Chitosan coated selenium: A versatile nano-delivery system for molecular cargoes.

The use of nanoscale delivery platforms holds tremendous potential to overcome the current limitations associated with the conventional delivery of genetic materials and hydrophobic compounds. Therefore, there is an imperative need to develop a suitable alternative nano-enabled delivery platform to overcome these limitations. This work reports the first one-step hydrothermal synthesis of chitosan functionalized selenium nanoparticles (Selenium-chitosan, SeNP) that are capable of serving as a versatile nanodelivery platform for different types of active ingredients. The chitosan functionalization modified the surface charge to allow the loading of active ingredients and improve biocompatibility. The effective loading of the SeNP was demonstrated using genetic material, a hydrophobic small molecule, and an antibiotic. Furthermore, the loading of active ingredients showed no detrimental effect on the specific properties (fluorescence and bactericidal) of the studied active ingredients. In vitro antimicrobial inhibitory studies exhibited good compatibility between the SeNP delivery platform and Penicillin G (Pen), resulting in a reduction of the minimum inhibitory concentration (MIC) from 32 to 16 ppm. Confocal microscopy images showed the uptake of the SeNP by a macrophage cell line (J774A.1), demonstrating trackability and intracellular delivery of an active ingredient. In summary, the present work demonstrates the potential of SeNP as a suitable delivery platform for biomedical and agricultural applications.

Selenium's Role in Neuroprotection Against Stroke-Induced Inflammation.

Acute ischemic stroke (AIS) incidence across the globe is on the rise, and the deleterious effects have not yet been improved with the use of current pharmaceuticals. Tissue plasminogen activator (tPA) has many risks and time constraints, making it difficult to use even as the standard treatment. Selenium deficiency and stroke incidence have a strong linear correlation among various populations. Using the ADME-Tox software, selenious acid absorption in brain cells, tissue, and interstitium was modeled under ischemic conditions to determine the bioavailability of selenium (Se) in the brain using various IV (intravenous) infusion doses. Additionally, we studied the cytotoxicity of selenious acid and selenourea on human dermal fibroblasts (HDF) and lung carcinoma cells (A549) to determine the overall growth and toxicity of different body cell lines to account for systemic side effects of IV infusion. Our data suggest that selenium can reach a dose-dependent concentration of 1.5µg/L or 250µg/L in brain cells within two hours of a one-time IV infusion, showing the ability to reach brain vasculature. Furthermore, cell viability can be maintained between 95% and 100% using 1nM and 0.5nM concentrations of selenious acid.

Reasons for antiretroviral switching in Colombia: A retrospective cohort study.

INTRODUCTION: Long-term use of antiretroviral therapy (ART) for HIV infection might lead to the necessity of switching regimens. We aimed to analyze the reasons for the ART switch, the time-to-switch of ART, and its associated factors in a Colombian cohort. METHODS: We conducted a retrospective cohort in 20 HIV clinics, including participants ≥18 years old with confirmed HIV infection who underwent an ART switch from January 2017 to December 2019 with at least 6 months of follow-up. A time-to-event analysis and an exploratory Cox model were performed. RESULTS: 796 participants switched ART during the study period. The leading cause of ART switch was drug intolerance (n = 449; 56.4%) with a median time-to-switch of 12.2 months. The longest median time-to-switch was due to regimen simplification (42.4 months). People ≥50 years old (HR = 0.6; 95% CI (0.5-0.7) and CDC stage 3 at diagnosis (HR = 0.8; 95% CI (0.6-0.9) had less hazard for switching ART over time. CONCLUSIONS: In this Colombian cohort, drug intolerance was the main cause of the ART switch, and the time-to-switch is shorter than reports from other countries. In Colombia, it is crucial to apply current recommendations for ART initiation to choose regimens with a better tolerability profile.

Randomized clinical trial comparing pericapsular nerve group (PENG) block and periarticular local anesthetic infiltration for total hip arthroplasty.

BACKGROUND: This randomized trial compared pericapsular nerve group block and periarticular local anesthetic infiltration in patients undergoing primary total hip arthroplasty. We hypothesized that, compared with pericapsular nerve group block, periarticular local anesthetic infiltration would decrease the postoperative incidence of quadriceps weakness at 3 hours fivefold (ie, from 45% to 9%). METHODS: Sixty patients undergoing primary total hip arthroplasty under spinal anesthesia were randomly allocated to receive a pericapsular nerve group block (n=30) using 20 mL of adrenalized bupivacaine 0.50%, or periarticular local anesthetic infiltration (n=30) using 60 mL of adrenalized bupivacaine 0.25%. Both groups also received 30 mg of ketorolac, either intravenously (pericapsular nerve group block) or periarticularly (periarticular local anesthetic infiltration), as well as 4 mg of intravenous dexamethasone.Postoperatively, a blinded evaluator carried out sensory assessment and motor assessment (knee extension and hip adduction) at 3, 6 and 24 hours. Furthermore, the blinded observer also recorded static and dynamic pain scores at 3, 6, 12, 18, 24, 36 and 48 hours; time to first opioid request; cumulative breakthrough morphine consumption at 24 hours and 48 hours; opioid-related side effects; ability to perform physiotherapy at 6, 24 and 48 hours; as well as length of stay. RESULTS: There were no differences in quadriceps weakness at 3 hours between pericapsular nerve group block and periarticular local anesthetic infiltration (20% vs 33%; p=0.469). Furthermore, no intergroup differences were found in terms of sensory block or motor block at other time intervals; time to first opioid request; cumulative breakthrough morphine consumption; opioid-related side effects; ability to perform physiotherapy; and length of stay. Compared with pericapsular nerve group block, periarticular local anesthetic infiltration resulted in lower static pain scores (at all measurement intervals) and dynamic pain scores (at 3 and 6 hours). CONCLUSION: For primary total hip arthroplasty, pericapsular nerve group block and periarticular local anesthetic infiltration result in comparable rates of quadriceps weakness. However, periarticular local anesthetic infiltration is associated with lower static pain scores (especially during the first 24 hours) and dynamic pain scores (first 6 hours). Further investigation is required to determine the optimal technique and local anesthetic admixture for periarticular local anesthetic infiltration. TRIAL REGISTRATION NUMBER: NCT05087862.

Cardiovascular risk factors and comorbidities in people living with HIV: A cross-sectional multicenter study from Colombia comorbidities in a Colombian PLWHIV population.

INTRODUCTION: HIV is an independent risk factor for cardiovascular diseases (CVD). There is insufficient information regarding comorbidities and cardiovascular risk factors in the Colombian HIV population. The aim of this study is to describe the prevalence of cardiovascular risk factors and comorbidities in patients from the HIV Colombian Group VIHCOL. METHODS: This is a multicenter, cross-sectional study conducted in the VIHCOL network in Colombia. Patients 18 years or older who had at least 6 months of follow-up were included. A stratified random sampling was performed to estimate the adjusted prevalence of cardiovascular risk factors and comorbidities. RESULTS: A total of 1616 patients were included. 83.2% were men, and the median age was 34 years. The adjusted prevalence for dyslipidemia, active tobacco use, hypothyroidism, and arterial hypertension was 51.2% (99% CI: 48.0%-54.4%), 7.6% (99% CI: 5.9%-9.3%), 7.4% (99% CI: 5.7%-9.1%), and 6.3% (99% CI: 4.8%-7.9%), respectively. CONCLUSIONS: In this Colombian HIV cohort, there is a high prevalence of modifiable CVD risk factors such as dyslipidemia and active smoking. Non-pharmacological and pharmacological measures for the prevention and management of these risk factors should be reinforced.

The role of anterior supra-acetabular external fixator as definitive treatment for anterior ring fixation in unstable pelvic fractures.

PURPOSE: Management of anterior ring injuries is still a matter of discussion, and there are only few studies reporting anterior external fixator as definitive treatment for unstable pelvic injuries. This study aimed to describe the clinical and radiological outcomes of a consecutive series of mechanically unstable pelvic injuries that were treated with definitive anterior supra-acetabular external fixator for the anterior ring, and to identify risk factors for failure. METHODS: We included a consecutive series of patients with unstable pelvic ring fractures who underwent anterior supra-acetabular external fixation for definitive treatment, between January 2012 and January 2020. All demographics, associated injuries and procedures, injury mechanism, and complications were analysed. Pelvic fracture was classified based on Orthopaedic Trauma Association/Tile AO (OTA/AO) and Young-Burgess classifications. Complications associated with the external fixator were revised. All patients were functionally evaluated at final follow-up and asked to report their clinical outcomes using the Majeed score. RESULTS: A total of 47 patients were included, of which 25 were females. The median age was 44 years (interquartile range 23-59). Median follow-up duration was 14 months (interquartile range 6-31). The most frequent aetiology was motor vehicle accident (35), followed by fall from height (8). All fractures required posterior pelvic ring fixation. The median time during which patients had external fixation in situ was 11 weeks (interquartile range 9-13). All patients achieved healing of pelvic fracture at median time of 10 weeks (interquartile range 8-12). At final follow-up, the median displacement of the anterior pelvis was 6 mm (interquartile range 0-11). Superficial infection was the most common complication (n = 7). No washout procedures were needed. No major complication was reported. No patient required reoperation for anterior ring fracture. The median Majeed score was 88 points (range 60-95; interquartile range 80-90) at final follow-up. CONCLUSION: Our findings suggest that the use of supra-acetabular external fixator is safe and effective for definitive treatment of the anterior ring in unstable pelvic fractures. It is a method with high proportion of excellent results, regardless of the type of fracture. The rate of complications is low, and it does not compromise functional results.

Impact of seawater desalination and wastewater treatment on water stress levels and greenhouse gas emissions: The case of Chile.

Many regions around the world are suffering from water stress, and desalinated water and recycled water are seen as alternatives for meeting the water demand. However, high energy consumption and associated greenhouse gas emissions are some of the main environmental impacts. This is notable for many arid and semi-arid countries where desalination and water recycling are considered options for ensuring water resources availability. This research presents the incorporation of the quantification of greenhouse gas emissions generated during the operation of desalination and wastewater treatment plants in the assessment of water stress levels using the water stress indicator adopted by the 2030 Agenda for Sustainable Development. Chile was chosen as a case study, as it is a country where there is a considerable difference between the availability of conventional water sources and the water demand, and the electrical grid is fed mainly by fossil fuels. The methodology proposed allows calculating the indirect greenhouse gas emissions due to electrical consumption for the operation of desalination and wastewater treatment plants, and the direct greenhouse gas emissions coming from biological processes used in wastewater treatment plants. The results showed that Chilean arid climate zones will not experience water stress in the future at the regional level, mainly because of the installation of several desalination plants by 2030. Meanwhile, recycled water from the urban sector will slightly contribute to the reduction in the level of water stress in almost all Chilean regions by 2030. Moreover, desalination and wastewater treatment plant will contribute only between 0.34% and 0.75% of total greenhouse gas emitted in Chile by 2030. Therefore, the operation of these industrial systems for facing water scarcity problems in northern and central zones of Chile is a suitable alternative because it does not generate large environmental problems.

Review of complications, functional outcome, and long-term survival following conversion of hip fusion to total hip arthroplasty.

AIMS: Improvements in functional results and long-term survival are variable following conversion of hip fusion to total hip arthroplasty (THA) and complications are high. The aim of the study was to analyze the clinical and functional results in patients who underwent conversion of hip fusion to THA using a consistent technique and uncemented implants. METHODS: A total of 39 hip fusion conversions to THA were undertaken in 38 patients by a single surgeon employing a consistent surgical technique and uncemented implants. Parameters assessed included Harris Hip Score (HHS) for function, range of motion (ROM), leg length discrepancy (LLD), satisfaction, and use of walking aid. Radiographs were reviewed for loosening, subsidence, and heterotopic ossification (HO). Postoperative complications and implant survival were assessed. RESULTS: At mean 12.2 years (2 to 24) follow-up, HHS improved from mean 34.2 (20.8 to 60.5) to 75 (53.6 to 94.0; p < 0.001). Mean postoperative ROM was flexion 77° (50° to 95°), abduction 30° (10° to 40°), adduction 20° (5° to 25°), internal rotation 18° (2° to 30°), and external rotation 17° (5° to 30°). LLD improved from mean -3.36 cm (0 to 8) to postoperative mean -1.14 cm (0 to 4; p < 0.001). Postoperatively, 26 patients (68.4%) required the use of a walking aid. Complications included one (2.5%) dislocation, two (5.1%) partial sciatic nerve injuries, one (2.5%) deep periprosthetic joint infection, two instances of (5.1%) acetabular component aseptic loosening, two (5.1%) periprosthetic fractures, and ten instances of HO (40%), of which three (7.7%) were functionally limiting and required excision. Kaplan-Meier Survival was 97.1% (95% confidence interval (CI) 91.4% to 100%) at ten years and 88.2% (95% CI 70.96 to 100) at 15 years with implant revision for aseptic loosening as endpoint and 81.7% (95% CI 70.9% to 98.0%) at ten years and 74.2% (95% CI 55.6 to 92.8) at 15 years follow-up with implant revision for all cause failure as endpoint. CONCLUSION: The use of an optimal and consistent surgical technique and cementless implants can result in significant functional improvement, low complication rates, long-term implant survival, and high patient satisfaction following conversion of hip fusion to THA. The possibility of requiring a walking aid should be discussed with the patient before surgery. Cite this article: Bone Joint J 2021;103-B(7 Supple B):129-134.

Does Trochanteric Osteotomy Length Affect the Amount of Proximal Trochanteric Migration During Revision Total Hip Arthroplasty?

BACKGROUND: Nonunion and proximal trochanteric migration is a known complication of trochanteric osteotomy. This study examines the effect of osteotomy length on proximal greater trochanter (GT) migration. METHODS: We analyzed 113 modified trochanteric slide osteotomies and 73 extended trochanteric osteotomies performed between 2008 and 2016. All osteotomies were fixed using cerclage wires and had minimum 6-month radiographic follow-up. Spearman correlations were used to assess association between osteotomy length and GT migration distance. Chi-squared test and logistic regression were used to assess association between patient and surgical factors and GT migration >1 cm. Receiver operating characteristic curves were constructed to determine the optimal cutoff osteotomy length for predicting GT migration >1cm. RESULTS: Mean osteotomy length was 6.1 cm (range 3-12) for modified trochanteric slide osteotomies and 14.8 cm (range 8-23) for extended trochanteric osteotomies. Osteotomy length was negatively correlated (r = -0.340, P < .001) with GT migration distance. Longer osteotomy length was protective against GT migration >1 cm (odds ratio 0.67, P = .002). Receiver operating characteristic curve analysis demonstrated an optimal cutoff osteotomy length of 9.8 cm for predicting GT migration >1 cm (sensitivity 0.971, specificity 0.461). Among osteotomies <10 cm, those fixed using at least one distal wire below the lesser trochanter and vastus ridge demonstrated less mean GT migration (3.86 vs 7.12 mm, P = .009) and higher mean union rate (68.8% vs 31.2%, P < .001). CONCLUSION: Osteotomies shorter than 10 cm are at higher risk of developing proximal GT migration >1 cm. A distal cerclage wire below the lesser trochanter and vastus ridge may help decrease the amount of GT migration. LEVEL OF EVIDENCE: Prognostic Level IV.

Long-Term Results of Treating Large Posttraumatic Tibial Plateau Lesions with Fresh Osteochondral Allograft Transplantation.

BACKGROUND: The use of fresh osteochondral allograft (FOCA) transplantation is a treatment option for large posttraumatic tibial osteochondral defects in young, high-demand patients. We aimed to assess the long-term outcomes of this procedure and factors impacting graft survivorship. METHODS: Evaluated were patients with a posttraumatic tibial plateau defect of >3 cm in diameter and >1 cm in depth who were treated with use of a FOCA, with or without a realignment osteotomy, before September 2007. The primary outcome was survivorship according to Kaplan-Meier analysis, with conversion to arthroplasty or another allograft procedure as the end point. The secondary outcome was the functional outcome of knees with a surviving FOCA, as assessed using the modified Hospital for Special Surgery (mHSS) scoring system. Multivariate Cox regression analysis of the role of potential variables was performed for both outcomes. RESULTS: Included were 113 patients (67 female) with a mean age at the time of the index surgery of 43 years (range, 24 to 72 years) and a mean follow-up of 13.8 years (range, 1.7 to 34 years). Forty-eight conversions to arthroplasty or another FOCA procedure had been performed at a mean of 11.6 years (range, 1.7 to 34 years) after the index surgery. The remaining 65 patients had a mean follow-up of 15.5 years (range, 4.3 to 31.7 years). The mean mHSS score among those with a surviving FOCA was 85.5 (range, 56 to 100) at the most recent follow-up, which was significantly higher than the preoperative value of 69 (range, 48 to 85) (p < 0.001). Graft survivorship was 90% at 5 years, 79% at 10 years, 64% at 15 years, and 47% at 20 years. Complications included infection (1.8%), nonunion (0.9%), and knee pain from hardware (8.8%). Multivariate analysis revealed that older age at the time of surgery, involvement of the medial plateau, and a higher number of previous surgeries were inversely associated with graft survivorship. Having a Workers' Compensation file was associated with less improvement in the mHSS score, and the score tended to decline over time for knees with a surviving FOCA. CONCLUSIONS: FOCA transplantation is a viable option for posttraumatic tibial osteochondral defects, with satisfactory survivorship and functional outcome. Although approximately half of the patients in our study demonstrated graft failure by 20 years, FOCA was an excellent option that delayed the need for arthroplasty. Older patients, those with medial defects, and those with multiple previous surgeries had a less favorable prognosis. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Hemi-pelvic slope is correlated with the acetabular depth in adults-a radiological study.

OBJECTIVE: The purpose of this study was to determine if there is an anatomic relationship between pelvic geometry and acetabular depth. MATERIALS AND METHODS: One hundred and fifty-one anteroposterior pelvic radiographs (157 hip joints) were selected and analyzed in a retrospective fashion. Six parameters, including iliac offset, ischial offset, acetabular offset, pelvic height, center-edge (CE) angle of Wiberg, and acetabular index (AI) angle of Tönnis were measured for each of the hip joints. Based on the defined variables, three formulas (formulas 1, 2, and 3) were calculated to represent the hemi-pelvis slope. RESULTS: There was a strong relationship between the hemi-pelvis slope and probability of acetabular dysplasia. Wider upper pelvis was associated with deeper acetabulum and wider lower pelvis was associated with dysplastic acetabulum. CONCLUSIONS: Pelvic anatomic dimensions and the relationship between them are strongly correlated with hip dysplasia indices. Dysplastic hips tend to be found in pelvises with lower slope (low width of the upper pelvis at the level of iliac crest and high width of the lower part at the level of ischium).

The Effect of Dietary Supplementation With Curcumin on Redox Status and Nrf2 Activation in Patients With Nondiabetic or Diabetic Proteinuric Chronic Kidney Disease: A Pilot Study.

OBJECTIVE: Chronic kidney disease (CKD) is a worldwide public health problem, and proteinuria may accelerate the progression of CKD, being oxidative stress a common mechanism in nondiabetic or diabetic proteinuric kidney disease. This study was designed to evaluate the effect of the dietary supplementation with curcumin (CUR) on the redox status and the nuclear factor erythroid 2-related factor 2 (Nrf2) activation in patients with nondiabetic or diabetic proteinuric CKD. DESIGN: Randomized double-blind placebo-controlled clinical trial. SUBJECTS: A total of 101 Mexican patients from the National Institute of Cardiology "Ignacio Chavez", with nondiabetic or diabetic proteinuric CKD (proteinuria ≥ 1 g protein/24 hours), aged 20 to 70 years; 60% were male, and 51% were diabetic. INTERVENTION: Patients with nondiabetic proteinuric CKD received placebo (n = 26) or CUR 320 mg/day (n = 24) for 8 weeks, and patients with diabetic proteinuric CKD were intervened with placebo (n = 23) or CUR 320 mg/day (n = 28) for the same period. MAIN OUTCOME MEASURE: Anthropometrical, clinical, and biochemical characteristics, as well as oxidative stress markers, antioxidant enzyme activities and Nrf2 activation were evaluated at baseline and after intervention. RESULTS: The intervention with CUR did not improve proteinuria, estimated glomerular filtration rate, or lipid profile. However, in plasma, CUR attenuated lipid peroxidation in individuals with nondiabetic proteinuric CKD (P<.05) and enhanced the antioxidant capacity in subjects with diabetic proteinuric CKD (P<.05). No effect of CUR was observed on the antioxidant enzymes activities or Nrf2 activation. CONCLUSIONS: Dietary supplementation with CUR has the potential to reduce oxidative stress in Mexican patients with nondiabetic or diabetic proteinuric CKD. Studies with higher doses of CUR and longer follow-up are granted to confirm our findings.

Changing trends in infectious disease in heart transplantation.

BACKGROUND: During the past 25 years, advances in immunosuppression and the use of selective anti-microbial prophylaxis have progressively reduced the risk of infection after heart transplantation. This study presents a historical perspective of the changing trends of infectious disease after heart transplantation. METHODS: Infectious complications in 4 representative eras of immunosuppression and anti-microbial prophylaxis were analyzed: (1) 38 in the pre-cyclosporine era (1978-1980), (2) 72 in the early cyclosporine era (1982-1984), where maintenance immunosuppression included high-dose cyclosporine and corticosteroid therapy; (3) 395 in the cyclosporine era (1988-1997), where maintenance immunosuppression included cyclosporine, azathioprine, and lower corticosteroid doses; and (4) 167 in the more recent era (2002-2005), where maintenance immunosuppression included cyclosporine and mycophenolate mofetil. RESULTS: The overall incidence of infections decreased in the 4 cohorts from 3.35 episodes/patient to 2.03, 1.35, and 0.60 in the more recent cohorts (p < 0.001). Gram-positive bacteria are emerging as the predominant cause of bacterial infections (28.6%, 31.4%, 51.0%, 67.6%, p = 0.001). Cytomegalovirus infections have significantly decreased in incidence and occur later after transplantation (88 +/- 77 days, pre-cyclosporine era; 304 +/- 238 days, recent cohort; p < 0.001). Fungal infections also decreased, from an incidence of 0.29/patient in the pre-cyclosporine era to 0.08 in the most recent era. A major decrease in Pneumocystis jiroveci and Nocardia infections has also occurred. CONCLUSIONS: The overall incidence and mortality associated with infections continues to decrease in heart transplantation and coincides with advances in immunosuppression, the use of selective anti-microbial prophylaxis, and more effective treatment regimens.

Shared geriatric mental health care in a rural community.

INTRODUCTION: A pilot project in shared mental health care was initiated to explore opportunities to increase the capacity of the rural primary care system as a resource for older people with mental health needs. This was done within a framework for the delivery of best practices in geriatric mental health outreach. METHODS: Shared-care strategies combining education and clinical consultation between mentor psychiatrists and family physicians were implemented and then evaluated after one year to identify key factors in the success of approaches to shared mental health care for older people in a rural setting. RESULTS: Results provided new insights into shared care between primary care and specialty geriatric mental health services, rural geriatric mental health service delivery, developmental phases in service learning approaches, and building knowledge networks to promote continuing best practices. CONCLUSION: The results from the project's process evaluation have been integrated into the development of a permanent shared geriatric mental health care service for the rural setting. Preparation for an outcome evaluation that will focus on the impact on patient care has also been initiated.

[Accidental punctures: ten years of experience with our protocol]. / Punturas accidentales: Diez años de experiencia con nuestro protocolo.

OBJECTIVE: We report our experience during the past 10 years in the management of accidental punctures. PATIENTS AND METHODS: A study was made of all hypodermic needle punctures recorded in children aged 0-14 years in our center since 1987. A clinical protocol consisting of 5 visits and duration of 6-7 months was used in all cases. RESULTS: A total of 150 punctures were recorded during the study period with a decrease in prevalence over time. All cases the clinical protocol was accepted and correct follow-up procedures were performed. In no case was post-puncture sero-conversion detected for HCV, HBV, or HIV among correctly immunized children. CONCLUSIONS: The protocol employed is useful and well accepted with the risk of infection caused by accidental puncture being remote provided initial patient care was adequate.