Fracture pattern and risk factors for reoperation after treatment of 156 periprosthetic fractures around an anatomic cemented hip stem.

BACKGROUND AND PURPOSE: The Lubinus SP2 stem has been associated with a very low risk of periprosthetic femoral fractures (PPFFs). We aimed, primarily, to study the radiographic morphology of PPFFs close to a Lubinus SP2 stem. Secondarily, we analyzed whether higher reoperation rate was correlated to the revision method chosen or to the characteristics of the fracture and of the bone. PATIENTS AND METHODS: The study included 156 femoral fractures close to a Lubinus cemented stem. These fractures were treated in 40 hospitals in Sweden between 2006 and 2011 and were followed up until 2019. Data from the Swedish Arthroplasty Register was used. Medical records and radiographs were studied. The fractures were classified according to the Vancouver classification. The fracture location and anatomy were delineated. We also measured the remaining attachment index (RAI) and the canal thickness ratio. RESULTS: Vancouver type C (n = 101) and spiral fractures (n = 67, 41 in Vancouver C and 26 in Vancouver B) were the most common fracture types. 4 fractures were avulsion of the greater trochanter. The remaining 51 fractures occurred around the stem (B1: 25, B2: 16, and B3: 10). B fractures were more commonly reoperated on (18 of 51, 35%) than type C fractures (11 of 101, 11%, P = 0.001). In most femurs with type B3 fracture, the fracture line covered an area only around the stem, but in all B1 and in 11 of 16 B2 fractures, it was extended even distal to the stem. ORIF instead of stem revision in B2 fractures, use of short stems or plates, and inadequate reduction of the fractures were risk factors for subsequent reoperations. CONCLUSION: The higher reoperation rate in type B fractures, compared with fractures distal to the stem, could be caused by their higher degree of complexity and reduced capacity for healing in the region around the stem.

Hepatic Impact of Different Concentrations of Hibiscus rosa Zinc Oxide Nanoparticles on Rats.

Nanomaterial, especially zinc oxide nanoparticles, has entered the manufacture of many materials used in daily lives. The current study aimed to assess the impact of three concentrations of hibiscus rosa zinc oxide nanoparticles (HrZnONPs) and hibiscus rosa extract (Hre) on the liver tissue and DNA fragmentation of liver cells. A total of 35 adult male Wistar rats were grouped as follows: The first group which was the control (n=7) did not receive any treatment. The remaining 28 animals were randomly assigned to four groups. Group 1 (n=7) were subcutaneously injected with 100mg\kg BW of Hibiscus rosa extract for 60 days; the rats in group 2 were subcutaneouslyinjected with 25 mg\kg BW of HrZnONPs for 60 days; rats in group 3 were subcutaneouslyinjected with 75mg\kg BW of HrZnONPs for 60 days; rats in group 4 were subcutaneously injected with 100mg\kg BW of HrZnONPs for 60 days. The liver biomarkers, aspartate aminotransferase (AST), alkaline phosphatase (ALP), and alanine aminotransferase (ALT) have been assessed in serum at zero time, after one month, and after two months of the experiment. At the end of the experiment, all animals were euthanized, the liver was dissected, the specimen underwent a pathohistological investigation, and the percentage of DNA fragmentation was evaluated. The results pointed out that the rats which were treated with HrZnONPs at concentrations of 75 and 100 mg\kg B.W. demonstrated a salient elevation in serum AST, ALT, or ALP activity, a modulation in hepatic tissue architecture, and an elevated percentage of high DNA damage, as compared to those treated with HrZnONPs at a concentration of 25 mg\kg B.W. On the other hand, the recorded data indicated that the administration of Hre has some ameliorative effects on AST, ALP, and ALT levels, histological cross-section, and the value of comet assay for liver cells due to the role of Hre antioxidant. In conclusion, the results of the current study demonstrated that high doses of HrZnONPs had exerted more adverse effects, compared to low doses. Moreover, the findings confirmed the ameliorative impact of Hre on liver biomarkers, a histological cross-section of the liver, and DNA damage.

HIV prevalence and risk behaviors of male injection drug users in Cairo, Egypt.

OBJECTIVE: To measure HIV prevalence and related risk behaviors among male injection drug users (IDUs) in Cairo, Egypt in the context of the first survey wave of an integrated biological and behavioral surveillance system. DESIGN AND METHODS: Given the hidden nature of injection drug use, we used the peer-referral methodology of respondent-driven sampling in a cross-sectional study to recruit a sample of male IDUs in Cairo between May and August 2006. Behavioral data were collected through face-to-face interviews and serum was obtained for HIV antibody testing. Population estimates were produced using respondent-driven sampling Analysis Tool. RESULTS: The study enrolled 413 male IDUs. The population estimated HIV prevalence was 0.6% (95% confidence interval 0.1-1.8). More than half (53.0%) reported injecting drugs with used needles or syringes and nearly one-third (32.4%) shared their used needle or syringe with one or more persons in the preceding month. Overall, 70.5% had sex in the preceding year, of whom 9.4% reported sex with male partners and 13.2% reported sex with commercial sex workers in the preceding 12 months. Ever use of a condom during sex was low with all partner types and only 5.8% ever had an HIV test. CONCLUSION: This first survey wave of integrated biological and behavioral surveillance system in Egypt to track the HIV epidemic among male IDUs found relatively low prevalence of infection compared to global estimates, though the figure is many times higher than the general population. In addition, risky injection practices and unprotected sex were high with sexual networks including men who have sex with men, female sex workers, wives, and other regular and casual partners. The respondent-driven sampling method was effective in recruiting male IDUs and the results are being used to inform surveillance and prevention programs.