Clinical outcomes of triclosan-coated barbed suture in open hernia repair: a retrospective cohort study.

PURPOSE: We assessed clinical outcomes of patients undergoing open hernia repair using STRATAFIX™ Symmetric, a barbed triclosan-coated suture (TCS; Ethicon), versus conventional polydioxanone suture (PDS) for abdominal wall closure. METHODS: This single-center retrospective cohort study identified patients undergoing hernia repair. The site used PDS from 2013 to 2016 and switched exclusively to barbed TCS in 2017. Outcomes were assessed at 30, 60, and 90 days. Multivariate regression analyses and Cox proportional hazards models were used. RESULTS: Of 821 hernia repairs, 446 used barbed TCS and 375 used conventional PDS. Surgical site infections (SSIs) were significantly less frequent with barbed TCS (60 days, 5.9% vs. 11.4%; P = 0.0083; 90 days, 5.9% vs. 11.7%; P = 0.006) and this remained consistent after multivariate adjustment (60 days, OR [95% CI]: 0.5 [0.3-0.9]; 90 days, 0.5 [0.3-0.9]). Among patients with SSI, deep SSIs were less frequent with barbed TCS (60 days, 9.1% vs. 35.7%; P = 0.022; 90 days, 9.1% vs. 34.9%; P = 0.0252). Barbed TCS significantly reduced the risk of perioperative complications (HR [95% CI]: 0.5[0.3-0.8]; P = 0.0058). Hospital length of stay was 2.5 days shorter with barbed TCS (mean [95% CI]: 5.7[4.9-6.6] vs. 8.2[7.3-9.1] days; P < 0.0001). No differences in reoperation rate over time were observed by type of suture (HR[95% CI]:1.3 [0.5-3.4]; P = 0.4793). CONCLUSIONS: This study showed that patients who underwent open hernia repair appeared to recover equally well regardless of the suture type. In addition, the use of barbed TCS was associated with significantly reduced risk of perioperative complications and hospital length of stay.

Decreased mebrofenin uptake in patients with non-colorectal liver tumors requiring liver volume augmentation-a single-center analysis.

BACKGROUND: Posthepatectomy liver failure (PHLF) remains a life-threatening complication after hepatectomy. To reduce PHLF, a preoperative assessment of liver function is indispensable. For this purpose, 99mTc-mebrofenin hepatobiliary scintigraphy with SPECT (MSPECT) can be used. The aim of the current study was to evaluate the predictive value of MSPECT for PHLF in patients with non-colorectal liver tumors (NCRLT) compared to patients with colorectal liver metastasis (CRLM) undergoing extended liver resection. METHODS: We included all patients undergoing extended liver resections via two-stage procedures between January 2019 and December 2021 at the University Medical Center Hamburg-Eppendorf, Germany. All patients received a preoperative MSPECT. RESULTS: Twenty patients were included. In every fourth patient, PHLF was observed. Four patients had PHLF grade C. There were no differences between patients with CRLM and NCRLT regarding PHLF rate and future liver remnant (FLR) volume. Patients with CRLM had higher mebrofenin uptake in the FLR compared to those with NCRLT (2.49%/min/m2 vs. 1.51%/min/m2; p = 0.004). CONCLUSION: Mebrofenin uptake in patients with NCRLT was lower compared to those patients with CRLM. However, there was no difference in the PHLF rate and FLR volume. Cut-off values for the mebrofenin uptake might need adjustments for different surgical indications, surgical procedures, and underlying diseases.

Prognostic factors of poor postoperative outcomes in gastrectomies.

Background: Gastric cancer is one of the most common cancers worldwide and is the third most common cause of cancer related death. Improving postoperative results by understanding risk factors which impact outcomes is important. The current study aimed to compare immediate perioperative outcomes following gastrectomy. Methods: 302 patients following gastric resections over a 10-year period (January 2009-January 2020) were identified in a database and retrospectively analysed. Epidemiological as well as perioperative data was analysed, and a univariate and multivariate analysis performed to identify risk factors for in-hospital mortality. Results: In general, gastrectomies were mainly performed electively (total vs. subtotal 95% vs. 85%, p = 0.004). Patients having subtotal gastrectomy needed significantly more PRBC transfusions compared to total gastrectomy (p = 0.039). Most emergency surgeries were performed for benign diseases, such as ulcer perforations or bleeding and gastric ischaemia. Only emergency surgery was significantly associated with poorer overall survival (HR 2.68, 95% CI 1.32-5.05, p = 0.003). Conclusion: In-hospital mortality was comparable between total and subtotal gastrectomies. Only emergency interventions increased postoperative fatality risk.

Low-threshold Buprenorphine Treatment in a Syringe Services Program: Program Description and Outcomes.

OBJECTIVES: Low-threshold buprenorphine treatment aims to reduce barriers to evidence-based opioid use disorder treatment. We aimed to describe the treatment philosophy, practices, and outcomes of a low-threshold syringe services program (SSP)-based buprenorphine program developed through an SSP-academic medical center partnership. METHODS: We included all SSP participants who received 1 or more buprenorphine prescription from Feb 5, 2019 to October 9, 2020. We collected data on patient characteristics, substance use, buprenorphine prescriptions, and urine drug tests (UDTs). We evaluated buprenorphine treatment retention using prescription data and buprenorphine adherence using UDTs. We used 2 retention definitions: (1) percentage of patients with buprenorphine prescriptions at 30, 90, and 180 days; and (2) total percentage of days "covered" with buprenorphine prescriptions through 180 days. RESULTS: One-hundred and eighteen patients received 1 or more buprenorphine prescriptions. Patients were largely middle-aged (mean age 44, standard deviation 11), male (68%), Hispanic (31%) or Non-Hispanic Black (32%), with heroin (90%) and crack/cocaine (62%) use, and injection drug use (59%). Retention was 62%, 43%, and 31% at 30, 90, and 180 days, respectively. The median percentage of days covered with buprenorphine prescriptions through 180 days was 43% (interquartile range 8%-92%). Of the 82 patients who completed 2 or more UDTs, the median percentage of buprenorphine-positive UDTs was 71% (interquartile range 40%-100%). CONCLUSIONS: In an SSP-based low-threshold buprenorphine treatment program, approximately one-third of patients continued buprenorphine treatment for 180 days or more, and buprenorphine adherence was high. SSPs can be a pathway to buprenorphine treatment for patients at high risk for opioid-related harms.

Interest in long-acting injectable buprenorphine among syringe services program participants.

OBJECTIVE: To examine syringe services program (SSP) participants' interest in long-acting injectable buprenorphine. DESIGN: SSP participants completed a 136-item questionnaire by phone. Items assessed quantitative ratings of interest in sublingual and injectable buprenorphine, preference for sublingual versus injectable buprenorphine, and reasons for preferences. SETTING: Two large urban SSPs. PARTICIPANTS: SSP participants ≥18 years of age with current or lifetime opioid use disorder (OUD). MAIN OUTCOME MEASURE(S): (1) Interest in sublingual and injectable buprenorphine, respectively, on a scale from 0 to 10 (0 = no interest and 10 = high interest); and (2) preference for sublingual buprenorphine versus injectable buprenorphine. Participants were also asked whether they agreed with statements that presented potential reasons for preferring each formulation. RESULTS: A total of 104 unique participants were interviewed, of which 72 (69 percent) were currently receiving or considering buprenorphine treatment. Among these 72 participants, the median level of interest in starting or continuing sublingual buprenorphine was 8 out of 10 (interquartile range [IQR]: 6-10) and in starting injectable buprenorphine was 5 out of 10 (IQR: 1-9). Thirty-six (50 percent) preferred sublingual, 27 (38 percent) preferred injectable, and 9 (13 percent) preferred neither or declined to answer. Participants who preferred injectable buprenorphine most commonly agreed that the convenience of the monthly injection was the reason for their preference. CONCLUSIONS: Among SSP participants with OUD, we found moderate interest in injectable buprenorphine. Introducing this new form of buprenorphine treatment at SSPs could help meet the needs of individuals who are not well-served by standard OUD treatment models.

Implementing a fracture liaison service open model of care utilizing a cloud-based tool.

PURPOSE: Although half of women and one-quarter of men aged 50 and older will sustain an acute low-trauma fracture, less than a quarter receive appropriate secondary fracture prevention. The goal of this quality improvement demonstration project was to implement a Fracture Liaison Service (FLS) focused on secondary prevention of an osteoporotic fracture in three open health care systems aided by a cloud-based tool. METHODS: The pre-post study design examined the proportion of men and women over age 50 who received appropriate assessment (bone mineral density, vitamin D levels) and treatment (calcium/vitamin D, pharmacologic therapy) in the six months following a recently diagnosed fracture. The pre-study (Pre FLS) included a retrospective chart review for baseline data (N = 344 patients) within each health care system. In the post-evaluation (Post FLS, N = 148 patients), the FLS coordinator from each health care system examined these parameters following enrollment and for 6 months following the recently diagnosed fracture. Data were managed in the cloud-based FLS application tool. RESULTS: Ninety-three participants completed the program. The FLS program increased the percentage of patients receiving bone mineral density testing from 21% at baseline to 93% (p < 0.001) Post FLS implementation. Assessments of vitamin D levels increased from 25 to 84% (p < 0.001). Patients prescribed calcium/vitamin D increased from 36% at baseline to 93% (p < 0.001) and those prescribed pharmacologic treatment for osteoporosis increased on average from 20 to 54% (p < 0.001) Post FLS. CONCLUSIONS: We conclude that the FLS model of care in an open health care system, assisted by a cloud-based tool, significantly improved assessment and/or treatment of patients with a recently diagnosed osteoporotic fracture. Future studies are necessary to determine if this model of care is scalable and if such programs result in prevention of fractures. Mini-Abstract: The goal was to implement a Fracture Liaison Service (FLS) focused on secondary prevention of an osteoporotic fracture in open health care systems aided by a cloud-based tool. This model significantly improved assessment and/or treatment of patients with a recently diagnosed fracture.

Selective method for identification and quantification of Bifidobacterium animalis subspecies lactis BB-12 (BB-12) from the gastrointestinal tract of healthy volunteers ingesting a combination probiotic of BB-12 and Lactobacillus rhamnosus GG.

AIM: To develop a novel validated method for the isolation of Bifidobacterium animalis ssp. lactis BB-12 (BB-12) from faecal specimens and apply it to studies of BB-12 and Lactobacillus rhamnosus GG (LGG) recovered from the healthy human gastrointestinal (GI) tract. METHODS AND RESULTS: A novel method for isolating and enumerating BB-12 was developed based on its morphologic features of growth on tetracycline-containing agar. The method identified BB-12 correctly from spiked stool close to 100% of the time as validated by PCR confirmation of identity, and resulted in 97-104% recovery of BB-12. The method was then applied in a study of the recovery of BB-12 and LGG from the GI tract of healthy humans consuming ProNutrients® Probiotic powder sachet containing BB-12 and LGG. Viable BB-12 and LGG were recovered from stool after 21 days of probiotic ingestion compared to baseline. In contrast, no organisms were recovered 21 days after baseline in the nonsupplemented control group. CONCLUSIONS: We demonstrated recovery of viable BB-12, using a validated novel method specific for the isolation of BB-12, and LGG from the GI tract of healthy humans who consumed the probiotic supplement. SIGNIFICANCE AND IMPACT OF THE STUDY: This method will enable more detailed and specific studies of BB-12 in probiotic supplements, including when in combination with LGG.

Evolución clínico-radiológica a largo plazo en una serie de 26 pacientes con displasia de cadera del adulto sintomática tratados mediante osteotomía periacetabular bernesa / Long-term clinical and radiological outcomes in a serie of 26 cases of symptomatic adult developmental dysplasia of the hip managed with bernese periacetabular osteotomy

Objetivo. La displasia del desarrollo de cadera es causa frecuente de dolor coxofemoral del adulto joven. La osteotomía periacetabular bernesa se perfila como una forma de abordar el problema de dolor, limitación funcional y necesidad de artroplastia a edades tempranas en estos pacientes. Material y método. Estudio descriptivo retrospectivo de 26 pacientes seleccionados con displasia del desarrollo de cadera sintomáticos, tratados mediante osteotomía periacetabular bernesa, entre 1996 y 2009 (mujeres 94%). La edad media en el momento de la cirugía era de 39,8 años (rango: 15-49), con seguimiento medio de 10 años. Valoramos radiológicamente evolución de artrosis (escala de Tönnis), índice acetabular y ángulo de Wiberg; funcionalmente utilizamos la escala de Merle-D’Aubigné-Postel. Resultados. El tiempo medio de hospitalización fue de 10 días. El valor radiográfico medio a los 10 años fue de índice acetabular: 9,03° y ángulo de Wiberg: 38,3° (corrección de 17° y 27° respectivamente, sobre valores medios preoperatorios). El 43% refería bloqueo articular y el 53% fallo del miembro no evidenciable. Valor promedio funcional de 14,30 (bueno). A los 5 años de seguimiento, el 20% progresó en al menos un grado según la escala de Tönnis respecto a su estado preoperatorio, y a los 10 años, el 55%. A largo plazo, el 83% de los pacientes no precisó artroplastia a los 10 años y el 85% de nuestros pacientes confesó alto grado de satisfacción. Conclusiones. La osteotomía periacetabular bernesa es una alternativa terapéutica útil en adultos jóvenes con displasia del desarrollo de cadera sintomática, mejorando el dolor, la cobertura cefálica femoral y retrasando la progresión de osteoartrosis coxofemoral (AU)

Objective. Developmental hip dysplasia is a frequent cause of coxofemoral pain in young adults. Bernese periacetabular osteotomy emerges as a possible option for the management of pain relief and functional limitation, in order to delay the need for arthroplasty in these patients. Material and methods. A descriptive-retrospective study was conducted on 26 selected patients with symptomatic developmental hip dysplasia treated with bernese periacetabular osteotomy between 1996 and 2009 (94% women). Mean age at time of surgery was 39.8 y (15-49y), with a mean follow-up of 10 years. Osteoarthritis (OA Tönnis scale), acetabular index and Wiberg angle were evaluated by radiology and functionality was valued by using the de Merle-D’Aubigné-Postel scale. Results. The mean hospitalization time was 10 days. At 10 years, the mean radiography value of acetabular index was 9.03° and 38.3° for Wiberg angle (17° and 27° correction, respectively, above the mean pre-operative values). Joint lock was referred to by 43% of patients, and 53% to non-evidence based limb failure. Mean functional value was 14.30 (Good). At 5 years of follow-up, 20% advanced at least by one grade in OA Tönnis scale compared to their pre-operative status, increasing to 55% at 10 years. At 10 years after surgery, 83% patients did not need arthroplasty and 85% showed high satisfaction level. Conclusions. Bernese periacetabular osteotomy is a useful alternative in young adults with symptomatic developmental hip dysplasia that can improve pain relief, femoral head coverage, and slow down coxofemoral osteoarthrosis progression in order to delay arthroplasty (AU)

[Long-term clinical and radiological outcomes in a serie of 26 cases of symptomatic adult developmental dysplasia of the hip managed with bernese periacetabular osteotomy]. / Evolución clínico-radiológica a largo plazo en una serie de 26 pacientes con displasia de cadera del adulto sintomática tratados mediante osteotomía periacetabular bernesa.

OBJECTIVE: Developmental hip dysplasia is a frequent cause of coxofemoral pain in young adults. Bernese periacetabular osteotomy emerges as a possible option for the management of pain relief and functional limitation, in order to delay the need for arthroplasty in these patients. MATERIAL AND METHODS: A descriptive-retrospective study was conducted on 26 selected patients with symptomatic developmental hip dysplasia treated with bernese periacetabular osteotomy between 1996 and 2009 (94% women). Mean age at time of surgery was 39.8 y (15-49 y), with a mean follow-up of 10 years. Osteoarthritis (OA Tönnis scale), acetabular index and Wiberg angle were evaluated by radiology and functionality was valued by using the de Merle-D'Aubigné-Postel scale. RESULTS: The mean hospitalization time was 10 days. At 10 years, the mean radiography value of acetabular index was 9.03° and 38.3° for Wiberg angle (17° and 27° correction, respectively, above the mean pre-operative values). Joint lock was referred to by 43% of patients, and 53% to non-evidence based limb failure. Mean functional value was 14.30 (Good). At 5 years of follow-up, 20% advanced at least by one grade in OA Tönnis scale compared to their pre-operative status, increasing to 55% at 10 years. At 10 years after surgery, 83% patients did not need arthroplasty and 85% showed high satisfaction level. CONCLUSIONS: Bernese periacetabular osteotomy is a useful alternative in young adults with symptomatic developmental hip dysplasia that can improve pain relief, femoral head coverage, and slow down coxofemoral osteoarthrosis progression in order to delay arthroplasty.

[Cost per responder associated with romiplostim and rituximab treatment for adult primary immune thrombocytopenia in France]. / Coût par patient répondeur associé au traitement du purpura thrombopénique immunologique primaire par romiplostim et rituximab chez l'adulte en France.

PURPOSE OF THE STUDY: This analysis compared the response rates and cost per responder associated with romiplostim and rituximab in adult immune thrombocytopenia from the French National Health System payer perspective. METHODS: A decision analytic model was developed to estimate the cost per patient and per responder of treating adult immune thrombocytopenia patients with romiplostim versus rituximab over 6 months. A systematic literature review identified phase 3 randomized controlled trials. Published response rates were extracted (response definition: ≥50×10(9) platelets/liter). Resource utilization was based on French and international treatment guidelines, and clinical expert opinion. Unit costs were derived from literature and French reimbursement lists, and included the costs of routine physician visits, treatment administration, and emergency care. Non-responders incurred bleeding-related event costs. RESULTS: The literature review identified a phase 3 randomized controlled trial for romiplostim with a response rate of 83%. Due to a lack of phase 3 randomized controlled trials for rituximab, a systematic review of studies was selected as the best source, reporting a response rate of 62.5%. Romiplostim and rituximab were associated with similar treatment costs, with an estimated cost per patient for romiplostim of €17,456 and €17,068 for rituximab. Rituximab resulted in a 30% higher cost per responder (€27,308 for rituximab versus €21,031 for romiplostim). Romiplostim use reduced drug administration, intravenous immunoglobulin, and bleeding-related hospitalization costs compared to rituximab. CONCLUSIONS: Due to its high efficacy leading to lower bleeding-related costs, romiplostim represents an efficient use of resources for adult immune thrombocytopenia patients in the French healthcare system.

Resultados de la reducción abierta y osteosíntesis de fracturas de húmero distal en mayores de 65 años / Results after internal fixation of humerus distal fractures in patients over than 65 years old

Introducción y objetivo. Las fracturas de húmero distal en ancianos asocian mala calidad ósea y gran conminución, lo que teóricamente dificultaría la síntesis de las mismas. Nuestro objetivo es evaluar los resultados radiológicos y funcionales del tratamiento mediante reducción abierta y fijación interna de estas fracturas. Material y métodos. Estudio retrospectivo entre los años 2005-2010 de 26 pacientes tratados mediante reducción abierta y fijación interna. Seguimiento medio de 42 meses. Al finalizar el mismo se realizó una valoración radiográfica (Knirk and Jupiter scale) y funcional mediante las escalas Mayo Elbow Performance Score y Quick-Disabilities of the Arm, Shoulder and Hand Score. La edad media fue de 76,8 años (65-89) siendo el 83% mujeres. Se encontraron 16 pacientes con fractura tipo C y 8 tipo A (según la AO). Todos fueron tratados mediante abordaje posterior. Resultados. La flexión media fue de 118,86° con un déficit de extensión medio de 25°. El 79,1% de los pacientes presentaban un grado 0-1 de artrosis. La media obtenida en las escalas funcionales fue: Quick-Disabilities of the Arm, Shoulder and Hand Score: 19,87; Mayo Elbow Performance Score: 85. Encontramos 2 casos de seudoartrosis: una de húmero distal y otra de la osteotomía del olécranon. Hallamos 2 casos de neuroapraxias cubitales y una radial que se recuperaron sin secuelas. Hubo 3 reintervenciones: 2 retiradas de material y un caso de nueva osteosíntesis. Discusión. El tratamiento con reducción abierta y osteosíntesis con placa para las fracturas tipo A y C de húmero distal en ancianos proporciona unos resultados funcionales satisfactorios para las demandas de este tipo de paciente, lo que altera escasamente la calidad de vida percibida por los mismos (AU)

Introduction and objective. Distal humerus fractures in the elderly frequently associated with poor bone quality and comminution, making it harder to achieve proper osteosynthesis. Our aim is to evaluate the radiological and functional results of open reduction and internal fixation of these fractures. Material and methods. Retrospective study of 26 patients treated by open reduction and internal fixation between the years 2005-2010. Mean follow-up was 42 months. At final follow-up, a radiography evaluation (Knirk and Jupiter score) and clinical examination using Mayo Elbow Performance Score and Quick-Disabilities of the Arm, Shoulder and Hand Score was performed. Mean age of the group was 76.8 years (65-89), with 83% of the patients being female. Sixteen patients suffered type C fractures and 8 type A by AO classification. All underwent posterior surgical approach. Results. Mean elbow flexion reached 118.86°, with a mean extension deficit of 25°. More than 3-quarters (79.1%) of the patients showed 0-1 grade degenerative changes on the X-ray films at final follow-up. Functional results reached an average 19.87 points on Quick-Disabilities of the Arm, Shoulder and Hand Score, and 85 points on Mayo Elbow Performance Score scores. Non-union occurred in 2 cases: distal humerus in one patient and olecranon osteotomy in another. Ulnar nerve neuropraxia was recorded in 2 cases, and radial nerve in one. All 3 recovered uneventfully. Revision surgery was required, with 2 patients needing hardware removal and one a new fixation. Discussion. Treatment by open reduction and internal fixation with plating in elderly people for type A and C distal humerus fractures gives good functional results regarding this population, and thus scarcely disturbs their quality of life (AU)

[Results after internal fixation of humerus distal fractures in patients over than 65 years old]. / Resultados de la reducción abierta y osteosíntesis de fracturas de húmero distal en mayores de 65 años.

INTRODUCTION AND OBJECTIVE: Distal humerus fractures in the elderly frequently associated with poor bone quality and comminution, making it harder to achieve proper osteosynthesis. Our aim is to evaluate the radiological and functional results of open reduction and internal fixation of these fractures. MATERIAL AND METHODS: Retrospective study of 26 patients treated by open reduction and internal fixation between the years 2005-2010. Mean follow-up was 42 months. At final follow-up, a radiography evaluation (Knirk and Jupiter score) and clinical examination using Mayo Elbow Performance Score and Quick-Disabilities of the Arm, Shoulder and Hand Score was performed. Mean age of the group was 76.8 years (65-89), with 83% of the patients being female. Sixteen patients suffered type C fractures and 8 type A by AO classification. All underwent posterior surgical approach. RESULTS: Mean elbow flexion reached 118.86°, with a mean extension deficit of 25°. More than 3-quarters (79.1%) of the patients showed 0-1 grade degenerative changes on the X-ray films at final follow-up. Functional results reached an average 19.87 points on Quick-Disabilities of the Arm, Shoulder and Hand Score, and 85 points on Mayo Elbow Performance Score scores. Non-union occurred in 2 cases: distal humerus in one patient and olecranon osteotomy in another. Ulnar nerve neuropraxia was recorded in 2 cases, and radial nerve in one. All 3 recovered uneventfully. Revision surgery was required, with 2 patients needing hardware removal and one a new fixation. DISCUSSION: Treatment by open reduction and internal fixation with plating in elderly people for type A and C distal humerus fractures gives good functional results regarding this population, and thus scarcely disturbs their quality of life.

Efecto del fresado y enclavado endomedular sobre la producción de factores de crecimiento en el callo de fractura de fémur en ratas / Effect of intramedullary reaming and nailing on the production of growth factors in the femur fracture callus in rats

Introducción. Existen muchos estudios referentes a los diferentes efectos producidos por el fresado intramedular en el callo de fractura, pero no existe evidencia en la literatura del efecto de dicho fresado en la osteogénesis. Realizamos un estudio prospectivo para analizar el efecto del fresado endomedular y enclavado en la producción de factores de crecimiento durante el proceso de consolidación de la fractura en el fémur producida en ratas. Material y métodos. Producimos una fractura diafisaria, transversa, no conminuta de fémur en 64 ratas: 34 ratas no recibieron ningún tratamiento y las otras 30 se trataron mediante un procedimiento quirúrgico estandarizado, consistente en fresado del canal medular de distal a proximal y fijación de la fractura con una aguja de Kirschner. Las ratas fueron sacrificadas a las 24 h, 4.°, 7.° y 15.° días después de la fractura. Medimos la cantidad de factores de crecimiento (PDGFA, TGF2 y TGFBeta-R2) en el callo de fractura mediante estudio anatomopatológico en los diferentes momentos del sacrificio. Resultados. Los resultados de las variables primarias del estudio, estratificadas por tiempo hasta el sacrificio, no mostraron diferencias estadísticas significativas. Discusión. Aunque la presencia de una aguja intramedular facilita la estabilización de la fractura y la formación del callo de fractura, no hemos encontrado ninguna evidencia significativa de que el fresado endomedular produzca cambios en la expresión de los factores de crecimiento estudiados (TGFBEta-R2, PDGFA y TGFBeta2) durante la formación del callo de fractura de fémur en ratas (AU)

Introduction: Many studies have been conducted to determine the different effects that reaming or intramedullary nailing have on fracture healing, but there is no evidence in the literature of the effect of intramedullary reaming on osteogenesis. We performed a prospective study to analyse the effect of intramedullary reaming and nailing on the production of growth factors during the process of fracture healing in the femur of rats. Material and methods: A transverse mid-shaft non-comminuted femur fracture was produced in 64 rats; 34 rats did not receive any treatment, and a standardized surgical procedure was performed on 30 rats, by exposing the left knee, reaming the medullary canal from distal to proximal, and then fixing the fracture with a steel pin. The rats were sacrificed at the 24th hour, 4th, 7th and 15th days after the fracture. The amount of growth factors that appeared in the callus fracture was measured using histopathology studies. The primary categorical variables analysed were PDGFA, TGF2 and TGFBeta-R2. These variables were analysed in each group at the different sacrifice times. Results: The results of the primary variables of the study, stratified by the time until sacrifice, showed no statistically significant differences. Discussion: Even if the presence of an intramedullary wire facilitates the fracture repair and the stabilising the bridge of bone between both edges of the fracture site, no evidence was found that reaming changes the expression of the growth factors studied (PDGFA, TGFBeta-R2 and TGFBeta) during the callus formation in rats (AU)

Hormone therapy in women after heart transplantation.

BACKGROUND: Hormone therapy (HT) for menopausal women has been controversial regarding cardiac outcomes and adverse effects. Studies suggest that HT may cause increase in heart disease, stroke, and cancer. The use of HT in heart transplantation has not been firmly established. METHODS: The records of 356 female heart transplant recipients, undergoing transplantation from 1994 to 2011, were reviewed. We found 19 patients after age 35 years who were initiated on HT for noncontraceptive purposes. These patients were compared 1:3 with a contemporaneous control group matched for age, sex, era, and time after heart transplantation (paired for time from transplantation to initiation of HT). We assessed for subsequent 5-year survival, freedom from cardiac allograft vasculopathy (CAV; stenosis ≥ 30%), freedom from nonfatal major adverse cardiac events (NF-MACE; myocardial infarction, heart failure, percutaneous cardiac intervention, stroke, and need for pacemaker/defibrillator), and subsequent 1-year freedom from any-treated rejection. Additionally, we compared significant adverse effects of HT between groups. RESULTS: HT patients compared with control subjects revealed no significant difference in subsequent 5-year survival (79% vs 75%; P = .66), freedom from CAV (90% vs 88%; P = .85), or NF-MACE (90% vs 93%; P = .65). There was also no significant difference in subsequent 1-year freedom from any-treated rejection between the groups. Other adverse effects of HT including subsequent 5-year incidence of thrombosis (pulmonary embolus), malignancy, and stroke were also similar to control subjects. CONCLUSIONS: HT is not associated with poor outcome or adverse effects in female heart transplant patients after age 35 years. However, a larger cohort of patients is necessary to confirm these observations.

[Effect of intramedullary reaming and nailing on the production of growth factors in the femur fracture callus in rats]. / Efecto del fresado y enclavado endomedular sobre la producción de factores de crecimiento en el callo de fractura de fémur en ratas.

INTRODUCTION: Many studies have been conducted to determine the different effects that reaming or intramedullary nailing have on fracture healing, but there is no evidence in the literature of the effect of intramedullary reaming on osteogenesis. We performed a prospective study to analyse the effect of intramedullary reaming and nailing on the production of growth factors during the process of fracture healing in the femur of rats. MATERIAL AND METHODS: A transverse mid-shaft non-comminuted femur fracture was produced in 64 rats; 34 rats did not receive any treatment, and a standardized surgical procedure was performed on 30 rats, by exposing the left knee, reaming the medullary canal from distal to proximal, and then fixing the fracture with a steel pin. The rats were sacrificed at the 24th hour, 4th, 7th and 15th days after the fracture. The amount of growth factors that appeared in the callus fracture was measured using histopathology studies. The primary categorical variables analysed were PDGFA, TGF2 and TGFß-R2. These variables were analysed in each group at the different sacrifice times. RESULTS: The results of the primary variables of the study, stratified by the time until sacrifice, showed no statistically significant differences. DISCUSSION: Even if the presence of an intramedullary wire facilitates the fracture repair and the stabilising the bridge of bone between both edges of the fracture site, no evidence was found that reaming changes the expression of the growth factors studied (PDGFA, TGFß-R2 and TGFß2) during the callus formation in rats.

Synthesis of nanowires via helium and neon focused ion beam induced deposition with the gas field ion microscope.

The ion beam induced nanoscale synthesis of platinum nanowires using the trimethyl (methylcyclopentadienyl)platinum(IV) (MeCpPt(IV)Me3) precursor is investigated using helium and neon ion beams in the gas field ion microscope. The He(+) beam induced deposition resembles material deposited by electron beam induced deposition with very small platinum nanocrystallites suspended in a carbonaceous matrix. The He(+) deposited material composition was estimated to be 16% Pt in a matrix of amorphous carbon with a large room-temperature resistivity (∼3.5 × 10(4)-2.2 × 10(5) µΩ cm) and temperature-dependent transport behavior consistent with a granular material in the weak intergrain tunnel coupling regime. The Ne(+) deposited material has comparable composition (17%), however a much lower room-temperature resistivity (∼600-3.0 × 10(3) µΩ cm) and temperature-dependent electrical behavior representative of strong intergrain coupling. The Ne(+) deposited nanostructure has larger platinum nanoparticles and is rationalized via Monte Carlo ion-solid simulations which show that the neon energy density deposited during growth is much larger due to the smaller ion range and is dominated by nuclear stopping relative to helium which has a larger range and is dominated by electronic stopping.

Tratamiento de la infección recalcitrante de cadera mediante colgajo de músculo vasto lateral / Treatment of a recalcitrant hip infection with a vastus lateralis muscle flap

Introducción. La infección recalcitrante de cadera tras artroplastia es una complicación de difícil tratamiento para el cirujano ortopédico. El objetivo de este estudio es evaluar los resultados de estas infecciones de cadera recalcitrantes que hemos tenido en nuestro Servicio tratadas con el colgajo de vasto externo. Material y métodos. Estudio descriptivo retrospectivo de 5 pacientes con infecciones profundas de cadera mediante trasposición de colgajo del músculo vasto lateral. Edad media: 70,5 años. Tiempo medio de seguimiento: 30 meses (rango, 25-34 meses). Previamente todos los pacientes habían sido sometidos a distintos procedimientos quirúrgicos mayores (media de 3,7 procedimientos previos). Todos presentaban infecciones polimicrobianas previas a la cirugía. Se estudió los agentes patógenos involucrados mediante cultivo de la fístula, la evolución de la herida, así como controles analíticos, incluidos la proteína C-reactiva (PCR). Resultados. Se consiguió la curación de la herida en los 5 pacientes intervenidos, sin necesidad de realizar ningún otro procedimiento posterior ni aparición de fístula ni otros signos flogóticos de infección. La PCR se normalizó al mes de la intervención y no hubo morbi-mortalidad relacionada con la técnica quirúrgica. Conclusión. En nuestra experiencia, el colgajo de músculo vasto lateral como tratamiento para la infección profunda recalcitrante tras artroplastia de cadera ha presentado buenos resultados, siempre enmarcado dentro de un adecuado tratamiento antibiótico y desbridamiento quirúrgico, consiguiendo la curación de la herida y normalización de la PCR (AU)

Background. Recalcitrant hip infection after arthroplasty presents a reconstructive challenge to orthopedic surgeons. The aim of this study is to evaluate the results with a vastus lateralis muscle flap used to treat these recalcitrant hip infections in our Department. Material and methods. A retrospective descriptive study was conducted on five patients with deep hip infections by transposition of the vastus lateralis muscle flap. Average age: 70.5 years. Mean follow-up: 30 months (range, 25-34 months). All patients had previously undergone other major surgical procedures (mean of 3.7 previous procedures). All had multiple microbial infections before surgery. The pathogens involved using cultures of the fistula, the outcome of the wound and laboratory results, including C-reactive protein (CRP), were analysed. Results. Healing was achieved in the five patients who underwent surgery without requiring any further procedures or inflammatory signs of infection. CRP returned to normal one month after surgery, and there was no morbidity or mortality related to surgical technique. Conclusion. In our experience, the vastus lateralis muscle flap as a treatment for recalcitrant deep infection after arthroplasty has presented good results, provided there is appropriate antibiotic therapy and surgical debridement, thus achieving wound healing and a return to normal of the CRP (AU)

[Treatment of a recalcitrant hip infection with a vastus lateralis muscle flap]. / Tratamiento de la infección recalcitrante de cadera mediante colgajo de músculo vasto lateral.

BACKGROUND: Recalcitrant hip infection after arthroplasty presents a reconstructive challenge to orthopedic surgeons. The aim of this study is to evaluate the results with a vastus lateralis muscle flap used to treat these recalcitrant hip infections in our Department. MATERIAL AND METHODS: A retrospective descriptive study was conducted on five patients with deep hip infections by transposition of the vastus lateralis muscle flap. Average age: 70.5 years. Mean follow-up: 30 months (range, 25-34 months). All patients had previously undergone other major surgical procedures (mean of 3.7 previous procedures). All had multiple microbial infections before surgery. The pathogens involved using cultures of the fistula, the outcome of the wound and laboratory results, including C-reactive protein (CRP), were analysed. RESULTS: Healing was achieved in the five patients who underwent surgery without requiring any further procedures or inflammatory signs of infection. CRP returned to normal one month after surgery, and there was no morbidity or mortality related to surgical technique. CONCLUSION: In our experience, the vastus lateralis muscle flap as a treatment for recalcitrant deep infection after arthroplasty has presented good results, provided there is appropriate antibiotic therapy and surgical debridement, thus achieving wound healing and a return to normal of the CRP.

Real-world practices to prevent venous thromboembolism with pharmacological prophylaxis in US orthopedic surgery patients: an analysis of an integrated healthcare database.

Major orthopedic surgery patients are at high risk of venous thromboembolism (VTE) in-hospital and post-discharge. This study assessed real-world inpatient and outpatient thromboprophylaxis practices following knee or hip arthroplasty. Patients from the Henry Ford Health System aged ≥18 years undergoing knee and hip arthroplasty (January 1997-June 2007) were identified using Current Procedural Terminology codes from administrative databases. Patients with <18 months of continuous enrollment in the system's health maintenance organization or with a current diagnosis of atrial fibrillation were excluded. Both inpatient and outpatient pharmacological prophylaxis was assessed. The analysis included 1393 (58.5%) patients following knee arthroplasty and 989 (41.5%) following hip arthroplasty. Average length of hospitalization was 4.9 days over the study period, although the median stay decreased from 5 days in 1997 to 3 days in 2007. Of patients included, 72.7% received pharmacological prophylaxis only in the inpatient setting following knee arthroplasty and 73.9% following hip arthroplasty. Both inpatient and outpatient pharmacological prophylaxis was received by 12.5% of knee and 12.3% of hip arthroplasty patients. Total length of pharmacological prophylaxis fluctuated between 2 to 4 days between 1997 and 2005, but increased to 11.5 ± 9.0 days in 2007. Although the duration of prophylaxis has recently increased, considerable numbers of hip and knee arthroplasty patients only receive prophylaxis for part of the time period recommended by guidelines. Further efforts are required to ensure the recommended duration of thromboprophylaxis is prescribed to all patients and continued outpatient VTE prophylaxis is provided.

Evaluation of cinacalcet HCl treatment after kidney transplantation.

BACKGROUND: Hyperparathyroidism often remains or develops after kidney transplantation. Vitamin D sterol used as treatment for an elevated parathyroid hormone (PTH) level and associated bone disease may be contraindicated due to hypercalcemia. The calcimimetic cinacalcet HCl (cinacalcet), which lowers PTH and calcium (Ca) in chronic kidney disease patients, may represent an alternate therapeutic modality. METHODS: This multicenter, retrospective, observational study examined 41 kidney transplant patients receiving cinacalcet for ≥3 months starting ≥3 months posttransplantation. Levels of intact PTH, Ca, and phosphorus (P) were examined during the assessment phase (3-6 months after initiation). RESULTS: Median PTH decreased 21.8% during the assessment phase (P < .001), with 32.5% of patients exhibiting a ≥30% decrease in PTH from baseline. Median Ca decreased 6.8% (P < .0001). Median serum P rose 10.0% (P = .0124), but remained within normal limits. The estimated glomerular filtration rate was stable throughout the study. CONCLUSIONS: Cinacalcet may be useful for the treatment of hyperparathyroidism after kidney transplantation. Randomized, prospectively designed clinical trials are required to confirm these results.