Alignment outcomes in navigated total knee arthroplasty: a meta-analysis.

PURPOSE: Whether navigated total knee arthroplasty can improve the limb and component alignment is a matter of debate. This systematic literature review analyzed the differences on alignment outcomes between navigated total knee arthroplasty and conventional total knee arthroplasty. METHODS: Multiple databases, online registers of randomized controlled trials were searched. Published and unpublished randomized controlled trials were included, and data on methodological quality, population, intervention, and outcomes were abstracted in duplicate. Data were pooled across studies, and odds ratios for categorical outcomes were calculated according to study sample size. RESULTS: Twenty-one randomized controlled trials of varying methodological quality involving 2,414 patients were included. Statistically significant differences were observed between navigated group and conventional group in mechanical axis malalignment of >3° (odds ratio, 0.26; 95% confidence interval, 0.17-0.38) and mechanical axis malalignment of >2° (odds ratio, 0.33; 95% confidence interval, 0.26-0.42). Navigated group had a lower risk of malalignment for both coronal femoral component and coronal tibial component of >3° and >2°. Both sagittal femoral component alignment and tibial slope showed statistical significance in favor of navigated arthroplasty at >2° and 3° malalignment. CONCLUSION: Meta-analysis indicates significant improvement in alignment of the limb and the component position with use of computer navigation system. Its clinical benefits are unclear and remain to be defined on a larger scale randomized controlled trials with long-term follow-up. LEVEL OF EVIDENCE: Therapeutic study (Systematic review of Level-I studies with inconsistent results), Level II.

Optimal BMI cutoff points in obesity screening for Chinese college students.

Objective: An accurate BMI classification system specific to the population is of great value in health promotion. Existing studies have shown that the BMI recommended cut-off value for adults is not suitable for college students. Thus, the current study aims to identify optimal BMI cutoff points in obesity screening for Chinese college students. Methods: Anthropometric assessments were performed on 6,798 college students (Male = 3,408, Female = 3,390) from three universities in Jiangsu, China. Exploratory factor analysis (EFA) was conducted to establish the standardized models to estimate anthropometry for male and female students. Further indices were derived from the assessments, including body mass index (BMI), relative fat mass (RFM), obesity degree percentage (OBD%), waist-to-hip ratio (WHR), waist circumference (WC), and body fat percentage (BF%). The anthropometric index with the highest correlation to the models for male and female students were selected as the gold standard for obesity screening. Receiver operating characteristic (ROC) curve was applied to evaluate diagnostic value of each anthropometric index according to the area under curve (AUC). Youden index maximum points determined the optimal cutoff points with the highest accuracy in obesity screening. Results: The anthropometric models for both male and female students consisted of three factors. Vervaeck index was selected as the gold standard for obesity screening. By comparing AUC of the anthropometric indices, we found BMI provided the highest value in obesity screening. Further analysis based on Youden index identified the optimal BMI of 23.53 kg/m2 for male and 23.41 kg/m2 for female. Compared with the universal standard recommended by World Health Organization (WHO), the adjusted BMI criteria were characterized by high sensitivity as well as specificity. Conclusion: BMI is the most appropriate anthropometric index of obesity screening for Chinese college students. The optimal cutoff points were lower than the WHO reference. Evidence substantiated the adjusted BMI criteria as an effective approach to improve accuracy of obesity screening for this population.

Programmable two-dimensional nanocrystals assembled from POSS-containing peptoids as efficient artificial light-harvesting systems.

Inspired by the formation of hierarchically structured natural biominerals (e.g., bone and tooth), various sequence-defined polymers have been synthesized and exploited for design and synthesis of functional hybrid materials. Here, we synthesized a series of organic-inorganic hybrid peptoids by using polyhedral oligomeric silsesquioxane (POSS) nanoclusters as side chains at a variety of backbone locations. We further demonstrated the use of these hybrid peptoids as sequence-defined building blocks to assemble a new class of programmable two-dimensional (2D) nanocrystals. They are highly stable and exhibit an enhanced mechanical property and electron scattering due to the incorporated POSS nanoclusters. By varying peptoid side-chain chemistry, we further demonstrated the precise displacement of a large variety of function groups within these 2D nanocrystals and developed a highly efficient aqueous light-harvesting system for live cell imaging. Because these 2D nanocrystals are biocompatible and highly programmable, we expect that they offer unique opportunities for applications.

Veterans Health Administration and Indian Health Service: healthcare utilization by Indian Health Service enrollees.

BACKGROUND: The Veterans Health Administration (VHA) and Indian Health Service (IHS) have executed an agreement to share resources to improve access and health outcomes for American Indian and Alaska Native (AIAN) veterans. OBJECTIVES: To describe the extent of dual use, health needs, and utilization patterns for IHS-enrollees served by VHA and IHS. Our objective is to fill those gaps in knowledge to inform strategic planning between these federal agencies. METHODS: Secondary data analysis of linked and merged VHA and IHS centralized administrative data from FY02 and FY03. RESULTS: Of 64,746 IHS enrollees who used VHA and/or IHS, 25% accessed care at both healthcare organizations, whereas most used either the VHA (28%) or the IHS (46%). The proportion of dual users varied markedly by state. Like all other VHA users, these AIAN veterans have the same 3 most frequent diagnoses associated with healthcare encounters: posttraumatic stress disorder, hypertension, and diabetes. VHA-IHS dual users were more likely to receive primary care from IHS and to receive diagnostic and behavioral healthcare from VHA. Many dual users who had been diagnosed with diabetes, hypertension, and/or cardiovascular disease received overlapping attention in VHA and IHS. CONCLUSIONS: Strategies to improve outcomes for AIAN veterans should target those receiving care in both systems and include information sharing or coordination of clinical care to reduce the potential for duplication and for treatment conflicts. Strategies to improve access may differ regionally.

Regulatory Tweak/Fn14 signaling pathway as a potent target for controlling bone loss.

Metabolic bone diseases, such as rheumatoid arthritis (RA) and osteoporosis, are characterized as imbalance between bone formation and bone resorption, leading to bone microarchitecture damage and bone mineral density loss. Bone loss is huge threat for older people's health, which imposes a heavy financial burden on patients and their families. However, the effectiveness of bone loss treatment in clinical practice is limited. With the understanding of the molecular and cellular regulators and mediators of bone remodelling, we know that some signaling pathways and inflammatory cytokines play important roles in the development of RA and osteoporosis. The increasing evidence showed that tumor necrosis factor (TNF)-like weak inducer of apoptosis (Tweak)/fibroblast growth factor-inducible 14 (Fn14) signalling controls a variety of cellular activities in biological processes, such as proliferation, differentiation, and apoptosis and has diverse biological functions in pathological mechanisms like inflammation that are associated with the process of bone metabolism. Recent studies suggest that the interactions between Tweak/Fn14 play critical roles in osteoblast and osteoclast differentiation and apoptosis, especially in those rheumatoid arthritis patients. These findings suggest that interventions targeting Tweak/Fn14 signaling pathway to regulate osteoblast-osteoclast coupling according to its biological effects, which results in promoting osteoblast formation and inhibiting osteoclast resorption, may be a promising approach for bone loss prevention and treatment in the near future.

[Topical injection and systemic application of glucocorticoids in the treatment of idiopathic sudden sensorineural hearing loss by type].

OBJECTIVE: To investigate the therapeutic effect of topical corticosteroids injection and systemic application in the treatment of typing idiopathic sudden sensorineural hearing loss (ISSNHL). METHODS: Total of 438 patients with ISSNHL, including 76 with hearing loss in low-middle frequencies, 43 in middle-high frequencies, 162 in all frequencies and 157 in total deafness, were randomly divided into two groups, the systemic application group: dexamethasone (DEX) was applied by intravenous injection in dose of 10 mg×3 d followed by 5 mg×4 d, and the topical injection group: methylprednisolone sodium succinate of 40 mg was injected into cortical bone of mastoid region every three days. According to the results of pure-tone threshold audiometry, the curative effect among ISSNHL with low-middle frequencies, middle-high frequencies, all frequencies hearing loss, and total deafness were evaluated. SPSS 18.0 software was used to analyze the data. RESULTS: Among 220 patients with systemic application of DEX, 66 subjects (30.0%) cases were recovery, 51 (23.2%) were excellent better, 39 (17.7%) better, 64 (29.1%) were poor, and the total effective rate was 70.9% (156/220) . There was no statistical difference in total effective rate of four typing subgroups (χ(2) = 1.60, P > 0.05). And the recovery rate in total deafness subgroup was significant lower than that in low-middle and all frequencies subgroups (χ(2) = 10.63 and 15.94 respectively, both P < 0.05). In the topical injection group, the recovery rate was 30.3% (66 cases), excellent better 18.8% (41), better 15.6% (34), poor 35.3% (77), and the total effective rate was 64.7% (141/220) . There were statistical differences of total effective rate in low-middle frequencies in comparison with that in all frequencies (χ(2) = 8.38) and total deafness (χ(2) = 7.28) subgroups (both P < 0.05). Regarding recovery rate, there were significant differences between each two typing subgroups, except middle-high frequencies subgroup vs. all frequencies (χ(2) = 1.60) and total deafness (χ(2) = 2.29) subgroups (both P < 0.05). In 76 ISSNHL with hearing loss in low-middle frequencies, the recovery rate in cases with local corticosteroids injection(65.0%) was significantly increased in comparison with that with systemic application (41.7%), χ(2) = 4.15, P < 0.05. There were increasing tendencies of curative effect in other three typing groups by systemic corticosteroids application when compared with local injection, but no statistical significances (all P > 0.05). CONCLUSIONS: For low-middle frequencies ISSNHL, the corticosteroids administration of local injection should be the optimization. Systemic application would be applied for middle-high frequencies, all frequencies and total deafness.