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1.
Acta Orthop ; : 1-6, 2021 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-34607501

RESUMO

Background and purpose - Improving health care and demographic change have resulted in a steady increase in geriatric patients undergoing total hip (THA) and knee (TKA) arthroplasty. Postoperative delirium (POD) is a frequent and severe complication after major surgery. Therefore, we analyzed the impact of POD on outcome after THA and TKA.Patients and methods - In a consecutive series of 10,140 patients who had undergone elective THA or TKA between 2011 and 2020, rates of reoperation within 90 days, readmission within 90 days, complications, and responder rate as defined by the OMERACT-OARSI criteria were compared between patients with and without POD. Multivariable logistic regression models were used to assess the relationship between POD and other postoperative complications.Results - Patients with POD showed higher rates of reoperation (12% vs. 5%), readmission (15% vs. 5%), surgical complications (7% vs. 2%), non-surgical complications (8% vs. 4%), Clavien-Dindo IV° complications (10% vs. 2%) and transfusion (14% vs. 2%). POD led to lower responder rate (76% vs. 87%) 1 year after total joint replacement. All previous comparisons statistically significant. Multivariable logistic regression analyses revealed POD as an independent risk factor for reoperation (OR = 2; CI 1-3), readmission (OR = 2; CI 2-4) and Clavien-Dindo IV° complications (OR = 3; CI 2-5).Interpretation - POD is a serious problem in elective joint replacement. Affected patients suffer more complications and show poor patient-reported outcome 1 year postoperatively. Systematic prevention strategies and standardized therapy protocols are mandatory to avoid burden to patients and healthcare providers.

2.
Anal Chim Acta ; 1177: 338770, 2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34482891

RESUMO

The plug-and-play hyphenation of UV-laser ablation (LA) and mass spectrometry is presented, using dielectric barrier discharge ionization (DBDI). The DBDI source employed here is characterized by its unique geometry, being directly mounted onto the inlet capillary of a mass spectrometer. In the literature, this particular kind of DBDI source is also referred to as active capillary plasma ionization. It has been commercialized as soft ionization by chemical reaction in transfer (SICRIT) and will be addressed as DBDI in this study. LA-DBDI-MS was used for the direct, molecule-specific and spatially resolved analysis of various solid samples, such as coffee beans and pain killer tablets without extensive sample preparation. The combination of fast washout UV-laser ablation and the principle of the DBDI source used here allowed for highly efficient soft ionization as well as high spatial resolution down to 10 µm for molecular imaging.


Assuntos
Terapia a Laser , Espectrometria de Massas , Imagem Molecular
3.
J Am Soc Mass Spectrom ; 32(7): 1707-1715, 2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34170138

RESUMO

Soft ionization by a chemical reaction in transfer (SICRIT) is applied to couple gas chromatography (GC) to a high-resolution atmospheric pressure inlet mass spectrometer. These instruments are generally used in combination with liquid chromatography systems (LC-MS). Ionization of alkanes is not possible here with conventional electrospray ionization. Alternatively, separate GC-electron ionization (EI)-MS is employed for the analysis of nonpolar substances like alkanes, however, with the inherent challenge of strong fragmentation. In the case of alkanes, the determination of molecular masses becomes nearly impossible in complex hydrocarbon mixtures because of the wealth of similar fragment ions and the absence of the molecular ion signal. SICRIT, a soft ionization technique based on dielectric barrier discharge (DBDI), produces characteristic oxidized cations from alkanes that can be directly correlated to their molecular mass. Isotope labeling experiments reveal an ionization mechanism via hydride abstraction and reaction with water. Soft ionization can be achieved for iso- and n-alkanes, with very little fragmentation, enabling the determination of their molecular mass. Calibrations for n-alkanes from C10 to C30 were performed exhibiting high linearity, reproducibility, and sensitivity with an average LOD of 69 pg (on column). Measurements of diesel fuel samples are compared to traditional GC-EI-MS. The presented method combines sensitivity and easy handling of a GC-EI-MS with the determination of molecular mass commonly only achieved with field ionization (FI)-MS, while using existing and highly optimized mass spectrometers commonly coupled with LC. Additionally, many other analytes such as (alkylated-) PAHs could be detected simultaneously in the diesel sample.

4.
J Orthop Res ; 2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34057752

RESUMO

Static pelvic tilt impacts functional cup position in total hip arthroplasty (THA). In the current study we investigated the effect of kinematic pelvic changes on cup position. In the course of a prospective controlled trial postoperative 3D-computed tomography (CT) and gait analysis before and 6 and 12 months after THA were obtained in 60 patients. Kinematic pelvic motion during gait was measured using Anybody Modeling System. By fusion with 3D-CT, the impact of kinematic pelvic tilt alterations on cup anteversion and inclination was calculated. Furthermore, risk factors correlating with high pelvic mobility were evaluated. During gait a high pelvic range of motion up to 15.6° exceeding 5° in 61.7% (37/60) of patients before THA was found. After surgery, the pelvis tilted posteriorly by a mean of 4.0 ± 6.6° (p < .001). The pelvic anteflexion led to a mean decrease of -1.9 ± 2.2° (p < .001) for cup inclination and -15.1 ± 6.1° (p < .001) for anteversion in relation to the anterior pelvic plane (APP). Kinematic pelvic changes resulted in a further change up to 2.3° for inclination and up to 12.3° for anteversion. In relation to the preoperative situation differences in postoperative cup position ranged from -4.4 to 4.6° for inclination and from -7.8 to 17.9° for anteversion, respectively. Female sex (p < .001) and normal body weight (p < .001) correlated with high alterations in pelvic tilt. Kinematic pelvic changes highly impact cup anteversion in THA. Surgeons using the APP as reference should aim for a higher anteversion of about 15° due to the functional anteflexion of the pelvis during gait.

5.
Acta Radiol ; : 2841851211009466, 2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-33982602

RESUMO

BACKGROUND: Computed tomography (CT) is the gold standard for the accurate measurement of cup inclination and anteversion in total hip arthroplasty (THA). However, functional cup position strongly depends on the tilt of the pelvis and thus pelvic tilt in the supine position on the CT table harbors the risk of misinterpretation. PURPOSE: To evaluate the influence of pelvic tilt on cup measurements in postoperative CT scans. MATERIAL AND METHODS: This is a secondary outcome analysis of a prospective study. In 123 patients undergoing THA, anatomic cup inclination and anteversion as measured on postoperative 3D-CT scans were compared between: (i) the anterior pelvic plane (APP) resembling neutral pelvic tilt; and (ii) the coronal plane representing the standard planes on CT. Furthermore, the effect of the variation on cup positions within Lewinnek's safe zone in relation to the applied reference plane was assessed. RESULTS: Mean pelvic tilt in supine position was -3.5° ± 5.6°. This resulted in a mean difference for anteversion between APP und coronal plane of 2.1° ± 3.7° and of 2.1° ± 1.9° for cup inclination, respectively. The change varied up to 20.2° for cup inclination and up 12.2° for cup anteversion. The overall conversion rate for inclination and/or anteversion regarding Lewinnek's safe zone was high at 23.6% (29/123). CONCLUSION: Pelvic tilt affects cup orientation on CT scans depending on the applied reference plane. Standard CT planes should be corrected regarding pelvic tilt before measurements to avoid errors in measurement.

6.
Z Rheumatol ; 80(4): 339-347, 2021 May.
Artigo em Alemão | MEDLINE | ID: mdl-33885947

RESUMO

Infections are a severe complication after an artificial joint replacement. The clinical symptoms are highly variable, particularly in patients with inflammatory rheumatic diseases, which often makes the diagnosis difficult. In addition to clinical and laboratory findings, joint puncture is an essential component of the diagnostics and enables the identification of pathogens. Treatment of periprosthetic infections in patients with rheumatism should be an interdisciplinary cooperation between surgeons, rheumatologists and specialists for infectious diseases. The two essential pillars of treatment are surgical intervention and antibiotics. For acute joint infections an attempt at preservation of the artificial joint can be carried out, whereas for chronic infection situations only replacement of the prosthesis is possible as a curative treatment. In order to reduce the probability of occurrence of a joint infection, modifiable risk factors should be preoperatively identified and specifically treated.


Assuntos
Artrite Infecciosa , Artroplastia de Quadril , Artroplastia de Substituição , Infecções Relacionadas à Prótese , Doenças Reumáticas , Humanos , Próteses e Implantes , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/etiologia , Reoperação , Doenças Reumáticas/diagnóstico
7.
Int Orthop ; 2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33860337

RESUMO

INTRODUCTION: The Hospital Frailty Risk Score (HFRS) is a validated risk stratification model referring to the cumulative deficits model of frailty. The purpose of this study was to evaluate the HFRS as a predictor of 90-day readmission and complications after revision total hip (rTHA) and knee (rTKA) arthroplasty. METHODS: In a retrospective analysis of 565 patients who had undergone rTHA or rTKA between 2011 and 2019, the HFRS was calculated for each patient. Rates of adverse events were compared between patients with low and intermediate or high frailty risk. Multivariable logistic regression models were used to assess the relationship between the HFRS and post-operative adverse events. RESULTS: Patients with intermediate or high frailty risk showed higher rates of readmission (30days: 23.8% vs. 9.9%, p = 0.006; 90days: 26.2% vs. 13.0%, p < 0.018), surgical complications (28.6% vs. 7.8%, p < 0.001), medical complications (11.9% vs. 1.0%, p < 0.001), other complications (28.6% vs. 2.3%, p < 0.001), Clavien-Dindo grade IV complications (14.3% vs. 4.8%, p = 0.009), and transfusion (33.3% vs. 6.1%, p < 0.001). Multivariable logistic regression analyses revealed a high HFRS as independent risk factor for surgical complications (OR = 3.45, 95% CI 1.45-8.18, p = 0.005), medical complications (OR = 7.29, 95% CI 1.72-30.97, p = 0.007), and other complications (OR = 14.15, 95% CI 5.16-38.77, p < 0.001). CONCLUSION: The HFRS predicts adverse events after rTHA and rTKA. As it derives from routinely collected data, the HFRS could be implemented automated in hospital information systems to facilitate identification of at-risk patients.

8.
Orthopade ; 50(4): 270-277, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33666672

RESUMO

Computer-assisted surgery represents a relatively novel treatment option in total hip arthroplasty, which has been supported by the technological progress over the latest decades. Navigation and robotics enable increasing the precision of cup positioning, as well as successful biomechanical restoration of leg length and offset. However, the intended target area is still one of debate in literature. Besides the learning curve, the use of navigation and robotics requires additional time and financial expense, which has not yet been addressed in the German healthcare system. This is one reason why computer-assisted surgery has not fully attained everyday routine. The number of comparative studies is limited, but the results are promising. However, if these surrogate measures will end in reduced revision rates or better outcome is unclear. Further prospective studies and register analysis might illuminate the potential benefit of navigation and robotics.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Robótica , Cirurgia Assistida por Computador , Humanos , Estudos Prospectivos
9.
Arch Orthop Trauma Surg ; 141(11): 1983-1991, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33620530

RESUMO

INTRODUCTION: Because of the ongoing discussion of imageless navigation in total knee arthroplasty (TKA), its advantages and disadvantages were evaluated in a large patient cohort. METHODS: This retrospective analysis included 2464 patients who had undergone TKA at a high-volume university arthroplasty center between 2012 and 2017. Navigated and conventional TKA were compared regarding postoperative mechanical axis, surgery duration, complication rates, one-year postoperative patient-reported outcome measures (PROMs) (WOMAC and EQ-5D indices), and responder rates as defined by the criteria of the Outcome Measures in Rheumatology and Osteoarthritis Research Society International consensus (OMERACT-OARSI). RESULTS: Both navigated (1.8 ± 1.6°) and conventional TKA (2.1 ± 1.6°, p = 0.002) enabled the exact reconstruction of mechanical axis. Surgery duration was six minutes longer for navigated TKA than for conventional TKA (p < 0.001). Complication rates were low in both groups with comparable frequencies: neurological deficits (p = 0.39), joint infection (p = 0.42 and thromboembolic events (p = 0.03). Periprosthetic fractures occurred more frequently during conventional TKA (p = 0.001). One-year PROMs showed excellent improvement in both groups. The WOMAC index was statistically higher for navigated TKA than for conventional TKA (74.7 ± 19.0 vs. 71.7 ± 20.7, p = 0.014), but the increase was not clinically relevant. Both groups had a similarly high EQ-5D index (0.23 ± 0.24 vs. 0.26 ± 0.25, p = 0.11) and responder rate (86.5% [256/296] vs. 85.9% [981/1142], p = 0.92). CONCLUSION: Both methods enable accurate postoperative leg alignment with low complication rates and equally successful PROMs and responder rates one year postoperatively. LEVEL OF EVIDENCE: III. Retrospective cohort study.

10.
BMC Surg ; 21(1): 89, 2021 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-33602217

RESUMO

BACKGROUND: Mesenteric ischemia is associated with poor outcome and high overall mortality. The aim was to analyze an interdisciplinary treatment approach of vascular and visceral specialists focusing on the in-hospital outcome and follow-up in patients with acute and acute-on-chronic mesenteric ischemia. METHODS: From 2010 until 2017, 26 consecutive patients with acute or acute on chronic mesenteric ischemia were treated by an interdisciplinary team. Data were prospectively collected and retrospectively evaluated. Throughout the initial examination, the extent of bowel resection was determined by the visceral surgeon and the appropriate mode of revascularization by the vascular surgeon. The routine follow-up included clinical examination and ultrasound- or CT-imaging for patency assessment and overall survival as primary endpoint of the study. RESULTS: Out of 26 patients, 18 (69.2%) were rendered for open repair. Ten patients (38.5%) received reconstruction of the superior mesenteric artery with an iliac-mesenteric bypass. Seven patients (26.9%) underwent thrombembolectomy of the mesenteric artery. One patient received an infra-diaphragmatic aorto-celiac-mesenteric bypass. Out of the 8 patients, who were not suitable for open revascularization, 2 patients (7.7%) were treated endovascularly and 6 (23.1%) underwent explorative laparotomy. The in-hospital mortality was 23% (n = 6). The mean survival of the revascularized group (n = 20) was 51.8 months (95% CI 39.1-64.5) compared to 15.7 months in the non-revascularized group (n = 6) (95% CI - 4.8-36.1; p = 0.08). The median follow-up was 64.6 months. Primary patency in the 16 patients after open and 2 after interventional revascularization was 100% and 89.9% in the follow-up. CONCLUSION: The interdisciplinary treatment of mesenteric ischemia improves survival if carried out in time. Hereby open revascularization measures are advantageous as they allow bowel assessment, resection, and revascularization in a one-stop fashion especially in advanced cases.


Assuntos
Serviços Médicos de Emergência , Isquemia Mesentérica , Equipe de Assistência ao Paciente , Doença Aguda , Serviços Médicos de Emergência/métodos , Humanos , Artéria Mesentérica Superior/cirurgia , Isquemia Mesentérica/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
11.
Acta Orthop ; 92(3): 358-363, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33538225

RESUMO

Background and purpose - There is growing evidence that hypoproteinemia is an important risk factor for adverse events after surgery. Less is known about the impact of vitamin deficiency on postoperative outcome. Therefore we evaluated the prevalence and impact of malnutrition and vitamin deficiency in geriatric patients undergoing elective orthopedic surgery.Patients and methods - In a retrospective analysis of 599 geriatric patients who had undergone elective orthopedic surgery in 2018 and 2019, hypoproteinemia, and deficiency of vitamin D, vitamin B12, and folate were assessed. Reoperation rates, readmission rates, complication rates, and transfusion rates were compared between malnourished patients and patients with normal parameters. Multivariable logistic regression models were used to assess the relationship between malnutrition and postoperative adverse events, controlling for confounding factors such as age, sex, diabetes mellitus, and frailty.Results - Patients with malnutrition showed a higher rate of reoperation (13% vs. 5.5%; p = 0.01) and exhibited more wound-healing disorders (7.4% vs. 1.3%, p = 0.001) as well as Clavien-Dindo IV° complications (7.4% vs. 2.4%; p = 0.03). Deficiency of vitamin D led to a higher rate of falls (8.4% vs. 2.9%, p = 0.006). Deficiency of vitamin B12 and folate did not affect postoperative adverse events. Although correlated to frailty (p = 0.004), multivariable regression analysis identified malnutrition as independent risk factor for reoperation (OR 2.6, 95% CI 1.1-6.2) and wound healing disorders (OR 7.1, CI 1.9-26).Interpretation - Malnutrition is common among geriatric patients undergoing elective orthopedic surgery and represents an independent risk factor for postoperative adverse events.


Assuntos
Deficiência de Vitaminas/epidemiologia , Desnutrição/epidemiologia , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Deficiência de Vitaminas/complicações , Feminino , Humanos , Masculino , Desnutrição/complicações , Readmissão do Paciente , Reoperação , Estudos Retrospectivos , Fatores de Risco
12.
Ann Neurol ; 89(4): 686-697, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33389754

RESUMO

OBJECTIVE: The role of the survival of motor neuron (SMN) gene in amyotrophic lateral sclerosis (ALS) is unclear, with several conflicting reports. A decisive result on this topic is needed, given that treatment options are available now for SMN deficiency. METHODS: In this largest multicenter case control study to evaluate the effect of SMN1 and SMN2 copy numbers in ALS, we used whole genome sequencing data from Project MinE data freeze 2. SMN copy numbers of 6,375 patients with ALS and 2,412 controls were called from whole genome sequencing data, and the reliability of the calls was tested with multiplex ligation-dependent probe amplification data. RESULTS: The copy number distribution of SMN1 and SMN2 between cases and controls did not show any statistical differences (binomial multivariate logistic regression SMN1 p = 0.54 and SMN2 p = 0.49). In addition, the copy number of SMN did not associate with patient survival (Royston-Parmar; SMN1 p = 0.78 and SMN2 p = 0.23) or age at onset (Royston-Parmar; SMN1 p = 0.75 and SMN2 p = 0.63). INTERPRETATION: In our well-powered study, there was no association of SMN1 or SMN2 copy numbers with the risk of ALS or ALS disease severity. This suggests that changing SMN protein levels in the physiological range may not modify ALS disease course. This is an important finding in the light of emerging therapies targeted at SMN deficiencies. ANN NEUROL 2021;89:686-697.


Assuntos
Esclerose Amiotrófica Lateral/genética , Esclerose Amiotrófica Lateral/patologia , Proteína 1 de Sobrevivência do Neurônio Motor/genética , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Dosagem de Genes , Humanos , Masculino , Reprodutibilidade dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Proteína 2 de Sobrevivência do Neurônio Motor/genética , Sequenciamento Completo do Genoma
13.
J Arthroplasty ; 36(5): 1533-1542, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33380352

RESUMO

BACKGROUND: Models for risk stratification and prediction of outcome, such as the Charlson Comorbidity Index (CCI), the Elixhauser Comorbidity Method (ECM), the 5-factor modified Frailty Index (mFI-5), and the Hospital Frailty Risk Score (HFRS) have been validated in orthopedic surgery. The aim of this study is to compare the predictive power of these models in total hip and knee replacement. METHODS: In a retrospective analysis of 8250 patients who had undergone total joint replacement between 2011 and 2019, CCI, ECM, mFI-5, and HFRS were calculated for each patient. Receiver operating characteristic curve plots were generated and the area under the curve (AUC) was compared between each score with regard to adverse events such as transfusion, surgical, medical, and other complications. Multivariate logistic regression models were used to assess the relationship among risk stratification models, demographic factors, and postoperative adverse events. RESULTS: In prediction of surgical complications, HFRS performed best (AUC: 0.719, P < .001), followed by ECM (AUC: 0.578, P < .001), mFI-5 (AUC: 0.564, P = .003), and CCI (AUC: 0.555, P = .012). With regard to medical complications, other complications, and transfusion, HFRS also was superior to ECM, mFI-5, and CCI. Multivariate logistic regression analyses revealed HFRS as an independent risk stratification model associated with all captured adverse events (P ≤ .001). CONCLUSION: The HFRS is superior to current risk stratification models in the context of total joint replacement. As the HRFS derives from routinely collected administrative data, healthcare providers can identify at-risk patients without additional effort or expense.


Assuntos
Artroplastia do Joelho , Fragilidade , Artroplastia do Joelho/efeitos adversos , Comorbidade , Fragilidade/epidemiologia , Hospitais , Humanos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
14.
Unfallchirurg ; 123(11): 836-842, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33037457

RESUMO

INTRODUCTION: In its digital agenda the German Federal Government pursues the ambitious objective to facilitate digital competence and perform research into digital learning and teaching processes. Considerable investments are to be concentrated into the future viability of education, academic research and digitalization. As far as academic teaching and further education are concerned, not only in the field of orthopedics and trauma surgery, three aspects can be identified: digital organization, digital competence and digital tools. DIGITAL APPLICATIONS: New formats, such as the elective subject digital health of the Charité in Berlin, enable digital competences to be mediated in a multimodal and interdisciplinary way. With the help of a newly developed app the University of Essen provides teachers and students with mobile and flexible access to information on lectures in terms of content and organization. Especially because of transparency, high legal compliance and predictability, the digital logbook for the resident training program promises a real innovation for trainees in the further training reformation. Augmented and virtual reality play a crucial role in the imparting of practical skills and interconnect high-tech with classical craftsmanship. Digital training course formats have significantly gained in importance and are meanwhile well-established tools for efficient advanced medical training. OUTLOOK: If orthopedic and trauma surgeons take an active role in the process of digitalization of teaching, they can take part in decisions, adequately prepare the colleagues of tomorrow, optimize patient care, encourage innovations and altogether improve the discipline even more.


Assuntos
Educação de Graduação em Medicina , Educação Médica , Ortopedia , Competência Clínica , Currículo , Humanos , Ortopedia/educação , Estudantes
15.
Orthopade ; 49(10): 893-898, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32909050

RESUMO

The optimal 3D positioning of the prosthesis components is of great importance for the stability and function of a total hip endoprosthesis. Pelvic tilt has a particular influence on the position of the implant. In order to use intraoperatively the knowledge on pelvic kinematics gained through preoperative imaging procedures and movement analyses, "image-based" and "image-free" robotic and navigation procedures are available. With the "image-based" procedures, a 3D CT scan serves as the surgeon's basis for operative planning. The "image-free" procedures are based on the principles of stereotaxy. In the future, information about static and dynamic pelvic tilt will be conntected with navigation and robotic systems for total hip arthroplasty. Along with intraoperative data a patientindividual optimized implant position can be achieved.


Assuntos
Artroplastia de Quadril , Robótica , Cirurgia Assistida por Computador , Acetábulo/cirurgia , Prótese de Quadril , Humanos , Tomografia Computadorizada por Raios X
16.
Sci Rep ; 10(1): 13208, 2020 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-32764592

RESUMO

Offset restoration in total hip arthroplasty (THA) is associated with postoperative range of motion (ROM) and gait kinematics. We aimed to research into the impact of high offset (HO) and standard stems on postoperative ROM. 121 patients received cementless THA through a minimally-invasive anterolateral approach. A 360° hip ROM analysis software calculated impingement-free hip movement based on postoperative 3D-CTs compared to ROM values necessary for activities of daily living (ADL). The same model was then run a second time after changing the stem geometry between standard and HO configuration with the implants in the same position. HO stems showed higher ROM for all directions between 4.6 and 8.9° (p < 0.001) compared with standard stems but with high interindividual variability. In the subgroup with HO stems for intraoperative offset restoration, the increase in ROM was even higher for all ROM directions with values between 6.1 and 14.4° (p < 0.001) compared to offset underrestoration with standard stems. Avoiding offset underrestoration resulted in a higher amount of patients of over 20% for each ROM direction that fulfilled the criteria for ADL (p < 0.001). In contrast, in patients with standard stems for offset restoration ROM did increase but not clinically relevant by offset overcorrection for all directions between 3.1 and 6.1° (p < 0.001). Offset overcorrection by replacing standard with HO stems improved ROM for ADL in a low number of patients below 10% (p > 0.03). Patient-individual restoration of offset is crucial for free ROM in THA. Both over and underrestoration of offset should be avoided.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Amplitude de Movimento Articular , Idoso , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Período Pós-Operatório , Tomografia Computadorizada por Raios X
17.
Anal Chem ; 92(18): 12273-12281, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32812753

RESUMO

The use of liquid chromatography coupled with high-resolution mass spectrometry (LC-HRMS) has steadily increased in many application fields ranging from metabolomics to environmental science. HRMS data are frequently used for nontarget screening (NTS), i.e., the search for compounds that are not previously known and where no reference substances are available. However, the large quantity of data produced by NTS analytical workflows makes data interpretation and time-dependent monitoring of samples very sophisticated and necessitates exploiting chemometric data processing techniques. Consequently, in this study, a prioritization method to handle time series in nontarget data was established. As proof of concept, industrial wastewater was investigated. As routine industrial wastewater analyses monitor the occurrence of a limited number of targeted water contaminants, NTS provides the opportunity to detect also unknown trace organic compounds (TrOCs) that are not in the focus of routine target analysis. The developed prioritization method enables reducing raw data and including identification of prioritized unknown contaminants. To that end, a five-month time series for industrial wastewaters was utilized, analyzed by liquid chromatography-time-of-flight mass spectrometry (LC-qTOF-MS), and evaluated by NTS. Following peak detection, alignment, grouping, and blank subtraction, 3303 features were obtained of wastewater treatment plant (WWTP) influent samples. Subsequently, two complementary ways for exploratory time trend detection and feature prioritization are proposed. Therefore, following a prefiltering step, featurewise principal component analysis (PCA) and groupwise PCA (GPCA) of the matrix (temporal wise) were used to annotate trends of relevant wastewater contaminants. With sparse factorization of data matrices using GPCA, groups of correlated features/mass fragments or adducts were detected, recovered, and prioritized. Similarities and differences in the chemical composition of wastewater samples were observed over time to reveal hidden factors accounting for the structure of the data. The detected features were reduced to 130 relevant time trends related to TrOCs for identification. Exemplarily, as proof of concept, one nontarget pollutant was identified as N-methylpyrrolidone. The developed chemometric strategies of this study are not only suitable for industrial wastewater but also could be efficiently employed for time trend exploration in other scientific fields.


Assuntos
Modelos Estatísticos , Compostos Orgânicos/análise , Águas Residuárias/química , Poluentes Químicos da Água/análise , Cromatografia Líquida , Monitoramento Ambiental , Espectrometria de Massas , Estrutura Molecular , Análise Multivariada
18.
Surg Res Pract ; 2020: 4090797, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32802938

RESUMO

Purpose: Although laparoscopic Roux-en-Y gastric bypass (LRYGB) is a frequently performed bariatric procedure, there is still no consensus on its technical implementation. Methods: 211 patients treated with LRYGB in a single institution between March 2011 and October 2016 were analyzed retrospectively. A subgroup analysis for the linear (LSA) versus circular stapler technique (CSA) for gastrojejunal anastomosis (GJA) was performed to evaluate complications and outcomes. Results: 128 (60.6%) patients received GJA with CSA and 83 (39.4%) with LSA. Average weight loss one year after surgery, respectively, BMI after one year of follow-up (kg/m2), showed no significant difference. Median surgery time was significantly shorter in the LSA group. If the procedure was performed with CSA, significantly more wound infections occurred. Conclusions: Both the circular and the linear stapler techniques for gastrojejunal anastomosis in laparoscopic Roux-en-Y gastric bypass are safe methods with comparable outcomes. A disadvantage of CSA is the significantly higher rate of wound infections, a circumstance which requires increased attention.

19.
J Med Chem ; 63(18): 10287-10306, 2020 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-32787079

RESUMO

Despite the broad implications of the cannabinoid type 2 receptor (CB2) in neuroinflammatory processes, a suitable CB2-targeted probe is currently lacking in clinical routine. In this work, we synthesized 15 fluorinated pyridine derivatives and tested their binding affinities toward CB2 and CB1. With a sub-nanomolar affinity (Ki for CB2) of 0.8 nM and a remarkable selectivity factor of >12,000 over CB1, RoSMA-18-d6 exhibited outstanding in vitro performance characteristics and was radiofluorinated with an average radiochemical yield of 10.6 ± 3.8% (n = 16) and molar activities ranging from 52 to 65 GBq/µmol (radiochemical purity > 99%). [18F]RoSMA-18-d6 showed exceptional CB2 attributes as demonstrated by in vitro autoradiography, ex vivo biodistribution, and positron emission tomography (PET). Further, [18F]RoSMA-18-d6 was used to detect CB2 upregulation on postmortem human ALS spinal cord tissues. Overall, these results suggest that [18F]RoSMA-18-d6 is a promising CB2 PET radioligand for clinical translation.


Assuntos
Piridinas/farmacologia , Compostos Radiofarmacêuticos/farmacologia , Receptor CB2 de Canabinoide/metabolismo , Animais , Encéfalo/diagnóstico por imagem , Radioisótopos de Flúor/química , Humanos , Ligantes , Masculino , Simulação de Acoplamento Molecular , Estrutura Molecular , Tomografia por Emissão de Pósitrons , Piridinas/síntese química , Piridinas/farmacocinética , Compostos Radiofarmacêuticos/síntese química , Compostos Radiofarmacêuticos/farmacocinética , Ratos Wistar , Medula Espinal/diagnóstico por imagem , Baço/diagnóstico por imagem , Relação Estrutura-Atividade , Trítio/química
20.
J Arthroplasty ; 35(12): 3498-3504.e3, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32800437

RESUMO

BACKGROUND: The Hospital Frailty Risk Score (HFRS) is a validated geriatric comorbidity measure derived from routinely collected administrative data. The purpose of this study is to evaluate the utility of the HFRS as a predictor for postoperative adverse events after primary total hip (THA) and knee (TKA) arthroplasty. METHODS: In a retrospective analysis of 8250 patients who had undergone THA or TKA between 2011 and 2019, the HFRS was calculated for each patient. Reoperation rates, readmission rates, complication rates, and transfusion rates were compared between patients with low and intermediate or high frailty risk. Multivariate logistic regression models were used to assess the relationship between the HFRS and postoperative adverse events. RESULTS: Patients with intermediate or high frailty risk showed a higher rate of reoperation (10.6% vs 4.1%, P < .001), readmission (9.6% vs 4.3%, P < .001), surgical complications (9.1% vs 1.8%, P < .001), internal complications (7.3% vs 1.1%, P < .001), other complications (24.4% vs 2.0%, P < .001), Clavien-Dindo grade IV complications (4.1% vs 1.5%, P < .001), and transfusion (10.4% vs 1.3%, P < .001). Multivariate logistic regression analyses revealed a high HFRS as independent risk factor for reoperation (odds ratio [OR] = 2.1; 95% confidence interval [CI], 1.46-3.09; P < .001), readmission (OR = 1.78; 95% CI, 1.21-2.61; P = .003), internal complications (OR = 3.72; 95% CI, 2.28-6.08; P < .001), surgical complications (OR = 3.74; 95% CI, 2.41-5.82; P < .001), and other complications (OR = 9.00; 95% CI, 6.58-12.32; P < .001). CONCLUSION: The HFRS predicts adverse events after THA and TKA. As it derives from routinely collected data, the HFRS enables hospitals to identify at-risk patients without extra effort or expense. LEVEL OF EVIDENCE: Level III-retrospective cohort study.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Fragilidade , Idoso , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Bases de Dados Factuais , Hospitais , Humanos , Readmissão do Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco
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