Association between history of cannabis use and outcomes after total hip or knee arthroplasty: a systematic review and meta-analysis.

Background: Cannabis use may be increasing as countries legalize it and it becomes socially acceptable. A history of cannabis use may increase risk of complications after various kinds of surgery and compromise functional recovery. Here we systematically reviewed and meta-analyzed available evidence on how history of cannabis use affects recovery after hip or knee arthroplasty (THA/TKA). Methods: The PubMed, EMBASE, and Web of Science databases were comprehensively searched and studies were selected and analyzed in accordance with the PRISMA guidelines. The methodological quality of included studies was assessed based on the Newcastle-Ottawa Scale, while quality of evidence was evaluated according to the "Grading of recommendations assessment, development, and evaluation" system. Data on various outcomes were pooled when appropriate and meta-analyzed. Results: The systematic review included 16 cohort studies involving 5.91 million patients. Meta-analysis linked history of cannabis use to higher risk of the following outcomes: revision (RR 1.68, 95% CI 1.31-2.16), mechanical loosening (RR 1.77, 95% CI 1.52-2.07), periprosthetic fracture (RR 1.85, 95% CI 1.38-2.48), dislocation (RR 2.10, 95% CI 1.18-3.73), cardiovascular events (RR 2.49, 95% CI 1.22-5.08), cerebrovascular events (RR 3.15, 95% CI 2.54-3.91), pneumonia (RR 3.97, 95% CI 3.49-4.51), respiratory failure (RR 4.10, 95% CI 3.38-4.97), urinary tract infection (RR 2.46, 95% CI 1.84-3.28), acute kidney injury (RR 3.25, 95% CI 2.94-3.60), venous thromboembolism (RR 1.48, 95% CI 1.34-1.63), and deep vein thrombosis (RR 1.42, 95% CI 1.19-1.70). In addition, cannabis use was associated with significantly greater risk of postoperative transfusion (RR 2.23, 95% CI 1.83-2.71) as well as higher hospitalization costs. Conclusion: History of cannabis use significantly increases the risk of numerous complications and transfusion after THA or TKA, leading to greater healthcare costs. Clinicians should consider these factors when treating cannabis users, and pre-surgical protocols should give special consideration to patients with history of cannbis use.

O-POSSUM and P-POSSUM as predictors of morbidity and mortality in older patients after hip fracture surgery: a meta-analysis.

BACKGROUND: The POSSUM model has been widely used to predict morbidity and mortality after general surgery. Modified versions known as O-POSSUM and P-POSSUM have been used extensively in orthopedic surgery, but their accuracy is unclear. This systematic review evaluated the predictive value of these models in older patients with hip fractures. METHODS: This study was performed and reported based on the "Preferred reporting items for systematic reviews and meta-analyses" guidelines. PubMed, Cochrane, EMBASE, and Web of Science were comprehensively searched for relevant studies, whose methodological quality was evaluated according to the "Methodological index for non-randomized studies" scale. Revman 5 was used to calculate weighted ratios of observed to expected morbidity or mortality. RESULTS: The meta-analysis included 10 studies, of which nine (2549 patients) assessed the ability of O-POSSUM to predict postoperative morbidity, nine (3649 patients) assessed the ability of O-POSSUM to predict postoperative mortality, and four (1794 patients) assessed the ability of P-POSSUM to predict postoperative mortality. The corresponding weighted ratios of observed to expected morbidity or mortality were 0.84 (95% CI 0.70-1.00), 0.68 (95% CI 0.49-0.95), and 0.61 (95% CI 0.16-2.38). CONCLUSIONS: While O-POSSUM shows reasonable accuracy in predicting postoperative morbidity in older patients with hip fractures, both P-POSSUM and O-POSSUM substantially overestimate postoperative mortality. The POSSUM model should be optimized further for this patient population.

Pneumonia Patients Caused by Co-infection With SARS-CoV-2 and Human Adenovirus in China.

Objectives: To data, no patients with obvious epidemiological relationship co-infected with SARS-CoV-2 and other pathogens have been reported. Here, we investigated 10 patients caused by co-infection with SARS-CoV-2 and human adenovirus (HAdV), resulting in third-generation transmission. Materials and Methods: From Jan 15, 2020, we enrolled 10 patients with pneumonia in Hunan Province, China. Epidemiological, clinical, and laboratory investigation results from these patients were analyzed. An epidemiological investigation was performed to assess whether patient infections were linked using conventional methods and metagenomic sequencing. Results: The presence of co-infection with SARS-CoV-2 and HAdV was determined via RT-PCR and metagenomic sequencing. Phylogenetic analysis revealed that SARS-CoV-2 and HAdV genomes clustered together, with similar genetic relationships. The first patient likely became co-infected during meetings or travel in Wuhan. The patient transmitted the virus via dinners and meetings, which resulted in four second-generation cases. Then, a second-generation case transmitted the virus to her family members or relatives via presymptomatic transmission. Conclusions: This study described an example of co-infection with SARS-CoV-2 and HAdV in pneumonia patients, which caused third-generation cases and inter-regional transmission via meetings, household interactions, and dinner parties. We also observed the persistent and presymptomatic transmission of co-infection, which has the potential to make the continued control of the COVID-19 pandemic challenging. Continuous surveillance is needed to monitor the prevalence, infectivity, transmissibility, and pathogenicity of SARS-CoV-2 co-infection with other pathogens to evaluate its real risk.

Characteristics and Risk Factors of Intraocular Lens Tilt and Decentration of Phacoemulsification After Pars Plana Vitrectomy.

Purpose: The purpose of this study was to investigate the characteristics and risk factors of intraocular lens (IOL) tilt and decentration of phacoemulsification after pars plana vitrectomy (PPV) using swept-source optical coherence tomography (SS-OCT). Methods: One hundred four eyes with prior PPV and 104 eyes without PPV undergoing uneventful cataract surgery were enrolled in this study. IOL tilt and decentration were measured by SS-OCT (CASIA2) 3 months postoperatively. Results: The mean IOL tilt and decentration were greater in the PPV group (5.36 ± 2.50 degrees and 0.27 ± 0.17 mm, respectively) than in the non-PPV group (4.54 ± 1.46 degrees, P = 0.005; 0.19 ± 0.12 mm, P < 0.001, respectively). Multiple logistic regression showed that silicone oil (SO) tamponade (odds ratio [OR] = 5.659, P = 0.021) and hydrophilic IOL (OR = 5.309, P = 0.022) were associated with IOL tilt over 7 degrees, and diabetes mellitus (DM; OR = 5.544, P = 0.033) was associated with IOL decentration over 0.4 mm. Duration of SO tamponade was positively correlated with IOL tilt (P = 0.014) and decentration (P < 0.001). The internal total higher-order aberration, coma, trefoil, and secondary astigmatism in the PPV group were higher than in the non-PPV group, and positively correlated with IOL tilt (P < 0.05). Conclusions: Patients with prior vitrectomy had greater IOL tilt and decentration than the non-PPV group. Longer duration of SO tamponade, hydrophilic IOL, as well as DM were the risk factors of greater IOL tilt and decentration in patients with prior PPV. Translational Relevance: Optically sophisticated designed IOLs should be used cautiously in vitrectomized eyes.

Body mass index is not associated with early onset cataract in the 45 and Up cohort study.

BACKGROUND: Body mass index (BMI) has been reported to be associated with age-related cataract, whereas its impact on early onset cataract (EOC) remains unknown. METHODS: A total of 73,007 individuals aged 45-55 years who had no previous cataract surgeries at baseline were enrolled from the population-based 45 and Up Study. BMI was calculated based on self-reported height and weight from the baseline questionnaire. Data on cataract surgeries were obtained from the Medicare Benefits Schedule database. EOC was defined as cataract surgically treated prior to 65 years of age. A Cox proportional hazards regression was used to assess the association between BMI and the incidence of EOC during the follow-up. RESULTS: A total of 1,764 participants underwent cataract surgery over 643,717 person-years of follow-up. No significant association was observed between BMI and EOC (P for trend 0.35). Among participants who drank 5 to 7 alcoholic drinks per week, a 73% and 27% reduction in the risk of EOC was observed in participants with a BMI of 18.5-19.99 and 25.0-27.49 kg/m2, respectively, compared to those with a BMI of 20.0-22.49 kg/m2. CONCLUSIONS: No association was identified between BMI and the incidence of EOC. Moderate alcohol intake may be protective against EOC.

Accuracy of new-generation intraocular lens calculation formulas in eyes undergoing combined silicone oil removal and cataract surgery.

PURPOSE: To compare the performance of new-generation and traditional intraocular lens (IOL) calculation formulas in eyes undergoing combined silicone oil (SO) removal and cataract surgery and to evaluate the prediction accuracy of Wang-Koch (WK) adjustment in SO-filled long eyes. SETTING: Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. DESIGN: Retrospective consecutive case-series study. METHODS: New-generation formulas (Barrett Universal II, Emmetropia Verifying Optical, Kane, and Ladas Super formulas) and traditional formulas (Haigis, Hoffer Q, Holladay 1, and SRK/T formulas) were compared. The performance of WK adjustment was assessed in eyes with axial length more than 26 mm. The median absolute error (MedAE) was the main parameter to evaluate the accuracy of formulas. RESULTS: A total of 211 participants (211 eyes) who underwent combined SO removal and phacoemulsification with IOL implantation were included. Four new-generation formulas displayed statistically significant lower MedAE (0.32 to 0.35 diopter [D]) and higher percentage of eyes within ±1.00 D of prediction error (85.31% to 87.20%) compared with those of the traditional formulas (MedAE: 0.39 to 0.50 D; ±1.00 D: 81.04% to 81.99%, P < .05). For SO-filled long eyes, all traditional formulas showed hyperopic bias (0.36 to 0.65 D, P < .05), except for Haigis formula (0.28 D, P = .083), and this bias could be corrected by WK adjustment (P > .05). EVO formula displayed the lowest MedAE both in total (0.32 D) and in long eyes (0.33 D). CONCLUSIONS: New-generation formulas and traditional formulas with WK adjustment showed satisfactory prediction accuracy in eyes undergoing combined SO removal and cataract surgery. EVO formula displayed the highest accuracy.

Computer-Aided System Application Value for Assessing Hip Development.

PURPOSE: A computer-aided system was used to semiautomatically measure Tönnis angle, Sharp angle, and center-edge (CE) angle using contours of the hip bones to establish an auxiliary measurement model for developmental screening or diagnosis of hip joint disorders. METHODS: We retrospectively analyzed bilateral hip x-rays for 124 patients (41 men and 83 women aged 20-70 years) who presented at the Affiliated Zhongshan Hospital of Dalian University in 2017 and 2018. All images were imported into a computer-aided detection system. After manually outlining hip bone contours, Tönnis angle, Sharp angle, and CE angle marker lines were automatically extracted, and the angles were measured and recorded. An imaging physician also manually measured all angles and recorded hip development, and Pearson correlation coefficients were used to compare computer-aided system measurements with imaging physician measurements. Accuracy for different angles was calculated, and the area under the receiver operating characteristic (AUROC) curve was used to represent the diagnostic efficiency of the computer-aided system. RESULTS: For Tönnis angle, Sharp angle, and CE angle, correlation coefficients were 0.902, 0.887, and 0.902, respectively; the accuracies of the computer-aided detection system were 89.1, 93.1, and 82.3%; and the AUROC curve values were 0.940, 0.956, and 0.948. CONCLUSION: The measurements of Tönnis angle, Sharp angle, and CE angle using the semiautomatic system were highly correlated with the measurements of the imaging physician and can be used to assess hip joint development with high accuracy and diagnostic efficiency.

Determinants of intraocular lens tilt and decentration after cataract surgery.

BACKGROUND: To identify the main determinants of intraocular lens (IOL) tilt and decentration after cataract surgery using a novel anterior segment optical coherence tomography (AS-OCT) method. METHODS: Fifty-six patients who underwent phacoemulsification with IOL implantation in one eye were continuously enrolled in this cohort study. Axial length (AL) was measured with IOL Master 700. The tilt and decentration of patients' preoperative crystalline lenses and postoperative IOLs, as well as crystalline lens thickness (LT), were measured using AS-OCT before surgery and 1 week after surgery. RESULTS: The mean tilt and decentration of the patients' preoperative crystalline lenses were 4.90°±1.81° and 0.21±0.02 mm, and the mean tilt and decentration of IOLs were 4.75°±1.66° and 0.21±0.02 mm, respectively. There were no significant differences in magnitude, direction of tilt, or decentration between crystalline lenses and IOLs. The strongest determinant of IOL tilt was preoperative crystalline lens tilt (R2=0.512, P<0.001), followed by AL (R2=0.154, P=0.003). Additionally, crystalline lens decentration and AL explained 54.6% of the variability in IOL decentration. AL was the factor most highly associated with IOL decentration (R2=0.332, P<0.001), rather than crystalline lens decentration (R2=0.214, P<0.001). CONCLUSIONS: The position of the preoperative crystalline lens and AL were the critical determinants of IOL tilt and decentration. The tilt and decentration of IOLs will be greater in patients with larger tilt and decentration of crystalline lenses, or shorter and longer AL.

A Semi-automatic Diagnosis of Hip Dysplasia on X-Ray Films.

Background: Diagnosis of hip joint plays an important role in early screening of hip diseases such as coxarthritis, heterotopic ossification, osteonecrosis of the femoral head, etc. Early detection of hip dysplasia on X-ray films may probably conduce to early treatment of patients, which can help to cure patients or relieve their pain as much as possible. There has been no method or tool for automatic diagnosis of hip dysplasia till now. Results: A semi-automatic method for diagnosis of hip dysplasia is proposed. Considering the complexity of medical imaging, the contour of acetabulum, femoral head, and the upper side of thigh-bone are manually marked. Feature points are extracted according to marked contours. Traditional knowledge-driven diagnostic criteria is abandoned. Instead, a data-driven diagnostic model for hip dysplasia is presented. Angles including CE, sharp, and Tonnis angle which are commonly measured in clinical diagnosis, are automatically obtained. Samples, each of which consists of these three angle values, are used for clustering according to their densities in a descending order. A three-dimensional normal distribution derived from the cluster is built and regarded as the parametric model for diagnosis of hip dysplasia. Experiments on 143 X-ray films including 286 samples (i.e., 143 left and 143 right hip joints) demonstrate the effectiveness of our method. According to the method, a computer-aided diagnosis tool is developed for the convenience of clinicians, which can be downloaded at http://www.bio-nefu.com/HIPindex/. The data used to support the findings of this study are available from the corresponding authors upon request. Conclusions: This data-driven method provides a more objective measurement of the angles. Besides, it provides a new criterion for diagnosis of hip dysplasia other than doctors' experience deriving from knowledge-driven clinical manual, which actually corresponds to very different way for clinical diagnosis of hip dysplasia.

Self-Toughening and Self-Enhancement Poly(arylene ether nitrile) with Low Dielectric Constant by Solid Crosslinking Reaction.

A novel poly(arylene ether nitrile) terminated with hydroxyl groups (PEN-OH) was synthesized successfully. The effects of heat-treatment temperature on the thermal properties, mechanical properties, and dielectric properties of the PEN-OH films were studied in detail. Due to the cross-linking reaction occurring, at high temperature, among the nitrile groups on the side of the PEN-OH main chain to form a structurally stable triazine ring, the structure of materials changes from a linear structure to a bulk structure. Thus, the thermal properties and mechanical properties were improved. In addition, the occurrence of cross-linking reactions can reduce the polar groups in the material, leading to the decrease of dielectric constant. As the heat-treatment temperature increased, the glass-transition temperature increased from 180.6 °C to 203.6 °C, and the dielectric constant decreased from 3.4 to 2.8 at 1 MHz. Proper temperature heat-treatment could improve the tensile strength, as well as the elongation, at the break of the PEN-OH films. Moreover, because of the excellent adhesive property of PEN-OH to copper foil, a double-layer flexible copper clad laminate (FCCL) without any adhesives based on PEN-OH was prepared by a simple hot-press method, which possessed high peel strength with 1.01 N/mm. Therefore, the PEN-OH has potential applications in the electronic field.

Investigation of the Match Relation between Steel Fiber and High-Strength Concrete Matrix in Reactive Powder Concrete.

This study investigated the strength and toughness of reactive powder concrete (RPC) made with various steel fiber lengths and concrete strengths. The results indicated that among RPC samples with strength of 150 MPa, RPC reinforced with long steel fibers had the highest compressive strength, peak strength, and toughness. Among the RPC samples with strength of 270 MPa, RPC reinforced with short steel fibers had the highest compressive strength, and peak strength, while RPC reinforced with medium-length steel fibers had the highest toughness. As a result of the higher bond adhesion between fibers and ultra-high-strength RPC matrix, long steel fibers were more effective for the reinforcement of RPC with strength of 150 MPa, while short steel fibers were more effective for the reinforcement of RPC with strength of 270 MPa.

Mutual regulation between microRNA-373 and methyl-CpG-binding domain protein 2 in hilar cholangiocarcinoma.

AIM: To investigate the reciprocal modulation between microRNA (miRNA) and DNA methylation via exploring the correlation between miR-373 and methyl-CpG-binding domain protein (MBD)2. METHODS: MiR-373 expression was examined using the TaqMan miRNA assay. Methylation of miR-373 was investigated using methylation-specific polymerase chain reaction, and recruitment of methyl binding proteins was studied using the chromatin immunoprecipitation assay. Mutation analysis was conducted using the QuikChange™ Site-Directed Mutagenesis kit. The activity of miR-373 gene promoter constructs and targeting at MBD2-three prime untranslated region (3'UTR) by miR-373 were evaluated by a dual-luciferase reporter gene assay. RESULTS: In hilar cholangiocarcinoma, miR-373 decreased and was closely associated with poor cell differentiation, advanced clinical stage, and shorter survival. The promoter-associated CpG island of miR-373 gene was hypermethylated and inhibited expression of miR-373. MBD2 was up-regulated and enriched at the promoter-associated CpG island of miR-373. Methylation-mediated suppression of miR-373 required MBD2 enrichment at the promoter-associated CpG island, and miR-373 negatively regulated MBD2 expression through targeting the 3'UTR. CONCLUSION: MiR-373 behaves as a direct transcriptional target and negative regulator of MBD2 activity through a feedback loop of CpG island methylation.