Machine Learning-based Deep Analysis of Human Blood using NIR Spectrophotometry Signatures.

BACKGROUND: Non-invasive bio-diagnostics are essential for providing patients with safer treatment. In this subject, significant growth is attained for noninvasive anaemia detection in terms of Hb concentration by means of spectroscopic and image analysis. The lower satisfaction rate is found due to inconsistent results in various patient settings. OBJECTIVE: This observational study aims to present an adaptable point-of-care Near-Infrared (NIR) spectrophotometric approach with a constructive Machine Learning (ML) algorithm for monitoring Haemoglobin (Hb) concentration by considering dominating influencing factors into account. METHODS: To accomplish this objective, 121 subjects (19.2-55.4 years) were enrolled in the study, having a wide range of Hb concentrations (8.2-17.4 g/dL) obtained from two standard Laboratory analyzers. To inspect the performance, the unique dimensionality reduction approaches are applied with numerous regression models using 5-fold cross-validation. RESULTS: The optimum accuracy is found using support vector regression (SVR) and mutual information having 3 independent features i.e. Pearson correlation (r)= 0.79, standard deviation (SD)= 1.07 g/dL, bias=-0.13 g/dL and limits of agreement (LoA)=-2.22 to 1.97 g/dL. Additionally, comparability between two standard laboratory analyzers is found as; r=0.97, SD=0.50 g/dL, bias=0.21 g/dL, and LoA= -0.77 to 1.19 g/dL. CONCLUSION: The precision of ±1 g/dL in 5-fold cross-validation ensures the same performance irrespective of different age groups, gender, BMI, smoking level, drinking level, and skin type. The outcomes with the offered NIR sensing system and an exclusive ML algorithm can accelerate its' requirement at remote locative rural areas and critical care units where continuous Hb monitoring is compulsory.

Postoperative Fluid Collections in Total Joint Arthroplasty: A Narrative Review.

A post-operative fluid collection (POFC) represents a common finding in both primary and revision total joint arthroplasty (TJA). Fortunately, most resolve on their own, but in instances where they become symptomatic, prompt identification and management are paramount, especially when they occur adjacent to a joint arthroplasty because of the increased the risk of developing a periprosthetic joint infection. A strong clinical suspicion with appropriate clinical exam is required along with select imaging modalities to arrive at a diagnosis. Meticulous surgical technique is crucial to prevent POFC, but new emerging treatments continue to evolve. This article presents an updated overview of incidence, pathophysiology, diagnosis, and management of POFC in the setting of TJA. We review the role of select imaging modalities as well as summarize current literature regarding new treatments such as sclerotherapy agents, acellular dermal matrices, and negative pressure wound therapy. Future studies are necessary to explore the interplay of inflammatory mediators in POFC formation and to define their role in fluid collection resolution.

Interleukin-1 receptor antagonist inhibits arthrofibrosis in a post-traumatic knee immobilization model.

BACKGROUND: Therapies for arthrofibrosis after knee surgery are needed to prevent loss of joint function. Interleukin-1 receptor antagonists (IL-1RA) have shown promise in treating established arthrofibrosis in pilot clinical studies. The objective of this study was to evaluate the ability of intra-articular injection of IL-1RA to prevent knee joint contracture in a post-traumatic knee immobilization model. METHODS: 20 male Sprague Dawley rats were block randomized into two groups: control and IL-1RA. Rats underwent intra-articular surgical trauma of the right knee with placement of an immobilization suture, securing the knees in 150° flexion. On post-operative days 1 and 8, each group received a 0.1 ml intra-articular injection of either saline (control) or anakinra (IL-1RA:single dosage; 2.63 mg/kg). Rats were euthanized fourteen days after surgery and the immobilization femorotibial angles were measured on the operative limbs with the suture and musculature intact. Subsequently, musculature was removed and femorotibial angles were measured in the operative and non-operative limbs with a defined extension moment applied with the posterior capsule intact or cut. A contracture angle was calculated as the angular difference between the operative and non-operative limb. RESULTS: The immobilization knee flexion angle did not differ (P = 0.761) between groups (control: 152 ± 9; IL-1RA: 150 ± 11). The joint contracture angles (smaller angle = improved outcome) were reduced by 12 degrees on average in the IL-1RA group compared to the control for both the capsule intact (P = 0.024) and cut (P = 0.019) states. CONCLUSIONS: Intra-articular IL-1RA injection was found to diminish knee extension deficits associated with arthrofibrosis in a post-traumatic joint immobilization model.

Meta-Analysis: Functional Outcome of ORIF Versus Primary Subtalar Arthrodesis of Sanders Type II and Type III Calcaneal Fractures.

The choice of treatment for Sanders Type II and Type III calcaneal fractures remains controversial with unclear patient functional outcomes. A meta-analysis was done to compare the functional outcome of ORIF vs primary subtalar arthrodesis (PSA) according to American Orthopedic Foot and Ankle Score (AOFAS) hindfoot-ankle scores. The PubMed, Embase, and Cochrane Library Databases were searched by two independent evaluators. Fourteen studies met the eligible criteria. ORIF of 501 Type II and Type III fractures was compared to primary subtalar arthrodesis treatment of 57 Type II and Type III fractures. AOFAS for a mixed ORIF group of "Type II and III" fractures was 82.16 ± 1.58 at average follow-up of 25.3 months. For a mixed PSA group of "Type II and III" fractures, the AOFAS was 74.22 ± 2.45 at average follow-up of 28.0 months. This showed a difference between ORIF and primary subtalar arthrodesis of 7.94 points (95% confidence interval [CI] = 7.75-7.98; p value .004) favoring ORIF when adjusting for minimally invasive and percutaneous methods. Without adjustment, there was a difference of 6.54 points favoring ORIF (95% CI = 6.22-6.46; p value .017). In conclusion, while high-quality randomized controlled trials comparing ORIF to primary subtalar arthrodesis for Type II and Type III fractures would further elucidate superior treatment outcomes, this meta-analysis of available data shows a tendency for ORIF of Type II and Type III Sanders calcaneal fractures to have a better functional outcome at approximately 2 years postoperatively compared to primary subtalar arthrodesis.

Minimally Invasive Quad Harvest Featuring Endoscopic Closure and Preparation With Adjustable Suspensory Fixation Device Incorporated With Braided Suture.

The quad tendon has increasingly became a very common option for anterior cruciate ligament reconstruction. Minimally invasive approaches are one of the many advantages to the quad tendon graft. One of the issues with a small incision is assuring appropriate proximal closure. In this technique, we use the arthroscope to view proximally and a Scorpion (Arthrex) device to close our proximal quad harvest. We also describe the updated preparation of the quad tendon with FiberTag TightRope (Arthrex) and FiberTag ABS (Arthrex). These implants have FiberTag incorporated to the suspensory devices that creates a stable construct that is faster to incorporate into the quad with the slotted clamp. Together, these updates to the preparation and harvest should make the construct more reproducible and decrease donor-site morbidity respectively.

Anterior Cruciate Ligament (ACL) Reconstruction Augmented With Bone Marrow Concentrate, Demineralized Bone Matrix, Autograft Bone, and a Suture Tape (The Fertilized ACL).

PURPOSE: To examine the early clinical outcomes as well as safety of the Fertilized anterior cruciate ligament (ACL) reconstruction procedure. METHODS: A total of 16 consecutive patients with a mean age of 24 years (range, 16-45 years), who had been treated with the fertilized ACL were evaluated and followed over 2 years. Four patients underwent reconstruction using an FGL GRAFTLINK allograft (LifeNet Virginia Beach, VA) and 12 using quadriceps autografts. All patients received the fertilized ACL as previously described using bone marrow composite, demineralized bone matrix, and an internal brace (Arthrex, Largo, FL). Clinical outcomes at 2 years including International Knee Documentation Committee and Marx scores were evaluated. Complication rates, including return to operating room, arthrofibrosis, infection, and rerupture rates, were also assessed. RESULTS: All patients were followed for 6 months and all were released to full activity. In total, 11 of 16 patients were available for 2-year follow-up after the fertilized ACL reconstruction. At 2 years, the average International Knee Documentation Committee and Marx scores were 81 (standard deviation, 5.9) and 9 (standard deviation, 5.7), respectively. One patient required a return trip to the operating room for manipulation under anesthesia. No reruptures were observed at the 2-year mark. Nine of 11 patients had returned to their preinjury activity status at 2 years. CONCLUSIONS: The fertilized ACL, which adds biology and an internal brace to an ACL reconstruction, is a reliable and safe option when performing an ACL reconstruction. Very low complication risks were seen in this consecutive series followed for 2 years. Patients consistently returned to their preinjury activity status. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Persistent Wound Drainage among Total Joint Arthroplasty Patients Receiving Aspirin vs Coumadin.

BACKGROUND: Persistent wound drainage (PWD) is one of the major risk factors for periprosthetic joint infections (PJI), arguably the most dreaded complications after a total hip and knee arthroplasty (THA and TKA). The aim of this study is to identify the rates of PWD among THA and TKA patients who received aspirin (ASA) or Coumadin for postoperative venous thromboembolism (VTE) prophylaxis. METHODS: Retrospective review of 5516 primary THA and TKA was performed. Patients with PWD were identified. Chi-square test was used to compare the incidences of PWD, 30-day VTE, and PJI at 6 months between the ASA and Coumadin groups. Multivariate regression model was used to identify independent risk factors for PWD using Charlson and Elixhauser comorbidity indexes. RESULTS: The prevalence of PWD was 6.4% (353/5516). Patients receiving ASA had lower incidence of PWD (3.2% vs 8.5%, P < .0001) while having comparable rates of 30-day VTE (1.3% vs 1.4%, P = .722) and PJI at 6 months (1.8% vs 1.4%, P = .233) compared to those receiving Coumadin. Risk factors for PWD were diabetes (odds ratio [OR], 19.3; 95% confidence interval [CI], 11.8-23.2), rheumatoid arthritis (OR, 15.3; 95% CI, 10.8-17.2), morbid obesity (OR, 13.2; 95% CI, 9.7-17.5), chronic alcohol use (OR, 3.5; 95% CI, 1.8-5.5), hypothyroidism (OR, 1.9; 95% CI, 1.1-3.2), and Coumadin (OR, 1.7; 95% CI, 1.2-2.2). CONCLUSION: Use of ASA is associated with significantly lower rates of PWD after THA and TKA when compared to Coumadin while being equally efficacious at preventing VTE. Coumadin was found to be an independent risk factor for PWD.

Iatrogenic Tibia Fracture from an "Errant" Traction Pin Placement Resulting in a Cortical Defect: A Case Study.

CASE: A 78-year-old women presented with a closed left midshaft femur fracture after sustaining a fall from standing height and underwent proximal tibial traction pin placement. After subsequent intramedullary nailing of femur fracture, the patient returned 2 months later with a proximal tibia fracture through the unicortical defect left from the traction pin site and underwent successful intramedullary nailing of the tibia. CONCLUSION: Errant anteriorly placed proximal tibial traction pins pass tangentially across the vertex of the tibia and create residual unicortical defects that may increase the risk for late iatrogenic pin site fractures.

Autograft Cartilage Transfer Augmented With Bone Marrow Concentrate and Allograft Cartilage Extracellular Matrix.

The use of biologics in sports medicine is increasing rapidly. An osteochondral defect in a young active patient remains a difficult issue to treat. Autograft cartilage has tremendous advantages for the treatment of full-thickness defects, but harvesting and preparation have been difficult in the past. Disadvantages have included donor-site morbidity and the need for further surgery. With the recent development of the GraftNet device (Arthrex, Naples, FL), harvesting and delivery of autograft have become easier and can be performed arthroscopically in a single surgical procedure. Bone marrow concentrate has recently increased in popularity owing to the presence of mesenchymal stem cells. These stem cells combined with autograft cartilage and BioCartilage (Arthrex) could lead to better incorporation and healing. In this article, we show how this unique biological composite is obtained and then added in the cartilage defect during a single-stage arthroscopic procedure.

The Lavender Fertilized Anterior Cruciate Ligament Reconstruction: A Quadriceps Tendon All-Inside Reconstruction Fertilized With Bone Marrow Concentrate, Demineralized Bone Matrix, and Autograft Bone.

The use of biologics in sports medicine is increasing rapidly. Bone marrow concentrate has recently increased in popularity because it includes mesenchymal stem cells which, combined with AlloSync Pure, could lead to better incorporation and healing. The mixture of bone marrow concentrate and Allosync Pure can be used in anterior cruciate ligament reconstruction. We recently expanded on this approach with the addition of saving the host bone normally lost from tunnel reaming, using the GraftNet. After harvesting the autograft bone, we combine it with the AlloSync Pure and bone marrow concentrate. In this Technical Note, we show how this unique biologic composite is obtained and then added back into the tunnels on both the femur and tibia during a quadriceps tendon autograft all-inside anterior cruciate ligament reconstruction.

Clinical and Pathophysiologic Significance of MRI Identified Bone Marrow Lesions Associated with Knee Osteoarthritis.

Knee osteoarthritis (OA) affects the joint beyond just the articular cartilage. Specifically, magnetic resonance imaging-identified bone marrow lesions (BML) in the subchondral bone have both clinical and pathophysiological significance. Compared to joint space narrowing on traditional radiographs, the presence of BMLs has been better correlated with severity of clinical symptoms as well as clinical deterioration. Presence of a BML increases the likelihood for progression to a total knee arthroplasty by up to nine fold. Histochemical analysis of BMLs has shown increased levels of tumor necrosis factor-alpha, matrix metalloproteinases and substance P, thought to stimulate pain receptors in osteoarthritis. LEVEL OF EVIDENCE: V.

Disordered Protein Diffusion under Crowded Conditions.

Intrinsically disordered proteins are important in signaling, regulation, and translocation. Understanding their diffusion under physiologically relevant conditions will yield insight into their functions. We used NMR to quantify the translational diffusion of a globular and a disordered protein in dilute solution and under crowded conditions. In dilute solution, the globular protein chymotrypsin inhibitor 2 (CI2, 7.4 kDa) diffuses faster than the disordered protein α-synuclein (14 kDa). Surprisingly, the opposite occurs under crowded conditions; α-synuclein diffuses faster than CI2, even though α-synuclein is larger than CI2. These data show that shape is a key parameter determining protein diffusion under crowded conditions, adding to the properties known to be affected by macromolecular crowding. The results also offer a clue about why many signaling proteins are disordered.