Machine learning-based immune phenotypes correlate with STK11/KEAP1 co-mutations and prognosis in resectable NSCLC: a sub-study of the TNM-I trial.

BACKGROUND: We aim to implement an immune cell score model in routine clinical practice for resected non-small-cell lung cancer (NSCLC) patients (NCT03299478). Molecular and genomic features associated with immune phenotypes in NSCLC have not been explored in detail. PATIENTS AND METHODS: We developed a machine learning (ML)-based model to classify tumors into one of three categories: inflamed, altered, and desert, based on the spatial distribution of CD8+ T cells in two prospective (n = 453; TNM-I trial) and retrospective (n = 481) stage I-IIIA NSCLC surgical cohorts. NanoString assays and targeted gene panel sequencing were used to evaluate the association of gene expression and mutations with immune phenotypes. RESULTS: Among the total of 934 patients, 24.4% of tumors were classified as inflamed, 51.3% as altered, and 24.3% as desert. There were significant associations between ML-derived immune phenotypes and adaptive immunity gene expression signatures. We identified a strong association of the nuclear factor-κB pathway and CD8+ T-cell exclusion through a positive enrichment in the desert phenotype. KEAP1 [odds ratio (OR) 0.27, Q = 0.02] and STK11 (OR 0.39, Q = 0.04) were significantly co-mutated in non-inflamed lung adenocarcinoma (LUAD) compared to the inflamed phenotype. In the retrospective cohort, the inflamed phenotype was an independent prognostic factor for prolonged disease-specific survival and time to recurrence (hazard ratio 0.61, P = 0.01 and 0.65, P = 0.02, respectively). CONCLUSIONS: ML-based immune phenotyping by spatial distribution of T cells in resected NSCLC is able to identify patients at greater risk of disease recurrence after surgical resection. LUADs with concurrent KEAP1 and STK11 mutations are enriched for altered and desert immune phenotypes.

Measuring consumer effort in circular economy initiatives in the food domain: An exploratory analysis.

The transition towards a Circular Economy (CE) system requires a change in consumers' behavioural pattern that implies a certain level of effort which, in turn, could affect initiatives' success. Although consumers' role in CE is increasingly drawing the attention of scholars, limited knowledge is available on the evaluation of consumer's effort in CE initiatives. The current research provides an identification and measurement of the core parameters affecting consumer effort, offering a comprehensive Effort Index applied to 20 CE companies operating in food domain. Companies were classified in 5 categories (Quantity of food, Appearance of food, Edibility of food, Living with food and Local and sustainable food); the analysis of the companies revealed 14 parameters building the Effort Index. Results showed that initiatives ascribable to the category "Local and sustainable food" require higher levels of consumer effort; in contrast, case studies belonging to "Edibility of food" group are less effort-requiring.

Effusion-synovitis worsening mediates the association between body mass index and Kellgren-Lawrence progression in obese individuals: data from the Osteoarthritis Initiative.

OBJECTIVE: Both obesity and synovitis are independently associated with knee osteoarthritis (KOA) progression. We examined whether synovitis mediates the relationship between body mass index (BMI) and KOA radiographic progression in the Osteoarthritis Initiative (OAI) cohort. DESIGN: We conducted a case-control study within the OAI. Cases (n = 315) were right knees with an increase of ≥1 Kellgren-Lawrence from baseline to 48 months of follow-up. Controls (n = 315) were right knees with no KL change. Cases and controls were matched by age, sex, race, and baseline KL. MRI Osteoarthritis Knee Score (MOAKS) at baseline and at 2 years was used for a semi-quantitative scoring (0-3) of effusion-synovitis and Hoffa-synovitis. Conditional logistic regression estimated associations between BMI and synovitis with KOA progression. Mediation analysis was used to assess the mediating effects of synovitis. RESULTS: The mean age of participants was 61 years, 70.8% were women, and 87% were White. KOA progression was associated with higher BMI (adjusted OR 1.05; 95%CI 1.01-1.09) and effusion-synovitis relative to no effusion-synovitis (adjusted OR 2.2; 95%CI 1.6-3.1). Associations between effusion-synovitis worsening and KOA progression were more pronounced among obese individuals (OR 34.1; 95%CI 4.2-274.8; P = 0.001) compared to normal weight (OR 3.2; 95%CI 0.8-12.8, P=0.096) individuals. Effusion-synovitis at 2 years, but not at baseline, mediated the relationship between BMI and KOA progression over a 4-year period. CONCLUSIONS: We found that effusion-synovitis worsening mediated the association between BMI and KOA progression and was associated with increased risk of KOA progression, particularly among obese individuals.

Tratamiento quirúrgico de las úlceras por presión sacras con colgajo miocutáneo de gluteus maximus por deslizamiento en V-Y: Técnica quirúrgica / Surgical treatment of sacral pressure ulcers with gluteus maximus myocutaneous flap due to V-Y sliding: surgical technique

Resumen Introducción: La úlcera por presión más frecuente es la sacra. Si compromete el hueso puede provocar osteomielitis por lo que requiere aseo quirúrgico y colgajo miocutáneo de gluteus maximus por deslizamiento en V-Y. Materiales y Método: En el servicio de cirugía plástica del hospital del Salvador entre 2011 y 2020 se han operado 82 pacientes con ulceras sacras grado 4 que requirieron cobertura con colgajo miocutáneo de gluteus maximus en V-Y. De ellas se analizaron los últimos 37 pacientes. Resultados De los 37 pacientes, 12 fueron mujeres, 25 hombres, 17 parapléjicos, 12 tetrapléjicos y 8 deambulaban. 6 pacientes presentaron COVID-19. 24 fueron bilaterales y 13 unilaterales. Los colgajos cicatrizaron bien en 30 pacientes. Las complicaciones fueron de 16% consistente en 2 hematomas, 2 dehiscencias, 2 celulitis y 1 seroma, todas resueltas sin problemas. Seguimiento de entre 3 y 6 meses. Discusión El tratamiento quirúrgico con colgajo miocutáneo de gluteus maximus en V-Y, aparte de aportar volumen para ocluir la úlcera, aporta irrigación excelente con oxígeno, nutrientes y antibióticos que aseguran una óptima cicatrización. Dependiendo del diámetro de la úlcera el colgajo puede ser uni o bilateral. Dado lo complejo del tratamiento, en general, el porcentaje de complicaciones de 16% se considera bajo. Conclusión: El tratamiento quirúrgico de las úlceras por presión sacras con colgajos miocutáneos deslizantes de gluteus maximus ha sido exitoso con buenos resultados quirúrgicos con buen flujo sanguíneo y buena evolución.

Introduction: Pressure sores are the result of the compression of soft tissues in the prominent bones areas, mainly in patients without movement. If the depth of the ulcer compromises the sacral bone, the treatment will be the gluteus maximus myocutaneous flap in V-Y. Materials and Method: In the plastic surgery service of the hospital del Salvador 82 patients with sacral pressure sores grade 4 were operated on between 2011 and 2020 with gluteus maximus myocutaneous V-Y flap. The last 37 patients were analyzed. Results: With this treatment the flaps were doing well in all cases with good blood supply. Complications: dehiscence: 2 patients, cellulitis: 2 patients, hematoma: 2 patients and seroma: 1 patient. The overall complication was 16%. Follow up between three and six months. Discussion: The most important part in pressure sores is their prevention. When the ulcer is in prominent parts of the body, the sore, could be in different grades of depth. The classification of them is in grades 1: erythema, 2: subcutaneous tissue. These two grades are solved with conservative treatment. When the ulcers are in grade 3 or 4, and with little ulcer in the skin but with damage of the deep plane, the treatment will be with surgery. In our casuistic the most frequent pressure sore is in the sacrum treated with gluteus maximus sliding myocutaneous flap in V-Y. With this treatment the flaps were doing well in all cases with good blood supply. The complications of 16% were considered low. Conclusion: The sliding gluteus Maximus myocutaneous flap in V-Y for treatment for sacral pressures sores have been successful for our patients.

SARS-CoV-2 mRNA vaccine BNT162b2 triggers a consistent cross-variant humoral and cellular response.

As the SARS-CoV-2 pandemic continues to rage worldwide, the emergence of numerous variants of concern (VOC) represents a challenge for the vaccinal protective efficacy and the reliability of commercially available high-throughput immunoassays. Our study demonstrates the administration of two doses of the BNT162b2 vaccine that elicited a robust SARS-CoV-2-specific immune response which was assessed up to 3 months after full vaccination in a cohort of 37 health care workers (HCWs). SARS-CoV-2-specific antibody response, evaluated by four commercially available chemiluminescence immunoassays (CLIA), was qualitatively consistent with the results provided by the gold-standard in vitro neutralization assay (NTA). However, we could not observe a correlation between the quantity of the antibody detected by CLIA assays and their neutralizing activity tested by NTA. Almost all subjects developed a SARS-CoV-2-specific T-cell response. Moreover, vaccinated HCWs developed a similar protective neutralizing antibodies response against the EU (B.1), Alpha (B.1.1.7), Gamma (P.1), and Eta (B.1.525) SARS-CoV-2 variants, while Beta (B.1.351) and Delta (B.1.617.2) strains displayed a consistent partial immune evasion. These results underline the importance of a solid vaccine-elicited immune response and a robust antibody titre. We believe that these relevant results should be taken into consideration in the definition of future vaccinal strategies.

Cierre progresivo de heridas en pacientes con pie diabético / Progressive suture in diabetic foot patients with difficult healing

Resumen Introducción: Los pacientes diabéticos insulino requirientes con heridas del pie, producto de amputaciones con exposición de huesos, cartílagos o tendones, son de difícil manejo por el déficit de irrigación distal. Alternativa de tratamiento a los colgajos pediculados o microquirúrgicos es el cierre progresivo de las heridas. Objetivo: Reportar la técnica de cierre progresivo de heridas de pie en pacientes diabéticos insulino requirientes. Materiales y Método: Con esta técnica se operó a 15 pacientes diabéticos insulino requirientes que, después de amputación, presentaron heridas del pie con exposición de huesos, cartílagos y tendones. Lesiones de talón: 4, lesiones de antepie: 5 y lesiones plantares: 6. Las edades fluctuaron entre 45 y 70 años. Fueron 11 hombres y 4 mujeres operados entre 2014 y 2019. En ambos bordes de la herida se instaló dos placas de Ventrofil® unidas por sutura en U transversa y se tensó cada 3 días hasta obtener cicatrización. Resultados: 14 pacientes obtuvieron cicatrización en un plazo de entre 15 y 21 días y sólo uno presentó sufrimiento de los bordes de la herida por afrontamiento muy seguido. El seguimiento fue de tres meses sin recidiva de las heridas. Discusión: En pacientes diabéticos las heridas, producto de amputaciones y con exposición de huesos, cartílagos y tendones, son de muy difícil tratamiento debido el déficit de irrigación distal. En estas condiciones el uso de complejos colgajos locales o microquirúrgicos es de alto riesgo dada la posibilidad de necrosis. En esta situación, el cierre progresivo con sutura de Ventrofil® es una alternativa viable, segura, reproducible y con buenos resultados. Conclusión: Es un procedimiento rápido, seguro y reproducible.

Introduction: The closure of wounds in diabetic foot patients, after amputation with esposure of bones, is difficult because of lack of blood supply to this area. The progressive suture with Ventrofil® is a good alternative. Aim: Report the technique of progressive closure of foot wounds in insulin-requiring diabetic patients. Materials and Method: 15 patients with diabetic foot were operated on in the Hospital del Salvador, between 2014 and 2019.The ages were among 45 and 70 years. 11 men and 4 women. In those patients two plaques of Ventrofil® were positioned in both borders of the wound an tied through a horizontal suture.This suture was tensioned every 3 days until get the complete wound healing. Results: 14 patients healed very well and in just only one patient there was suffering of the edges of the wound. The follow up was of 3 months without relapse. Discussion: In patients with diabetic foot with wounds after amputation the closure is difficult because of lack of adecuate blood supply. In these case the progressive suture with plaques of Ventrofil® is a good alternative to a more complex flaps like microsurgicals ones. Conclusion: This technique is sure, easy to perfom and safe.

High expression of miR-17-5p in tumor epithelium is a predictor for poor prognosis for prostate cancer patients.

MicroRNAs (miRs) are small non-coding RNA molecules, which are involved in the development of various malignancies, including prostate cancer (PCa). miR-17-5p is considered the most prominent member of the miR-17-92 cluster, with an essential regulatory function of fundamental cellular processes. In many malignancies, up-regulation of miR-17-5p is associated with worse outcome. In PCa, miR-17-5p has been reported to increase cell proliferation and the risk of metastasis. In this study, prostatectomy specimens from 535 patients were collected. Tissue microarrays were constructed and in situ hybridization was performed, followed by scoring of miR-17-5p expression on different tumor compartments. High expression of miR-17-5p in tumor epithelium was associated with biochemical failure (BF, p < 0.001) and clinical failure (CF, p = 0.019). In multivariate analyses, high miR-17-5p expression in tumor epithelial cells was an independent negative prognostic factor for BF (HR 1.87, 95% CI 1.32-2.67, p < 0.001). In vitro analyses confirmed association between overexpression of miR-17-5p and proliferation, migration and invasion in prostate cancer cell lines (PC3 and DU145). In conclusion, our study suggests that a high cancer cell expression of miR-17-5p was an independent negative prognostic factor in PCa.

Inversion Recovery Ultrashort TE MR Imaging of Myelin is Significantly Correlated with Disability in Patients with Multiple Sclerosis.

BACKGROUND AND PURPOSE: MR imaging has been widely used for the noninvasive evaluation of MS. Although clinical MR imaging sequences are highly effective in showing focal macroscopic tissue abnormalities in the brains of patients with MS, they are not specific to myelin and correlate poorly with disability. We investigated direct imaging of myelin using a 2D adiabatic inversion recovery ultrashort TE sequence to determine its value in assessing disability in MS. MATERIALS AND METHODS: The 2D inversion recovery ultrashort TE sequence was evaluated in 14 healthy volunteers and 31 patients with MS. MPRAGE and T2-FLAIR images were acquired for comparison. Advanced Normalization Tools were used to correlate inversion recovery ultrashort TE, MPRAGE, and T2-FLAIR images with disability assessed by the Expanded Disability Status Scale. RESULTS: Weak correlations were observed between normal-appearing white matter volume (R = -0.03, P = .88), lesion load (R = 0.22, P = .24), and age (R = 0.14, P = .44), and disability. The MPRAGE signal in normal-appearing white matter showed a weak correlation with age (R = -0.10, P = .49) and disability (R = -0.19, P = .31). The T2-FLAIR signal in normal-appearing white matter showed a weak correlation with age (R = 0.01, P = .93) and disability (R = 0.13, P = .49). The inversion recovery ultrashort TE signal was significantly negatively correlated with age (R = -0.38, P = .009) and disability (R = -0.44; P = .01). CONCLUSIONS: Direct imaging of myelin correlates with disability in patients with MS better than indirect imaging of long-T2 water in WM using conventional clinical sequences.

Downregulation of E-cadherin in pluripotent stem cells triggers partial EMT.

Epithelial to mesenchymal transition (EMT) is a critical cellular process that has been well characterized during embryonic development and cancer metastasis and it also is implicated in several physiological and pathological events including embryonic stem cell differentiation. During early stages of differentiation, human embryonic stem cells pass through EMT where deeper morphological, molecular and biochemical changes occur. Though initially considered as a decision between two states, EMT process is now regarded as a fluid transition where cells exist on a spectrum of intermediate states. In this work, using a CRISPR interference system in human embryonic stem cells, we describe a molecular characterization of the effects of downregulation of E-cadherin, one of the main initiation events of EMT, as a unique start signal. Our results suggest that the decrease and delocalization of E-cadherin causes an incomplete EMT where cells retain their undifferentiated state while expressing several characteristics of a mesenchymal-like phenotype. Namely, we found that E-cadherin downregulation induces SNAI1 and SNAI2 upregulation, promotes MALAT1 and LINC-ROR downregulation, modulates the expression of tight junction occludin 1 and gap junction connexin 43, increases human embryonic stem cells migratory capacity and delocalize ß-catenin. Altogether, we believe our results provide a useful tool to model the molecular events of an unstable intermediate state and further identify multiple layers of molecular changes that occur during partial EMT.

[What factors contributed to the higher incidence rate of in-hospital falls at the time of Covid 19? A paradigm shift?] / Quali sono I fattori contribuenti la caduta dei pazienti in ospedale al tempo del Covid 19? Un cambio di paradigma?

The COVID-19 pandemic has put a strain on all health systems as there has been a growing rapidity in the demand for health care from COVID 19 positive patients in hospitals around the world. With the intensification of the pandemic, determining in real time the consequent needs for health resources (beds, personnel, equipment) has in fact become the fundamental priority for many countries to ensure health services consistent with the health needs expressed by the population. In Italy, the demand has often been satisfied with the conversion of existing beds and the remodeling of the healthcare offer or where the available resources allow it also with the opening of new beds dedicated to pandemic assistance. This work analyzes the falls detected at the time of COVID in patients and hospitalized in direct hospital beds (600 beds) of a Local Health Authority of Lazio (ASL ROMA 2). Although the data on the incidence of falls recorded in the three centers were equal to 2.21 every 1000 days of beds occupied and that the data recorded are lower than those reported in the literature, it is also true that the increase in average hospital stay and the reduction in the rotation rate of beds had an impact on the still low occupancy rates compared to the literature data.The COVID-19 pandemic has put a strain on all health systems as there has been a growing rapidity in the demand for health care from COVID 19 positive patients in hospitals around the world. With the intensification of the pandemic, determining in real time the consequent needs for health resources (beds, personnel, equipment) has in fact become the fundamental priority for many countries to ensure health services consistent with the health needs expressed by the population. In Italy, the demand has often been satisfied with the conversion of existing beds and the remodeling of the healthcare offer or where the available resources allow it also with the opening of new beds dedicated to pandemic assistance. This work analyzes the falls detected at the time of COVID in patients and hospitalized in direct hospital beds (600 beds) of a Local Health Authority of Lazio (ASL ROMA 2). Although the data on the incidence of falls recorded in the three centers were equal to 2.21 every 1000 days of beds occupied and that the data recorded are lower than those reported in the literature, it is also true that the increase in average hospital stay and the reduction in the rotation rate of beds had an impact on the still low occupancy rates compared to the literature data. In fact, the scientific literature shows that in England and Wales, whose national health service is very similar to the Italian one, the falls of patients in hospitals with optimal bed occupancy rates and optimal average hospitalization rates (equal to 4.5 days in general medicine, 3.5 days in general surgery, 3 days in orthopedics) represent the first sentinel event in terms of incidence and frequency, albeit with a very variable damage detection. The average falls is 6.63 falls per 1,000 bed-occupied days, which equates to approximately 1,700 falls per year in an 800-bed hospital with an optimal occupancy rate. Regarding damage, the literature documents that physical injuries and fractures occur in 30-50% of events and fractures occur in 1-3% of cases. The data collected in ASL ROMA 2 have documented that despite the increase in staff dedicated to assistance by 15 - 30%, an increase due to the application of COVID pathways and to the activities of compression of the risk of circulation of the virus among hospitalized patients , the rate of falls has nevertheless increased by 13.5% despite the persistence of standards of quality and safety of patients in care activities, debunking the paradigm that falls can be caused by an undersizing of the care staff and by the possible overcrowding of the emergency departments - urgency.

Active targeting of cancer cells by CD44 binding peptide-functionalized oil core-based nanocapsules.

Selectivity in tumor targeting is one of the major issues in cancer treatment. Therefore, surface functionalization of drug delivery systems with active moieties, able to selectively target tumors, has become a worldwide-recognized strategy. The CD44 receptor is largely used as a biomarker, being overexpressed in several tumors, and consequently as a target thanks to the identification of the CD44 binding peptide. Here we implemented the CD44 binding peptide logic onto an oil core-polymer multilayer shell, taking into account and optimizing all relevant features of drug delivery systems, such as small size (down to 100 nm), narrow size distribution, drug loading capability, antifouling and biodegradability. Besides promoting active targeting, the oil core-based system enables the delivery of natural and synthetic therapeutic compounds. Biological tests, using curcumin as a bioactive compound and fluorescent tag, demonstrated that CD44 binding peptide-functionalized nanocapsules selectively accumulate and internalize in cancer cells, compared to the control, thanks to ligand-receptor binding.

High quality factor photonic cavity for dark matter axion searches.

Searches for dark matter axions involve the use of microwave resonant cavities operating in a strong magnetic field. Detector sensitivity is directly related to the cavity quality factor, which is limited, until recently, to the use of non-superconducting metals by the presence of the external magnetic field. In this paper, we present a cavity of novel design whose quality factor is not affected by a magnetic field. It is based on a photonic structure by the use of sapphire rods. The quality factor at cryogenic temperature is in excess of 5 × 105 for a selected mode.

Identifying potential gene biomarkers for Parkinson's disease through an information entropy based approach.

Parkinson's disease (PD) is a chronic, progressive neurodegenerative disease and represents the most common disease of this type, after Alzheimer's dementia. It is characterized by motor and nonmotor features and by a long prodromal stage that lasts many years. Genetic research has shown that PD is a complex and multisystem disorder. To capture the molecular complexity of this disease we used a complex network approach. We maximized the information entropy of the gene co-expression matrix betweenness to obtain a gene adjacency matrix; then we used a fast greedy algorithm to detect communities. Finally we applied principal component analysis on the detected gene communities, with the ultimate purpose of discriminating between PD patients and healthy controls by means of a random forests classifier. We used a publicly available substantia nigra microarray dataset, GSE20163, from NCBI GEO database, containing gene expression profiles for 10 PD patients and 18 normal controls. With this methodology we identified two gene communities that discriminated between the two groups with mean accuracy of 0.88 ± 0.03 and 0.84 ± 0.03, respectively, and validated our results on an independent microarray experiment. The two gene communities presented a considerable reduction in size, over 100 times, compared to the initial network and were stable within a range of tested parameters. Further research focusing on the restricted number of genes belonging to the selected communities may reveal essential mechanisms responsible for PD at a network level and could contribute to the discovery of new biomarkers for PD.

Characteristics of 1573 healthcare workers who underwent nasopharyngeal swab testing for SARS-CoV-2 in Milan, Lombardy, Italy.

OBJECTIVES: The management of healthcare workers (HCWs) exposed to confirmed cases of coronavirus disease 2019 (COVID-19) is still a matter of debate. We aimed to assess in this group the attack rate of asymptomatic carriers and the symptoms most frequently associated with infection. METHODS: Occupational and clinical characteristics of HCWs who underwent nasopharyngeal swab testing for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a university hospital from 24 February 2020 to 31 March 2020 were collected. For those who tested positive and for those who tested positive but who were asymptomatic, we checked the laboratory and clinical data as of 22 May to calculate the time necessary for HCWs to then test negative and to verify whether symptoms developed thereafter. Frequencies of positive tests were compared according to selected variables using multivariable logistic regression models. RESULTS: There were 139 positive tests (8.8%) among 1573 HCWs (95% confidence interval, 7.5-10.3), with a marked difference between symptomatic (122/503, 24.2%) and asymptomatic (17/1070, 1.6%) workers (p < 0.001). Physicians were the group with the highest frequency of positive tests (61/582, 10.5%), whereas clerical workers and technicians had the lowest frequency (5/137, 3.6%). The likelihood of testing positive for COVID-19 increased with the number of reported symptoms; the strongest predictors of test positivity were taste and smell alterations (odds ratio = 76.9) and fever (odds ratio = 9.12). The median time from first positive test to a negative test was 27 days (95% confidence interval, 24-30). CONCLUSIONS: HCWs can be infected with SARS-CoV-2 without displaying any symptoms. Among symptomatic HCWs, the key symptoms to guide diagnosis are taste and smell alterations and fever. A median of almost 4 weeks is necessary before nasopharyngeal swab test results are negative.

Axion Search with a Quantum-Limited Ferromagnetic Haloscope.

A ferromagnetic axion haloscope searches for dark matter in the form of axions by exploiting their interaction with electronic spins. It is composed of an axion-to-electromagnetic field transducer coupled to a sensitive rf detector. The former is a photon-magnon hybrid system, and the latter is based on a quantum-limited Josephson parametric amplifier. The hybrid system consists of ten 2.1 mm diameter yttrium iron garnet spheres coupled to a single microwave cavity mode by means of a static magnetic field. Our setup is the most sensitive rf spin magnetometer ever realized. The minimum detectable field is 5.5×10^{-19} T with 9 h integration time, corresponding to a limit on the axion-electron coupling constant g_{aee}≤1.7×10^{-11} at 95% C.L. The scientific run of our haloscope resulted in the best limit on dark matter axions to electron coupling constant in a frequency span of about 120 MHz, corresponding to the axion-mass range 42.4-43.1 µeV. This is also the first apparatus to perform a wide axion-mass scanning by only changing the static magnetic field.

Does patient-reported perception of pain differ based on surgical approach in total hip arthroplasty?

AIMS: Whether patient-reported pain differs among surgical approaches in total hip arthroplasty (THA) remains unclear. This study's purposes were to determine differences in pain based on surgical approach (direct anterior (DA) vs posterolateral (PL)) and PL approach incision length. PATIENTS AND METHODS: This was a retrospective investigation from two centres and seven surgeons (three DA, three PL, one both) of primary THAs. PL patients were categorized for incision length (6 cm to 8 cm, 8 cm to 12 cm, 12 cm to 15 cm). All patients had cementless femoral and acetabular fixation, at least one year's follow-up, and well-fixed components. Patients completed a pain-drawing questionnaire identifying the location and intensity of pain on an anatomical diagram. Power analysis indicated 800 patients in each cohort for adequate power to detect a 4% difference in pain (alpha = 0.05, beta = 0.80). RESULTS: A total of 1848 patients (982 DA, 866 PL) were included. PL patients were younger (59.4 years, sd 12.9 vs 62.7 years, sd 9.7; p < 0.001) and had shorter follow-up (3.3 years, sd 1.3 vs 3.7 years, sd 1.3; p < 0.001). DA patients reported decreased moderate to severe trochanteric (14% vs 21%; p < 0.001) and groin pain (19% vs 24%; p = 0.004) than PL patients. There were no differences in anterior, lateral, or posterior thigh, back, or buttock pain between cohorts (p = 0.05 to 0.7). PL approach incision length did not impact the incidence or severity of pain (p = 0.3 to 0.7). CONCLUSION: A significant proportion of patients perceive persistent pain following THA regardless of approach. DA patients reported less trochanteric and groin pain versus PL patients. PL incision length did not influence the incidence or severity of patient-reported pain. Cite this article: Bone Joint J 2019;101-B(6 Supple B):31-36.

Should postoperative haemoglobin and potassium levels be checked routinely following blood-conserving primary total joint arthroplasty?

AIMS: Despite declining frequency of blood transfusion and electrolyte supplementation following total joint arthroplasty, postoperative blood analyses are still routinely ordered for these patients. This study aimed to determine the rate of blood transfusion and electrolyte restoration in arthroplasty patients treated with a perioperative blood conservation protocol and to identify risk factors that would predict the need for transfusion and electrolyte supplementation. PATIENTS AND METHODS: Patients undergoing primary total joint arthroplasty of the hip or knee between July 2016 and February 2017 at a single institution were included in the study. Standard preoperative and postoperative laboratory data were collected and reviewed retrospectively. A uniform blood conservation programme was implemented for all patients. Need for blood transfusion or potassium supplementation was determined through a coordinated decision by the care team. Rates of transfusion and supplementation were observed, and patient risk factors were noted. RESULTS: The overall rate of blood transfusion was 1.06% in the study population of 1132 total joint arthroplasties performed in 1023 patients. Of the 12 patients requiring transfusion, 11 were female, ten occurred in patients undergoing total hip arthroplasty, and all 12 patients had a preoperative haemoglobin level less than 130 g/l. Operative duration and surgical blood loss were significantly greater in those patients requiring blood transfusion. Nearly all patients requiring transfusion had a history of, or risk factors for, cardiovascular disease. Potassium supplementation was required in 15.5% of the study cohort; 72% of these patients receiving potassium presented with a potassium level less than 4 mmol/l during preoperative testing, while the remaining 28% had a past medical history of either significant anaemia, cardiopulmonary, cardiovascular, or renal diseases that had required substantial medical management. CONCLUSION: A consistent blood-conserving perioperative strategy effectively minimized need for blood transfusion in total joint arthroplasty patients below previously reported rates in the literature. We suggest that postoperative full blood counts and basic metabolic panels should not routinely be ordered in these patients unless their preoperative haemoglobin and potassium is below 130 g/dl or 4 mmol/l respectively, and they have medical comorbidities.

Correction to: New clotting disorders that cast new light on blood coagulation and may play a role in clinical practice.

The original version of the article unfortunately contained few errors.