Improving the Stability, Foliar Utilization and Biological Activity of Imidacloprid Delivery Systems: Size Effect of Nanoparticles.

Nanotechnology could improve the effectiveness and functionality of pesticides, but the size effect of nanopesticides on formulation performance and the related mechanisms have yet to be explored, hindering the precise design and development of efficient and eco-friendly nanopesticides. In this study, two non-carrier-coated imidacloprid formulations (Nano-IMI and Micro-IMI) with identical composition but varying particle size characteristics were constructed to exclude other interferences in the size effect investigation. Nano-IMI and Micro-IMI both exhibited rod-like structures. Specifically, Nano-IMI had average vertical and horizontal axis sizes of 239.5 nm and 561.8 nm, while Micro-IMI exhibited 6.7 µm and 22.1 µm, respectively. Compared to Micro-IMI, the small size effect of Nano-IMI affected the arrangement of interfacial molecules, reduced surface tension and contact angle, thereby improving the stability, dispersibility, foliar wettability, deposition and retention of the nano-system. Nano-IMI exhibited 1.3 times higher toxicity to Aphis gossypii Glover compared to Micro-IMI, attributed to its enhanced foliar utilization efficiency. Importantly, the Nano-IMI did not intensify the toxicity to non-target organism Apis mellifera L. This study systematically elucidates the influence of size effect on key indicators related to the effectiveness and safety, providing a theoretical basis for efficient and safe application of nanopesticides and critical insights into sustainable agriculture and environmental development.

Dual-loaded nano pesticide system based on industrial grade scaleable carrier materials with combinatory efficacy and improved safety.

Repeated and widespread use of single chemical pesticides raises concerns about efficiency and safety, developing multi-component synergistic pesticides provides a new route for efficient control of diseases. Most commercial compound formulations are open systems with non-adjustable released rates, resulting in a high frequency of applications. Meanwhile, although nano pesticide delivery systems constructed with different carrier materials have been extensively studied, realizing their actual scale-up production still has important practical significance due to the large-scale field application. In this study, a boscalid and pyraclostrobin dual-loaded nano pesticide system (BPDN) was constructed with industrial-grade carrier materials to facilitate the realization of large-scale production. The optimal industrial-scale preparation mechanism of BPDN was studied with surfactants as key factors. When agricultural emulsifier No.600 and polycarboxylate are used as the ratio of 1:2 in the preparation process, the BPDN has a spherical structure with an average size of 270 nm and exhibits superior physical stability. Compared with commercial formulation, BPDN maintains rate-stabilized release up to 5 times longer, exhibits better dispersion and spreading performance on foliar, has more than 20% higher deposition amounts, and reduces loss. A single application of BPDN could efficiently control tomato gray mold during the growing period of tomatoes due to extended duration and combinatory effectiveness, reducing two application times and labor costs. Toxicology tests on various objects systematically demonstrated that BPDN has improved safety for HepG2 cells, and nontarget organism earthworms. This research provides insight into creating safe, efficient, and environmentally friendly pesticide production to reduce manual operation times and labor costs. Accompanied by production strategies that can be easily scaled up industrially, this contributes to the efficient use of resources for sustainable agriculture.

The key factors of solid nanodispersion for promoting the bioactivity of abamectin.

Solid nanodispersion (SND) is an important variety of nanopesticides which have been extensively studied in recent years. However, the key influencing factors for bioactivity enhancement of nanopesticides remain unclear, which not only limits the exploration of relevant mechanisms, but also hinders the precise design and development of nanopesticides. In this study, we explored the potential of SND in enhancing the bioactivity of nanopesticides, specifically focusing on abamectin SND prepared using a self-emulsifying-carrier solidifying technique combined with parameter optimization. Our formulation, consisting of 8% abamectin, 1% antioxidant BHT (2,6-di-tert-butyl-4-methylphenol), 12% complex surfactants, and 79% sodium benzoate, significantly increased the pseudo-solubility of abamectin by at least 3300 times and reduced its particle size to a mere 15 nm, much smaller than traditional emulsion in water (EW) and water-dispersible granule (WDG) forms. This reduction in particle size and increase in surface activity resulted in improved foliar adhesion and retention, enabling a more efficient application without the need for organic solvents. The inclusion of antioxidants also enhanced photostability compared to EW, and overall stability tests confirmed SND's resilience under various storage conditions. Bioactivity tests demonstrated a marked increase in toxicity against diamondback moths (Plutella xylostella L.) with abamectin SND, which exhibited 3.7 and 7.6 times greater efficacy compared to EW and WDG, respectively. These findings underscore the critical role of small particle size, high surface activity, and strong antioxidant properties in improving the performance and bioactivity of abamectin SND, highlighting its significance in the design and development of high-efficiency, eco-friendly nanopesticides and contributing valuably to sustainable agricultural practices.

The effect of intraoperative fluoroscopy on acetabular component positioning and patient anatomy restoration during posterior or posterolateral approach total hip arthroplasty: a meta-analysis.

BACKGROUND: Positioning implant components and restoring patient anatomy during total hip arthroplasty (THA) are essential for joint stability, polyethylene liner wear, and range of motion. Previous studies comparing intraoperative fluoroscopy with no fluoroscopy during the posterior or posterolateral approach have reported conflicting results. This meta-analysis evaluated if intraoperative fluoroscopy improves component positioning and femoral component position compared to no fluoroscopy during posterior or posterolateral approach total hip arthroplasty. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were followed when conducting the systematic review. We searched Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database in May 2023 to identify studies involving Intraoperative fluoroscopy versus no fluoroscopy during posterior or posterolateral approach total hip arthroplasty. Finally, we identified 1133 patients (1145 hips) assessed in seven studies. RESULTS: There were no significant differences in terms of acetabular cup inclination angle (ACIA, P = 0.43), ACIA within safe zone rate (P = 0.58), acetabular cup anteversion angle (ACAA, P = 0.46); ACAA within safe zone rate (P = 0.72), Combined safe zone rate (P = 0.28), dislocation rate (P = 0.64) and infection rate (P = 0.94) between two groups. Compared with the no fluoroscopy group, the intraoperative fluoroscopy group had more operation time (P < 0.00001), less femoral component offset difference (FCOD, P = 0.03), and less LLD (P < 0.00001). CONCLUSION: Even though intraoperative fluoroscopy was not related to an improvement in cup location or dislocation incidence. Our findings demonstrate that the restoration of leg lengths and femoral offset can be significantly improved by using intraoperative fluoroscopy to supplement good surgical skills in THA. The advantages of intraoperative fluoroscopy might become more apparent for surgeons with less experience. To ascertain whether intraoperative fluoroscopy for posterior or posterolateral approach total hip arthroplasty will have clinical benefits and improve the survival of prostheses, more well-powered and well-designed long-term follow-up studies were necessary.

Nanomaterials and nanotechnology for the delivery of agrochemicals: strategies towards sustainable agriculture.

Nanomaterials (NMs) have received considerable attention in the field of agrochemicals due to their special properties, such as small particle size, surface structure, solubility and chemical composition. The application of NMs and nanotechnology in agrochemicals dramatically overcomes the defects of conventional agrochemicals, including low bioavailability, easy photolysis, and organic solvent pollution, etc. In this review, we describe advances in the application of NMs in chemical pesticides and fertilizers, which are the two earliest and most researched areas of NMs in agrochemicals. Besides, this article concerns with the new applications of NMs in other agrochemicals, such as bio-pesticides, nucleic acid pesticides, plant growth regulators (PGRs), and pheromone. We also discuss challenges and the industrialization trend of NMs in the field of agrochemicals. Constructing nano-agrochemical delivery system via NMs and nanotechnology facilitates the improvement of the stability and dispersion of active ingredients, promotes the precise delivery of agrochemicals, reduces residual pollution and decreases labor cost in different application scenarios, which is potential to maintain the sustainability of agricultural systems and improve food security by increasing the efficacy of agricultural inputs.

The combined utilization of predictors seems more suitable to diagnose and predict rotator cuff tears.

BACKGROUND: Morphological markers presenting the lateral extension of acromion and the greater tuberosity of humerus were proposed to diagnose and predict rotator cuff tears (RCTs) in recent years, but few studies have addressed the combined performance when using two predictors together. As a presence of a RCT may be associated with the impingement caused by both acromion and the greater tuberosity, we believe a combined utilization of predictors could result in a better diagnostic and predictive performance than using a single predictor. The aim of this study is to (i) explore whether the combination is more efficient to predict and diagnose RCTs; (ii) find out which combination is the most superior screening approach for RCTs. METHODS: This was a retrospective study and patients who visited our hospital and were diagnosed with or without partial-thickness or full-thickness RCTs via magnetic resonance imaging from January 2018 to April 2022 were enrolled and classified into two groups respectively. Four predictors, the critical shoulder angle (CSA), the acromion index (AI), the greater tuberosity angle (GTA) and the double-circle radius ratio (DRR) were picked to participate in the present study. Quantitative variables were compared by independent samples t tests and qualitative variables were compared by chi-square tests. Binary logistic regression analysis was used to construct discriminating combined models to further diagnose and predict RCTs. Receiver operating characteristic (ROC) curves were pictured to determine the overall diagnostic performance of the involved predictors and the combined models. RESULTS: One hundred and thirty-nine shoulders with RCTs and 57 shoulders without RCTs were included. The mean values of CSA (35.36 ± 4.57 versus 31.41 ± 4.09°, P < 0.001), AI (0.69 ± 0.08 versus 0.63 ± 0.08, P < 0.001), DRR (1.43 ± 0.10 versus 1.31 ± 0.08, P < 0.001) and GTA (70.15 ± 7.38 versus 64.75 ± 7.91°, P < 0.001) were significantly higher in the RCT group than for controls. Via ROC curves, we found the combined model always showed a better diagnostic performance than either of its contributors. Via logistic regression analysis, we found the values of both predictors over their cutoff values resulted in an increasement (20.169-161.214 folds) in the risk of having a RCT, which is more than that by using a single predictor only (2.815 -11.191 folds). CONCLUSION: The combined utilization of predictors is a better approach to diagnose and predict RCTs than using a single predictor, and CSA together with DRR present the strongest detectability for a presence of RCTs.

Construction and Characterization of Novel Hydrophilic Nanospheres Loaded with Lambda-Cyhalothrin via Ultrasonic Emulsification-Solvent Evaporation.

Safe and efficient pesticide formulations have attracted great attention for the prevention and control of diseases and pests. In recent years, improving the effectiveness and duration of pesticides through nanotechnology has become a research hotspot in the field of pesticide formulations. Here, we develop a novel hydrophilic lambda-cyhalothrin nanospheres encapsulated with poly(styrene-co-maleic anhydride) (PSMA) via the ultrasonic emulsification-solvent evaporation method, which exhibited better particle size uniformity and dispersion in comparison with the traditional method. The effects of PSMA content, oil phase/water phase ratio and phacoemulsification time on the particle size and morphology of nanoparticles were investigated to optimize preparation process parameters. Meanwhile, the wettability and adhesion behavior on the leaf surface, the release properties, and the storage stability of nanoparticles were characterized to evaluate the performance of the novel nano-formulation. This work not only establishes a facile and promising method for the applicable of insoluble pesticides, but also develops an innovative nano-formulation with hydrophilicity and high leaf adhesion, which opens a new direction in plant protection and residue reduction.

Preparation and Size Control of Efficient and Safe Nanopesticides by Anodic Aluminum Oxide Templates-Assisted Method.

Efficient and safe nanopesticides play an important role in pest control due to enhancing target efficiency and reducing undesirable side effects, which has become a hot spot in pesticide formulation research. However, the preparation methods of nanopesticides are facing critical challenges including low productivity, uneven particle size and batch differences. Here, we successfully developed a novel, versatile and tunable strategy for preparing buprofezin nanoparticles with tunable size via anodic aluminum oxide (AAO) template-assisted method, which exhibited better reproducibility and homogeneity comparing with the traditional method. The storage stability of nanoparticles at different temperatures was evaluated, and the release properties were also determined to evaluate the performance of nanoparticles. Moreover, the present method is further demonstrated to be easily applicable for insoluble drugs and be extended for the study of the physicochemical properties of drug particles with different sizes.

Preservation of Devitalized Bone in Necrotic Digits Following Crush Injury With Free Tissue Transfer.

Traditional management of necrotic digits has been to allow demarcation between viable and nonviable tissues to occur, and thus to indicate the level of amputation required. In this case report, the phalangeal length of the necrotic thumb was maintained in 2 patients who had sustained crush injury. After nonviable soft tissues were debrided, the devitalized bones were covered with soft tissue flaps. All wounds healed without infection. Both cosmetic and functional results of the reconstructed thumbs were satisfactory. In one patient, radiographs of the thumb demonstrated resorption of the distal phalanx, but this did not impede daily use. This experience supports an earlier observation suggesting that devitalized bone can be covered for salvage in some cases.

[Causes of failure after total knee arthroplasty].

OBJECTIVE: To identify the causes of failure after total knee arthroplasty (TKA). METHODS: Retrospective reviews were conducted for the causes of failures of 181 TKA patients between January 2007 and December 2013. RESULTS: Among the causes of failures after primary TKA, infection was the major cause of failure (53%, 96/181) followed by aseptic loosening (16%, 29/181), arthrofibrosis (10%, 18/181), instability (6.6%, 12/181), extensor mechanism problem (5%, 9/181), wear (4.4%, 8/181), periprosthetic fracture (2.8%, 5/181) and others (2.2%, 4/181). And 64.1% occurred in the first two years, 19.9% occurred between 2 and 5 years and 16.0% occurred after 5 years after operation. Up to 84.0% occurred in 5 years. CONCLUSION: The top three causes of failures after primary TKA at our center are infection, aseptic loosening and arthrofibrosis.

[Modes of medium failures after total hip arthroplasty in China: a single-center retrospective study].

OBJECTIVE: To explore the modes of medium failures after total hip arthroplasty (THA) in China and compare our results with foreign countries. METHODS: Retrospective reviews were conducted for the causes of medium failures of 137 revision THAs between January 2007 and December 2013. The causes of failure included infection, aseptic loosening, dislocation, periprosthetic fracture, implant-related failure, heterotopic ossification and liner wear. RESULTS: The causes in a decreasing order were aseptic loosening (55.5%, 76/137), infection (31.4%, 43/137), liner wear (6.6%, 9/137), periprosthetic fracture (5.1%, 7/137) and dislocation (1.5%, 2/137). CONCLUSION: The top three domestic causes of medium failure after primary THA are aseptic loosening, infection and liner wear.

[Elution properties of linezolid bone cement].

OBJECTIVE: To explore the elution properties of linezolid bone cement so as to guide the clinical application of linezolid bone cement in the treatment of infection after total joint arthroplasty. METHODS: The specimens of bone cement (40 g each) were divided into 6 groups depending on mixed different contents with linezolid (5 specimens in each group), group I (1.2 g), group II (2.4 g), group III (3.6 g), group IV (4.8 g), group V (6.0 g) and group VI (7.2 g). The time-dependent elution of linezolid from bone cement was measured by high performance liquid chromatography (HPLC). RESULTS: The release rate of linezolid bone cement samples was positively correlated with the concentration of antibiotics. And he release rate increased with the rising concentrations. The release of all groups dropped dramatically at Day 1. And as of Day 2 there was a slow release at a very low level. The elution of all groups persisted through 7 weeks. The analysis of variance between groups showed significant differences in release rates. And further examination by q test revealed that the release of group of 3.6-7.2 g was significantly higher than other groups. CONCLUSION: The drainage tube should be clamped at Day 1 post-operation so that there is a full release of high concentration of linezolid. Adding 3.6 g linezolid to 40 g cement may provide better cost-effective outcomes.

[Analysis of microbiology and antibiotic susceptibility in 131 cases of prosthetic hip infections].

OBJECTIVE: To explore the microbiological etiology of prosthetic hip infections during two-staged revision and analyze antibiotic susceptibility of bacteria isolated from infected hip arthroplasty specimens so as to provide clinical recommendations for empiric prophylactic and therapeutic antibiotics therapy. METHODS: A retrospective review was conducted for hospitalized patients of prothetic hip infections during two-staged revision between January 1, 2007 and December 31, 2013. Suspicious intraoperative tissues were cultured and microbiological data sets and antibiotic susceptibility of bacteria were analyzed. RESULTS: A total of 131 patients met the inclusion criteria. Micro-organisms were isolated in 96 patients. The negative culture rate was 26.7%. Nearly half of primary diseases were of fractures and 31.29% of all infected patients had previous surgery. Gram-positive isolates were the most common genus encountered (n = 81, 74.3%), followed by Gram-negative isolates (n = 22, 20.2%) and fungal isolates (n = 6, 5.5%). Polymicrobial infections accounted for 11.5%. Coagulase-negative staphylococci was the most common causative organism of infection (n = 42, 38.5%), followed by Staphylococcus aureus (19.3%). The proportion of isolated methicillin-resistant Staphylococcus was 29.36% for all organisms and 44.4% for Staphylococcus. Gram-negative isolates were dominated by Pseudomonas aeruginosa and Escherichia coli. Fungal isolates were dominated by Candida albicans. Enterococcus was the most common causative organism of polymicrobialinfection. The results of antibiotic susceptibility showed cefazolin and cefuroxime were poorly susceptible to coagulase negative staphylococci (CNS) and methicillin-resistant staphylococcus (MRS). Some third and fourth-generation cephalosporins also had problems of bacterial resistance to Gram-negative isolates. Some antibiotics such as vancomycin, linezolid and rifampin were sensitive to Gram-positive isolates. Some antibiotics such as amikacin piperacillin/tazobactam, cefoperazone/sulbactam, levofloxacinareand carbapenems were sensitive to Gram-negative isolates. CONCLUSION: Most infections are caused by staphylococci. The proportion of isolated methicillin-resistant Staphylococcus is high. Empiric antibiotics should include vancomycin for Gram-positive organisms and piperacillin/tazobactam (cefoperazone/sulbactam), levofloxacinare or carbapenems for most Gram-negative bacteria. Antibiotics should be timely adjusted according to the antibiotic susceptibility results.

[Analyses of microbiology and antibiotic susceptibility in prosthetic knee infections].

OBJECTIVE: To explore the microbiological etiology of prosthetic knee infections during two-staged revision and analyze antibiotic susceptibility of bacteria so as to provide clinical recommendations for empiric antibiotic therapy. METHODS: A retrospective review was performed for 78 hospitalized patients for prothetic knee infections undergoing two-staged revision between January 1, 2007 and February 28, 2014.Suspicious intra-operative tissues were collected and cultured. Microbiological data sets and antibiotic susceptibility of bacteria were analyzed. RESULTS: Micro-organisms were isolated from 65 patients. The negative culture rate was 16.7%. The most common genus encountered was Gram-positive isolates (75.7%), followed by Gram-negative isolates (20.5%) and fungi isolates (2.7%). Polymicrobialinfections accounted for 15.4% of patients. The most common causative organism of infection was coagulase-negative staphylococci (46.6%) and followed by Staphylococcus aureus (20.5%). The detection rate of methicillin-resistant staphylococcus(MRS) was 34.3% (25/73) and it accounted for 47.5% of staphylococcus.Gram-negative isolates were dominated by Escherichia coli (4/15) and Acinetobacter baumannii (4/15). All A.baumanniiscame from polymicrobial infection. Coagulase-negative staphylococci and A. baumannii were the most common causative organisms of polymicrobial infection. The results of antibiotic susceptibility showed cefazolin and cefuroxime were poorly susceptible to isolates. The drug resistance rates were 43.5% and 53.6%.Some third or fourth generation cephalosporins also have problems of bacterial resistance.Some antibiotics such as vancomycin, linezolid, imipenem, rifampin, cefoperazone/sulbactam and levofloxacin had high rates of drug sensitivity. CONCLUSION: Most infections are caused by staphylococci. The proportion of isolated MRS is high.Empiric prophylacticantibiotics therapy may include vancomycin and cefoperazone/sulbactam to cover Gram-positive and Gram-negative organisms.Empiric therapeutic antibiotics therapy includes vancomycin and carbapenems. After the results of antibiotic susceptibility, antibiotics should be timely adjusted.

[Causes of early failure after total hip arthroplasty].

OBJECTIVE: To explore the causes of early failure after primary total hip arthroplasty (THA). METHODS: The causes of early THA failures were retrospectively reviewed for 215 cases of revision THA between January 2007 and December 2013. RESULTS: The causes of early failures of primary THA in decreasing frequencies were infection (50.7%, 109/215), aseptic loosening (31.6%, 68/215), dislocation (8.8%, 19/215), periprosthetic fracture (3.7%, 8/215), implant-related failure (2.3%, 5/215), heterotopic ossification (1.4%, 3/215) and liner wear (0.9%, 2/215). CONCLUSION: The top three causes of early failure after primary THA are infection, aseptic loosening and dislocation.

Evaluation of the consistency of the MRI- based AI segmentation cartilage model using the natural tibial plateau cartilage.

OBJECTIVE: The study aims to evaluate the accuracy of an MRI-based artificial intelligence (AI) segmentation cartilage model by comparing it to the natural tibial plateau cartilage. METHODS: This study included 33 patients (41 knees) with severe knee osteoarthritis scheduled to undergo total knee arthroplasty (TKA). All patients had a thin-section MRI before TKA. Our study is mainly divided into two parts: (i) In order to evaluate the MRI-based AI segmentation cartilage model's 2D accuracy, the natural tibial plateau was used as gold standard. The MRI-based AI segmentation cartilage model and the natural tibial plateau were represented in binary visualization (black and white) simulated photographed images by the application of Simulation Photography Technology. Both simulated photographed images were compared to evaluate the 2D Dice similarity coefficients (DSC). (ii) In order to evaluate the MRI-based AI segmentation cartilage model's 3D accuracy. Hand-crafted cartilage model based on knee CT was established. We used these hand-crafted CT-based knee cartilage model as gold standard to evaluate 2D and 3D consistency of between the MRI-based AI segmentation cartilage model and hand-crafted CT-based cartilage model. 3D registration technology was used for both models. Correlations between the MRI-based AI knee cartilage model and CT-based knee cartilage model were also assessed with the Pearson correlation coefficient. RESULTS: The AI segmentation cartilage model produced reasonably high two-dimensional DSC. The average 2D DSC between MRI-based AI cartilage model and the tibial plateau cartilage is 0.83. The average 2D DSC between the AI segmentation cartilage model and the CT-based cartilage model is 0.82. As for 3D consistency, the average 3D DSC between MRI-based AI cartilage model and CT-based cartilage model is 0.52. However, the quantification of cartilage segmentation with the AI and CT-based models showed excellent correlation (r = 0.725; P values < 0.05). CONCLUSION: Our study demonstrated that our MRI-based AI cartilage model can reliably extract morphologic features such as cartilage shape and defect location of the tibial plateau cartilage. This approach could potentially benefit clinical practices such as diagnosing osteoarthritis. However, in terms of cartilage thickness and three-dimensional accuracy, MRI-based AI cartilage model underestimate the actual cartilage volume. The previous AI verification methods may not be completely accurate and should be verified with natural cartilage images. Combining multiple verification methods will improve the accuracy of the AI model.

Design and Synthesis of a Water-Based Nanodelivery Pesticide System for Improved Efficacy and Safety.

Developing an environmentally friendly and safe nanodelivery system is crucial to improve the efficacy of pesticides and minimize environmental and health risks. However, preparing a completely water-based nanopesticide without using harmful solvents is a technical challenge. In this study, a water-based nanodelivery pesticide system was constructed to improve the efficacy and safety of Emamectin Benzoate (EB). A specific surfactant, 29-(4-(5-hydroxynonan-5-yl)phenoxy)-3,6,9,12,15,18,21,24,27-nonaoxanonacosan-1-ol (SurEB) was designed and synthesized to form a water-based nanodelivery system (EBWNS) with EB. Molecular dynamics simulations revealed the self-assembly and interaction forces between SurEB and EB in water, providing insights into the formation mechanism of EBWNS nanoparticles. The nanodelivery system showed the prolonged effectivity of EB with reduced degradation and demonstrated a good control efficacy for multiple target pests, such as red spider mite, beet armyworm larvae (Lepidoptera: Noctuidae), and rice stem borers (Chilo suppressalis). Toxicology tests on various objects demonstrated that the EBWNS has low toxicity for seeds, HaCaT cells, zebrafish, earthworm, and E. coli. This study provides a distinctive perspective for developing environmentally friendly nanopesticide formulations, which clarified a water-based treatment method for specific lipid-soluble pesticides. The water-based nanodelivery pesticide system has the potential to improve the efficacy and safety of pesticides in the process of field applications.

A New Arthroscopic Tightrope Suture-Button Fixation Procedure for Tibial Eminence Avulsion Fracture.

This case-series outcome study presents a new arthroscopic technique for tibial eminence avulsion fracture (TEAF) with double-tunnel using two tightrope suture buttons. From May 2017 to July 2020, we performed a new arthroscopic technique for TEAF with double tunnels, using two tightrope suture buttons on 13 patients. Clinical assessments included anterior drawer, Lachman, and pivot shift tests, the International Knee Documentation Committee (IKDC), Lysholm knee scores, visual analog scale (VAS) scores, and range of motion (ROM). An independent observer noted conditions before surgery and during the last follow-up. The patients had an average follow-up of 26.2 months, ranging from 15 to 37 months. During the last postsurgical follow-up, the anterior drawer, Lachman, and pivot shift tests were negative in all the cases. According to the IKDC, Lysholm, and VAS final scores, all patients presented a significant knee function improvement at last follow-ups compared with preoperatively. The study shows that satisfactory results about an anatomic reduction of the fragment, knee stability, function, and strength can be achieved with the new arthroscopic technique for TEAF with double tunnels using two tightrope suture buttons. This study is a therapeutic case series and its level of evidence is IV.

Does intraoperative fluoroscopy improve acetabular component positioning and limb-length discrepancy during direct anterior total hip arthroplasty? A meta-analysis.

BACKGROUND: The positioning of implant components for total hip arthroplasty (THA) is essential for joint stability, polyethylene liner wear, and range of motion. One potential benefit of the direct anterior approach (DAA) for THA is the ability to use intraoperative fluoroscopy for acetabular cup positioning and limb-length evaluation. Previous studies comparing intraoperative fluoroscopy with no fluoroscopy during DAA have reported conflicting results. This meta-analysis aimed to evaluate whether intraoperative fluoroscopy improves component positioning compared to no fluoroscopy during direct anterior total hip arthroplasty. METHODS: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. We searched Web of Science, EMBASE, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database in May 2023 to identify studies involving intraoperative fluoroscopy versus no fluoroscopy during direct anterior total hip arthroplasty. Finally, we identified 1262 hips assessed in seven studies. RESULTS: There were no significant differences in terms of acetabular cup inclination angle (ACIA, P = 0.21), ACIA within safe zone rate (P = 0.97), acetabular cup anteversion angle (ACAA, P = 0.26); ACAA within safe zone rate (P = 0.07), combined safe zone rate (P = 0.33), and limb-length discrepancy (LLD, P = 0.21) between two groups. CONCLUSION: Even though intraoperative fluoroscopy was not related to an improvement in cup location or LDD. With fewer experienced surgeons, the benefit of intraoperative fluoroscopy might become more evident. More adequately powered and well-designed long-term follow-up studies were required to determine whether the application of the intraoperative fluoroscopy for direct anterior total hip arthroplasty will have clinical benefits and improve the survival of prostheses.

The Double-Circle System in the Greater Tuberosity: Using Radius to Predict Rotator Cuff Tear.

OBJECTIVE: In this study we concerned on the morphological characteristics of the greater tuberosity of humerus and proposed the double-circle radius ratio as a new predictor for the diagnosis of rotator cuff tears. METHODS: This was a retrospective study and patients who visited our hospital and were diagnosed with or without rotator cuff tears via magnetic resonance imaging from January 2018 to July 2021 were enrolled and classified into two groups respectively. In a standard anteroposterior view, the radius of the best-fit circle of humeral head and the radius of the concentric circle passing through the most lateral edge of the greater tuberosity were measured in each shoulder. The ratio of these two radiuses was named as the double-circle radius ratio. Angular parameters including the greater tuberosity angle and the critical shoulder angle were also measured in the anteroposterior view. Independent samples t tests and chi-square tests were used to find significant differences between groups. Significant associations between those measured variables and demographic characteristics were analyzed with simple linear regression analysis. Receiver operating characteristic curves were pictured to determine applied cutoff values by using Youden index. Multivariable-adjusted analysis for the occurrence of rotator cuff tears was carried out by using multiple logistic regression analysis. For all tests a p value of <0.05 was considered statistically significant. RESULTS: One hundred and twelve shoulders with rotator cuff tears and 42 shoulders without rotator cuff tears were included. The mean value of the double-circle radius ratio was significantly larger in shoulders with rotator cuff tears (1.42 ± 0.09 vs. 1.30 ± 0.07, P = 0.000). With simple linear regression analysis, the radiuses of the humeral head and the greater tuberosity were significantly associated with heights and weights. In receiver operating characteristic curves, the largest area was found under the curve of the double-circle radius ratio as 0.846 (95% CI, 0.781-0.911; P = 0.000) with an applied cutoff value as 1.38 (sensitivity, 70.5%; specificity, 88.1%). Multivariable-adjusted analysis showed that a value of the double-circle radius ratio >1.38 resulted in 11.252-fold odds of developing rotator cuff tears (95% CI, 3.388-37.368; P = 0.000). CONCLUSION: The double-circle radius ratio is significantly larger in patients with rotator cuff tears and could be regarded as an eligible predictor for rotator cuff tears.