Arthroscopic Superior Capsular Reconstruction With Tensor Fascia Lata Allograft for Irreparable Rotator Cuff Tears: Clinical and Radiologic Outcomes for a Minimum 1-Year Follow-Up.

PURPOSE: To confirm the radiologic and clinical outcomes after performing arthroscopic superior capsular reconstruction (ASCR) using a tensor fascia lata (TFL) allograft. METHODS: Thirty-three patients with irreparable rotator cuff tears were treated with ASCR with a TFL allograft. The mean age and follow-up period were 62 years and 20.1 months, respectively. TFL allografts were used as 3, 4, and 6 layers, and the graft thickness was 3.7, 3.9, and 5.4 mm, respectively. Range of motion, visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons score, and Constant score were evaluated preoperatively and at the final follow-up. The pre-, postoperative, and final acromiohumeral distances (AHD) were compared. The graft integrity was checked through a follow-up magnetic resonance imaging at least 6 months after surgery. RESULTS: Torn grafts were identified in 6 cases (19%). AHD significantly increased from 5.0 to 8.0 mm postoperatively (P < .0001). However, there was no significant difference of 5.0 mm at the final follow-up AHD. Five cases (83%) of torn grafts were induced in the 3-layered graft sheet group, but the difference was not statistically significant (P = .067). Visual analog scale, forward elevation, internal rotation, American Shoulder and Elbow Surgeons, and Constant scores significantly improved at the last follow-up. Two cases of early infection were confirmed and the graft materials were all removed. CONCLUSIONS: Despite the possibility of early infection, ASCR using TFL allograft is a reliable procedure for the irreparable rotator cuff tear. In particular, if the number of layers of TFL allograft increases, it is judged that it could become a more effective graft. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Impact of concomitant upper-extremity injuries in patients with hip fractures: a systematic review and meta-analysis.

INTRODUCTION: Combined hip and upper-extremity fractures raise clinical concerns because upper-extremity fractures may hinder early mobilization, thereby affecting rehabilitation and mortality. This systematic review and meta-analysis aimed to evaluate the effects of combined upper-extremity and hip fractures on rehabilitation and mortality. MATERIALS AND METHODS: We systematically searched MEDLINE, Embase, and the Cochrane Library for studies published before March 20, 2022, that evaluated the impact of concomitant upper-extremity injuries in geriatric patients with hip fractures. The pooled analysis identified differences in the (1) length of hospital stay, (2) discharge destination, and (3) mortality rates between the isolated and combined hip fracture groups. RESULTS: A total of 217,233 patients with isolated hip fractures (n = 203,816) and combined hip and upper-extremity fractures (n = 13,417) from 12 studies were analyzed. The average length of hospital stay was significantly longer in the combined upper-extremity fracture group than in the isolated hip fracture group (mean difference = 1.67 days; 95% confidence interval [CI] 0.63-2.70; P = 0.002). Patients in the combined upper limb fracture group were less likely to be discharged directly home (odds ratio [OR] = 0.64; 95% CI 0.52-0.80; P < 0.001) and showed significantly higher 30-day mortality (OR = 1.44; 95% CI 1.32-1.58; P < 0.001). The mortality rate after 30 days was not significantly different between the two groups. CONCLUSIONS: Concomitant upper-extremity fractures have debilitating effects on rehabilitation and early mortality in geriatric patients with hip fractures. Therefore, more focus should be placed on the early ambulation of patients with hip fractures and simultaneous upper limb fractures to promote rehabilitation and alleviate the public health burden. LEVEL OF EVIDENCE: III meta-analysis.

Light extraction enhancement of AlGaN-based vertical type deep-ultraviolet light-emitting-diodes by using highly reflective ITO/Al electrode and surface roughening.

AlGaN-based vertical type high power ultraviolet-C light emitting diodes (UV-C LEDs), which have a Ga-face n-contact structure, were fabricated on a LED epilayer transferred to a carrier wafer through a laser lift-off (LLO) process. A significant light extraction enhancement of the vertical chip by using a highly reflective ITO/Al p-type electrode is demonstrated, along with surface roughening. A GaN-free LED epi structure is employed to prevent light absorption in the UV-C wavelength region. The vertical chip with the ITO/Al reflector and n-AlGaN surface roughening exhibited a high light output power of 104.4mW with a peak wavelength of 277.6nm at an injection current of 350mA. Comparing the device characteristics of the vertical chip and the flip chip showed that the light output power of the vertical chip was 1.31 times higher than that of the flip chip at 350mA. In particular, with the high power vertical type UV-C LED, a maximum light output power of 630mW could be achieved at a current of 3.5A, and this is mainly attributed to efficient heat dissipation through a metal substrate and the resulting relatively lower junction temperature of the vertical chip.

Insulin Promotes Adipose-Derived Stem Cell Differentiation after Fat Grafting.

BACKGROUND: Adipose-derived stem cells are used to enhance fat graft survival. However, their mechanism of action when grafted is controversial. The grafted cells can be replaced by connective tissue or survive at the recipient site and differentiate. Insulin is a powerful agent used to induce their differentiation to adipocytes. The purpose of this study was to elucidate the fate of grafted adipose-derived stem cells in nonvascularized fat grafts with or without insulin. METHODS: Fat was harvested from a female human donor who had undergone reduction mammaplasty. The authors also isolated and cultured adipose-derived stem cells expressing green fluorescent protein from transgenic Sprague-Dawley rats. Injection of free fat graft, the adipose-derived stem cells, phosphate-buffered saline, and insulin was performed on the four paravertebral points of the back of each mouse (n = 30) as follows: group A (control group) received adipose tissue and phosphate-buffered saline; group B received adipose tissue and adipose-derived stem cells; group C received adipose tissue, adipose-derived stem cells, and phosphate-buffered saline; and group D received adipose tissue, adipose-derived stem cells, and insulin. Green fluorescent protein expression was evaluated using an in vivo imaging system. The volume of transplanted fat was evaluated at 8 weeks after graft with six histologic parameters. The fat graft was immunostained with green fluorescent protein, 4',6-diamidino-2-phenylindole, and perilipin. Statistical analysis was performed using a one-way analysis of variance test. RESULTS: The fat graft volume was significantly higher in group D (p < 0.05). Histologic examination revealed reduced fibrosis and increased cysts, vacuoles, integrity, and vascularity in group D. The green fluorescent protein and perilipin co-positive area was more apparent in group D compared with groups B and C. CONCLUSION: Insulin could enhance the survival and differentiation of adipose-derived stem cells in nonvascularized fat grafts.

Effect of fibroblast-seeded artificial dermis on wound healing.

In covering wounds, efforts should include use of the safest and least invasive methods with a goal of achieving optimal functional and cosmetic outcome. The recent development of advanced technology in wound healing has triggered the use of cells and/or biological dermis to improve wound healing conditions. The purpose of the study was to evaluate the effects of fibroblast-seeded artificial dermis on wound healing efficacy.Ten nude mice were used in this study. Four full-thickness 6-mm punch wounds were created on the dorsal surface of each mouse (total, 40 wounds). The wounds were randomly assigned to one of the following 4 treatments: topical application of Dulbecco phosphate-buffered saline (control), human fibroblasts (FB), artificial dermis (AD), and human fibroblast-seeded artificial dermis (AD with FB). On the 14th day after treatment, wound healing rate and wound contraction, which are the 2 main factors determining wound healing efficacy, were evaluated using a stereoimage optical topometer system, histomorphological analysis, and immunohistochemistry.The results of the stereoimage optical topometer system demonstrated that the FB group did not have significant influence on wound healing rate and wound contraction. The AD group showed reduced wound contraction, but wound healing was delayed. The AD with FB group showed decreased wound contraction without significantly delayed wound healing. Histomorphological analysis exhibited that more normal skin structure was regenerated in the AD with FB group. Immunohistochemistry demonstrated that the AD group and the AD with FB group produced less α-smooth muscle actin than the control group, but this was not shown in the FB group.Fibroblast-seeded artificial dermis may minimize wound contraction without significantly delaying wound healing in the treatment of skin and soft tissue defects.

Comparison of tissue-engineered and artificial dermis grafts after removal of basal cell carcinoma on face--a pilot study.

BACKGROUND: Planning reconstruction for facial defects should include the safest and least-invasive methods, with a goal of achieving optimal functional and cosmetic outcomes. OBJECTIVE: To compare tissue-engineered dermis grafts with artificial dermis grafts after removal of basal cell carcinoma (BCC) on the face. MATERIALS AND METHODS: A tissue-engineered dermis composed of autologous cultured dermal fibroblasts seeded on a hyaluronic acid sheet was applied to 16 patients. Grafting of hyaluronic acid sheets that did not contain fibroblasts (artificial dermis group) was performed in 13 patients. Healing time, scar condition, and patient satisfaction were compared. RESULTS: The wounds of the tissue-engineered dermis group reepithelialized after 31.4 ± 5.3 days and those of the artificial dermis group after 34.2 ± 4.9 days. The tissue-engineered dermis graft was superior in scar quality. In particular, statistically significant differences were detected in the height and contracture of scars, although there were no significant differences in terms of scar texture or color match. Patient satisfaction in the tissue-engineered dermis graft group (8.3 ± 1.0) was also statistically superior to that in the artificial dermis group (6.9 ± 1.4). CONCLUSION: The tissue-engineered dermis graft is superior to the artificial dermis graft for covering defects after removal of BCC on the face.