A Meta-Analysis of the Incidence and Temporal Trends of Postoperative Dislocation in Revision Total Hip Arthroplasty Utilizing Constrained Acetabular Components or Dual Mobility Implants.

BACKGROUND: The incidence of dislocation after revision total hip arthroplasty (rTHA) is reported to be up to 25% and remains a common source of failure. Constrained acetabular components and dual mobility implants are two implant classes being utilized to alleviate this burden in patients who have recurrent instability or major intraoperative instability. This meta-analysis evaluated the incidence and temporal trends of dislocation after implantation with constrained acetabular components and dual mobility implants in rTHA. METHODS: Longitudinal studies reporting dislocation after the use of constrained acetabular components or dual mobility implants in rTHA were sought from Medline and Embase to October 2022. Secondary outcomes included re-revision surgery for dislocation and all causes. A total of 75 relevant citations were identified comprising 36 datasets of 3,784 constrained acetabular components and 47 datasets of 10,216 dual mobility implants. RESULTS: For constrained acetabular components, the pooled incidence of dislocation was 9% (95% confidence interval: 7.2, 11.7) (range 0.0%-35.3%) over a weighted mean follow-up of 6 years, in contrast to 3% (95% confidence interval: 2.2, 4.4) (range 0.0%-21.4%) over 5 years for dual mobility implants. Re-revision rates for dislocation after using constrained acetabular components were around 9%, in contrast to 2% for dual mobility implants. Re-revision rates for all causes after using constrained acetabular components were around 19%, in contrast to 8% for dual mobility implants. CONCLUSION: Dual mobility implants in the context of rTHA demonstrate lower incidences of dislocation (3% versus 9%), re-revision for dislocation (2% versus 9%), and rer-evision for any cause (8% versus 19%) in contrast to constrained acetabular components. This must be considered by surgeons when implanting such devices, often selected to treat instability.

The Incidence and Temporal Trends of Dislocation After the Use of Constrained Acetabular Components and Dual Mobility Implants in Primary Total Hip Replacements: A Systematic Review and Meta-Analysis of Longitudinal Observational Studies.

BACKGROUND: Dislocation after a primary total hip replacement (pTHR) remains a common cause of treatment failure. Constrained acetabular components (CACs) and dual mobility implants (DMIs) may mitigate this in patients at high risk of dislocation or with significant intraoperative instability. This meta-analysis evaluated the incidence and temporal trends of dislocation after implantation with CACs and DMIs in pTHR. METHODS: Longitudinal studies reporting dislocation after the use of CACs or DMIs in pTHR were sought from Medline and Embase to September 2020. Secondary outcomes included revision surgery for dislocation and for all causes. RESULTS: A total of 46 studies (3 CAC and 43 DMI) comprising 582 CACs and 18,748 DMIs were included. The pooled incidence of dislocation was 1.08% (95% confidence interval [CI]: 0.00-3.72; range 0.27%-2.60%) over a weighted mean follow-up of 4.1 years for CACs, compared with 0.25% (95% CI: 0.08-0.46; range 0.00%-4.72%) over 6.2 years for DMIs. For DMIs, there was a temporal decline in dislocations from the 1980s onward, and dislocation rates remained low (<1%) until 15 years postoperatively. There were insufficient data for similar analysis of CACs. All studies were at high risk of bias. The incidence of revision for dislocation after CACs was 0.3% vs 0.1% for DMIs, and the incidence of revision for all causes after CACs was 4.8% vs 2.7% for DMIs. CONCLUSION: DMIs demonstrated a lower incidence of dislocation compared with CACs; however, there was a relative absence of CACs used in the context of pTHR in the literature. Temporal trends in dislocation have improved over time for DMIs.

Assessment of a Novel, 22-lead Mobile Electrocardiogram in Elite, Adolescent Footballers.

The 12-lead electrocardiogram is a key component of cardiac screening in elite adolescent footballers. Current technology hampers mobile electrocardiogram monitoring that could reduce the time-to-diagnosis in symptomatic athletes. Recently, a 22-lead mobile electrocardiogram monitor, CardioSecur (Personal MedSystems GmbH), has been approved for use in adults. In this study, the differences in parameter accuracy between CardioSecur's 22-lead electrocardiogram and the gold standard 12-lead electrocardiogram were assessed in elite adolescent footballers (n=31) using Bland-Altman and paired t-tests/Wilcoxon analysis. Agreement between the two devices was clinically acceptable for heart rate (bias=- 0.633 bpm), PR Interval (bias=- 1.73 ms), Bazzett's corrected QTc interval (bias=2.03 ms), T-wave axis (bias=6.55°), P-wave duration (bias=- 0.941 ms), Q-wave amplitude (bias=0.0195 mV), Q-wave duration (bias=1.98 ms), rhythm (bias=0.0333), ST-segment (bias=- 0.0629), J-point analysis (bias=- 0.01) and extended T wave and QRS duration analysis. Unsatisfactory agreement was observed in QRS axis (bias=- 19.4°), P-wave axis (bias=- 0.670°), QRS amplitude (bias=- 0.660 mV), P-wave amplitude (bias=0.0400 mV) and T-wave amplitude (bias=- 0.0675 mV). CardioSecur's 22-lead electrocardiogram agrees with the gold standard in rhythm, durations, T-wave determination in all leads assessed, permitting its use in adolescent footballers for immediate pitch- or track-side analysis.

Characterization and suitability of therapeutic antibody dense phases for subcutaneous delivery.

Subcutaneous antibody dosing formulations comprising solid suspensions have the potential to reduce dosage viscosity and injection volume. Gel beads of three therapeutic antibodies were prepared to determine the feasibility of such formulations. The beads were formed directly from aqueous solution within 0.1-4 days upon addition of biocompatible precipitating agents under conditions compatible with the use of stabilizing excipients. The phase behavior of antibody gel beads and their mechanical characteristics were measured. Gel beads were characterized by reduced elastic moduli of 0.4-1.0 MPa, as measured by atomic force microscopy, and completely redissolved within 10-20 min under physiologic conditions, in vitro. Crystalline particles could also be prepared in some cases and were found to have reduced elastic moduli 3 orders of magnitude greater than those for the gel beads. Both crystalline and gel particles had protein concentrations of 100-180 mg/mL within the dense phase. Protein stored within the dense phase was recoverable after 40 days of incubation at room temperature or 4 °C.

Solubilization and stabilization of bacteriophage MS2 in organic solvents.

Several techniques were examined for the solubilization of bacteriophage MS2 in organic solvents. Direct extraction of the MS2 from an aqueous phase into isooctane containing 2 mM AOT, a proven approach for the organic solubilization of many proteins, was not successful. However, predried samples of MS2 were solubilized through the direct addition of organic solvents containing 500 mM AOT. As an alternative procedure, reverse micelles containing aqueous solutions of MS2 were prepared in isooctane using AOT, dehydrated through solvent evaporation and azeotropic drying, and resolubilized in a solvent of choice. The structure and microenvironment of organic-solubilized MS2 were investigated by UV absorbance, the fluorescence emission of an attached solvatochromatic dye, tryptophan fluorescence, and atomic force microscopy, all of which contributed evidence for a fully assembled capsid in the organic solvent. The solubilized MS2 was derivatized with stearic acid in chloroform, illustrating that bioconjugation reactions can be performed on organic-solubilized capsids using reagents that are completely insoluble in water. Furthermore, the organic-solubilized phage remained infectious after heating at 90 degrees C for 20 min, whereas phage in aqueous buffer or dried with nitrogen were nonviable following the heat treatment protocol. The extended range of available chemical modifications and the enhanced thermal stability of the organic-solubilized capsids bodes well for the formulation of storage-stable vaccines predicated on reactions in or exposure to organic media.

Direct solubilization of enzyme aggregates with enhanced activity in nonaqueous media.

A protein solubilization method has been developed to directly solubilize protein clusters into organic solvents containing small quantities of surfactant and trace amounts of water. Termed "direct solubilization," this technique was shown to solubilize three distinct proteins - subtilisin Carlsberg, lipase B from Candida antarctica, and soybean peroxidase - with much greater efficiencies than extraction of the protein from aqueous solution into surfactant-containing organic solvents (referred to as extraction). More significant, however, was the dramatic increase in directly solubilized enzyme activity relative to extracted enzyme activity, particularly for subtilisin and lipase in polar organic solvents. For example, in THF the initial rate towards bergenin transesterification was ca. 70 times higher for directly solubilized subtilisin than for the extracted enzyme. Furthermore, unlike their extracted counterparts, the directly solubilized enzymes yielded high product conversions across a spectrum of non-polar and polar solvents. Structural characterization of the solubilized enzymes via light scattering and atomic force microscopy revealed soluble proteins consisting of active enzyme aggregates containing approximately 60 and 100 protein molecules, respectively, for subtilisin and lipase. Formation of such clusters appears to provide a microenvironment conducive to catalysis and, in polar organic solvents at least, may protect the enzyme from solvent-induced inactivation.

Bubble-induced detachment of affinity-adsorbed erythrocytes.

It is desirable that cells adsorbed in affinity-separation processes be easily recovered from the adsorption surface, without excessive dilution, once contaminants have been removed. The present study investigates the use of gas-bubble-induced shear stress for the recovery of affinity-adsorbed human erythrocytes. This method has previously been demonstrated to be effective with yeast cells, where it allows cells to be attached, washed and detached under isocratic conditions. Concanavalin A (Con A), used as the binding agent, was attached to the inside of nylon tubes. Whole blood solution, diluted to an erythrocyte concentration of 1x10(8) x ml(-1) with PBS, was incubated with the Con A-nylon surface and then washed with PBS prior to elution. To effect elution, air bubbles of known volume were introduced to the buffer feed to the tubes and the effects of bubble size, bubble volume and bubble velocity on detachment being determined. The results obtained showed that the most significant parameter was bubble number, with up to 90% of attached cells being recovered using a five-bubble sequence. Microscopic examination showed no evidence of mechanical damage to the detached cells.

Predictive crystallization of ribonuclease A via rapid screening of osmotic second virial coefficients.

Important progress has been made in recent years toward developing a molecular-level understanding of protein phase behavior in terms of the osmotic second virial coefficient, a thermodynamic parameter that characterizes pairwise protein interactions. Yet there has been little practical application of this knowledge to the field of protein crystallization, largely because of the difficult and time-consuming nature of traditional techniques for characterizing protein interactions. Self-interaction chromatography has recently been proposed as a highly efficient method for measuring the osmotic second virial coefficient. The utility of the technique is examined in this work by characterizing virial coefficients for ribonuclease A under 59 solution conditions using several crystallization additives, including PEG, sodium chloride, ammonium sulfate, and propanol. The virial coefficient measurements show some counterintuitive trends and shed light on the previous difficulties in crystallizing ribonuclease A. Crystallization experiments at the corresponding solution conditions were conducted by using ultracentrifugal crystallization. Using this methodology, ribonuclease A crystals were obtained under conditions for which the virial coefficients fell within the "crystallization slot." Crystallographic characterization showed that the crystals diffract to high resolution. Metastable crystals were also obtained for conditions outside, but near, the "crystallization slot," and they could also be frozen and used to collect structural information.