply contrast medium for magnetic resonance arthrography. Therapeutic punctures allow the injection of drugs or platelet-rich plasma (PRP) as well as the relief or drainage of effusions. CONTRAINDICATIONS: If there are inflammatory skin alterations-especially purulent inflammation-joint punctures through these lesions are absolutely contraindicated. Special attention is necessary if the patients are on anticoagulants. SURGICAL TECHNIQUE: Absolute sterile handling is mandatory. Unnecessary pain can be avoided by a sterile skin wheal of local anesthesia, safe puncture points, and careful handling of the cannulas. POSTOPERATIVE MANAGEMENT: Joint aspiration material has to be handled according to the local, intrahospital rules in a timely manner. Puncture sites are covered with sterile dressings, and if intra-articular medication is administered, the joints have to be passively moved through the range of motion to distribute the medication. Thereafter, compression therapy from distally to proximally while also covering the puncture site avoids recurrence of swelling or hematoma. FACTS: If sterile conditions are guaranteed, infections rarely occur (0.04-0.08%, 4-8/10,000 cases). The risk of false-positive detection of microorganisms is extremely low.

The Sinus Tract in Bone and Joint Infection: Minimally Invasive Salvation or Prolonged Suffering? A Multicenter Study.

This study assessed the quality of life (QOL) and the functional outcome in daily living in patients with a chronic, treatment-resistant periprosthetic joint infection (PJI) or osteomyelitis, living with a natural or iatrogenic sinus tract. METHODS: A follow-up examination in three national reference centers for septic bone and joint surgery was performed utilizing the Hospital Anxiety and Depression Scale (HADS-D/A), the Visual Analogue Scale (VAS), and the Short Form-36 (SF-36) score, including patients with a chronic sinus tract due to treatment-resistant PJI or osteomyelitis. RESULTS: In total, 48 patients were included, with a mean follow-up time of 43.1 ± 23.9 months. The mean SF-36 Mental Component Summary (MCS) was 50.2 (±12.3) and the Physical Component Summary (PCS) was 33.9 (±11.3). The mean HADS-D was 6.6 (±4.4) and HADS-A was 6.2 (±4.6), and the VAS was 3.4 (±2.6). The SF-36 MCS showed no significant differences between the study group and the standard population (47.0, p = 0.10), as well as the HADS-A. The PCS in the study population was significantly worse (50.0, p < 0.001), as was the HADS-D. CONCLUSIONS: A sinus tract represents a treatment option in selected cases with an acceptable QOL. The treatment should be considered for multimorbid patients with a high perioperative risk or if the bone or soft tissue quality prevents surgery.

The Impact of Obesity on the Health of the Older Population: A Cross-Sectional Study on the Relationship between Health-Related Quality of Life and Body Mass Index across Different Age Groups.

Obesity is strongly associated with mortality and morbidity, but there is a lack of data on its impact on health-related quality of life (HRQoL) across different age groups. Therefore, this study's objective was to determine the association between body mass index (BMI) and HRQoL in the Austrian adult population based on age groups using the 36-Item Short Form (SF-36) survey. METHODS: The SF-36 survey was sent to 500 randomly assigned Austrian adults (response rate: 80.6%). This study assessed HRQoL subscale and component scores based on gender, level of education, smoking status, and alcohol consumption in 403 participants. RESULTS: Increasing BMI is associated with a negative impact on all domains of physical health and social function. The study uncovered substantial variations in the impact of increasing BMI on HRQoL across different age groups, with a pronounced effect observed in the physical components, particularly among individuals aged 65-74. CONCLUSIONS: BMI is negatively associated with the physical aspects of HRQoL and social function, affecting various adult age groups differently. Consequently, our results emphasize assessing different age groups and possible influencing factors on HRQoL, such as BMI, for further optimization in designing prevention programs against obesity.

Hepatobiliary transporter expression and post-operative jaundice in patients undergoing partial hepatectomy.

BACKGROUND AND AIMS: Post-operative hyperbilirubinaemia in patients undergoing liver resections is associated with high morbidity and mortality. Apart from different known factors responsible for the development of post-operative jaundice, little is known about the role of hepatobiliary transport systems in the pathogenesis of post-operative jaundice in humans after liver resection. METHODS: Two liver tissue samples were taken from 14 patients undergoing liver resection before and after Pringle manoeuvre. Patients were retrospectively divided into two groups according to post-operative bilirubin serum levels. The two groups were analysed comparing the results of hepatobiliary transporter [Na-taurocholate cotransporter (NTCP); multidrug resistance gene/phospholipid export pump(MDR3); bile salt export pump (BSEP); canalicular bile salt export pump (MRP2)], heat shock protein 70 (HSP70) expression as well as the results of routinely taken post-operative liver chemistry tests. RESULTS: Patients with low post-operative bilirubin had lower levels of NTCP, MDR3 and BSEP mRNA compared to those with high bilirubin after Pringle manoeuvre. HSP70 levels were significantly higher after ischaemia-reperfusion (IR) injury in both groups resulting in 4.5-fold median increase. Baseline median mRNA expression of all four transporters prior to Pringle manoeuvre tended to be lower in the low bilirubin group whereas expression of HSP70 was higher in the low bilirubin group compared to the high bilirubin group. DISCUSSION: Higher mRNA levels of HSP70 in the low bilirubin group could indicate a possible protective effect of high HSP70 levels against IR injury. Although the exact role of hepatobiliary transport systems in the development of post-operative hyper bilirubinemia is not yet completely understood, this study provides new insights into the molecular aspects of post-operative jaundice after liver surgery.