Formulation of Deformable Liponiosomal Hybrid of Repaglinide: In vitro Characterization and Evaluation of the Anti-Diabetic Effect.

Purpose: The current study sought to create novel deformable liponiosomal hybrids (LNHs) as a viable RPG delivery system. Repaglinide (RPG) is an effective anti-hyperglycemic drug. However, its limited solubility may limit its therapeutic applicability. LNHs are a potential liposome-niosome combination. Using phospholipids and non-ionic surfactants together improves their functionality in regulating drug release and increasing their permeability and stability. Materials and Methods: The development of RPG-loaded LNHs was performed using the reverse ethanol injection method based on the 23 factorial design to explore the potential of various variables on the encapsulation efficiency (EE%) and % RPG released after 12 h (Q12h). Further in vitro characterization tests and in vivo study were also performed on the optimal RPG-loaded LNHs. Results: After investigating how the examined independent factors could affect significantly both the EE % and Q12h, F7 was selected as the optimal liponiosomal formulation. F7 showed 87.07 ± 2.27 EE% and 94.32 ± 1.25 Q12h. F7 demonstrated higher permeability and stability than the corresponding liposomes and niosomes. Furthermore, F7 demonstrated greater hypoglycemic efficacy and bioavailability than pure RPG. Conclusion: The combination of liponiosomes and niosomes in the form of LNHs has the potential to be an effective nano-drug delivery vehicle for RPG.

Acromioclavicular joint Stabilization: Our experience with the lockdown technique.

Background: Acromioclavicular joint (AC joint) disruption is a common injury with considerable variation with regards to surgical management. The Lockdown™ procedure (previously known as Surgilig™), Modified Weaver-Dunn procedure, Arthroscopic AC joint stabilization and Ligament Augmentation and Reconstruction system (LARS) procedure have all been described for treatment of this injury with varying outcomes. Purpose: To measure the functional and radiological outcomes following all cases of AC joint reconstruction using the Lockdown™ technique over the last 10 years at Medway Maritime Hospital. Methods: Data on a total of 53 patients who underwent AC joint reconstruction between 2012 and 2021 were collected. Electronic records were used to extract data regarding patient characteristics, surgery details, and duration of follow-up. Telephonic interviews of patients were conducted to collect data on hand dominance, surgical complications, and responses to Oxford shoulder score (OSS) and QuickDASH score questionnaires. Hospital PACS data were reviewed to record preoperative injury severity and postoperative acromioclavicular joint reduction. Results: Results for 42 patients were available and analysed as 10 could not be contacted and 1 patient sadly passed away. Of the patients reviewed, 92.9% were males with a mean age of 42.2 years (Range 16-67 years) and mean follow up of 68 months (12-119.1 months). The injury involved the dominant arm in 59.5%cases. Majority of the cases were Rockwood type V injuries (71.43%) while the rest were either type III(19.05%) or type IV(9.52%).The mean preoperative OSS was 21.3/48 which improved to 44.3/48 in the postoperative period. Similarly, the mean QuickDASH score was 50.6 preoperatively, that improved to 9.1 postoperatively.The most common patient reported complication was prominent metalwork seen in 5 cases (11.6%) followed by stiffness seen in 3 cases (7%) and superficial infection seen in 1 case (2.3%). The AC joint remained reduced radiologically in 81% of cases, while a resubluxation between 50 and 100% was seen in the rest of the cases. Patients with radiological resubluxation did not report this as a complication in 87.5% of the cases. Overall, 38 patients reported their outcome as excellent, 2 patients rated it good while 1 patient reported it as fair and 1 as poor. Conclusion: The Lockdown™ technique for stabilization of AC joint has excellent or good patient satisfaction in 95.2% of cases in long term follow up of more than 5.7 years. Prominent metalwork and stiffness are the commonest clinical complications. Radiological resubluxation can be seen in a fifth of the cases but does not directly lead to patient dissatisfaction. Level of evidence: Level IV Retrospective case series.

Traumatic rotator cuff tears - Current concepts in diagnosis and management.

Rotator cuff tears represent one of common shoulder pathologies presenting over a wide spectrum of age groups and varying presentation. Typically, rotator cuff tears occur more frequently in elderly than in younger patients, following a chronic or acute-on-chronic course and usually secondary to due to tendon degeneration. Though there has been a considerable debate in the literature of the terms "acute" and "traumatic" used in the classification of rotator cuff tears, there appears to be consensus about the need for early diagnosis to facilitate prompt surgical treatment and the improve patient outcome. Significant differences in rotator cuff tears between those occurring in younger and older patients could be due to mechanism of injury, presentation, severity of the tear, biological healing potential and rehabilitation. Acute traumatic rotator cuff tears especially in younger age group represent a distinct entity from other patterns of rotator cuff tears. Consequently, a high index of suspicion, focused clinical examination, complementary imaging is a pre-requisite for an early diagnosis and effective management. We analyze the biomechanical consequences of acute rotator cuff tears along with characteristic mechanism of injury and spectrum of tendon involvement. The evolving concepts in the diagnosis and management of these distinct injuries are discussed with review of current literature.

Surgical outcomes of pancreaticoduodenectomy in young patients: A case series.

BACKGROUND: Pancreaticoduodenectomy (PD) is a complex procedure for management periampullary neoplasms The aim of our work is to report the surgical outcomes after PD in young adult (YA) (<35 years) and to compare it to a adult patients who underwent PD. METHODS: We retrospectively analyzed the data of all patients who underwent PD in the period from January 1993 to December 2016. The primary outcome was the rate of total postoperative complications. Secondary outcomes included postoperative pathology, exocrine and endocrine function and survival rate. RESULTS: 58/975 patients (5.9%) were YA and the majority of them were females. The incidence of post-operative complications in the YA was comparable to that in the adult group. Delayed gastric emptying developed significantly in adult group than YA group (0.008). The overall survival was significantly higher in the YA (P = 0.0001). The most common pathology in the YA was adenocarcinoma (41.4%) and solid pseudopapillary tumor (SPT) (29.3%). No significant difference as regards postoperative pancreatic exocrine and endocrine function in both groups. CONCLUSION: PD in YA when performed in tertiary centers with good surgical experience is safe. The most common pathological diagnosis in the YA was adenocarcinoma followed by SPT.

Short- to mid-term results of ulna head replacement as both a primary and revision implant.

We present the results of short- to medium-term follow-up of 10 patients following ulna head replacement. The mean age of patients was 63.2 years (range 48-81 years), with the mean duration of follow-up being 48 months (12-88 months). The indications for the procedure were primary osteoarthritis (n = 3), post-traumatic osteoarthritis (n = 4), failed Darrach's procedure (n = 2) and rheumatoid arthritis (n = 1). Two patients required revision (20%), one for gross aseptic loosening of the stem and another for an initially oversized head. At final follow-up, the satisfactory rate was 90%. The mean VAS score was 2.4 (range 0-8). The average DASH score was 37 (range 0-72.5). Our study suggests that ulna head replacement can give satisfactory forearm function; however, concerns exist regarding bone resorption and tapering around the prosthesis, which may affect the long-term performance of the prosthesis. LEVEL OF EVIDENCE: IV.

Ultrasound for accurate measurement of invasive breast cancer tumor size.

Accurate presurgical assessment of tumor size is important for choosing appropriate treatment, especially with the increasing use of neoadjuvant and minimally invasive therapy. Breast sonography is increasingly used by breast surgeons as a part of their basic clinical evaluation. We undertook this study to compare clinical evaluation, mammography, and breast sonography for evaluating breast tumor size. A prospective analysis of 124 consecutive patients with palpable breast cancer was performed. Tumor masses belonging to T1 and small T2 were selectively selected. All women had clinical, mammographic, and sonographic assessment of tumor size. Measurements were compared to the pathologic tumor size of the surgical specimen. Both mammographic and sonographic measurements tend to underestimate tumor size, while clinical assessment tends to overestimate it. Ultrasound was significantly more accurate in determining tumor size. The maximal tumor diameter measured was within 2 mm of the pathologic tumor size in 45.2% of cases measured by breast ultrasound, 28.2% of cases measured by mammography, and 14.5% of cases measured clinically. These data suggest that ultrasound is more accurate than clinical breast examination and mammography in assessing breast cancer size. Ultrasound assessment should be used by surgeons as an accurate adjunct to clinical examination in outpatient breast clinics.