Intrapelvic prosthetic migration prosthesis following hip arthroplasty can occur due to aseptic loosening, infection, injury and malposition of the cup with chronic instability. Revision surgery is the treatment optio...Intrapelvic prosthetic migration prosthesis following hip arthroplasty can occur due to aseptic loosening, infection, injury and malposition of the cup with chronic instability. Revision surgery is the treatment option, but is often complex, is high risk owing to the co-morbidities of the patient, has higher complications and sometimes even patients refuse for the surgery. Osteoclast mediated bone resorption at the prosthetic bone interface is the main pathophysiology process involved in aseptic loosening associated intrapelvic migration. RANK/RANKL (Receptor Activated Nuclear factor κB Ligand) is the primary pathway responsible for the periprosthetic osteolysis, therefore, we have offered Denosumab which binds to RANKL and inhibits osteoclasts mediated bone resorption, to our two patients with intrapelvic prosthetic migration who have refused for the revision surgery. Here, we report the outcome of these two cases of Intrapelvic prosthetic migration following a hip arthroplasty that was treated using subcutaneous injection of 120 mg denosumab monthly for 3 months. Both the cases had good functional outcomes and radiographs showed good consolidation of bone around the prosthesis. These cases suggest denosumab can be repurposed to arrest further intrapelvic prosthetic migration due to its anti-resorptive and bone forming action and can avoid the need for a complex revision surgery.展开更多
In exploration geochemistry,advances in the detection limit,breadth of elements analyze-able,accuracy and precision of analytical instruments have motivated the re-analysis of legacy samples to improve confidence in g...In exploration geochemistry,advances in the detection limit,breadth of elements analyze-able,accuracy and precision of analytical instruments have motivated the re-analysis of legacy samples to improve confidence in geochemical data and gain more insights into potentially mineralized areas.While a re-analysis campaign in a geochemical exploration program modernizes legacy geochemical data by providing more trustworthy and higher-dimensional geochemical data,especially where modern data is considerably different than legacy data,it is an expensive exercise.The risk associated with modernizing such legacy data lies within its uncertainty in return(e.g.,the possibility of new discoveries,in primarily greenfield settings).Without any advanced knowledge of yet unanalyzed elements,the importance of re-analyses remains ambiguous.To address this uncertainty,we apply machine learning to multivariate geochemical data from different regions in Canada(i.e.,the Churchill Province and the Trans-Hudson Orogen)in order to use legacy geochemical data to predict modern and higher dimensional multi-elemental concentrations ahead of planned re-analyses.Our study demonstrates that legacy and modern geochemical data can be repurposed to predict yet unanalyzed elements that will be realized from re-analyses and in a manner that significantly reduces the latency to downstream usage of modern geochemical data(e.g.,prospectivity mapping).Findings from this study serve as a pillar of a framework for exploration geologists to predictively explore and prioritize potentially mineralized districts for further prospects in a timely manner before employing more invasive and expensive techniques.展开更多
文摘Intrapelvic prosthetic migration prosthesis following hip arthroplasty can occur due to aseptic loosening, infection, injury and malposition of the cup with chronic instability. Revision surgery is the treatment option, but is often complex, is high risk owing to the co-morbidities of the patient, has higher complications and sometimes even patients refuse for the surgery. Osteoclast mediated bone resorption at the prosthetic bone interface is the main pathophysiology process involved in aseptic loosening associated intrapelvic migration. RANK/RANKL (Receptor Activated Nuclear factor κB Ligand) is the primary pathway responsible for the periprosthetic osteolysis, therefore, we have offered Denosumab which binds to RANKL and inhibits osteoclasts mediated bone resorption, to our two patients with intrapelvic prosthetic migration who have refused for the revision surgery. Here, we report the outcome of these two cases of Intrapelvic prosthetic migration following a hip arthroplasty that was treated using subcutaneous injection of 120 mg denosumab monthly for 3 months. Both the cases had good functional outcomes and radiographs showed good consolidation of bone around the prosthesis. These cases suggest denosumab can be repurposed to arrest further intrapelvic prosthetic migration due to its anti-resorptive and bone forming action and can avoid the need for a complex revision surgery.
基金Supported by a Department of Science and Innovation(DSI)-National Research Foundation(NRF)Thuthuka Grant(Grant UID:121973),and DSI-NRF CIMERA.
文摘In exploration geochemistry,advances in the detection limit,breadth of elements analyze-able,accuracy and precision of analytical instruments have motivated the re-analysis of legacy samples to improve confidence in geochemical data and gain more insights into potentially mineralized areas.While a re-analysis campaign in a geochemical exploration program modernizes legacy geochemical data by providing more trustworthy and higher-dimensional geochemical data,especially where modern data is considerably different than legacy data,it is an expensive exercise.The risk associated with modernizing such legacy data lies within its uncertainty in return(e.g.,the possibility of new discoveries,in primarily greenfield settings).Without any advanced knowledge of yet unanalyzed elements,the importance of re-analyses remains ambiguous.To address this uncertainty,we apply machine learning to multivariate geochemical data from different regions in Canada(i.e.,the Churchill Province and the Trans-Hudson Orogen)in order to use legacy geochemical data to predict modern and higher dimensional multi-elemental concentrations ahead of planned re-analyses.Our study demonstrates that legacy and modern geochemical data can be repurposed to predict yet unanalyzed elements that will be realized from re-analyses and in a manner that significantly reduces the latency to downstream usage of modern geochemical data(e.g.,prospectivity mapping).Findings from this study serve as a pillar of a framework for exploration geologists to predictively explore and prioritize potentially mineralized districts for further prospects in a timely manner before employing more invasive and expensive techniques.
