Convertible glenoid replacement in the anatomical total shoulder arthroplasty: medium-term results.

INTRODUCTION: The older generation of high thickness metal-backed glenoid prostheses had a high failure rate. The goal of our study was to analyze the medium-term clinical and radiological results of a technically modified generation of metal backed glenoids with 35% decrease in thickness. METHODS: Thirty-nine patients (43 shoulders) with a mean age of 66.5 years at surgery were examined from two to ten years (mean 71.2 months) using the Constant-Score, Subjective Shoulder Value and X-ray in a.p. and axial view. Indication for surgery included patients with glenoid types B1, B2, or B3 and/or posterior subluxation but intact rotator cuff, or patients who did not want a reverse prosthesis and had high functional demands. Inclusion criteria comprised participation in a clinical and radiological follow-up examination, along with a minimum follow-up duration of 24 months. Additionally, in all cases, the Constant Score and the Subjective Shoulder Value (PROM) had to be determined. Exclusion criteria were an incomplete dataset, implantation of a different prosthesis type, and failure to meet the minimum follow-up time. RESULTS: The absolute Constant Score (CS) improved significantly (p < 0.0001) from 43 ± 13 (range: 20-69) points before to 80 ± 13 (range: 46-98) points after surgery. The only preoperative negative influencing factor on the result was the glenoid protrusion according to Lévigne (p = 0.0150). No significant differences in functional outcomes were found between glenoid types A2, B1, B2 and B3. Radiolucent lines at the interface were observed in a total of four patients (13%). Radiological signs of glenoid osteolysis were seen in six patients (20%). Humeral upward migration was observed in four patients (13%) and posterior shoulder joint decentering occurred in one patient (3%). Implant-specific complications occurred in three cases (7%). Due to a massive rotator cuff tear, two cases (4.7%) had to be converted to a reversed implant, with the primary metal component remaining in place. If the implant-specific and rotator cuff-associated complications are summarized, the rate is 11.7%. All components that required conversion to an reverse implant have so far remained free of complications. CONCLUSION: Favorable clinical results can be achieved, especially in patients with an eccentric glenoid type. Severe preoperative glenoid erosion (Walch A2, B2, B3) does not appear to have any influence on postoperative functional results. The complication and revision rates are significantly better than in previous studies with conventional metal-backed glenoid components. Conversion of the anatomical glenoid component to a reverse system was always possible and good clinical results were achieved.

Convertible-platform shoulder arthroplasty.

Background: Shoulder arthroplasty has become an increasingly common procedure used to treat degenerative, inflammatory, and traumatic conditions of the glenohumeral joint. With a significant increase in primary anatomic and reverse total shoulder arthroplasty, revision procedures have likewise increased. Updates in shoulder arthroplasty have allowed for the convertibility of implants, which allows for the retention of both glenoid and humeral components during revision surgery. This review aims to highlight the epidemiology, indications, and outcomes of convertible-platform total shoulder arthroplasty procedures. Methods: A review of the current literature surrounding convertible-platform shoulder arthroplasty was completed to highlight the advantages and disadvantages of commercially available instrumentation and implant systems as well as their outcomes. Discussion: Leading causes of shoulder arthroplasty revision surgery include glenoid failure, implant instability, and rotator cuff dysfunction. Variations in implant design between inlay and onlay humeral components and metal-backed glenoid components are important considerations at the time of revision surgery. Advantages of convertible-platform systems include increased efficiency and decreased complications during revision procedures as well as shorter recovery, lower cost, and better functional outcomes. Limitations of convertible systems include poorly positioned components during the index procedure, excessive soft-tissue tensioning, and problems associated with metal-backed glenoid implants. Changes in arm length have also been documented. These findings indicate the benefit of additional research and design to improve the effectiveness and utility of convertible-platform shoulder arthroplasty systems.

Ugi bisamides based on pyrrolyl-ß-chlorovinylaldehyde and their unusual transformations.

By one-pot four- and three-component Ugi reactions involving convertible isocyanides and unexplored pyrrole-containing ß-chlorovinylaldehyde, a small library of 20 bisamides with unusual behavior in post-Ugi transformations was prepared and characterized. Surprisingly, a well-documented approach to obtain peptide-containing carboxylic acids through acid hydrolysis of the convertible isocyanide moiety in the Ugi bisamides proceeded in an unexpected manner in our case, leading to the formation of derivatives of amides of heterylidenepyruvic acid. An optimized synthetic protocol for this transformation was elaborated and a plausible sequence involving the elimination of the 2-chloroacetamide moiety and the conversion of the ß-chlorovinyl fragment into a vinyl one is provided.

Complications and revisions in metal-backed anatomic total shoulder arthroplasty: a comparative study of revision rates between stemless and stemmed humeral components.

BACKGROUND: The primary objective of this study was to evaluate and compare the incidence of complications and revision surgeries between in 2 of convertible metal-back glenoid systems in total shoulder arthroplasty (aTSA) groups over a follow-up period of up to 5 years. METHODS: A retrospective analysis included 69 shoulders from 65 patients with primary aTSA. Patients were divided into group 1 (n = 31), receiving convertible cementless stemmed aTSA (Lima SMR) and group 2 (n = 38), receiving humeral head replacement aTSA (Arthrex, Eclipse) both with metal-back glenoid components. Clinical and radiological assessments were conducted at 2, 5, and 10 years postoperatively. Assessments included the following: Constant Score, Disabilities of the Arm, Shoulder, and Hand, Shoulder Pain and Disability Index, Subjective Shoulder Value, Glenohumeral Distance, Critical Shoulder Angle, and Lateral Acromion Index. In addition, we compared complications, revision rates, and survival rates between groups using Kaplan-Maier curves and Log-Rank-test. RESULTS: Baseline demographics and preoperative outcome scores showed no significant differences between groups (P ≥ .05). The overall revision rate did not significantly differ between groups (group 1:32% vs. group 2:24%, P = .60), nor did the mean time to revision (P = .27). The mean follow-up was 71 ± 41 months (group 1: 94 ± 48 months, group 2: 53 ± 23 months, P < .001). Kaplan-Meier analysis showed similar midterm survival probabilities (P = .94). Revision reasons included rotator cuff insufficiency (n = 4 in group 1, n = 2 in group 2) and glenoid wear/loosening (n = 5 in group 1, n = 7 in group 2). Interestingly, group 1 demonstrated no occurrence of glenoid metal baseplate or humeral loosening, while complex revisions were more common in the group 2. At 2 and 5 years, nonrevised patients in both groups had similar outcome scores. CONCLUSION: Metal-backed glenoid implants in combination with both stemless and stemmed humeral components in aTSA exhibit comparable revision rates and survival probabilities. Rotator cuff insufficiency and polyethylene wear are the 2 most common complications leading to revision. To facilitate ongoing monitoring and optimize patient safety, we implemented a modification in the follow-up protocol, transitioning to annual appointments or earlier when necessary. This study underscores the unsolved disadvantages in metal-back components and the importance of a midterm to long-term longitudinal assessment of those patients.

Bio­Inspired Magnetic­Responsive Supramolecular­Covalent Semi­Convertible Hydrogel.

Bio-inspired magnetic-responsive hydrogel is confined in exceedingly narrow spaces for soft robots and biomedicine in either gel state or magnetofluidic sol state. However, the motion of the gel state magnetic hydrogel will be inhibited in various irregular spaces due to the fixed shape and size and the sol-state magnetofluid gel may bring unpredictable residues in the confined narrow space. Inspired by the dynamic liquid lubricating mechanism of biological systems, novel magnetic-responsive semi-convertible hydrogel (MSCH) is developed through imbedding magnetic-responsive gelatin and amino-modified Fe3O4 nanoparticles network into the covalent network of polyvinyl alcohol, which can be switched between gel state and gel-sol state in response to magnetic stimuli. It can be attributed the disassembly of triple-helix structures of the gelatin under the action of the magnetic field, driven by force from the magnetic particles conjugated on the gelatin chain through electrostatic interactions, while the covalent network retains the hydrogel structural integrity. This leads to a sol layer on the MSCH surface enabling the MSCH to pass effectively through the confined channel or obstacle under magnetic field. The present MSCH will provide an alternative mode for magnetic field-related soft robots or actuators.

Can convertible metal-backed glenoid components replace cemented polyethylene glenoid components in anatomical total shoulder arthroplasty?

BACKGROUND: Anatomical total shoulder arthroplasty (aTSA) has been used to manage degenerative diseases such as primary osteoarthritis. An increase in the use of this procedure has led to several developments in humeral and glenoid components to improve patient outcomes. This study aimed to compare clinical and radiological outcomes of the newly-introduced convertible metal-backed glenoid components with cemented polyethylene glenoid components in aTSA, and to determine whether the new component would be comparable to a conventional one for reducing the burden of future revision or conversion surgeries. METHODS: Medical records of fifty patients who underwent aTSA with at least two years of follow-up were retrospectively reviewed. Eighteen patients received convertible metal-backed glenoid components with vitamin E1-coated liner (MB group), while thirty-two patients received conventional cemented polyethylene glenoid components (PE group). Pre- and postoperative clinical and radiological outcomes (acromion-greater tuberosity angle [AGA] and humeral lateral offset [LO]) at final follow-up were assessed. Radiolucent lines (RLLs) and loosening around the humeral and glenoid components were also evaluated. RESULTS: Clinical outcomes improved after surgery in both groups (all p < 0.001). The arc of rotation measured by AGA improved postoperatively in both groups (all p < 0.001), and AGA and LO were not different according to the type of glenoid components (all p > 0.05). Overall complication rates including RLLs of PE and MB groups were 43.8% (14/32) and 16.7% (3/18), respectively (p = 0.031). Although the PE group had more RLLs than did the MB group (p < 0.05), related symptoms and/or glenoid implant loosening were not observed in both groups. Subscapularis failure occurred in two patients in the PE group and in one in the MB group. CONCLUSION: The convertible metal-backed glenoid implant with vitamin E1-coated liner may be a good alternative for considering the potential for an easier conversion to reverse total shoulder arthroplasty.

Key Design Features of Lipid Nanoparticles and Electrostatic Charge-Based Lipid Nanoparticle Targeting.

Lipid nanoparticles (LNP) have gained much attention after the approval of mRNA COVID-19 vaccines. The considerable number of currently ongoing clinical studies are testament to this fact. These efforts towards the development of LNPs warrant an insight into the fundamental developmental aspects of such systems. In this review, we discuss the key design aspects that confer efficacy to a LNP delivery system, i.e., potency, biodegradability, and immunogenicity. We also cover the underlying considerations regarding the route of administration and targeting of LNPs to hepatic and non-hepatic targets. Furthermore, since LNP efficacy is also a function of drug/nucleic acid release within endosomes, we take a holistic view of charged-based targeting approaches of LNPs not only in the context of endosomal escape but also in relation to other comparable target cell internalization strategies. Electrostatic charge-based interactions have been used in the past as a potential strategy to enhance the drug release from pH-sensitive liposomes. In this review, we cover such strategies around endosomal escape and cell internalization in low pH tumor micro-environments.

A pH-Responsive Charge-Convertible Drug Delivery Nanocarrier for Precise Starvation and Chemo Synergistic Oncotherapy.

A pH-responsive charge-convertible drug delivery nanocarrier (MSN-TPZ-GOx@ZnO@PAH-PEG-DMMA, abbreviated as MTGZ@PPD) was prepared, which could specifically release hypoxia-activated chemotherapeutic Tirapazamine (TPZ) and glucose oxidase (GOx) in the tumor site for precise starvation and chemo synergistic oncotherapy. Acid-responsive Schiff base structure modified mesoporous silica nanoparticles (MSN) co-load with GOx and TPZ, then link with ZnO quantum dots (QDs). PAH-PEG-DMMA (PPD) polymer makes MTGZ@PPD with biocompatibility and charge-convertible feature. MTGZ@PPD is negatively charged at physiological pH, and the charge reversal of PPD and acidolysis of the Schiff base structure under the acidic tumor microenvironment (TME) induce a positively charged surface, which could potentiate the cell internalization. ZnO QDs could decompose at acidic TME, achieving controllable drug release. GOx could starve the tumor cells and enhance hypoxia level, thus initiates the activation of TPZ to realize synergistic starvation therapy and chemotherapy. This intelligent MTGZ@PPD has shown great potential for starvation and chemo synergistic oncotherapy.

Temperature-Dependent Reversible Optical Properties of Mn-Based Organic-Inorganic Hybrid (C8H20N)2MnCl4 Metal Halides.

Organic-inorganic metal halides (OIMHs) have abundant optical properties and potential applications, such as light-emitting diodes, displays, solar cells, and photodetectors. Herein, we report zero-dimensional Mn-based OIMH (C8H20N)2MnCl4 single crystals synthesized by a simple slow evaporation method, which exhibit intense green emission at 520 nm originating from 4T1-6A1 transition of Mn2+ ions. Large organic cations in the crystal structure result in the isolated [MnCl4]2- tetrahedrons, and the closest Mn-Mn distance reaches 9.07 Å, which effectively inhibits the migration of excitation energy between adjacent Mn2+ emission centers, thus achieving a high quantum yield (∼87%) and a long photoluminescence (PL) lifetime (3.42 ms). The different optical and structural properties at low and high temperatures are revealed by temperature-dependent PL and X-ray diffraction spectra. The PL spectra and lifetimes under the heating and cooling processes indicate that the optical property transitions are reversible at 220/240 K. Our work provides a promising strategy for building multifunctional optoelectronic materials and insights into the understanding convertible photophysical properties from isomers of metal halides.

A Dual-Functional Triboelectric Nanogenerator Based on the Comprehensive Integration and Synergetic Utilization of Triboelectrification, Electrostatic Induction, and Electrostatic Discharge to Achieve Alternating Current/Direct Current Convertible Outputs.

Traditional alternating current (AC) and direct current (DC) triboelectric nanogenerators (TENGs), which are implemented via the pairwise coupling of triboelectrification, electrostatic induction, and electrostatic discharge, have been widely explored in various fields. In this work, the comprehensive integration and synergetic utilization of triboelectrification, electrostatic induction, and electrostatic discharge in a single device for the first time is realized, achieving a dual-functional TENG (DF-TENG) to produce an AC/DC convertible output. Distinguishing from the conventional TENGs, the coupling of triboelectrification and electrostatic discharge enables charge circulation between the dielectric tribo-layers, while electrostatic induction realizes charge transfer in the external circuit. This novel energy conversion mechanism has been proven to be applicable to a variety of materials, including polymers, fabrics, and semiconductors. The output mode of the DF-TENG can be tuned by adjusting the slider motion state, and its constant output current and power density can reach 1.51 mA m-2 Hz-1 and 398 mW m-2 Hz-1 , respectively, which are the highest records reported for constant DC-TENGs to date. This work not only provides a paradigm shift to achieve AC/DC convertible output, but it also exhibits high potential for extending the TENG design philosophy.