N-Containing Hybrid Composites Coatings for Enhanced Fire-Retardant Properties of Cotton Fabric Using One-Pot Sol-Gel Process.

In this report, a unique methodology/process steps were followed using Sol-gel-based concept to deposit thin flame-retardant coatings on cotton fabric. Surface microstructure and compositional analysis of the coated cotton were carried out using scanning electronic microscope (SEM), which explored significant coverage of the fabric. The obtained samples were further analyzed through rupturing mechanism test and color check. Compositional investigation of the coated samples was carried through Attenuated total reflection Fourier transform infrared (ATR-FTIR) and energy-dispersive X-rays spectroscopy (EDS) analysis. Thermal analyses were carried out through Thermogravimetric analysis (TGA) and Vertical flame tests (VFT), which suggested higher resistance of the coatings obtained for 5 h and zero heat-treatment time on the cotton fabric. A 28.86% char residue was obtained for the same sample (ET-5h-RT) coupled with higher degradation temperature and excellent combustion properties.

Risk factors of de novo hyperextension developed after posterior cruciate ligament substituting total knee arthroplasty: a matched case-control study.

PURPOSE: To investigate factors contributing to the de novo hyperextension after posterior cruciate ligament substituting (PS) total knee arthroplasty (TKA). METHODS: Through a retrospective case-control study, de novo hyperextension patients were compared with patients without hyperextension after primary PS TKA. Eighty-five hyperextension patients were compared with 85 patients in a control group matched by age, sex, surgeon and implant. The clinical and radiographic parameters, including the mechanical axis (MA), joint line convergence angle (JLCA), posterior tibial slope angle (PTSA), posterior condylar offset (PCO), and the gamma angle, were evaluated preoperatively and immediate postoperatively. Comparisons between the two groups and logistic regression analysis were performed to investigate factors contributing to de novo hyperextension. RESULTS: Among the clinical factors, preoperative flexion contracture was less (5° ± 6° vs. 11° ± 6°, p < 0.001) and the range of motion was greater (125° ± 12° vs. 118° ± 5°, p = 0.041) in the de novo hyperextension group than in the control group. Among the radiographic parameters, preoperative and postoperative JLCA were greater (8.1° ± 4.4° vs. 6.1° ± 3.5°, p < 0.001, 1.0° ± 1.3° vs. 0.2° ± 0.8°, p = 0.002, respectively), postoperative PTSA was greater (3.7° ± 2.0° vs. 3.3° ± 1.6°, p < 0.001) and preoperative and postoperative PCO were less in the hyperextension group than in the control group (26.3 mm ± 3.3 mm vs. 29.1 mm ± 3.2 mm, p < 0.001, 26.4 mm ± 3.2 mm vs. 29.1 mm ± 3.0 mm, p < 0.001, respectively), whereas, change in PCO was greater in the hyperextension group (1.1 mm ± 7.7 mm vs. - 0.1 mm ± 3.3 mm, p < 0.001). In multivariate analysis, the degree of medial soft tissue release [odds ratio (OR) 2.83, p = 0.003], flexion contracture [OR 0.86, p = 0.028], postoperative JLCA [OR 2.45, p = 0.004], preoperative PCO and a change in PCO [OR 0.74, p = 0.002, OR 1.89, p = 0.001, respectively] were the factors associated with de novo hyperextension. CONCLUSIONS: An increased degree of medial soft tissue release, small preoperative flexion contracture, increased postoperative JLCA, decreased preoperative PCO and increased change in PCO were risk factors of de novo hyperextension. LEVEL OF EVIDENCE: III.

Reduction of postoperative nausea and vomiting risk in the second stage during bilateral total knee arthroplasty with a 1-week interval.

PURPOSE: Total knee arthroplasty (TKA) is often performed sequentially on both sides during a single hospital stay. Patients who experience postoperative nausea and vomiting (PONV) after the first operation are concerned about PONV recurrence after the second operation. However, there are few studies regarding the incidence of PONV in staged bilateral TKA with a ≥ 1-week interval. This study aimed to identify the differences in (1) PONV incidence, (2) use of rescue antiemetics, and (3) the amount of opioid consumption between the first and second operations for staged bilateral TKA with a 1-week interval. Based on our anecdotal experience, the hypothesis of this study was that during staged bilateral TKA at a 1-week interval, the PONV incidence and rescue antiemetic requirement after the second operation will be lower than those after the first operation, regardless of opioid consumption. METHODS: Fifty-eight consecutive patients who underwent staged bilateral TKA with a 1-week interval were retrospectively reviewed. All second-stage operations were performed with the same anaesthesia protocol and perioperative patient management protocol as the first-stage operation. PONV incidence was the primary outcome. The requirement for rescue antiemetic drugs and the amount of opioid consumption were secondary outcome variables. The outcome variables were recorded during three postoperative days (Days 0-2) for each stage and were compared between the first and second operations. RESULTS: The incidence rates of nausea and vomiting on Day 0 (p = 0.001 and p = 0.004, respectively) and nausea on Day 1 (p = 0.008) were significantly lower after the second operation. Rescue antiemetic use on Day 0 was significantly lower after the second operation (p = 0.001). The total opioid consumption 72 h after surgery was significantly higher after the second operation (61.76 vs. 34.28 mg, p < 0.001). CONCLUSION: During staged bilateral TKA with a 1-week interval, PONV incidence was lower after the second operation, even with increased opioid consumption. LEVEL OF EVIDENCE: III.

A high degree of knee flexion after TKA promotes the ability to perform high-flexion activities and patient satisfaction in Asian population.

BACKGROUND: This study investigated whether achieving a higher degree of knee flexion after TKA promoted the ability to perform high-flexion activities, as well as patient satisfaction and quality of life. METHODS: Clinical data on 912 consecutive primary TKA cases involving a single high-flexion posterior stabilized fixed-bearing prosthesis were retrospectively analyzed. Demographic and clinical data were collected, including knee flexion angle, the ability to perform high-flexion activities, and patient satisfaction and quality of life. RESULTS: Of the cases, 619 (68%) achieved > 130° of knee flexion after TKA (high flexion group). Knee flexion angle and clinical scores showed significant annual changes, with the maximum improvement seen at 5 years and slight deterioration observed at 10 years postoperatively. In the high flexion group, more than 50% of the patients could not kneel or squat, and 35% could not stand up from on the floor. Multivariate analysis revealed that > 130° of knee flexion, the ability to perform high-flexion activities (sitting cross-legged and standing up from the floor), male gender, and bilateral TKA were significantly associated with patient satisfaction after TKA, while the ability to perform high-flexion activities (sitting cross-legged and standing up from the floor), male gender, and bilateral TKA were significantly associated with patient quality of life after TKA. CONCLUSIONS: High knee flexion angle (> 130°) after TKA increased the ease of high-flexion activities and patient satisfaction. The ease of high-flexion activities also increased quality of life after TKA in our Asian patients, who frequently engage in these activities in daily life.

Biallelic novel mutations of the COL27A1 gene in a patient with Steel syndrome.

An 11-year-old Korean boy presented with short stature, hip dysplasia, radial head dislocation, carpal coalition, genu valgum, and fixed patellar dislocation and was clinically diagnosed with Steel syndrome. Scrutinizing the trio whole-exome sequencing data revealed novel compound heterozygous mutations of COL27A1 (c.[4229_4233dup]; [3718_5436del], p.[Gly1412Argfs*157];[Gly1240_Lys1812del]) in the proband, which were inherited from heterozygous parents. The maternal mutation was a large deletion encompassing exons 38-60, which was challenging to detect.

Effects of preoperative, scheduled administration of antiemetics in reducing postoperative nausea and vomiting in patients undergoing total knee arthroplasty.

ABSTRACT: There is no established protocol regarding the timing of administration of antiemetics in patients undergoing total knee arthroplasty (TKA). The purpose of this study was to determine whether preoperative, rather than postoperative administration of an antiemetic could reduce postoperative nausea and vomiting (PONV) in patients undergoing TKA, and whether there was a difference in postoperative pain, patient satisfaction and complications after TKA between the 2 different administration times.The included patients (N = 101) either received intravenous administration of the ramosetron 1 hour before surgery (N = 50) or at the end of surgery (N = 51) consecutively order. The incidence of PONV and the frequency of rescue medicine use were recorded until 48 hours postoperatively. The severity of postoperative pain and patient satisfaction were assessed using the visual analogue scale. The incidence of complications associated with use of antiemetic was assessed.Preoperative administration of ramosetron did not decrease PONV during the first 48 hours. There was no significant difference in the incidence of nausea and vomiting, use of rescue antiemetics, and the severity of nausea (P > .05). Postoperative pain, satisfaction scores, and the incidence of complications were not different between the 2 groups (P > .05).Preoperative administration of ramosetron did not show clinical advantage in reducing POVN, postoperative pain and improving patient satisfaction. However, the outcomes of complications were not inferior to those of postoperative administration. Therefore, under the current protocol of multimodal therapies, timing of administration of pre-emptive antiemetic did not have significant effect on PONV.

Association between forearm cortical bone properties and handgrip strength in women with distal radius fractures: A cross-sectional study.

OBJECTIVES: Mechanical and biochemical bone properties are influenced by muscles. However, the muscle-bone interaction has not been fully elucidated regarding the upper extremities. The objective of the present study was to evaluate the mechanical muscle-bone interaction at the forearm by evaluating the relationship between the properties of three-dimensional (3D) forearm cortical bone models derived from conventional computed tomography (CT) images and handgrip strength (HGS). METHODS: A total of 108 women (mean age, 75.2 ± 9.4 years; range, 62-101 years) with a distal radius fracture who took conventional CT scans for the assessment of the fracture were included in this study. Distal radius 3D models were reconstructed and the average cortical bone density (Cd) and thickness (Ct) of the region of interest (ROI), which might be affected by the forearm flexor muscles, were calculated using a 3D modeling software. Clinical parameters including HGS, lumbar and hip bone mineral densities (BMDs), and other demographic factors were also obtained. A multivariate linear regression analysis was performed to identify relevant factors associated with HGS. RESULTS: HGS was found to be independently associated with height and Cd, but no significant difference was found between HGS and Ct, age, weight, as well as lumber and hip BMDs. CONCLUSIONS: Cortical bone density might be associated with HGS, which is generated by the forearm flexor muscles. Hence, the mechanical muscle-bone interaction in the upper extremities could be supported by the present study.

Long Head of the Biceps Tendon Tenotomy versus Subpectoral Tenodesis in Rotator Cuff Repair.

BACKGROUD: Lesions of the long head of the biceps tendon (LHBT) are one of the most common pathologies in patients with a rotator cuff tear. Although various procedures have been shown to be effective for treating LHBT lesions during rotator cuff repair, no consensus has been reached regarding the most effective treatment. The purpose of this study was to compare the outcomes of tenotomy vs subpectoral tenodesis of the LHBT in arthroscopic rotator cuff repair. METHODS: The records of 135 patients who underwent arthroscopic rotator cuff repair with biceps tenotomy or subpectoral tenodesis for a partial LHBT tear of > 50% were initially reviewed. Finally, 77 patients (38 patients with tenotomy and 39 patients with subpectoral tenodesis) with an intact rotator cuff, who underwent a functional evaluation at 1 year postoperatively, were enrolled in this retrospective study. RESULTS: The average follow-up was 13.3 ± 4.36 months (13.2 ± 1.4 months in the tenotomy group and 13.6 ± 2.7 months in the subpectoral tenodesis group; p = 0.416). Demographic and surgical data were not significantly different between the 2 groups. Preoperatively, biceps groove tenderness, Speed's test, and Yergason test results were positive in 27.3%, 27.3%, and 10.4% of the study subjects, respectively. Compared with preoperative values, all functional scores including shoulder muscle power were significantly improved postoperatively, and no significant intergroup difference was observed (all p > 0.05). A visible Popeye deformity was not encountered in either group at the final follow-up. Eight patients in the tenotomy group and 7 patients in the subpectoral tenodesis group complained of mild anterior shoulder pain (p = 0.731), and 4 patients in each group complained of groove tenderness (p = 0.969). No surgical or postoperative complication occurred in either group. CONCLUSIONS: Both biceps tenotomy and subpectoral tenodesis performed during rotator cuff repair improved pain and function and resulted in comparable clinical outcomes. Residual symptoms associated with the remnant LHBT in the groove may not be a problem after adhesion of LHBT.

Aggravation of Ankle Varus Incongruency Following Total Knee Replacement Correcting ≥10° of Genu Varum Deformity: A Radiographic Assessment.

BACKGROUND: This study aimed to investigate the change in ankle varus incongruencies following total knee replacement (TKR) in patients with preoperative genu varum deformity of ≥10°. METHODS: The study cohort was composed of patients who underwent TKR in a single institution for knee osteoarthritis with preoperative genu varum deformity of ≥10° and concomitant varus ankle incongruencies. Eight radiographic measurements were evaluated preoperatively and postoperatively: mechanical tibiofemoral angle, mechanical lateral distal femoral angle, medial proximal tibial angle, lateral distal tibial angle, tibial plafond inclination, talar inclination, tibiotalar tilt angle (TTTA), and tibia-mechanical axis angle. Of these, TTTA represented the quantitative degree of ankle joint incongruency. RESULTS: A total of 110 patients (male = 2; female = 108) were included in the analysis. The mean patient age was 68.9 (standard deviation [SD] 7.2) years at the time of TKR. All radiographic measurements showed significant changes postoperatively, representing the appropriate correction of genu varum deformity and restoration of the mechanical axis. Nineteen patients (17.3%) showed postoperative decrease in TTTA, 2 (1.8%) remained the same, and 89 (80.9%) showed increase. Overall, mean preoperative and postoperative TTTA were 3.3° (SD 2.2°) and 4.7° (SD 2.9°), respectively (P < .001), representing the aggravation of varus ankle incongruencies. CONCLUSION: Varus ankle incongruencies showed aggravation following TKR despite correction of genu varum deformity and restoration of the mechanical axis. This could be an important cause of postoperative increase or development of ankle pain following TKR. Therefore, patients with preoperative varus ankle incongruencies need to be warned of possible aggravation of ankle symptoms and be evaluated before TKR. LEVEL OF EVIDENCE: Prognostic level III.

The Ideal Location of the Lateral Hinge in Medial Closing Wedge Osteotomy of the Distal Femur: Analysis of Soft Tissue Coverage and Bone Density.

BACKGROUND: Although an appropriate hinge position to prevent unstable lateral hinge fractures is well established in medial opening wedge high tibial osteotomy, the position during medial closing wedge distal femoral osteotomy has not been elucidated. PURPOSE/HYPOTHESIS: The purpose was to evaluate the ideal hinge position that would prevent an unstable lateral hinge fracture during biplanar medial closing wedge distal femoral osteotomy based on soft tissue coverage and bone density around the hinge area. The hypothesis was that the ideal hinge position could be clarified by analyzing soft tissue coverage and bone density around the lateral hinge area. STUDY DESIGN: Controlled laboratory study. METHODS: In 20 cadaveric knees (mean age, 70.3 ± 19.2 years), the femoral attachment of the gastrocnemius lateral head was quantitatively analyzed as a soft tissue stabilizer using digital photography and fluoroscopy. Then, medial closing wedge distal femoral osteotomy was performed, locating the lateral hinge either inside (group 1) or outside (group 2) the femoral attachment of the gastrocnemius lateral head, and the incidence of unstable lateral hinge fractures was compared between the 2 groups. Cortical bone density around the lateral hinge was measured using Hounsfield units on 30 computed tomography scans and reconstructed as a 3-dimensional mapping model. The transitional zone with low bone density was regarded as the safe hinge position with an increased capacity for bone deformation. RESULTS: The upper and lower margins of the femoral attachment of the gastrocnemius lateral head were 9.1 ± 0.9 mm above and 8.0 ± 1.4 mm below the upper border of the lateral femoral condyle, respectively, and the femoral attachment of the gastrocnemius lateral head was widest in the anteroposterior dimension 0.4 ± 1.7 mm above the upper border of the lateral femoral condyle. The incidence of unstable lateral hinge fractures during osteotomy was significantly decreased in group 1 compared with group 2 (group 1: 0/10; group 2: 5/10; P = .01). An isolated transitional zone with low bone density was observed in all 30 knees and located 1.3 ± 0.8 mm above the upper border of the lateral femoral condyle. Bone density of the transitional zone with low bone density was significantly lower than surrounding femoral cortices (P < .001). CONCLUSION: Only the upper border of the lateral femoral condyle can be recommended as an ideal hinge position to prevent unstable lateral hinge fractures during biplanar medial closing wedge distal femoral osteotomy based on soft tissue coverage and bone density. CLINICAL RELEVANCE: When the hinge is positioned at the upper border of the lateral femoral condyle during biplanar medial closing wedge distal femoral osteotomy, the risk of unstable hinge fractures can be minimized.

Preoperative embolization for bone metastasis from hepatocellular carcinoma.

Preoperative transcatheter arterial embolization for hypervascular bone tumors is now widely accepted as a safe and effective procedure for reducing intraoperative blood loss and surgical morbidity. However, few studies have reported the use of preoperative transcatheter arterial embolization for nonspine bone metastases from hepatocellular carcinoma. The goal of this study was to assess the effect of preoperative embolization on blood loss and clinical outcomes in surgery for nonspine bone metastasis from hepatocellular carcinoma. Seventy-five patients with metastases from hepatocellular carcinoma to the pelvis and extremities were reviewed retrospectively. The study population consisted of 62 men and 13 women, with a mean age of 64.6 years (range, 40.0-80.1). The average follow-up period was 8.2 months (range, 0.3-66.1). Twenty-two patients underwent transcatheter arterial embolization for preoperative devascularization (group A), and 53 patients underwent operative treatment only (group B). The proportion of pelvis metastases was significantly higher (P<.001) and operative time was longer (P=.006) in group A than in group B. However, a significantly smaller decrease in hemoglobin level before and after surgery was seen in group A (P=.017). No significant differences were seen in intraoperative estimated blood loss, perioperative hemoglobin level, number of allogeneic transfusions, or length of hospitalization between the 2 groups. Preoperative transcatheter arterial embolization is an effective means to reduce bleeding during surgery for nonspine metastases from hepatocellular carcinoma. In general, surgical procedures that included transcatheter arterial embolization took longer and were more extensive.