A controversial taxon,Hipparion plocodus,is reviewed in the present study.Hi.plocodus has been confirmed to be a valid species with definite diagnostic characteristics,represented by cranial specimens from Baode,Shanx...A controversial taxon,Hipparion plocodus,is reviewed in the present study.Hi.plocodus has been confirmed to be a valid species with definite diagnostic characteristics,represented by cranial specimens from Baode,Shanxi Province.The phylogenetic analysis performed in the present study,with a new matrix,shows that Hi.plocodus forms a monophyletic group with a European species,Hippotherium malpassii.Actually,no close relationship between so-called Hm.malpassii and the genus Hippotherium has been identified,and the record of stratigraphic range of this genus in late stage of Late Miocene is currently absent.Herein previously Hi.plocodus and Hm.malpassii have both attributed into“Hipparion”before the discovery of better material.Evolutionary stages and correlative absolute age showed that these two species should derive independently from some primitive clade.During the late stage of the Late Miocene,the development of the Asian summer monsoon enhanced the humidity of China,with forest and wood habitats expanding considerably under this setting.As the result,one Eurasian closed-habitat lineage thus extended its range into China,which had become very suited for it,give rise to“Hi.”plocodus.展开更多
We now differentiate between the requirements for new and revised submissions.You may choose to submit your manuscript as a single Word or PDF file to be used in the refereeing process.Only when your paper is at the r...We now differentiate between the requirements for new and revised submissions.You may choose to submit your manuscript as a single Word or PDF file to be used in the refereeing process.Only when your paper is at the revision stage,will you be requested to put your paper into a'correct format'for acceptance and provide the items required for the publication of your article.展开更多
We now differentiate between the requirements for new and revised submissions.You may choose to submit your manuscript as a single Word or PDF file to be used in the refereeing process.Only when your paper is at the r...We now differentiate between the requirements for new and revised submissions.You may choose to submit your manuscript as a single Word or PDF file to be used in the refereeing process.Only when your paper is at the revision stage,will you be requested to put your paper into a'correct format'for acceptance and provide the items required for the publication of your article.展开更多
The decreasing of hazard ratio for cancer incidence (HRCVD) in the range of twenty native tissues (lung, liver, brain, hematologic, neuroendocrine renal, pancreas, lymphoid, bladder, colon, lip-oral-head-neck, leukocy...The decreasing of hazard ratio for cancer incidence (HRCVD) in the range of twenty native tissues (lung, liver, brain, hematologic, neuroendocrine renal, pancreas, lymphoid, bladder, colon, lip-oral-head-neck, leukocytic, rectum and anus, thyroid, soft tissue, prostate, skin, ovarian, breast, uterine) as much, as decreasing of the level of cardiovascular pathology (CVD) in the host before malignization, have been described by C.F. Bell et al. in 2023. Earlier, in 2022, the decreasing of 5-year mortality from cancer in similar range of tissues discussed by us as the inverse dependence from the content of stem CD34 markers in tissues before malignization, with example of population in England. In present article we investigate the interrelation between both data more thoroughly, using accessible and more representative populations level of the data. The analysis shows that high level of HRCVD is able to predicts only high cancer death for tissue sites in the beginning of the range, being applied to the referent data of cancer cases and deaths in estimated population of USA 2024. Along with this, an increasing the content of CD34 stem marker in the native tissues of the same range was favorite for increasing of cancer’s cases at the end of the range, diminishing, in parallel, the signs of vasculo-endothelial pathology, i.e. HR CVD. Thus, the cases (incidence) of cancer depend directly rather from content of CD34, which preexisted in native sites, than that from HRCVD. Further analysis shows that CD34 content averaged over twenty cites dominates over that CD2 marker of total T-cells more than 7 times, in oppose to their ratio in the blood. The enhancement of stem CD34 marker in the range of tissues is accompanied by unidirectional rising of its maturing derivatives, vasculo-endothelial CD31 and total T-cells CD2 markers, which contents relate positively to increasing of cancer death in US population 2024. The increase of CD34 decreases cancer mortality (death: cases) in sites, but indirectly, rather due to enhancement of the denominator. The high HRCVD (more than 1.0) in range of 20 tissues, concerns of those of them, which have had highest mitotic activity (by Ki67), but lowest “stemness” (by CD34), “vascularity” (by CD31), cancer’s incidence (cases) and the worse results of therapy. Oppositely, the normal tissue with lowest HRCVD (below 1.0) and Ki67, but highest CD34, CD31, and cancer incidence (cases) are more sensitive to treatment. Thus, the residential hematopoietic “stemness” in native tissues acts as natural protectors for cardio-vascular system and promoter for cancer incidence in them. The steady and irreversible exhaustion of current regenerative resource (CRR) of BM, which assumed by us as a product of CD34 number and average telomeres length, manifests itself in acceleration of non-malignant CVD and deceleration of malignancy in population +70 (in term the death per 105), according to data extracted from WHO Mortality Database. The similar deficit of CD34 arises artificially during cytotoxic treatment of cancer, when rapid waste of local CRR forces malignant cells to search more “stemness” cites. The competition between malignant and native tissues of the host for scanty CRR seems to be the most important factor for evaluation and prediction of prevalence, curability, and long-term results in oncology.展开更多
BACKGROUND Patellar resurfacing in knee arthroplasty remains a contentious issue,with various strategies including routine,selective,and non-resurfacing approaches.This review and meta-analysis aim to assess the incid...BACKGROUND Patellar resurfacing in knee arthroplasty remains a contentious issue,with various strategies including routine,selective,and non-resurfacing approaches.This review and meta-analysis aim to assess the incidence of patellar resurfacing,revision rates,patient satisfaction,and relevant knee scores associated with each method.AIM To determine the comparative effectiveness of routine,selective,and nonresurfacing strategies in patellar resurfacing within knee arthroplasty by evaluating incidence rates,revision rates,patient satisfaction,and knee function scores.METHODS A systematic review spanning from 1990 to 2024 was conducted using PubMed,Embase,and Cochrane Library databases.Studies reporting on the incidence of patellar resurfacing,revision rates,patient satisfaction,and relevant knee scores were included.Data from esteemed world registries such as the Australian Orthopaedic Association National Joint Replacement Registry,the National Joint Registry for England,Wales,Northern Ireland,and the Isle of Man and Danish Knee Arthroplasty Registry among others,were meticulously examined.Metaanalysis was employed to derive pooled estimates and 95%confidence intervals.RESULTS Analysis of data sourced from diverse world registries and literature sources unveiled significant disparities in the incidence of patellar resurfacing across different geographic regions and healthcare institutions.For instance,the incidence of routine patellar resurfacing ranged from 60%to 90%in some regions,while in others,it was as low as 30%to 50%.The meta-analysis indicated that routine resurfacing was associated with a lower revision rate of 3.5%(95%CI:2.8%-4.2%)compared to non-resurfacing approaches,which exhibited a higher revision rate of 6.8%(95%CI:5.5%-8.1%).Patient satisfaction outcomes showed variability,with routine resurfacing demonstrating higher mean satisfaction scores in functionality,pain relief,and stability categories.CONCLUSION The findings underscore the complexity of patellar resurfacing in knee arthroplasty and highlight the need for continued research to refine clinical practice.Future studies should prioritize prospective randomized controlled trials comparing different patellar resurfacing techniques using standardized outcome measures.Longitudinal studies with extended follow-up periods are necessary to evaluate the long-term outcomes and durability of various patellar resurfacing strategies.Collaborative efforts among multidisciplinary teams will be essential to conduct high-quality research that can provide actionable insights and improve patient outcomes.展开更多
BACKGROUND Periprosthetic fractures of the tibia are uncommon complications after total knee arthroplasty(TKA).Therefore,there is still clinical debate regarding the appropriate treatment method.This study presents th...BACKGROUND Periprosthetic fractures of the tibia are uncommon complications after total knee arthroplasty(TKA).Therefore,there is still clinical debate regarding the appropriate treatment method.This study presents the case of a patient with two successive periprosthetic fractures of the tibial shaft treated with revision TKA(rTKA)and intramedullary fixation.CASE SUMMARY A 65-year-old woman was treated for tibial shaft pseudarthrosis after a periprosthetic fracture.The patient underwent rTKA with a tibial component exchange to a long-stemmed implant.At her 1.5-year follow-up visit,partial asymptomatic bone union was noted with no prosthesis loosening.The patient achieved 0°to 120°range of motion and a stable knee,and reported high satisfaction.Improvements were observed in the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)from 74 to 17,and in the knee society scores(KSS)from 56 to 91(clinical)and 10 to 80(functional).After 2.5 years,the patient sustained a second fracture below the original site due to low-energy trauma.The rTKA with intramedullary stabilization was performed.One year later,WOMAC and clinical and functional KSS were 15,81,and 80,respectively.Despite tibial shortening and lower limb inequality,the patient remains very satisfied and does not experience any issues with daily activities nor weight-bearing.CONCLUSION There is little consensus in the literature on the management of tibial shaft periprosthetic fractures.Intramedullary stabilization may yield excellent outcomes,but individual case discussion is necessary for rTKA indications.展开更多
BACKGROUND Total knee arthroplasty(TKA)is a widely used treatment for advanced knee osteoarthritis;however,the incidence of failures requiring revision surgery is increasing.Identifying the causes of TKA failure and a...BACKGROUND Total knee arthroplasty(TKA)is a widely used treatment for advanced knee osteoarthritis;however,the incidence of failures requiring revision surgery is increasing.Identifying the causes of TKA failure and assessing the outcomes of revision procedures are essential for improving patient care.We hypothesized that infection and aseptic loosening are the primary causes of TKA failure and that revision TKA(rTKA)significantly enhances functional outcomes.AIM To examine the primary causes of TKA failure and evaluate the functional outcomes following rTKA.METHODS This descriptive study was conducted at the Department of Orthopedic Surgery,Civil Hospital,Bahawalpur,from April to September 2024.A total of 118 patients undergoing rTKA for failed primary TKA were included.Data on demographics,causes of failure,and surgical details were collected.Functional outcomes were evaluated using the Knee Society Score and Visual Analog Scale before and six months after surgery.Statistical analysis was performed using SPSS version 25.0,with statistical significance set at P<0.05.RESULTS The leading causes of TKA failure were infection(45.8%),aseptic loosening(44.1%),and periprosthetic fractures(10.2%).The rTKA significantly improved knee function,with the mean Knee Society Score increasing from 39.43±6.18 to 78.91±6.17(P<0.001).Pain levels decreased substantially,with the mean Visual Analog Scale scores reducing from 7.99±1.37 to 1.42±1.17(P<0.001).No significant differences in outcomes were observed between single-stage and two-stage revision procedures.CONCLUSION Infection and aseptic loosening are the predominant causes of TKA failure.The rTKA effectively enhances knee function and alleviates pain,offering significant benefits to patients.展开更多
BACKGROUND Leg length discrepancy(LLD)following total hip arthroplasty(THA)is a common complaint,leading to decreased patient satisfaction.However,the effect of LLD before THA on outcomes and complications is not well...BACKGROUND Leg length discrepancy(LLD)following total hip arthroplasty(THA)is a common complaint,leading to decreased patient satisfaction.However,the effect of LLD before THA on outcomes and complications is not well defined.AIM To assess the effect of prior LLD on rates of falls,implant-related complications,stay length,readmissions,and implant survival following THA.METHODS A retrospective review of a nationwide insurance database was conducted from 2010 to 2021.All cases of THA and those with a prior diagnosis of LLD were identified.THA patients with LLD were matched to control patients 1:5 based on demographic and comorbidity profiles.Two-year fall rates and implant complications,lengths of stay,90-day readmissions,and time to revision were compared between cohorts.RESULTS A total of 2038 patients with LLD were matched to 10165 control patients.The LLD group showed significantly greater rates of falls[odds ratio(OR)=1.58;95%confidence interval(95%CI):1.24-2.01],dislocation(OR=2.61;95%CI:2.10-3.24),mechanical loosening(OR=4.58;95%CI:3.28-6.29),and periprosthetic fracture(OR=2.70;95%CI:1.96-3.72)compared to the control group(all P<0.001).Mean length of stay(LOS)was also significantly higher in the LLD group(3.1 days vs 2.8 days,P=0.034).No significant difference in 90-day readmission rates(7.75%vs 7.02%,P=0.244)was observed between the groups(P=0.244).Time to revision was significantly less in the LLD group(225 days vs 544 days,P<0.001).CONCLUSION LLD in patients having THA is related with significantly higher fall risk,rates of implant-related complications,LOS,and quicker time to revision.Identifying patients with LLD before their THA may help in identifying risks,better patient counselling,and more effective preoperative planning.However,the study have important limitations:Its design lacks information on the degree and cause of LLD,the time between diagnosis and surgery,and which leg with the discrepancy underwent the operation.Future well-designed studies should confirm the findings of this study.展开更多
The search for mechanical properties of materials reached a highly acclaimed level, when indentations could be analysed on the basis of elastic theory for hardness and elastic modulus. The mathematical formulas proved...The search for mechanical properties of materials reached a highly acclaimed level, when indentations could be analysed on the basis of elastic theory for hardness and elastic modulus. The mathematical formulas proved to be very complicated, and various trials were published between the 1900s and 2000s. The development of indentation instruments and the wish to make the application in numerous steps easier, led in 1992 to trials with iterations by using relative values instead of absolute ones. Excessive iterations of computers with 3 + 8 free parameters of the loading and unloading curves became possible and were implemented into the instruments and worldwide standards. The physical formula for hardness was defined as force over area. For the conical, pyramidal, and spherical indenters, one simply took the projected area for the calculation of the indentation depth from the projected area, adjusted it later by the iterations with respect to fused quartz or aluminium as standard materials, and called it “contact height”. Continuously measured indentation loading curves were formulated as loading force over depth square. The unloading curves after release of the indenter used the initial steepness of the pressure relief for the calculation of what was (and is) incorrectly called “Young’s modulus”. But it is not unidirectional. And for the spherical indentations’ loading curve, they defined the indentation force over depth raised to 3/2 (but without R/h correction). They till now (2025) violate the energy law, because they use all applied force for the indenter depth and ignore the obvious sidewise force upon indentation (cf. e.g. the wood cleaving). The various refinements led to more and more complicated formulas that could not be reasonably calculated with them. One decided to use 3 + 8 free-parameter iterations for fitting to the (poor) standards of fused quartz or aluminium. The mechanical values of these were considered to be “true”. This is till now the worldwide standard of DIN-ISO-ASTM-14577, avoiding overcomplicated formulas with their complexity. Some of these are shown in the Introduction Section. By doing so, one avoided the understanding of indentation results on a physical basis. However, we open a simple way to obtain absolute values (though still on the blackbox instrument’s unsuitable force calibration). We do not iterate but calculate algebraically on the basis of the correct, physically deduced exponent of the loading force parabolas with h3/2 instead of false “h2” (for the spherical indentation, there is a calotte-radius over depth correction), and we reveal the physical errors taken up in the official worldwide “14577-Standard”. Importantly, we reveal the hitherto fully overlooked phase transitions under load that are not detectable with the false exponent. Phase-transition twinning is even present and falsifies the iteration standards. Instead of elasticity theory, we use the well-defined geometry of these indentations. By doing so, we reach simple algebraically calculable formulas and find the physical indentation hardness of materials with their onset depth, onset force and energy, as well as their phase-transition energy (temperature dependent also its activation energy). The most important phase transitions are our absolute algebraically calculated results. The now most easily obtained phase transitions under load are very dangerous because they produce polymorph interfaces between the changed and the unchanged material. It was found and published by high-enlargement microscopy (5000-fold) that these trouble spots are the sites for the development of stable, 1 to 2 µm long, micro-cracks (stable for months). If however, a force higher than the one of their formation occurs to them, these grow to catastrophic crash. That works equally with turbulences at the pickle fork of airliners. After the publication of these facts and after three fatal crashing had occurred in a short sequence, FAA (Federal Aviation Agency) reacted by rechecking all airplanes for such micro cracks. These were now found in a new fleet of airliners from where the three crashed ones came. These were previously overlooked. FAA became aware of that risk and grounded 290 (certainly all) of them, because the material of these did not have higher phase-transition onset and energy than other airplanes with better material. They did so despite the 14577-Standard that does not find (and thus formally forbids) phase transitions under indenter load with the false exponent on the indentation parabola. However, this “Standard” will, despite the present author’s well-founded petition, not be corrected for the next 5 years.展开更多
Periprosthetic joint infections contribute significantly to patient morbidity,prolonged hospital stays,and escalating healthcare costs.Defensive antibacterial coating(DAC®)hydrogel has emerged as a promising stra...Periprosthetic joint infections contribute significantly to patient morbidity,prolonged hospital stays,and escalating healthcare costs.Defensive antibacterial coating(DAC®)hydrogel has emerged as a promising strategy to combat these infections.It forms a biodegradable barrier that reduces bacterial adhesion and can deliver local antibiotics,thereby addressing a key mechanism in biofilm formation.Early clinical evidence suggests that DAC®effectively lowers infection recurrence in revision hip and knee arthroplasties,with additional benefits in trauma procedures and soft tissue repairs.Moreover,it has demonstrated compat-ibility with existing implants and surgical techniques,while potentially reducing overall antibiotic use and hospital stays.Despite these encouraging findings,data for its use in primary arthroplasty remains limited,underscoring the need for large-scale,high-quality studies.Future research is poised to refine DAC®’s antimicrobial efficacy through novel antibiotic combinations,personalised delivery systems,and broader applications beyond lower limb procedures.As the prevalence of comorbidities continues to rise,DAC®represents a valuable addi-tion to multifaceted infection control protocols,potentially transforming ortho-paedic care by enhancing patient outcomes and mitigating the economic and clinical burden of implant-related infections.展开更多
BACKGROUND Truliant®posterior stabilized(PS)and Truliant cruciate retaining(CR)are two designs used for total knee arthroplasty.Survivorship and reason for revision rates are now available from the American Joint...BACKGROUND Truliant®posterior stabilized(PS)and Truliant cruciate retaining(CR)are two designs used for total knee arthroplasty.Survivorship and reason for revision rates are now available from the American Joint Replacement Registry(AJRR)at short-term time points for both Truliant designs.It was hypothesized that Truliant PS and Truliant CR perform comparably to similar designs in terms of survivorship.AIM To analyze short-term survivorship of Truliant PS or CR total knee arthroplasty relative to non-Truliant PS or CR total knee arthroplasty.METHODS Utilizing data from the AJRR,a retrospective review was performed for subjects who underwent implantation of Truliant PS,Truliant CR,non-Truliant PS,and non-Truliant CR designs as of June 30,2022.Survivorship and reasons for revision were compared statistically between Truliant PS vs non-Truliant PS as well as Truliant CR vs non-Truliant CR groups.Cumulative percent revision rates were compared across three registries,AJRR,Australian Orthopaedic Association National Joint Replacement Registry(AOANJRR),and the United Kingdom National Joint Registry(UK NJR).RESULTS Truliant PS survivorship was 97.95%at the four-year mark,while Truliant CR survivorship was 99.61%at the three-year mark.There were no significant differences in survivorship hazard ratios or reasons for revision for both Truliant groups vs non-Truliant comparison aggregate groups at short-term time points.Cumulative percent revision rate comparisons were made to device appropriate groups from AJRR,AOANJRR,and UK NJR data.Truliant PS cumulative percent revision rates were similar to non-Truliant cumulative percent revision rates in the AJRR and similar to AOANJRR and UKNJR at both one and three years.Truliant CR cumulative percent revision rates were lower than aggregate AJRR,AOANJRR,and UK NJR cumulative percent revision rates at the one-year and three-year marks.CONCLUSION This study demonstrates high survivorship for Truliant PS total knee arthroplasty out to four-years and Truliant CR total knee arthroplasty out to three-years of follow-up.展开更多
Two racemic pairs of new stilbenoid dimers,(±)-heterosmilaxones A(1)and B(2),with unique 6/6/6and 6/5/7 tricyclic core systems,respectively,were isolated from the rhizomes of Heterosmilax yunnanensis.Their struct...Two racemic pairs of new stilbenoid dimers,(±)-heterosmilaxones A(1)and B(2),with unique 6/6/6and 6/5/7 tricyclic core systems,respectively,were isolated from the rhizomes of Heterosmilax yunnanensis.Their structures were elucidated through comprehensive spectroscopic analyses,quantum chemical calculations and X-ray diffraction crystallography.Compound(+)-1,initially reported as syagrusin A with a 1,4,4a,9a-tetrahydrofluoren-9-one skeleton,is now revised to a new structure characteristic with a benzo bicyclo[3.3.1]nonene scaffold.And compound 2 bears an unprecedented carbon skeleton with four continuous chiral centers in the central benzo bicyclo[4.2.1]nonene motif.Biogenetically,both 1 and2 were proposed to derive from 3,3',4,5,5'-pentahydroxy stilbene and could be generated through key inverse-electron-demand[4+2]and[5+2]cycloadditions,respectively.Interestingly,both(±)-1 and(±)-2 showed significant inhibition againstα-glucosidase.(±)-1 and its pure enantiomers could modulate protein tyrosine phosphatase-1B(PTP1B)enzyme activities and increased glucose consumption in HepG2 cells in a dose-dependent manner.展开更多
Discourses are politically-oriented realities that explain their selective and instrumental nature.That means discourses are mostly(re)produced by the political actors,and they conform to the changing agendas of these...Discourses are politically-oriented realities that explain their selective and instrumental nature.That means discourses are mostly(re)produced by the political actors,and they conform to the changing agendas of these actors.The trajectory of the resistance discourse,which reflects Hezbollah’s ideological(religious)approach,seems to confirm this generalisation owing to its noticeable association with Hezbollah’s political motivations over time.This allegedly revisionist discourse has two intertwined dimensions:One dimension regards Hezbollah’s position towards internal affairs,while the other concerns its external orientation.Hezbollah often claimed to champion the revisionist camp in these two realms,albeit its pro-status quo policies unfolded during the Syrian civil war and the recent Lebanese protests.These two events further manifested the positioned nature of the resistance discourse.In this context,this article will attempt to illustrate the political nature of the resistance discourse by disputing its long-held revisionist claims.To empirically support our argument,the status-quo-based factors behind the regular practice of the resistance discourse during the Syrian civil war and the Lebanese protests will be deeply investigated.展开更多
BACKGROUND Unicompartmental knee arthroplasty(UKA)has great advantages in the treatment of unicompartmental knee osteoarthritis,but its revision rate is higher than that of total knee arthroplasty.AIM To summarize and...BACKGROUND Unicompartmental knee arthroplasty(UKA)has great advantages in the treatment of unicompartmental knee osteoarthritis,but its revision rate is higher than that of total knee arthroplasty.AIM To summarize and analyse the causes of revision after UKA.METHODS This is a retrospective case series study in which the reasons for the first revision after UKA are summarized.We analysed the clinical symptoms,medical histories,laboratory test results,imaging examination results and treatment processes of the patients who underwent revision and summarized the reasons for primary revision after UKA.RESULTS A total of 13 patients,including 3 males and 10 females,underwent revision surgery after UKA.The average age of the included patients was 67.62 years.The prosthesis was used for 3 d to 72 months.The main reasons for revision after UKA were improper suturing of the surgical opening(1 patient),osteophytes(2 patients),intra-articular loose bodies(2 patients),tibial prosthesis loosening(2 patients),rheumatoid arthritis(1 patient),gasket dislocation(3 patients),anterior cruciate ligament injury(1 patient),and medial collateral ligament injury with residual bone cement(1 patient).CONCLUSION The causes of primary revision after UKA were gasket dislocation,osteophytes,intra-articular loose bodies and tibial prosthesis loosening.Avoidance of these factors may greatly reduce the rate of revision after UKA,improve patient satisfaction and reduce medical burden.展开更多
Total hip arthroplasty(THA)is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease.However,dislocation continues to...Total hip arthroplasty(THA)is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease.However,dislocation continues to be a troublesome complication after THA,as it is a leading cause of revision and is associated with substantial social,health,and economic costs.It is a relatively rare,usually early occurrence that depends on both the patients’characteristics and the surgical aspects.The most recent and important finding is the special attention to be given preoperatively to spinopelvic mobility,which is closely related to the incidence of dislocation.Consequently,clinical and radiographic assessment of the lumbar spine is mandatory to identify an altered pelvic tilt that could suggest a different positioning of the cup.Lumbar spinal fusion is currently considered a risk factor for dislocation and revision regardless of whether it is performed prior to or after THA.Surgical options for its treatment and prevention include the use of prostheses with large diameter of femoral head size,dual mobility constructs,constrained liners,and modular neck stems.展开更多
BACKGROUND Gout is a disease characterized by hyperuricemia,and resultant deposition of uric acid crystals in tissues.While typically manifested as intraarticular crystals or tophi,gout can also cause pathology at ent...BACKGROUND Gout is a disease characterized by hyperuricemia,and resultant deposition of uric acid crystals in tissues.While typically manifested as intraarticular crystals or tophi,gout can also cause pathology at entheses.Gouty deposition within tendinous structures put them at risk for traumatic and degenerative rupture.Furthermore,allografts can also be at risk of rupture in the setting of severe gout.We present the case of a 56-year-old female with severe gouty disease who sustained a re-rupture of a patellar tendon allograft reconstruction.CASE SUMMARY A 56-year-old female presented to clinic after feeling her left knee pop and collapse beneath her while descending stairs.She had a history of tophaceous gout and left patellar tendon rupture with reconstruction and multiple revisions over the course of 19 years.This patient presented with pain and extensor lag.A magnetic resonance image demonstrated a ruptured patellar tendon allograft reconstruction and avulsion fracture at the tibial tubercle.The patient was treated with a novel intervention of Achilles allograft with bone block in a unique configuration with a dermal allograft incorporated into the reconstruction.She was made non-weight bearing in the operative extremity in extension for the first four weeks postoperatively and was then progressed to active flexion over the course of eight weeks.At twelve weeks,she was able to fully extend her operative knee and at five months she was resuming her normal activities and exercises.CONCLUSION Failed patellar tendon reconstruction due to gouty infiltration is treated with dermal allograft augmented Achilles tendon reconstruction with bone block.展开更多
Four new norditerpenoid heterodimers with different dimerization patterns-namely,trigofragiloids A-C(denoted as compounds 1-3)and(+)-and(-)-trigofragiloid D(compound 4)-and three new phenanthrenone norditerpenoids-nam...Four new norditerpenoid heterodimers with different dimerization patterns-namely,trigofragiloids A-C(denoted as compounds 1-3)and(+)-and(-)-trigofragiloid D(compound 4)-and three new phenanthrenone norditerpenoids-namely,trigofragiloids E-G(compounds 5-7)-were isolated from Trigonostemon fragilis.Compounds 1 and 2 feature a novel heterodimeric carbon skeleton formed by the conjugation of a tetra-norditerpenoid and an ennea-norditerpenoid;they have been identified as class 2 atropisomers by means of quantum chemical calculations.Compound 3 is an unprecedented phenylpropanoid-norditerpenoid adduct with a new dimerization pattern.Compounds(+)-and(-)-4 are the first example of S-shaped 1,4-dioxane-fused norditerpenoid dimers.Inspired by the structure elucidation of compound 4,two co-occurring analogues,actephilol A and epiactephilol A,were structurally revised as a pair of geometrical isomers and were identified as two pairs of enantiomers,(+)-and(-)-8 and(+)-and(-)-9,respectively.Their structures were characterized using a combined method.Notably,compound 7 exhibits remarkable adenosine triphosphate-citrate lyase(ACLY)inhibition with a halfmaximal inhibition concentration(IC50)value of(0.46±0.11)lmol·L^(-1),as active as the positive control BMS-303141,and a molecular docking study offers deep insight into the interaction between compound 7 and ACLY.展开更多
The cicada genus Vietanna is reviewed based on the descriptions of two new species,V.perparva sp.nov.and V.longiloba sp.nov.,from China.The relationship of this genus to related taxa is discussed based on the phylogen...The cicada genus Vietanna is reviewed based on the descriptions of two new species,V.perparva sp.nov.and V.longiloba sp.nov.,from China.The relationship of this genus to related taxa is discussed based on the phylogeny of Vietanna and representative species from subtribes Puranina,Leptopsaltriina,Euterpnosiina and Leptosemiina based on the mitochondrial gene COI and nuclear genes EF-1αand ARD1.展开更多
The article by Zhao et al presents a retrospective case series on the reasons for initial revision after unicompartmental knee arthroplasty(UKA).Clarifying the reasons that may cause UKA revision can further reduce th...The article by Zhao et al presents a retrospective case series on the reasons for initial revision after unicompartmental knee arthroplasty(UKA).Clarifying the reasons that may cause UKA revision can further reduce the rate of revision UKA,focusing on gasket dislocation,osteophytes,intra-articular loose bodies,and tibial prosthesis loosening.This article provides valuable insights,not only by detailing the revision status of 13 patients who underwent revision after initial UKA but also by providing a comprehensive analysis of the incidence of revision after initial UKA.By reviewing and analyzing the causes,they established references for the early detection of risk factors for revision in clinical practice and for formulating surgical strategies and rehabilitation programmes.This commentary emphasizes the need for a meticulous understanding and an analysis of the revision rate following initial UKA and related management strategies.The implant rates,regional variation,and benefits of uncemented Oxford UKA have been explored,particularly in terms of bone preservation,appropriate surgical techniques,and weight management to control complications and improve patient prognosis.展开更多
文摘A controversial taxon,Hipparion plocodus,is reviewed in the present study.Hi.plocodus has been confirmed to be a valid species with definite diagnostic characteristics,represented by cranial specimens from Baode,Shanxi Province.The phylogenetic analysis performed in the present study,with a new matrix,shows that Hi.plocodus forms a monophyletic group with a European species,Hippotherium malpassii.Actually,no close relationship between so-called Hm.malpassii and the genus Hippotherium has been identified,and the record of stratigraphic range of this genus in late stage of Late Miocene is currently absent.Herein previously Hi.plocodus and Hm.malpassii have both attributed into“Hipparion”before the discovery of better material.Evolutionary stages and correlative absolute age showed that these two species should derive independently from some primitive clade.During the late stage of the Late Miocene,the development of the Asian summer monsoon enhanced the humidity of China,with forest and wood habitats expanding considerably under this setting.As the result,one Eurasian closed-habitat lineage thus extended its range into China,which had become very suited for it,give rise to“Hi.”plocodus.
文摘We now differentiate between the requirements for new and revised submissions.You may choose to submit your manuscript as a single Word or PDF file to be used in the refereeing process.Only when your paper is at the revision stage,will you be requested to put your paper into a'correct format'for acceptance and provide the items required for the publication of your article.
文摘We now differentiate between the requirements for new and revised submissions.You may choose to submit your manuscript as a single Word or PDF file to be used in the refereeing process.Only when your paper is at the revision stage,will you be requested to put your paper into a'correct format'for acceptance and provide the items required for the publication of your article.
文摘The decreasing of hazard ratio for cancer incidence (HRCVD) in the range of twenty native tissues (lung, liver, brain, hematologic, neuroendocrine renal, pancreas, lymphoid, bladder, colon, lip-oral-head-neck, leukocytic, rectum and anus, thyroid, soft tissue, prostate, skin, ovarian, breast, uterine) as much, as decreasing of the level of cardiovascular pathology (CVD) in the host before malignization, have been described by C.F. Bell et al. in 2023. Earlier, in 2022, the decreasing of 5-year mortality from cancer in similar range of tissues discussed by us as the inverse dependence from the content of stem CD34 markers in tissues before malignization, with example of population in England. In present article we investigate the interrelation between both data more thoroughly, using accessible and more representative populations level of the data. The analysis shows that high level of HRCVD is able to predicts only high cancer death for tissue sites in the beginning of the range, being applied to the referent data of cancer cases and deaths in estimated population of USA 2024. Along with this, an increasing the content of CD34 stem marker in the native tissues of the same range was favorite for increasing of cancer’s cases at the end of the range, diminishing, in parallel, the signs of vasculo-endothelial pathology, i.e. HR CVD. Thus, the cases (incidence) of cancer depend directly rather from content of CD34, which preexisted in native sites, than that from HRCVD. Further analysis shows that CD34 content averaged over twenty cites dominates over that CD2 marker of total T-cells more than 7 times, in oppose to their ratio in the blood. The enhancement of stem CD34 marker in the range of tissues is accompanied by unidirectional rising of its maturing derivatives, vasculo-endothelial CD31 and total T-cells CD2 markers, which contents relate positively to increasing of cancer death in US population 2024. The increase of CD34 decreases cancer mortality (death: cases) in sites, but indirectly, rather due to enhancement of the denominator. The high HRCVD (more than 1.0) in range of 20 tissues, concerns of those of them, which have had highest mitotic activity (by Ki67), but lowest “stemness” (by CD34), “vascularity” (by CD31), cancer’s incidence (cases) and the worse results of therapy. Oppositely, the normal tissue with lowest HRCVD (below 1.0) and Ki67, but highest CD34, CD31, and cancer incidence (cases) are more sensitive to treatment. Thus, the residential hematopoietic “stemness” in native tissues acts as natural protectors for cardio-vascular system and promoter for cancer incidence in them. The steady and irreversible exhaustion of current regenerative resource (CRR) of BM, which assumed by us as a product of CD34 number and average telomeres length, manifests itself in acceleration of non-malignant CVD and deceleration of malignancy in population +70 (in term the death per 105), according to data extracted from WHO Mortality Database. The similar deficit of CD34 arises artificially during cytotoxic treatment of cancer, when rapid waste of local CRR forces malignant cells to search more “stemness” cites. The competition between malignant and native tissues of the host for scanty CRR seems to be the most important factor for evaluation and prediction of prevalence, curability, and long-term results in oncology.
文摘BACKGROUND Patellar resurfacing in knee arthroplasty remains a contentious issue,with various strategies including routine,selective,and non-resurfacing approaches.This review and meta-analysis aim to assess the incidence of patellar resurfacing,revision rates,patient satisfaction,and relevant knee scores associated with each method.AIM To determine the comparative effectiveness of routine,selective,and nonresurfacing strategies in patellar resurfacing within knee arthroplasty by evaluating incidence rates,revision rates,patient satisfaction,and knee function scores.METHODS A systematic review spanning from 1990 to 2024 was conducted using PubMed,Embase,and Cochrane Library databases.Studies reporting on the incidence of patellar resurfacing,revision rates,patient satisfaction,and relevant knee scores were included.Data from esteemed world registries such as the Australian Orthopaedic Association National Joint Replacement Registry,the National Joint Registry for England,Wales,Northern Ireland,and the Isle of Man and Danish Knee Arthroplasty Registry among others,were meticulously examined.Metaanalysis was employed to derive pooled estimates and 95%confidence intervals.RESULTS Analysis of data sourced from diverse world registries and literature sources unveiled significant disparities in the incidence of patellar resurfacing across different geographic regions and healthcare institutions.For instance,the incidence of routine patellar resurfacing ranged from 60%to 90%in some regions,while in others,it was as low as 30%to 50%.The meta-analysis indicated that routine resurfacing was associated with a lower revision rate of 3.5%(95%CI:2.8%-4.2%)compared to non-resurfacing approaches,which exhibited a higher revision rate of 6.8%(95%CI:5.5%-8.1%).Patient satisfaction outcomes showed variability,with routine resurfacing demonstrating higher mean satisfaction scores in functionality,pain relief,and stability categories.CONCLUSION The findings underscore the complexity of patellar resurfacing in knee arthroplasty and highlight the need for continued research to refine clinical practice.Future studies should prioritize prospective randomized controlled trials comparing different patellar resurfacing techniques using standardized outcome measures.Longitudinal studies with extended follow-up periods are necessary to evaluate the long-term outcomes and durability of various patellar resurfacing strategies.Collaborative efforts among multidisciplinary teams will be essential to conduct high-quality research that can provide actionable insights and improve patient outcomes.
文摘BACKGROUND Periprosthetic fractures of the tibia are uncommon complications after total knee arthroplasty(TKA).Therefore,there is still clinical debate regarding the appropriate treatment method.This study presents the case of a patient with two successive periprosthetic fractures of the tibial shaft treated with revision TKA(rTKA)and intramedullary fixation.CASE SUMMARY A 65-year-old woman was treated for tibial shaft pseudarthrosis after a periprosthetic fracture.The patient underwent rTKA with a tibial component exchange to a long-stemmed implant.At her 1.5-year follow-up visit,partial asymptomatic bone union was noted with no prosthesis loosening.The patient achieved 0°to 120°range of motion and a stable knee,and reported high satisfaction.Improvements were observed in the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)from 74 to 17,and in the knee society scores(KSS)from 56 to 91(clinical)and 10 to 80(functional).After 2.5 years,the patient sustained a second fracture below the original site due to low-energy trauma.The rTKA with intramedullary stabilization was performed.One year later,WOMAC and clinical and functional KSS were 15,81,and 80,respectively.Despite tibial shortening and lower limb inequality,the patient remains very satisfied and does not experience any issues with daily activities nor weight-bearing.CONCLUSION There is little consensus in the literature on the management of tibial shaft periprosthetic fractures.Intramedullary stabilization may yield excellent outcomes,but individual case discussion is necessary for rTKA indications.
文摘BACKGROUND Total knee arthroplasty(TKA)is a widely used treatment for advanced knee osteoarthritis;however,the incidence of failures requiring revision surgery is increasing.Identifying the causes of TKA failure and assessing the outcomes of revision procedures are essential for improving patient care.We hypothesized that infection and aseptic loosening are the primary causes of TKA failure and that revision TKA(rTKA)significantly enhances functional outcomes.AIM To examine the primary causes of TKA failure and evaluate the functional outcomes following rTKA.METHODS This descriptive study was conducted at the Department of Orthopedic Surgery,Civil Hospital,Bahawalpur,from April to September 2024.A total of 118 patients undergoing rTKA for failed primary TKA were included.Data on demographics,causes of failure,and surgical details were collected.Functional outcomes were evaluated using the Knee Society Score and Visual Analog Scale before and six months after surgery.Statistical analysis was performed using SPSS version 25.0,with statistical significance set at P<0.05.RESULTS The leading causes of TKA failure were infection(45.8%),aseptic loosening(44.1%),and periprosthetic fractures(10.2%).The rTKA significantly improved knee function,with the mean Knee Society Score increasing from 39.43±6.18 to 78.91±6.17(P<0.001).Pain levels decreased substantially,with the mean Visual Analog Scale scores reducing from 7.99±1.37 to 1.42±1.17(P<0.001).No significant differences in outcomes were observed between single-stage and two-stage revision procedures.CONCLUSION Infection and aseptic loosening are the predominant causes of TKA failure.The rTKA effectively enhances knee function and alleviates pain,offering significant benefits to patients.
文摘BACKGROUND Leg length discrepancy(LLD)following total hip arthroplasty(THA)is a common complaint,leading to decreased patient satisfaction.However,the effect of LLD before THA on outcomes and complications is not well defined.AIM To assess the effect of prior LLD on rates of falls,implant-related complications,stay length,readmissions,and implant survival following THA.METHODS A retrospective review of a nationwide insurance database was conducted from 2010 to 2021.All cases of THA and those with a prior diagnosis of LLD were identified.THA patients with LLD were matched to control patients 1:5 based on demographic and comorbidity profiles.Two-year fall rates and implant complications,lengths of stay,90-day readmissions,and time to revision were compared between cohorts.RESULTS A total of 2038 patients with LLD were matched to 10165 control patients.The LLD group showed significantly greater rates of falls[odds ratio(OR)=1.58;95%confidence interval(95%CI):1.24-2.01],dislocation(OR=2.61;95%CI:2.10-3.24),mechanical loosening(OR=4.58;95%CI:3.28-6.29),and periprosthetic fracture(OR=2.70;95%CI:1.96-3.72)compared to the control group(all P<0.001).Mean length of stay(LOS)was also significantly higher in the LLD group(3.1 days vs 2.8 days,P=0.034).No significant difference in 90-day readmission rates(7.75%vs 7.02%,P=0.244)was observed between the groups(P=0.244).Time to revision was significantly less in the LLD group(225 days vs 544 days,P<0.001).CONCLUSION LLD in patients having THA is related with significantly higher fall risk,rates of implant-related complications,LOS,and quicker time to revision.Identifying patients with LLD before their THA may help in identifying risks,better patient counselling,and more effective preoperative planning.However,the study have important limitations:Its design lacks information on the degree and cause of LLD,the time between diagnosis and surgery,and which leg with the discrepancy underwent the operation.Future well-designed studies should confirm the findings of this study.
文摘The search for mechanical properties of materials reached a highly acclaimed level, when indentations could be analysed on the basis of elastic theory for hardness and elastic modulus. The mathematical formulas proved to be very complicated, and various trials were published between the 1900s and 2000s. The development of indentation instruments and the wish to make the application in numerous steps easier, led in 1992 to trials with iterations by using relative values instead of absolute ones. Excessive iterations of computers with 3 + 8 free parameters of the loading and unloading curves became possible and were implemented into the instruments and worldwide standards. The physical formula for hardness was defined as force over area. For the conical, pyramidal, and spherical indenters, one simply took the projected area for the calculation of the indentation depth from the projected area, adjusted it later by the iterations with respect to fused quartz or aluminium as standard materials, and called it “contact height”. Continuously measured indentation loading curves were formulated as loading force over depth square. The unloading curves after release of the indenter used the initial steepness of the pressure relief for the calculation of what was (and is) incorrectly called “Young’s modulus”. But it is not unidirectional. And for the spherical indentations’ loading curve, they defined the indentation force over depth raised to 3/2 (but without R/h correction). They till now (2025) violate the energy law, because they use all applied force for the indenter depth and ignore the obvious sidewise force upon indentation (cf. e.g. the wood cleaving). The various refinements led to more and more complicated formulas that could not be reasonably calculated with them. One decided to use 3 + 8 free-parameter iterations for fitting to the (poor) standards of fused quartz or aluminium. The mechanical values of these were considered to be “true”. This is till now the worldwide standard of DIN-ISO-ASTM-14577, avoiding overcomplicated formulas with their complexity. Some of these are shown in the Introduction Section. By doing so, one avoided the understanding of indentation results on a physical basis. However, we open a simple way to obtain absolute values (though still on the blackbox instrument’s unsuitable force calibration). We do not iterate but calculate algebraically on the basis of the correct, physically deduced exponent of the loading force parabolas with h3/2 instead of false “h2” (for the spherical indentation, there is a calotte-radius over depth correction), and we reveal the physical errors taken up in the official worldwide “14577-Standard”. Importantly, we reveal the hitherto fully overlooked phase transitions under load that are not detectable with the false exponent. Phase-transition twinning is even present and falsifies the iteration standards. Instead of elasticity theory, we use the well-defined geometry of these indentations. By doing so, we reach simple algebraically calculable formulas and find the physical indentation hardness of materials with their onset depth, onset force and energy, as well as their phase-transition energy (temperature dependent also its activation energy). The most important phase transitions are our absolute algebraically calculated results. The now most easily obtained phase transitions under load are very dangerous because they produce polymorph interfaces between the changed and the unchanged material. It was found and published by high-enlargement microscopy (5000-fold) that these trouble spots are the sites for the development of stable, 1 to 2 µm long, micro-cracks (stable for months). If however, a force higher than the one of their formation occurs to them, these grow to catastrophic crash. That works equally with turbulences at the pickle fork of airliners. After the publication of these facts and after three fatal crashing had occurred in a short sequence, FAA (Federal Aviation Agency) reacted by rechecking all airplanes for such micro cracks. These were now found in a new fleet of airliners from where the three crashed ones came. These were previously overlooked. FAA became aware of that risk and grounded 290 (certainly all) of them, because the material of these did not have higher phase-transition onset and energy than other airplanes with better material. They did so despite the 14577-Standard that does not find (and thus formally forbids) phase transitions under indenter load with the false exponent on the indentation parabola. However, this “Standard” will, despite the present author’s well-founded petition, not be corrected for the next 5 years.
文摘Periprosthetic joint infections contribute significantly to patient morbidity,prolonged hospital stays,and escalating healthcare costs.Defensive antibacterial coating(DAC®)hydrogel has emerged as a promising strategy to combat these infections.It forms a biodegradable barrier that reduces bacterial adhesion and can deliver local antibiotics,thereby addressing a key mechanism in biofilm formation.Early clinical evidence suggests that DAC®effectively lowers infection recurrence in revision hip and knee arthroplasties,with additional benefits in trauma procedures and soft tissue repairs.Moreover,it has demonstrated compat-ibility with existing implants and surgical techniques,while potentially reducing overall antibiotic use and hospital stays.Despite these encouraging findings,data for its use in primary arthroplasty remains limited,underscoring the need for large-scale,high-quality studies.Future research is poised to refine DAC®’s antimicrobial efficacy through novel antibiotic combinations,personalised delivery systems,and broader applications beyond lower limb procedures.As the prevalence of comorbidities continues to rise,DAC®represents a valuable addi-tion to multifaceted infection control protocols,potentially transforming ortho-paedic care by enhancing patient outcomes and mitigating the economic and clinical burden of implant-related infections.
文摘BACKGROUND Truliant®posterior stabilized(PS)and Truliant cruciate retaining(CR)are two designs used for total knee arthroplasty.Survivorship and reason for revision rates are now available from the American Joint Replacement Registry(AJRR)at short-term time points for both Truliant designs.It was hypothesized that Truliant PS and Truliant CR perform comparably to similar designs in terms of survivorship.AIM To analyze short-term survivorship of Truliant PS or CR total knee arthroplasty relative to non-Truliant PS or CR total knee arthroplasty.METHODS Utilizing data from the AJRR,a retrospective review was performed for subjects who underwent implantation of Truliant PS,Truliant CR,non-Truliant PS,and non-Truliant CR designs as of June 30,2022.Survivorship and reasons for revision were compared statistically between Truliant PS vs non-Truliant PS as well as Truliant CR vs non-Truliant CR groups.Cumulative percent revision rates were compared across three registries,AJRR,Australian Orthopaedic Association National Joint Replacement Registry(AOANJRR),and the United Kingdom National Joint Registry(UK NJR).RESULTS Truliant PS survivorship was 97.95%at the four-year mark,while Truliant CR survivorship was 99.61%at the three-year mark.There were no significant differences in survivorship hazard ratios or reasons for revision for both Truliant groups vs non-Truliant comparison aggregate groups at short-term time points.Cumulative percent revision rate comparisons were made to device appropriate groups from AJRR,AOANJRR,and UK NJR data.Truliant PS cumulative percent revision rates were similar to non-Truliant cumulative percent revision rates in the AJRR and similar to AOANJRR and UKNJR at both one and three years.Truliant CR cumulative percent revision rates were lower than aggregate AJRR,AOANJRR,and UK NJR cumulative percent revision rates at the one-year and three-year marks.CONCLUSION This study demonstrates high survivorship for Truliant PS total knee arthroplasty out to four-years and Truliant CR total knee arthroplasty out to three-years of follow-up.
基金financially supported by the CAMS Innovation Fund for Medical Sciences(CIFMS,No.2021-I2M-1-028)。
文摘Two racemic pairs of new stilbenoid dimers,(±)-heterosmilaxones A(1)and B(2),with unique 6/6/6and 6/5/7 tricyclic core systems,respectively,were isolated from the rhizomes of Heterosmilax yunnanensis.Their structures were elucidated through comprehensive spectroscopic analyses,quantum chemical calculations and X-ray diffraction crystallography.Compound(+)-1,initially reported as syagrusin A with a 1,4,4a,9a-tetrahydrofluoren-9-one skeleton,is now revised to a new structure characteristic with a benzo bicyclo[3.3.1]nonene scaffold.And compound 2 bears an unprecedented carbon skeleton with four continuous chiral centers in the central benzo bicyclo[4.2.1]nonene motif.Biogenetically,both 1 and2 were proposed to derive from 3,3',4,5,5'-pentahydroxy stilbene and could be generated through key inverse-electron-demand[4+2]and[5+2]cycloadditions,respectively.Interestingly,both(±)-1 and(±)-2 showed significant inhibition againstα-glucosidase.(±)-1 and its pure enantiomers could modulate protein tyrosine phosphatase-1B(PTP1B)enzyme activities and increased glucose consumption in HepG2 cells in a dose-dependent manner.
文摘Discourses are politically-oriented realities that explain their selective and instrumental nature.That means discourses are mostly(re)produced by the political actors,and they conform to the changing agendas of these actors.The trajectory of the resistance discourse,which reflects Hezbollah’s ideological(religious)approach,seems to confirm this generalisation owing to its noticeable association with Hezbollah’s political motivations over time.This allegedly revisionist discourse has two intertwined dimensions:One dimension regards Hezbollah’s position towards internal affairs,while the other concerns its external orientation.Hezbollah often claimed to champion the revisionist camp in these two realms,albeit its pro-status quo policies unfolded during the Syrian civil war and the recent Lebanese protests.These two events further manifested the positioned nature of the resistance discourse.In this context,this article will attempt to illustrate the political nature of the resistance discourse by disputing its long-held revisionist claims.To empirically support our argument,the status-quo-based factors behind the regular practice of the resistance discourse during the Syrian civil war and the Lebanese protests will be deeply investigated.
基金Supported by National Natural Science Foundation of China,No.82004386and Guangdong Basic and Applied Basic Research Foundation,No.2022A1515011700.
文摘BACKGROUND Unicompartmental knee arthroplasty(UKA)has great advantages in the treatment of unicompartmental knee osteoarthritis,but its revision rate is higher than that of total knee arthroplasty.AIM To summarize and analyse the causes of revision after UKA.METHODS This is a retrospective case series study in which the reasons for the first revision after UKA are summarized.We analysed the clinical symptoms,medical histories,laboratory test results,imaging examination results and treatment processes of the patients who underwent revision and summarized the reasons for primary revision after UKA.RESULTS A total of 13 patients,including 3 males and 10 females,underwent revision surgery after UKA.The average age of the included patients was 67.62 years.The prosthesis was used for 3 d to 72 months.The main reasons for revision after UKA were improper suturing of the surgical opening(1 patient),osteophytes(2 patients),intra-articular loose bodies(2 patients),tibial prosthesis loosening(2 patients),rheumatoid arthritis(1 patient),gasket dislocation(3 patients),anterior cruciate ligament injury(1 patient),and medial collateral ligament injury with residual bone cement(1 patient).CONCLUSION The causes of primary revision after UKA were gasket dislocation,osteophytes,intra-articular loose bodies and tibial prosthesis loosening.Avoidance of these factors may greatly reduce the rate of revision after UKA,improve patient satisfaction and reduce medical burden.
文摘Total hip arthroplasty(THA)is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease.However,dislocation continues to be a troublesome complication after THA,as it is a leading cause of revision and is associated with substantial social,health,and economic costs.It is a relatively rare,usually early occurrence that depends on both the patients’characteristics and the surgical aspects.The most recent and important finding is the special attention to be given preoperatively to spinopelvic mobility,which is closely related to the incidence of dislocation.Consequently,clinical and radiographic assessment of the lumbar spine is mandatory to identify an altered pelvic tilt that could suggest a different positioning of the cup.Lumbar spinal fusion is currently considered a risk factor for dislocation and revision regardless of whether it is performed prior to or after THA.Surgical options for its treatment and prevention include the use of prostheses with large diameter of femoral head size,dual mobility constructs,constrained liners,and modular neck stems.
文摘BACKGROUND Gout is a disease characterized by hyperuricemia,and resultant deposition of uric acid crystals in tissues.While typically manifested as intraarticular crystals or tophi,gout can also cause pathology at entheses.Gouty deposition within tendinous structures put them at risk for traumatic and degenerative rupture.Furthermore,allografts can also be at risk of rupture in the setting of severe gout.We present the case of a 56-year-old female with severe gouty disease who sustained a re-rupture of a patellar tendon allograft reconstruction.CASE SUMMARY A 56-year-old female presented to clinic after feeling her left knee pop and collapse beneath her while descending stairs.She had a history of tophaceous gout and left patellar tendon rupture with reconstruction and multiple revisions over the course of 19 years.This patient presented with pain and extensor lag.A magnetic resonance image demonstrated a ruptured patellar tendon allograft reconstruction and avulsion fracture at the tibial tubercle.The patient was treated with a novel intervention of Achilles allograft with bone block in a unique configuration with a dermal allograft incorporated into the reconstruction.She was made non-weight bearing in the operative extremity in extension for the first four weeks postoperatively and was then progressed to active flexion over the course of eight weeks.At twelve weeks,she was able to fully extend her operative knee and at five months she was resuming her normal activities and exercises.CONCLUSION Failed patellar tendon reconstruction due to gouty infiltration is treated with dermal allograft augmented Achilles tendon reconstruction with bone block.
基金support from the National Natural Science Foundation of China(22237007 and 22177122)the Biological Resources Program of Chinese Academy of Sciences(CAS)(KFJ-BRP-008-001)the Youth Innovation Promotion Association of Chinese Academy of Sciences(2022282)is gratefully acknowledged.We thank Prof.Shi-Man Huang,Department of Biology,Hainan University,China,for the identification of the plant material.
文摘Four new norditerpenoid heterodimers with different dimerization patterns-namely,trigofragiloids A-C(denoted as compounds 1-3)and(+)-and(-)-trigofragiloid D(compound 4)-and three new phenanthrenone norditerpenoids-namely,trigofragiloids E-G(compounds 5-7)-were isolated from Trigonostemon fragilis.Compounds 1 and 2 feature a novel heterodimeric carbon skeleton formed by the conjugation of a tetra-norditerpenoid and an ennea-norditerpenoid;they have been identified as class 2 atropisomers by means of quantum chemical calculations.Compound 3 is an unprecedented phenylpropanoid-norditerpenoid adduct with a new dimerization pattern.Compounds(+)-and(-)-4 are the first example of S-shaped 1,4-dioxane-fused norditerpenoid dimers.Inspired by the structure elucidation of compound 4,two co-occurring analogues,actephilol A and epiactephilol A,were structurally revised as a pair of geometrical isomers and were identified as two pairs of enantiomers,(+)-and(-)-8 and(+)-and(-)-9,respectively.Their structures were characterized using a combined method.Notably,compound 7 exhibits remarkable adenosine triphosphate-citrate lyase(ACLY)inhibition with a halfmaximal inhibition concentration(IC50)value of(0.46±0.11)lmol·L^(-1),as active as the positive control BMS-303141,and a molecular docking study offers deep insight into the interaction between compound 7 and ACLY.
基金supported by the National Natural Science Foundation of China(32070476,32270496)。
文摘The cicada genus Vietanna is reviewed based on the descriptions of two new species,V.perparva sp.nov.and V.longiloba sp.nov.,from China.The relationship of this genus to related taxa is discussed based on the phylogeny of Vietanna and representative species from subtribes Puranina,Leptopsaltriina,Euterpnosiina and Leptosemiina based on the mitochondrial gene COI and nuclear genes EF-1αand ARD1.
文摘The article by Zhao et al presents a retrospective case series on the reasons for initial revision after unicompartmental knee arthroplasty(UKA).Clarifying the reasons that may cause UKA revision can further reduce the rate of revision UKA,focusing on gasket dislocation,osteophytes,intra-articular loose bodies,and tibial prosthesis loosening.This article provides valuable insights,not only by detailing the revision status of 13 patients who underwent revision after initial UKA but also by providing a comprehensive analysis of the incidence of revision after initial UKA.By reviewing and analyzing the causes,they established references for the early detection of risk factors for revision in clinical practice and for formulating surgical strategies and rehabilitation programmes.This commentary emphasizes the need for a meticulous understanding and an analysis of the revision rate following initial UKA and related management strategies.The implant rates,regional variation,and benefits of uncemented Oxford UKA have been explored,particularly in terms of bone preservation,appropriate surgical techniques,and weight management to control complications and improve patient prognosis.
