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1.
Am Fam Physician ; 101(3): 184-185, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32003948
3.
Am Fam Physician ; 101(3): 147-158, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32003959

RESUMO

Healthy development is likely to occur when an adolescent's risk factors are limited and when protective factors are fostered. Healthy development is further encouraged when youth feel valued, empowered, and form healthy social connections. Threats to the well-being of adolescents typically result from experimentation and psychosocial stressors. SSHADESS (strengths, school, home, activities, drugs, emotions/eating, sexuality, safety) is a mnemonic to facilitate collection of psychosocial history of critical life dimensions emphasizing strengths within a youth's life experience instead of solely focusing on risks, which in isolation can provoke feelings of shame. Because adolescents are more likely to access health care and share sensitive information when confidentiality is assured, clinicians should regularly offer confidential screening and counseling. When limited for time, a brief psychosocial screen may include current stressors, availability of a confidant, and school or work experience as a proxy for well-being. Clinicians should provide education to prevent initiation of tobacco use. Long-acting reversible contraceptives are safe and effective in adolescents and should be offered as first-line options to prevent pregnancy. Sexually active females 24 years or younger should be screened for gonorrhea and chlamydia annually. Adolescents 12 years or older should be screened for major depressive disorder when systems are available to ensure accurate diagnosis, treatment, and follow-up. Adolescents with body mass index at the 95th percentile or higher should be referred for comprehensive behavioral interventions. Seatbelt use and avoidance of distracted or impaired driving should be discussed. Clinicians should discuss digital literacy and appropriate online boundary setting and display of personal information.

4.
Biomacromolecules ; 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32003967

RESUMO

Supramolecular protein hydrogels with tunable properties represent promising candidates for advanced designer extracellular matrices (ECMs). To control cellular functions, ECMs should be able to spatiotemporally regulate synergistic signaling between transmembrane receptors and growth factor (GF) receptors. In this study, we developed genetically engineered temperature-responsive multifunctional protein hydrogels. The designed hydrogel was fabricated by combining the following four peptide blocks: thermosensitive elastin-like polypeptides (ELPs), a polyaspartic acid (polyD) chain to control aggregation and delivery of GFs, a de novo-designed helix peptide that forms antiparallel homotetrameric coiled-coils, and a biofunctional peptide. The resultant coiled-coil unit bound ELPs (CUBEs) exhibit a controllable sol-gel transition with tunable mechanical properties. CUBEs were functionalized with bone sialoprotein-derived RGD (bRGD), and human umbilical vein endothelial cells (HUVECs) were three-dimensionally cultured in bRGD-modified CUBE (bRGD-CUBE) hydrogels. Proangiogenic activity of HUVECs was promoted by bRGD. Moreover, heparin-binding angiogenic GFs were immobilized to bRGD-CUBEs via electrostatic interactions. HUVECs cultured in GF-tethered bRGD-CUBE hydrogels formed three-dimensional (3-D) tubulelike structures. The designed CUBE hydrogels may demonstrate utility as advanced smart biomaterials for biomedical applications. Further, the protein hydrogel design strategy may provide a novel platform for constructing designer 3-D microenvironments for specific cell types.

5.
J Nat Prod ; 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32004001

RESUMO

Vescalagin (1) is a major ellagitannin from young spring leaves of Quercus glauca; however, the amount of 1 decreases as the leaves mature with a concomitant rise in the levels of catechin (3) and procyanidins. In this report, the chemical mechanism responsible for the degradation of 1 was investigated. In vitro model experiments indicated that initially a polyphenol oxidase oxidizes the catechin B-ring, and the resulting catechin o-quinone oxidizes one of the pyrogallol rings of 1 to give a cyclopenten-1,2-dione-type product 4. The presence of 4 in young oak leaves was confirmed by the detection of 4 and its quinoxaline derivative 4a. Furthermore, it was demonstrated that the cyclopenten-1,2-dione moiety of 4 nonenzymatically reacted with the catechin A-ring to yield the conjugate 5. Similar conjugations probably occur with procyanidins; thus, these reactions are possibly responsible for the decrease in the levels of 1 in leaves. The same cyclopenten-1,2-dione product 4 was also generated by treatment of 1 with a wood-rotting mushroom, Lentinula edodes, and further oxidative cleavage of a second pyrogallol ring of 4 was also observed. The results indicate the presence of a common degradation mechanism of 1 by plants and microbes.

6.
Phys Rev Lett ; 124(2): 027203, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-32004033

RESUMO

Spin waves can probe the Dzyaloshinskii-Moriya interaction (DMI), which gives rise to topological spin textures, such as skyrmions. However, the DMI has not yet been reported in yttrium iron garnet (YIG) with arguably the lowest damping for spin waves. In this work, we experimentally evidence the interfacial DMI in a 7-nm-thick YIG film by measuring the nonreciprocal spin-wave propagation in terms of frequency, amplitude, and most importantly group velocities using all electrical spin-wave spectroscopy. The velocities of propagating spin waves show chirality among three vectors, i.e., the film normal direction, applied field, and spin-wave wave vector. By measuring the asymmetric group velocities, we extract a DMI constant of 16 µJ/m^{2}, which we independently confirm by Brillouin light scattering. Thickness-dependent measurements reveal that the DMI originates from the oxide interface between the YIG and garnet substrate. The interfacial DMI discovered in the ultrathin YIG films is of key importance for functional chiral magnonics as ultralow spin-wave damping can be achieved.

7.
Phys Rev Lett ; 124(2): 025003, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-32004037

RESUMO

We present a study on the impact of a gas atmosphere on the collision of two counterpropagating plasmas (gold and carbon). Imaging optical Thomson scattering data of the plasma collision with and without helium in between have been obtained at the Omega laser facility. Without gas, we observed large scale mixing of colliding gold and carbon ions. Once ambient helium is added, the two plasmas remain separated. The difference in ionic temperature is consistent with a reduction of the maximum Mach number of the flow from M=7 to M=4. It results in a reduction of a factor ∼10 of the counterstreaming ion-ion mean free path. By adding a low-density ambient gas, it is possible to control the collision of two high-velocity counterstreaming plasma, transitioning from an interpenetrating regime to a regime in agreement with a hydrodynamic description.

8.
Am J Sports Med ; : 363546519899087, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32004077

RESUMO

BACKGROUND: Early intervention with mesenchymal stem cells (MSCs) after articular trauma has the potential to limit progression of focal lesions and prevent ongoing cartilage degeneration by modulating the joint environment and/or contributing to repair. Integrin α10ß1 is the main collagen type II binding receptor on chondrocytes, and MSCs that are selected for high expression of the α10 subunit have improved chondrogenic potential. The ability of α10ß1-selected (integrin α10high) MSCs to protect cartilage after injury has not been investigated. PURPOSE: To investigate integrin α10high MSCs to prevent posttraumatic osteoarthritis in an equine model of impact-induced talar injury. STUDY DESIGN: Controlled laboratory study. METHODS: Focal cartilage injuries were created on the tali of horses (2-5 years, n = 8) by using an impacting device equipped to measure impact stress. Joints were treated with 20 × 106 allogenic adipose-derived α10high MSCs or saline vehicle (control) 4 days after injury. Synovial fluid was collected serially and analyzed for protein content, cell counts, markers of inflammation (prostaglandin E2, tumor necrosis factor α) and collagen homeostasis (procollagen II C-propeptide, collagen type II cleavage product), and glycosaminoglycan content. Second-look arthroscopy was performed at 6 weeks, and horses were euthanized at 6 months. Joints were imaged with radiographs and quantitative 3-T magnetic resonance imaging. Postmortem examinations were performed, and India ink was applied to the talar articular surface to identify areas of cartilage fibrillation. Synovial membrane and osteochondral histology was performed, and immunohistochemistry was used to assess type I and II collagen and lubricin. A mixed effect model with Tukey post hoc and linear contrasts or paired t tests were used, as appropriate. RESULTS: Integrin α10high MSC-treated joints had less subchondral bone sclerosis on radiographs (P = .04) and histology (P = .006) and less cartilage fibrillation (P = .04) as compared with control joints. On gross pathology, less India ink adhered to impact sites in treated joints than in controls, which may be explained by the finding of more prominent lubricin immunostaining in treated joints. Prostaglandin E2 concentration in synovial fluid and mononuclear cell synovial infiltrate were increased in treated joints, suggesting possible immunomodulation by integrin α10high MSCs. CONCLUSION: Intra-articular administration of integrin α10high MSCs is safe, and evidence suggests that the cells mitigate the effects of joint trauma. CLINICAL RELEVANCE: This preclinical study indicates that intra-articular therapy with integrin α10high MSCs after joint trauma may be protective against posttraumatic osteoarthritis.

9.
Artigo em Inglês | MEDLINE | ID: mdl-32004086

RESUMO

Biallelic variants in LZTR1 were recently reported to be associated with autosomal recessive Noonan syndrome (NS), with a phenotypic spectrum ranging from mild symptoms to lethality due to cardiac disease and leukemia1. All patients had features typically associated with NS. Here we report an additional family with two affected children who present with hypertrophic cardiomyopathy (HCM) without typical dysmorphism or other major features seen in NS.

10.
Artigo em Inglês | MEDLINE | ID: mdl-32004095

RESUMO

Objectives: The subxiphoid thoracoscopic approach may be an alternative to the lateral transthoracic approach in the treatment of thymic diseases. This study aimed to assess the safety and efficacy of subxiphoid video-assisted thoracoscopic surgery and compare this approach with the lateral transthoracic variation in terms of short-term perioperative outcomes. Methods: Data for 107 consecutive adult patients who underwent transthoracic or subxiphoid video-assisted thoracic surgery for thymic diseases from July 2015 to February 2019 were retrospectively reviewed. The patients were stratified according to whether they had accompanying myasthenia gravis (MG). Perioperative outcomes were compared between the two cohorts. Results: A total of 107 patients were identified, including 37 patients who underwent subxiphoid video-assisted thoracoscopic thymectomy (S-VATT) and 70 patients who underwent transthoracic video-assisted thoracoscopic thymectomy (T-VATT). The S-VATT group exhibited less operative blood loss (112.14 ± 117.01 versus 58.81 ± 48.67, P = .003), a shorter duration of chest tube usage (3.77 ± 1.83 versus 2.18 ± 1.88, P = .000), lower postoperative pain scores (4.99 ± 0.99 versus 1.57 ± 0.55, P = .000), and a shorter length of postoperative hospital stay (5.83 ± 1.38 versus 4.38 ± 1.26, P = .000) than the T-VATT group. For MG patients, the median operative time was significantly shorter in the S-VATT group than in the T-VATT group (141.46 ± 54.17 versus 95.63 ± 31.25, P = .004). Conclusions: S-VATT is a safe approach for patients with thymic diseases and has potential advantages of a shorter operative time, less intraoperative bleeding, and less postoperative pain compared with the lateral transthoracic approach, especially for patients with MG.

11.
Artigo em Inglês | MEDLINE | ID: mdl-32004104

RESUMO

Purpose: Purposes of this study were to (1) develop an instrument of connectedness with health care providers (HCPs) for adolescents and young adults (AYAs) with cancer (ages 13 to 21 years); (2) evaluate the content validity of the instrument through expert panels; (3) assess the dimensionality of the instrument; (4) evaluate the internal consistency reliability of the instrument; and (5) evaluate the convergent and discriminant validity of the instrument through hypothesis testing. Methods: The Connectedness with HCPs Scale (C-HCPS) was developed and evaluated in two phases. Phase I involved generating items, having two expert panels (AYAs and clinicians; n = 13) evaluate the items for content validity, and pretesting the instrument before pilot testing (n = 6). In phase II, the psychometric properties of the instrument (dimensionality, internal consistency reliability, and convergent/discriminant validity) were evaluated (n = 101). Results: The initial exploratory factor analysis revealed that the items separated into two separate instruments. In addition to the C-HCPS, a Disconnectedness with HCPs Scale (D-HCPS) was revealed. The C-HCPS contains 35 items and the D-HCPS contains 11 items. Exploratory factor analysis suggested a five-factor solution for the C-HCPS and a two-factor solution for the D-HCPS. Internal consistency reliability of the C-HCPS and D-HCPS was 0.0964 and 0.0881, respectively. Good evidence of convergent and discriminant validity was demonstrated through hypothesis testing. Conclusion: Findings indicate that the C-HCPS and D-HCPS are both reliable instruments with good evidence of convergent and discriminant validity. Further exploration of these instruments using confirmatory factor analysis in a larger sample is needed.

12.
J Clin Oncol ; : JCO1902834, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32004107

RESUMO

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.

13.
Ocul Immunol Inflamm ; 28(1): 67-69, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32004110

RESUMO

Purpose: To report a case of chronic anterior uveitis associated with relapsing polychondritis (RP).Case Report: A 43-year-old female patient presenting with bilateral progressive vision loss was diagnosed with bilateral anterior uveitis. According to her clinical signs and symptoms and biopsy results, RP was ultimately diagnosed. Her ocular inflammation was controlled with corticosteroids and systemic immunosuppressive treatment, and the symptoms related to RP improved.Conclusion: Chronic uveitis is an inflammatory disease that may be associated with many systemic autoimmune diseases. RP should especially be considered in patients with bilateral chronic uveitis, and a relevant detailed history should be obtained for early and accurate diagnosis and treatment.

14.
Radiographics ; : 190143, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32004117

RESUMO

Transgender patients seeking gender-affirming surgery are a growing population with unique health care needs. The radiologist must understand the challenges these patients face to facilitate a positive patient-physician interaction during the series of postoperative fluoroscopic evaluations. The authors present a standard two-stage surgical approach and common postoperative fluoroscopic findings after perineal masculinization and phalloplasty procedures. Perineal masculinization including urethral lengthening is performed first, followed by skin-flap-based phalloplasty. Patients undergo voiding cystourethrography (VCUG) after intravesical administration of contrast media by way of an indwelling suprapubic catheter after each stage. Retrograde urethrography plays a complementary role to supplement the limitations of VCUG after the second stage. The article reviews the expected postoperative anatomy and explains standardized terminology developed at the authors' institution. Imaging features of common and rare complications are discussed, including contained leak, stenosis, occlusion, and fistula. The successful postoperative imaging study in a transmasculine patient relies on open communication among the interdisciplinary team of specialized surgeons, radiologists, and medical providers, as well as special modifications to existing imaging techniques. ©RSNA, 2020.

15.
Drug Metab Pers Ther ; 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32004144

RESUMO

Background Hospitalized pediatric patients are at an increased risk of experiencing potential drug-drug interactions (pDDIs) due to polypharmacy and the unlicensed and off-label administration of drugs. The aim of this study is to characterize clinically significant pDDIs in pediatric patients hospitalized in a tertiary respiratory center. Methods A retrospective analysis of medications prescribed to pediatric patients admitted to the pediatric ward (PW) and pediatric intensive care unit (PICU) of a respiratory referral center was carried out over a six-month period. The pDDIs were identified using the Lexi-Interact database and considered as clinically relevant according to the severity rating as defined in the database. Frequency, drug classes, mechanisms, clinical managements, and risk factors were recorded for these potential interactions. Results Eight hundred and forty-five pDDIs were identified from the analysis of 176 prescriptions. Of the total pDDIs, 10.2% in PW and 14.6% in PICU were classified as clinically significant. Anti-infective agents and central nervous system drugs were the main drug classes involved in clinically significant pDDIs as object and/or precipitant drugs. A higher number of medications [odds ratio (OR): 4.8; 95% confidence interval (CI): 2.0-11.4; p < 0.001] and the existence of a nonrespiratory disease, which led to a respiratory disorder (OR: 3.8; 95% CI: 1.40-10.4; p < 0.05), were the main risk factors associated with an increased incidence of pDDIs. Conclusions A high and similar risk of pDDIs exists in pediatric patients with respiratory disorders hospitalized in PW and PICU. The patients prescribed a higher number of medications and presenting respiratory symptoms induced by a nonrespiratory disease require extra care and monitoring. Pediatricians should be educated about clinically significant DDIs for highly prescribed medications in their settings in order to take preventive measures and safeguard patient safety.

16.
Cornea ; 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-32004166

RESUMO

PURPOSE: Our objectives were to determine the anatomical and functional (visual and refractive) outcomes of corneal refractive surgery during breastfeeding and to compare the results with those of women who stopped breastfeeding at least 3 months before the procedure. We also evaluated predictability, safety, and efficacy indexes; number of retreatments; and adverse effects reported in babies. METHODS: We performed a multicenter, retrospective, interventional case series review of patients who were breastfeeding and who underwent laser in situ keratomileusis or surface ablation (photorefractive keratectomy) from September 11, 2002 to December 12, 2017 (group 1, n = 142 eyes in the case group). Patients were compared with women who stopped breastfeeding at least 3 months before the procedure from September 11, 2002 to December 12, 2017 (group 2, n = 95 eyes in the control group). A total of 168 women (237 eyes) were included. Patients were incorporated consecutively. Functional (visual and refractive) and anatomical outcomes are described. RESULTS: No significant intraoperative or postoperative complications were recorded. There were no significant differences between the groups in visual acuity, postoperative spherical equivalent, efficacy index, predictability, safety index, or retreatments. No infants experienced adverse effects. CONCLUSIONS: In our experience, laser in situ keratomileusis and photorefractive keratectomy can be performed effectively and safely in breastfeeding women.

17.
Artigo em Inglês | MEDLINE | ID: mdl-32004173

RESUMO

PURPOSE OF REVIEW: To review the advance of maternal--fetal surgery, the research of stem cell transplantation and tissue engineering in prenatal management of fetal meningomyelocele (fMMC). RECENT FINDINGS: Advance in the imaging study provides more accurate assessment of fMMC in utero. Prenatal maternal--fetal surgery in fMMC demonstrates favourable postnatal outcome. Minimally invasive fetal surgery minimizes uterine wall disruption. Endoscopic fetal surgery is performed via laparotomy-assisted or entirely percutaneous approach. The postnatal outcome for open and endoscopic fetal surgery shares no difference. Single layer closure during repair of fMMC is preferred to reduce postnatal surgical intervention. All maternal--fetal surgeries impose anesthetic and obstetric risk to pregnant woman. Ruptured of membrane and preterm delivery are common complications. Trans-amniotic stem cell therapy (TRASCET) showed potential tissue regeneration in animal models. Fetal tissue engineering with growth factors and dura substitutes with biosynthetic materials promote spinal cord regeneration. This will overcome the challenge of closure in large fMMC. Planning of the maternal--fetal surgery should adhere to ethical framework to minimize morbidity to both fetus and mother. SUMMARY: Combination of endoscopic fetal surgery with TRASCET or tissue engineering will be a new vision to achieve to improve the outcome of prenatal intervention in fMMC.

18.
Artigo em Inglês | MEDLINE | ID: mdl-32004181

RESUMO

PURPOSE: To report a case of retinal astrocytic hamartoma imaged by optical coherence tomography angiography (OCTA), followed for 2 years. METHODS: Observational case report. RESULTS: A 25-year-old woman was referred for an incidental retinal lesion in the left eye (LE). At baseline, the best-corrected visual acuity in the LE was 20/32, and fundus examination showed the presence of a round, pigmented lesion in juxtafoveal region, corresponding, on spectral domain OCT, to a hyperreflective lesion within nerve fiber layer. Optical coherence tomography angiography revealed the presence of a high-flow lesion in the superficial capillary plexus segmentation. The patient was followed up for 2 years: best-corrected visual acuity remained stable and multimodal imaging, including OCTA, confirmed the benign and stable nature of the lesion. At baseline, the total lesion area on OCTA (superficial capillary plexus) was 0.181 mm, whereas vascular density was 52.080%; the total area was 0.204 mm, and vascular density was 53.740% at 2-year follow-up. CONCLUSION: Optical coherence tomography angiography is helpful not only for the diagnosis and follow-up of such rare tumors, but also it gives insights as to how these tumors develop and how they affect surrounding structures.

19.
Artigo em Inglês | MEDLINE | ID: mdl-32004189

RESUMO

OBJECTIVE: The objective of this study was to develop a nomogrom for prediction of pathological complete response (PCR) to neoadjuvant chemotherapy in breast cancer patients. METHODS: Ninety-one patients were analyzed. A total of 396 radiomics features were extracted from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and apparent diffusion coefficient (ADC) maps. The least absolute shrinkage and selection operator was selected for data dimension reduction to build a radiomics signature. Finally, the nomogram was built to predict PCR. RESULTS: The radiomics signature of the model that combined DCE-MRI and ADC maps showed a higher performance (area under the receiver operating characteristic curve [AUC], 0.848) than the models with DCE-MRI (AUC, 0.750) or ADC maps (AUC, 0.785) alone in the training set. The proposed model, which included combined radiomics signature, estrogen receptor, and progesterone receptor, yielded a maximum AUC of 0.837 in the testing set. CONCLUSIONS: The combined radiomics features from DCE-MRI and ADC data may serve as potential predictor markers for predicting PCR. The nomogram could be used as a quantitative tool to predict PCR.

20.
J Bone Joint Surg Am ; 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32004190

RESUMO

BACKGROUND: Unicompartmental knee replacement (UKR) offers substantial benefits compared with total knee replacement (TKR) but is associated with higher revision rates. Data from registries suggest that revision rates for cementless UKR implants are lower than those for cemented implants. It is not known how much of this difference is due to the implant or to other factors, such as a greater proportion of high-volume surgeons using cementless implants. We aimed to determine the effect of surgeon caseload on the revision rate of matched cemented and cementless UKRs. METHODS: From a group of 40,522 Oxford (Zimmer Biomet) UKR implants (30,814 cemented, 9,708 cementless) recorded in the National Joint Registry, 14,814 (7,407 cemented, 7,407 cementless) were propensity-score matched. Surgeons were categorized into 3 groups: low volume (<10 cases/year), medium volume (10 to <30 cases/year), and high volume (≥30 cases/year). The effect of caseload on the relative risk of revision was assessed with use of Cox regression. RESULTS: The 10-year survival rates for unmatched cementless and cemented UKR implants were 93.3% (95% confidence interval [CI] = 89.8% to 95.7%) and 89.1% (95% CI = 88.6% to 89.6%), respectively, with the difference being significant (hazard ratio [HR] = 0.59; p < 0.001). Cementless UKR implants had a greater proportion of high-volume surgeon users than cemented implants (30.4% compared with 15.1%). Following matching, the 10-year survival rates were 93.2% (95% CI = 89.7% to 95.6%) and 90.2% (95% CI = 87.5% to 92.3%), which were still significantly different (HR = 0.76; p = 0.002). The 10-year survival rates for matched cementless and cemented UKR implants were 86.8% (95% CI = 73.6% to 93.7%) and 81.8% (95% CI = 73.0% to 88.0%) for low-volume surgeons, 94.3% (95% CI = 92.2% to 95.9%) and 92.5% (95% CI = 89.9% to 94.5%) for medium-volume surgeons, and 97.5% (95% CI = 96.5% to 98.2%) and 94.2% (95% CI = 90.8% to 96.4%) for high-volume surgeons. The revision rate for cementless implants was lower for surgeons in all 3 caseload groups (HR = 0.74, 0.79, 0.80, respectively). CONCLUSIONS: Cementless fixation decreased the revision rate by about a quarter, whatever the surgeon caseload. Caseload had a profound effect on implant survival. Low-volume surgeons had a high revision rate with cemented or cementless fixation and therefore should consider either stopping or doing more UKR procedures. High-volume surgeons performing cementless UKR demonstrated a 10-year survival rate of 97.5%, which was similar to that reported in registries for the best-performing TKRs. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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