BACKGROUND Knee osteoarthritis(OA)is a degenerative joint disease traditionally viewed through the lens of cartilage degradation.However,emerging evidence positions subchondral bone pathology-particularly bone marrow ...BACKGROUND Knee osteoarthritis(OA)is a degenerative joint disease traditionally viewed through the lens of cartilage degradation.However,emerging evidence positions subchondral bone pathology-particularly bone marrow lesions(BMLs)-as a key contributor to pain,progression,and structural deterioration.Mesenchymal stem cell exhaustion within the osteoarthritic subchondral zone further impairs intrinsic repair mechanisms,reinforcing the rationale for biologic interventions.AIM To evaluate the clinical efficacy of bone marrow aspirate concentrate(BMAC)therapy for knee OA,comparing subchondral vs intra-articular delivery routes,and elucidating the therapeutic impact on symptom relief and structural preservation.METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines,five clinical studies were included-comprising three randomized controlled trials and two prospective cohorts-with pooled data from 298 knees.Data on functional outcomes,imaging findings,and progression to total knee arthroplasty(TKA)were extracted and qualitatively synthesized.RESULTS Subchondral BMAC injections demonstrated superior improvements compared to intra-articular injection or placebo:Knee Injury and Osteoarthritis Outcome Score improved from 49.1±1.9 to 61.2±6.3 at 12 months(P<0.05),Knee Society Score increased from 57±12 to 87.3±12 at two years,and Western Ontario and McMaster Universities Arthritis Index scores showed significant improvement favoring combined approaches.Magnetic resonance imaging analyses revealed mean BML volume regression of 2.1 cm3,with 80%of knees avoiding TKA over 13-year follow-up.Magnetic resonance imaging analyses revealed regression of BMLs and increased cartilage preservation in subchondral-treated knees.Long-term data indicated delayed progression to TKA and biomechanical improvements(e.g.,Hip-Knee-Ankle angle correction).No major adverse events were reported.CONCLUSION Targeting subchondral bone with BMAC addresses underlying OA pathology and may offer disease-modifying potential beyond symptom relief.These findings support a paradigm shift toward whole-joint biologic therapy,positioning the subchondral matrix as a therapeutic epicenter in OA management.展开更多
BACKGROUND Rotator cuff tears and Bankart lesions significantly affect shoulder function and quality of life.Arthroscopic rotator cuff repair and Bankart repair has become the standard treatment for restoring function...BACKGROUND Rotator cuff tears and Bankart lesions significantly affect shoulder function and quality of life.Arthroscopic rotator cuff repair and Bankart repair has become the standard treatment for restoring function and reducing pain.Recent advancements include new suture anchor technologies,such as the Sironix suture anchor known for its biomechanical strength and promising outcomes.However,there are limited real-world data on its effectiveness and safety,particularly in the Indian population.AIM To evaluate the effectiveness and safety of Sironix suture anchors in rotator cuff and Bankart repair surgeries.METHODS Sixty participants underwent surgery between January 2021 and December 2022,and demographic data and postoperative outcomes were collected through retrospective reviews and telephonic interviews.Validated scales,including the PENN Shoulder Score(PSS),Disabilities of the Arm,Shoulder,and Hand(DASH)score,and Single Assessment Numeric Evaluation(SANE),were utilized for assessment.RESULTS Treatment with Sironix suture anchor devices,including Ceptre Knotted UHMWPE Suture Titanium Anchor,Spyke Knotted UHMWPE Suture Peek Anchor,Stativ Knotted UHMWPE Suture Anchor,and Viplok Knotless Peek Screw Anchor with Titanium Tip,revealed no repair failures.Participants demonstrated high satisfaction and functional improvement,as evidenced by the mean Quick DASH score(32.01)and PSS(71.65)and the satisfactory SANE scores for both injured joints(74.33)and non-injured(83.67)shoulder joints.CONCLUSION The study yielded favorable outcomes for rotator cuff tear repair and Bankart repair.No repair failures were observed,supporting the safety and efficacy of these devices in shoulder injury management.展开更多
BACKGROUND Total hip arthroplasty is a safe and effective procedure.To improve survivorship,ultrahigh molecular weight polyethylene hip liners with antioxidants have been developed.Additive antioxidant was deployed to...BACKGROUND Total hip arthroplasty is a safe and effective procedure.To improve survivorship,ultrahigh molecular weight polyethylene hip liners with antioxidants have been developed.Additive antioxidant was deployed to reduce oxidation and consequential wear,loosening,or osteolysis.A unique manufacturing process was utilized for two such hip liners,the Novation®and Alteon®XLE hip liners and this research represents the first large series on this specific material.The study hypothesis was that Novation and Alteon XLE hip liners have similar short-term survivorship as other manufacturers’antioxidant liners according to procedure and outcome data from the American Joint Replacement Registry(AJRR).AIM To demonstrate similar short-term survivorship of XLE antioxidant hip liners compared to all antioxidant hip liners in AJRR.METHODS Utilizing total hip arthroplasty data from the AJRR,a retrospective review was performed for subjects who underwent implantation of Novation XLE(n=461),Alteon XLE(n=989),or any other antioxidant hip liner(termed the aggregate antioxidant group;n=39964)as of March 31,2022.Survivorship at three years and revision rates were compared statistically between the Novation group and the aggregate antioxidant group as well as the Alteon group and the aggregate antioxidant group.RESULTS Survivorship at three years post-surgery was 99.09%for Novation,97.73%for Alteon,and 97.69%for the aggregate antioxidant group.There were no reports of failure due to wear in either the Novation or Alteon groups.Among the revision categories(fracture,infection,aseptic loosening,instability,mechanical complications,wear,pain,hematoma/wound complications,or other),there were no significant differences identified in either comparison.There were also no significant differences in cumulative percent revision rates up to three years post-surgery for the Novation vs aggregate antioxidant group or the Alteon vs aggregate antioxidant group.CONCLUSION Novation and Alteon XLE hip liner revision rate and survivorship are equivalent to other antioxidant hip liners in the short term.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
BACKGROUND The norursodeoxycholic acid(norUDCA),a side chain-shortened derivative of ursodeoxycholic acid,exhibits unique pharmacological properties that may benefit patients with metabolic dysfunction-associated stea...BACKGROUND The norursodeoxycholic acid(norUDCA),a side chain-shortened derivative of ursodeoxycholic acid,exhibits unique pharmacological properties that may benefit patients with metabolic dysfunction-associated steatotic liver disease(MASLD).AIM To evaluate the efficacy,safety,and tolerability of norUDCA 1500 mg compared to placebo in the patients with MASLD.METHODS This phase III,randomized,double-blind,multi-centric,placebo-controlled trial enrolled patients with MASLD,and were randomized in 2:1 ratio to receive either norUDCA 1500 mg or placebo for 24 weeks.Efficacy and safety were rigorously evaluated through clinical,biochemical,and imaging assessments.Primary endpoints assessed alanine aminotransferase(ALT)normalization and improvement in liver stiffness(FibroScan®)at week 12,while secondary endpoints included changes in nonalcoholic fatty liver disease fibrosis score,liver enzymes,lipid profile,glycosylated hemoglobin,and FibroScan-assessed liver stiffness.Safety was monitored throughout the study.RESULTS Of 165 randomized patients,110 received norUDCA and 55 placebos.At week 12,ALT normalization was achieved in 89%of norUDCA-treated group compared to 76%of placebo-treated group(P=0.022);with a statistically significant adjusted mean difference(P=0.016).Fibrosis improvement was observed in 57%of norUDCA-treated vs 40%in placebo-treated(P=0.035),with highly significant adjusted mean(P=0.002).nonalcoholic fatty liver disease fibrosis score at week 18 and 24(P=0.041 and P=0.032).Similarly,ALT reductions were significant at both week 18 and week 24(P=0.021 and P=0.035).Improvements in lipid profile trended towards norUDCA without statistical significance.Liver stiffness has improved in 90 patients in norUDCA-treated vs 36 patients in placebo group(P=0.009).NorUDCA demonstrated favorable safety profile,with no serious adverse events reported,and only mild to moderate adverse events were observed.CONCLUSION NorUDCA 1500 mg demonstrated clinically meaningful therapeutic efficacy in patients with MASLD,accompanied by consistently favorable safety profile.展开更多
BACKGROUND The hepatitis C virus(HCV) NS5A inhibitor ABT-267(ombitasvir, OBV), the HCV NS4/4A protease inhibitor ABT-450(paritaprevir, PTV), the CYP3A inhibitor ritonavir(r) and the non-nucleoside NS5B polymerase inhi...BACKGROUND The hepatitis C virus(HCV) NS5A inhibitor ABT-267(ombitasvir, OBV), the HCV NS4/4A protease inhibitor ABT-450(paritaprevir, PTV), the CYP3A inhibitor ritonavir(r) and the non-nucleoside NS5B polymerase inhibitor ABT-333(dasabuvir, DSV)(OBV/PTV/r + DSV) with or without ribavirin(RBV) is a direct-acting antiviral regimen approved in the United States and other major countries for the treatment of HCV in genotype 1(GT1) infected patients. Patients with HCV who are considered "hard-to-cure" have generally been excluded from registration trials due to rigorous study inclusion criteria, presence of comorbidities and previous treatment failures.AIM To investigate the efficacy of this regimen in HCV G1-infected patients historically excluded from clinical trials.METHODS Patients were ≥ 18 years old and chronically infected with HCV GT1(GT1a, GT1b or GT1a/1b). Patients were treatment-na?ve or previously failed a regimen including pegylated interferon/RBV +/-telaprevir, boceprevir, or simeprevir.One hundred patients were treated with the study drug regimen, which was administered for 12 or 24 wk +/-RBV according to GT1 subtype and presence/absence of cirrhosis. Patients were evaluated every 4 wk from treatment day 1 and at 4 and 12 wk after end-of-treatment.RESULTS Many of the patients studied had comorbidities(44.2% hypertensive, 33.7%obese, 20.2% cirrhotic) and 16% previously failed HCV treatment. Ninety-six patients completed study follow-up and 99% achieved 12-wk sustained virologic response. The majority(88.4%) of patients had undetectable HCV RNA by week 4. The most common adverse events were fatigue(12%), headache(10%),insomnia(9%) and diarrhea(8%); none led to treatment discontinuation. Physical and mental patient reported outcomes scores significantly improved after treatment. Almost all(98%) patients were treatment compliant.CONCLUSION In an all-comers HCV GT1 population, 12 or 24-wk of OBV/PTV/r + DSV +/-RBV is highly effective and tolerable and results in better mental and physical health following treatment.展开更多
With the development of endoscopic therapy,argon plasma coagulation(APC)has been widely used by endoscopists.It has many advantages,such as simple to operate,low cost,and minimal invasiveness.Because of its capability...With the development of endoscopic therapy,argon plasma coagulation(APC)has been widely used by endoscopists.It has many advantages,such as simple to operate,low cost,and minimal invasiveness.Because of its capability of lesion ablation and hemostasis,APC has several indications in the gastrointestinal tract.One of them is esophageal varices.The aim of this review is to summarize the research on APC in this field to provide a reference for clinical practice.展开更多
Objective: To determine the antibiotic resistance patterns of the Acinetobacter(A.) baumannii complex isolates that cause the confirmed infection. Methods: The present descriptive study was performed from March 2016 t...Objective: To determine the antibiotic resistance patterns of the Acinetobacter(A.) baumannii complex isolates that cause the confirmed infection. Methods: The present descriptive study was performed from March 2016 to March 2018 in three referral hospitals in Isfahan, Iran. All A. baumannii complex strains isolated from different clinical samples were identified by conventional phenotypic methods and antibiotic susceptibility pattern was detected. After the clinical investigation, contaminated samples were excluded and the source(hospital/community) and site of the infection were determined. Data on antibiotic susceptibility testing were extracted from WHONET software and analysis was done with SPSS.Results: From 254 patients who had confirmed A. baumannii complex infection, 158(62.20%) cases were male, 27(10.63%) were less than 20 years old, 172(67.72%) had healthcare-associated infections and 96(37.79%) were admitted in intensive care units. The most frequent infection was bloodstream infections(111, 43.70%). Our results showed that most of the isolates were resistant to most of the antibiotics(more than 75.00%) and a lower rate of non-susceptibility was observed against minocycline(20, 44.44%) and colistin(0%). The rate of multidrug-resistant isolates was 88.97%. There was no significant difference between resistance of A. baumannii complex isolates according to age. However, the resistance to amikacin and minocycline and the rate of multidrug resistance(MDR) were significantly different between males and females. In patients with healthcare associated infection(HAI), MDR isolates were significantly different regarding admission in ICU ward. Resistance to levofloxacin and ciprofloxacin were lower in isolates from patients with bloodstream infections in comparison to other diagnoses.Conclusions: In our study, a high level of antibiotic resistance was detected in both community-acquired and healthcare-associated A. baumannii complex infections. Appropriate antibiotic prescription in a clinical setting is an essential need for the control and prevention of A. baumannii resistant infections.展开更多
Each biological system possesses a widely unrecognized buffer system to maintain acid-base balance to a specific pH. The skin pH is crucial for physiological skin function. In aged or diseased skin, pH increase is obs...Each biological system possesses a widely unrecognized buffer system to maintain acid-base balance to a specific pH. The skin pH is crucial for physiological skin function. In aged or diseased skin, pH increase is observed and may negatively affect skin health. Skin care products with a pH that is slightly more acidic than the average normal skin pH and have an adequate buffering capacity, are considered beneficial for the skin. However, the buffer capacity of these products also plays an important role. In the present study, a possible normalization or acidification of skin surface pH and influence on skin hydration and skin barrier function was assessed via application of buffered skin care products that are formulated with pH ≤ 4.5. 48 subjects aged above 50 were treated with three different skin care products (Vitamin C Spheres, Collagen Spray, and Collagen Mask) and skin surface pH, skin hydration and barrier integrity were assessed before treatment start and after 4 weeks. The results show that after 4-week treatment with Vitamin C, the skin pH is acidified. Treatment with Collagen Spray and Collagen Mask showed maintenance of a physiological skin pH. Subgroup analysis of subjects that had a higher than average skin pH at study start demonstrated that all three tested skin care products were able to acidify the skin surface. In addition, skin hydration was also increased for two of the three tested products, whereas skin barrier is not significantly changed. This demonstrates that buffered skin care products formulated to a pH ≤ 4.5 are able to acidify and maintain physiological skin pH and may contribute to a physiological skin function.展开更多
The purpose of this exploratory study was to determine health information technology functionalities in inpatient care units that were associated with reduced fall risk among adult patients aged 65 years or older in a...The purpose of this exploratory study was to determine health information technology functionalities in inpatient care units that were associated with reduced fall risk among adult patients aged 65 years or older in acute care hospitals in the United States. This study compared the differences in the hospital-acquired injurious fall rates for hospitals in California, Florida, and New York with and without fully implemented IT functionalities in their general medical and surgical inpatient units. It used publicly available 2007 datasets, the hospital was the unit of analysis, and teaching and non-teaching hospitals were analyzed separately. Hospital-acquired injurious falls were identified based on fall-related primary and secondary diagnoses and were flagged by the hospitals as not “present on admission” in the 2007 California, Florida, and New York State Inpatient Database data. The 4 health IT functionalities in general medical and surgical inpatient units were 1) electronic clinical documentation, 2) results viewing, 3) computerized provider order entry, and 4) decision support. The research question was What are the effective health IT functionalities in the general medical and surgical units for reducing fall risk among adult patients aged 65 years or older at their hospitals? Independent t tests were used. The results showed that no significant difference was found in the hospital-acquired injurious fall rates between hospitals with and without each of the 4 functionalities and between the teaching hospitals with and without each of the 4 functionalities. Significant differences were found in the injurious fall rates between non-teaching hospitals with and without electronic clinical documentation and result viewing. Future research may focus on assessing the clinicians’ use of the IT functionalities of electronic clinical documentation and results viewing, as well as the effect of the clinicians’ use patterns on patient outcomes.展开更多
Background: Maintenance of lost weight is a challenging aspect of weight management, therefore, an online survey of OPTAVIA (“the Program”) coaches and clients was conducted to understand the habits of successful ma...Background: Maintenance of lost weight is a challenging aspect of weight management, therefore, an online survey of OPTAVIA (“the Program”) coaches and clients was conducted to understand the habits of successful maintainers. Methods: Coaches and clients who lost ≥ 10% body weight on the Program, had been trying to maintain their weight loss for ≥1 year, and maintained > 75% of their weight loss during that time were identified. Mean ± SD were calculated for continuous variables and categorical variables were quantified using frequencies and percentages. Results: The analysis included 590 respondents (342 coaches, 248 clients;84% female, 52.6 ± 11.9 years). Average weight loss was 23.7% ± 8.6%;average time in maintenance was 24.5 ± 15.8 months. The most common maintenance strategies included self-monitoring, leveraging habits learned during weight loss, food-related strategies, physical activity, establishing a healthy environment, and becoming a coach. Coaches identified several beneficial factors: higher accountability, increased self-awareness, paying it forward, aligning maintenance with their identity as a coach, being a role model, and engagement with the Program. Conclusions: Successful coaches and clients use behaviors consistent with existing literature combined with several unique to the Program. The novel insights from this research rest primarily on the strategy of becoming a coach to help maintain weight loss.展开更多
This research focuses on the effects of migration on the TB infection rate and its prevention in Saudi Arabia, which has a large number of expatriates from TB-affected countries. Despite, based on the current global s...This research focuses on the effects of migration on the TB infection rate and its prevention in Saudi Arabia, which has a large number of expatriates from TB-affected countries. Despite, based on the current global statistics of TB occurrence, it is evident that the national incidence of TB has reduced from 10.55 per 100,000 in 2015 to 8.36 per 100,000 in 2019;despite this, there are still some difficulties because migrants bring new strains of Mycobacterium tuberculosis. Hindrances, including language barriers and perceived immigration status, hinder patients from seeking medical attention or doctors from diagnosing diseases. Each patient and each cultural group need special attention to public health, enhancing living circumstances, and health care support. Community participation, inclusion of TB control programs into functional healthcare facilities, and the functioning of TB programs need to be stressed to address TB issues. Considering the focus on social, economic, and cultural approaches, the country can make severe advancements in TB control and population protection. This holistic analysis is critical for a long-term effective strategy to combat TB in the Kingdom.展开更多
Purpose: This article investigates the critical importance of integrating surgeons’ direct input into the development of innovative technologies that address gaps in surgical care, including those aimed at reducing a...Purpose: This article investigates the critical importance of integrating surgeons’ direct input into the development of innovative technologies that address gaps in surgical care, including those aimed at reducing anastomotic leaks (AL), a major complication in gastrointestinal surgery. While traditional quantitative research methods are prevalent, they often overlook the invaluable insights of the surgeons who manage these complications firsthand. Subjects and Methods: This study employs a qualitative approach, utilizing semi-structured interviews with 40 surgeons from various specialties, including general, bariatric, colorectal, trauma, hepato-biliary, and thoracic surgery. The interviews were designed to probe the needs of surgeons, challenges currently faced, and gaps in clinical practice, research, and technology for detection and/or management of AL. The data were analyzed using thematic analysis, which revealed significant gaps in current technologies for early detection and prevention of leaks. Results: Surgeons expressed strong interest in FluidAI’s Stream™ Platform, a non-invasive medical device designed to monitor postoperative drainage fluid in real-time, providing continuous data on AL risk. The ability of this platform to offer early prediction through pH and electrical conductivity analysis was particularly appealing to participants, who emphasized the importance of timely interventions in improving patient outcomes. The study’s findings highlight not only the clinical challenges but also the emotional toll that AL takes on surgeons, underlining the need for innovations that are both data-driven and humanistic. Conclusion: By centering surgeons’ perspectives, this research advocates for a human-centered approach to technological advancement, ensuring that new tools are both clinically effective and aligned with the real-world needs of surgical practitioners.展开更多
<strong>Background:</strong> Young and intact skin is highly responsive. As skin ages, its responsiveness decreases. Production of structural components of the skin slows down and signs of skin aging appea...<strong>Background:</strong> Young and intact skin is highly responsive. As skin ages, its responsiveness decreases. Production of structural components of the skin slows down and signs of skin aging appear. External influences like UV radiation and pollution contribute to signs of skin aging. They lead to an increased formation of so-called free radicals. Bioactive antioxidant compounds, such as polyphenols, have beneficial effects on skin health by free radical scavenging. The purpose of this study was to evaluate the topical effects of new and highly concentrated resveratrol containing emulsion (Medskin Solutions Dr. Suwelack AG, 2% trans-resveratrol) on age-related alterations to the skin. <strong>Methods:</strong> A clinical observation study was performed on 20 subjects to observe the effects of a 2% resveratrol emulsion on typical signs of skin aging. Product was applied once daily for a period of 8 weeks in combination with a standardized treatment. Tested parameters were skin elasticity, skin barrier function, skin smoothness, skin thickness and density. <strong>Results:</strong> After 8 weeks of treatment, skin pH value is significantly lowered and skin barrier function improved. The value of skin elasticity (+5.3%), and skin density (+ 10.7%) had increased, while skin roughness (-6.4%) and skin dispensability (-45.9%) had diminished. Intensity of skin redness had decreased. Furthermore, expert and participant evaluations show satisfaction, especially with regard to skin smoothness and skin moisture. Conclusion: The resveratrol emulsion shows positive outcomes by supporting reduction of skin wrinkling and increasing skin firmness, as well as reducing skin redness, and is therefore an all-round anti-aging treatment.展开更多
In a recent study in signal transduction and targeted therapy,Zhou et al.provided novel experimental data on the role of DNAdependent protein kinase catalytic subunit(DNA-PKcs)in causing abnormalities in the structure...In a recent study in signal transduction and targeted therapy,Zhou et al.provided novel experimental data on the role of DNAdependent protein kinase catalytic subunit(DNA-PKcs)in causing abnormalities in the structure and function of mitochondria of hepatocytes,leading to liver injury and alcohol-associated liver disease(ALD).展开更多
Background and Aims:Early detection of hepatocellular carcinoma(HCC)is crucial for improving survival in patients with chronic hepatitis.The GALAD algorithm combines gen-der(biological sex),age,α-fetoprotein(AFP),Len...Background and Aims:Early detection of hepatocellular carcinoma(HCC)is crucial for improving survival in patients with chronic hepatitis.The GALAD algorithm combines gen-der(biological sex),age,α-fetoprotein(AFP),Lens culinaris agglutinin-reactive fraction of AFP(AFP-L3),and protein in-duced by vitamin K absence or antagonist-II(PIVKA-II)for HCC detection.Similarly,the GAAD algorithm incorporates gender(biological sex),age,AFP,and PIVKA-II.This study aimed to assess the clinical utility of AFP-L3 in the GALAD algorithm and its potential synergies with ultrasound.We compared the clinical performance of GALAD with GAAD;AFP;AFP-L3;and PIVKA-II,with or without ultrasound,in Taiwan residents adults.Methods:A total of 439 serum samples were analyzed using a Cobas®e 601 analyzer(healthy con-trols,n=200;chronic liver disease controls,n=177;HCC cases,n=62).Performance was assessed through receiver operating characteristic curve analyses to calculate the area under the curve.Results:The area under the curve for dif-ferentiating early-stage HCC from patients with chronic liver disease was optimal for PIVKA-II(84.9%),GAAD(79.8%),and GALAD(79.4%),with slightly improved performance for detecting all-stage HCC.Clinical performance was unaffected by disease stage or etiology.Sensitivity for early-stage HCC was highest for GAAD(57.6%)and GALAD(57.6%).Sen-sitivity for each strategy was further enhanced when com-bined with ultrasound,regardless of disease stage or etiology(P<0.01).Conclusions:These findings indicate that the role of AFP-L3 in the GALAD algorithm is minimal,supporting the use of GAAD for HCC detection.A combination of GAAD,GALAD,or PIVKA-II with ultrasound may improve diagnostic efficiency compared with recommended strategies.展开更多
文摘BACKGROUND Knee osteoarthritis(OA)is a degenerative joint disease traditionally viewed through the lens of cartilage degradation.However,emerging evidence positions subchondral bone pathology-particularly bone marrow lesions(BMLs)-as a key contributor to pain,progression,and structural deterioration.Mesenchymal stem cell exhaustion within the osteoarthritic subchondral zone further impairs intrinsic repair mechanisms,reinforcing the rationale for biologic interventions.AIM To evaluate the clinical efficacy of bone marrow aspirate concentrate(BMAC)therapy for knee OA,comparing subchondral vs intra-articular delivery routes,and elucidating the therapeutic impact on symptom relief and structural preservation.METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines,five clinical studies were included-comprising three randomized controlled trials and two prospective cohorts-with pooled data from 298 knees.Data on functional outcomes,imaging findings,and progression to total knee arthroplasty(TKA)were extracted and qualitatively synthesized.RESULTS Subchondral BMAC injections demonstrated superior improvements compared to intra-articular injection or placebo:Knee Injury and Osteoarthritis Outcome Score improved from 49.1±1.9 to 61.2±6.3 at 12 months(P<0.05),Knee Society Score increased from 57±12 to 87.3±12 at two years,and Western Ontario and McMaster Universities Arthritis Index scores showed significant improvement favoring combined approaches.Magnetic resonance imaging analyses revealed mean BML volume regression of 2.1 cm3,with 80%of knees avoiding TKA over 13-year follow-up.Magnetic resonance imaging analyses revealed regression of BMLs and increased cartilage preservation in subchondral-treated knees.Long-term data indicated delayed progression to TKA and biomechanical improvements(e.g.,Hip-Knee-Ankle angle correction).No major adverse events were reported.CONCLUSION Targeting subchondral bone with BMAC addresses underlying OA pathology and may offer disease-modifying potential beyond symptom relief.These findings support a paradigm shift toward whole-joint biologic therapy,positioning the subchondral matrix as a therapeutic epicenter in OA management.
文摘BACKGROUND Rotator cuff tears and Bankart lesions significantly affect shoulder function and quality of life.Arthroscopic rotator cuff repair and Bankart repair has become the standard treatment for restoring function and reducing pain.Recent advancements include new suture anchor technologies,such as the Sironix suture anchor known for its biomechanical strength and promising outcomes.However,there are limited real-world data on its effectiveness and safety,particularly in the Indian population.AIM To evaluate the effectiveness and safety of Sironix suture anchors in rotator cuff and Bankart repair surgeries.METHODS Sixty participants underwent surgery between January 2021 and December 2022,and demographic data and postoperative outcomes were collected through retrospective reviews and telephonic interviews.Validated scales,including the PENN Shoulder Score(PSS),Disabilities of the Arm,Shoulder,and Hand(DASH)score,and Single Assessment Numeric Evaluation(SANE),were utilized for assessment.RESULTS Treatment with Sironix suture anchor devices,including Ceptre Knotted UHMWPE Suture Titanium Anchor,Spyke Knotted UHMWPE Suture Peek Anchor,Stativ Knotted UHMWPE Suture Anchor,and Viplok Knotless Peek Screw Anchor with Titanium Tip,revealed no repair failures.Participants demonstrated high satisfaction and functional improvement,as evidenced by the mean Quick DASH score(32.01)and PSS(71.65)and the satisfactory SANE scores for both injured joints(74.33)and non-injured(83.67)shoulder joints.CONCLUSION The study yielded favorable outcomes for rotator cuff tear repair and Bankart repair.No repair failures were observed,supporting the safety and efficacy of these devices in shoulder injury management.
文摘BACKGROUND Total hip arthroplasty is a safe and effective procedure.To improve survivorship,ultrahigh molecular weight polyethylene hip liners with antioxidants have been developed.Additive antioxidant was deployed to reduce oxidation and consequential wear,loosening,or osteolysis.A unique manufacturing process was utilized for two such hip liners,the Novation®and Alteon®XLE hip liners and this research represents the first large series on this specific material.The study hypothesis was that Novation and Alteon XLE hip liners have similar short-term survivorship as other manufacturers’antioxidant liners according to procedure and outcome data from the American Joint Replacement Registry(AJRR).AIM To demonstrate similar short-term survivorship of XLE antioxidant hip liners compared to all antioxidant hip liners in AJRR.METHODS Utilizing total hip arthroplasty data from the AJRR,a retrospective review was performed for subjects who underwent implantation of Novation XLE(n=461),Alteon XLE(n=989),or any other antioxidant hip liner(termed the aggregate antioxidant group;n=39964)as of March 31,2022.Survivorship at three years and revision rates were compared statistically between the Novation group and the aggregate antioxidant group as well as the Alteon group and the aggregate antioxidant group.RESULTS Survivorship at three years post-surgery was 99.09%for Novation,97.73%for Alteon,and 97.69%for the aggregate antioxidant group.There were no reports of failure due to wear in either the Novation or Alteon groups.Among the revision categories(fracture,infection,aseptic loosening,instability,mechanical complications,wear,pain,hematoma/wound complications,or other),there were no significant differences identified in either comparison.There were also no significant differences in cumulative percent revision rates up to three years post-surgery for the Novation vs aggregate antioxidant group or the Alteon vs aggregate antioxidant group.CONCLUSION Novation and Alteon XLE hip liner revision rate and survivorship are equivalent to other antioxidant hip liners in the short term.
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Supported by Shilpa Medicare Limited,Hyderabad,Telangana,India.
文摘BACKGROUND The norursodeoxycholic acid(norUDCA),a side chain-shortened derivative of ursodeoxycholic acid,exhibits unique pharmacological properties that may benefit patients with metabolic dysfunction-associated steatotic liver disease(MASLD).AIM To evaluate the efficacy,safety,and tolerability of norUDCA 1500 mg compared to placebo in the patients with MASLD.METHODS This phase III,randomized,double-blind,multi-centric,placebo-controlled trial enrolled patients with MASLD,and were randomized in 2:1 ratio to receive either norUDCA 1500 mg or placebo for 24 weeks.Efficacy and safety were rigorously evaluated through clinical,biochemical,and imaging assessments.Primary endpoints assessed alanine aminotransferase(ALT)normalization and improvement in liver stiffness(FibroScan®)at week 12,while secondary endpoints included changes in nonalcoholic fatty liver disease fibrosis score,liver enzymes,lipid profile,glycosylated hemoglobin,and FibroScan-assessed liver stiffness.Safety was monitored throughout the study.RESULTS Of 165 randomized patients,110 received norUDCA and 55 placebos.At week 12,ALT normalization was achieved in 89%of norUDCA-treated group compared to 76%of placebo-treated group(P=0.022);with a statistically significant adjusted mean difference(P=0.016).Fibrosis improvement was observed in 57%of norUDCA-treated vs 40%in placebo-treated(P=0.035),with highly significant adjusted mean(P=0.002).nonalcoholic fatty liver disease fibrosis score at week 18 and 24(P=0.041 and P=0.032).Similarly,ALT reductions were significant at both week 18 and week 24(P=0.021 and P=0.035).Improvements in lipid profile trended towards norUDCA without statistical significance.Liver stiffness has improved in 90 patients in norUDCA-treated vs 36 patients in placebo group(P=0.009).NorUDCA demonstrated favorable safety profile,with no serious adverse events reported,and only mild to moderate adverse events were observed.CONCLUSION NorUDCA 1500 mg demonstrated clinically meaningful therapeutic efficacy in patients with MASLD,accompanied by consistently favorable safety profile.
基金an investigatorinitiated grant from AbbVie(B15-791)
文摘BACKGROUND The hepatitis C virus(HCV) NS5A inhibitor ABT-267(ombitasvir, OBV), the HCV NS4/4A protease inhibitor ABT-450(paritaprevir, PTV), the CYP3A inhibitor ritonavir(r) and the non-nucleoside NS5B polymerase inhibitor ABT-333(dasabuvir, DSV)(OBV/PTV/r + DSV) with or without ribavirin(RBV) is a direct-acting antiviral regimen approved in the United States and other major countries for the treatment of HCV in genotype 1(GT1) infected patients. Patients with HCV who are considered "hard-to-cure" have generally been excluded from registration trials due to rigorous study inclusion criteria, presence of comorbidities and previous treatment failures.AIM To investigate the efficacy of this regimen in HCV G1-infected patients historically excluded from clinical trials.METHODS Patients were ≥ 18 years old and chronically infected with HCV GT1(GT1a, GT1b or GT1a/1b). Patients were treatment-na?ve or previously failed a regimen including pegylated interferon/RBV +/-telaprevir, boceprevir, or simeprevir.One hundred patients were treated with the study drug regimen, which was administered for 12 or 24 wk +/-RBV according to GT1 subtype and presence/absence of cirrhosis. Patients were evaluated every 4 wk from treatment day 1 and at 4 and 12 wk after end-of-treatment.RESULTS Many of the patients studied had comorbidities(44.2% hypertensive, 33.7%obese, 20.2% cirrhotic) and 16% previously failed HCV treatment. Ninety-six patients completed study follow-up and 99% achieved 12-wk sustained virologic response. The majority(88.4%) of patients had undetectable HCV RNA by week 4. The most common adverse events were fatigue(12%), headache(10%),insomnia(9%) and diarrhea(8%); none led to treatment discontinuation. Physical and mental patient reported outcomes scores significantly improved after treatment. Almost all(98%) patients were treatment compliant.CONCLUSION In an all-comers HCV GT1 population, 12 or 24-wk of OBV/PTV/r + DSV +/-RBV is highly effective and tolerable and results in better mental and physical health following treatment.
文摘With the development of endoscopic therapy,argon plasma coagulation(APC)has been widely used by endoscopists.It has many advantages,such as simple to operate,low cost,and minimal invasiveness.Because of its capability of lesion ablation and hemostasis,APC has several indications in the gastrointestinal tract.One of them is esophageal varices.The aim of this review is to summarize the research on APC in this field to provide a reference for clinical practice.
文摘Objective: To determine the antibiotic resistance patterns of the Acinetobacter(A.) baumannii complex isolates that cause the confirmed infection. Methods: The present descriptive study was performed from March 2016 to March 2018 in three referral hospitals in Isfahan, Iran. All A. baumannii complex strains isolated from different clinical samples were identified by conventional phenotypic methods and antibiotic susceptibility pattern was detected. After the clinical investigation, contaminated samples were excluded and the source(hospital/community) and site of the infection were determined. Data on antibiotic susceptibility testing were extracted from WHONET software and analysis was done with SPSS.Results: From 254 patients who had confirmed A. baumannii complex infection, 158(62.20%) cases were male, 27(10.63%) were less than 20 years old, 172(67.72%) had healthcare-associated infections and 96(37.79%) were admitted in intensive care units. The most frequent infection was bloodstream infections(111, 43.70%). Our results showed that most of the isolates were resistant to most of the antibiotics(more than 75.00%) and a lower rate of non-susceptibility was observed against minocycline(20, 44.44%) and colistin(0%). The rate of multidrug-resistant isolates was 88.97%. There was no significant difference between resistance of A. baumannii complex isolates according to age. However, the resistance to amikacin and minocycline and the rate of multidrug resistance(MDR) were significantly different between males and females. In patients with healthcare associated infection(HAI), MDR isolates were significantly different regarding admission in ICU ward. Resistance to levofloxacin and ciprofloxacin were lower in isolates from patients with bloodstream infections in comparison to other diagnoses.Conclusions: In our study, a high level of antibiotic resistance was detected in both community-acquired and healthcare-associated A. baumannii complex infections. Appropriate antibiotic prescription in a clinical setting is an essential need for the control and prevention of A. baumannii resistant infections.
文摘Each biological system possesses a widely unrecognized buffer system to maintain acid-base balance to a specific pH. The skin pH is crucial for physiological skin function. In aged or diseased skin, pH increase is observed and may negatively affect skin health. Skin care products with a pH that is slightly more acidic than the average normal skin pH and have an adequate buffering capacity, are considered beneficial for the skin. However, the buffer capacity of these products also plays an important role. In the present study, a possible normalization or acidification of skin surface pH and influence on skin hydration and skin barrier function was assessed via application of buffered skin care products that are formulated with pH ≤ 4.5. 48 subjects aged above 50 were treated with three different skin care products (Vitamin C Spheres, Collagen Spray, and Collagen Mask) and skin surface pH, skin hydration and barrier integrity were assessed before treatment start and after 4 weeks. The results show that after 4-week treatment with Vitamin C, the skin pH is acidified. Treatment with Collagen Spray and Collagen Mask showed maintenance of a physiological skin pH. Subgroup analysis of subjects that had a higher than average skin pH at study start demonstrated that all three tested skin care products were able to acidify the skin surface. In addition, skin hydration was also increased for two of the three tested products, whereas skin barrier is not significantly changed. This demonstrates that buffered skin care products formulated to a pH ≤ 4.5 are able to acidify and maintain physiological skin pH and may contribute to a physiological skin function.
文摘The purpose of this exploratory study was to determine health information technology functionalities in inpatient care units that were associated with reduced fall risk among adult patients aged 65 years or older in acute care hospitals in the United States. This study compared the differences in the hospital-acquired injurious fall rates for hospitals in California, Florida, and New York with and without fully implemented IT functionalities in their general medical and surgical inpatient units. It used publicly available 2007 datasets, the hospital was the unit of analysis, and teaching and non-teaching hospitals were analyzed separately. Hospital-acquired injurious falls were identified based on fall-related primary and secondary diagnoses and were flagged by the hospitals as not “present on admission” in the 2007 California, Florida, and New York State Inpatient Database data. The 4 health IT functionalities in general medical and surgical inpatient units were 1) electronic clinical documentation, 2) results viewing, 3) computerized provider order entry, and 4) decision support. The research question was What are the effective health IT functionalities in the general medical and surgical units for reducing fall risk among adult patients aged 65 years or older at their hospitals? Independent t tests were used. The results showed that no significant difference was found in the hospital-acquired injurious fall rates between hospitals with and without each of the 4 functionalities and between the teaching hospitals with and without each of the 4 functionalities. Significant differences were found in the injurious fall rates between non-teaching hospitals with and without electronic clinical documentation and result viewing. Future research may focus on assessing the clinicians’ use of the IT functionalities of electronic clinical documentation and results viewing, as well as the effect of the clinicians’ use patterns on patient outcomes.
文摘Background: Maintenance of lost weight is a challenging aspect of weight management, therefore, an online survey of OPTAVIA (“the Program”) coaches and clients was conducted to understand the habits of successful maintainers. Methods: Coaches and clients who lost ≥ 10% body weight on the Program, had been trying to maintain their weight loss for ≥1 year, and maintained > 75% of their weight loss during that time were identified. Mean ± SD were calculated for continuous variables and categorical variables were quantified using frequencies and percentages. Results: The analysis included 590 respondents (342 coaches, 248 clients;84% female, 52.6 ± 11.9 years). Average weight loss was 23.7% ± 8.6%;average time in maintenance was 24.5 ± 15.8 months. The most common maintenance strategies included self-monitoring, leveraging habits learned during weight loss, food-related strategies, physical activity, establishing a healthy environment, and becoming a coach. Coaches identified several beneficial factors: higher accountability, increased self-awareness, paying it forward, aligning maintenance with their identity as a coach, being a role model, and engagement with the Program. Conclusions: Successful coaches and clients use behaviors consistent with existing literature combined with several unique to the Program. The novel insights from this research rest primarily on the strategy of becoming a coach to help maintain weight loss.
文摘This research focuses on the effects of migration on the TB infection rate and its prevention in Saudi Arabia, which has a large number of expatriates from TB-affected countries. Despite, based on the current global statistics of TB occurrence, it is evident that the national incidence of TB has reduced from 10.55 per 100,000 in 2015 to 8.36 per 100,000 in 2019;despite this, there are still some difficulties because migrants bring new strains of Mycobacterium tuberculosis. Hindrances, including language barriers and perceived immigration status, hinder patients from seeking medical attention or doctors from diagnosing diseases. Each patient and each cultural group need special attention to public health, enhancing living circumstances, and health care support. Community participation, inclusion of TB control programs into functional healthcare facilities, and the functioning of TB programs need to be stressed to address TB issues. Considering the focus on social, economic, and cultural approaches, the country can make severe advancements in TB control and population protection. This holistic analysis is critical for a long-term effective strategy to combat TB in the Kingdom.
文摘Purpose: This article investigates the critical importance of integrating surgeons’ direct input into the development of innovative technologies that address gaps in surgical care, including those aimed at reducing anastomotic leaks (AL), a major complication in gastrointestinal surgery. While traditional quantitative research methods are prevalent, they often overlook the invaluable insights of the surgeons who manage these complications firsthand. Subjects and Methods: This study employs a qualitative approach, utilizing semi-structured interviews with 40 surgeons from various specialties, including general, bariatric, colorectal, trauma, hepato-biliary, and thoracic surgery. The interviews were designed to probe the needs of surgeons, challenges currently faced, and gaps in clinical practice, research, and technology for detection and/or management of AL. The data were analyzed using thematic analysis, which revealed significant gaps in current technologies for early detection and prevention of leaks. Results: Surgeons expressed strong interest in FluidAI’s Stream™ Platform, a non-invasive medical device designed to monitor postoperative drainage fluid in real-time, providing continuous data on AL risk. The ability of this platform to offer early prediction through pH and electrical conductivity analysis was particularly appealing to participants, who emphasized the importance of timely interventions in improving patient outcomes. The study’s findings highlight not only the clinical challenges but also the emotional toll that AL takes on surgeons, underlining the need for innovations that are both data-driven and humanistic. Conclusion: By centering surgeons’ perspectives, this research advocates for a human-centered approach to technological advancement, ensuring that new tools are both clinically effective and aligned with the real-world needs of surgical practitioners.
文摘<strong>Background:</strong> Young and intact skin is highly responsive. As skin ages, its responsiveness decreases. Production of structural components of the skin slows down and signs of skin aging appear. External influences like UV radiation and pollution contribute to signs of skin aging. They lead to an increased formation of so-called free radicals. Bioactive antioxidant compounds, such as polyphenols, have beneficial effects on skin health by free radical scavenging. The purpose of this study was to evaluate the topical effects of new and highly concentrated resveratrol containing emulsion (Medskin Solutions Dr. Suwelack AG, 2% trans-resveratrol) on age-related alterations to the skin. <strong>Methods:</strong> A clinical observation study was performed on 20 subjects to observe the effects of a 2% resveratrol emulsion on typical signs of skin aging. Product was applied once daily for a period of 8 weeks in combination with a standardized treatment. Tested parameters were skin elasticity, skin barrier function, skin smoothness, skin thickness and density. <strong>Results:</strong> After 8 weeks of treatment, skin pH value is significantly lowered and skin barrier function improved. The value of skin elasticity (+5.3%), and skin density (+ 10.7%) had increased, while skin roughness (-6.4%) and skin dispensability (-45.9%) had diminished. Intensity of skin redness had decreased. Furthermore, expert and participant evaluations show satisfaction, especially with regard to skin smoothness and skin moisture. Conclusion: The resveratrol emulsion shows positive outcomes by supporting reduction of skin wrinkling and increasing skin firmness, as well as reducing skin redness, and is therefore an all-round anti-aging treatment.
文摘In a recent study in signal transduction and targeted therapy,Zhou et al.provided novel experimental data on the role of DNAdependent protein kinase catalytic subunit(DNA-PKcs)in causing abnormalities in the structure and function of mitochondria of hepatocytes,leading to liver injury and alcohol-associated liver disease(ALD).
基金funded by Roche Diagnostics GmbH and partly supported by the“Center of Excellence for Metabolic Associated Fatty Liver Disease,National Sun Yat-sen University,Kaohsiung”,under The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education in Taiwan.
文摘Background and Aims:Early detection of hepatocellular carcinoma(HCC)is crucial for improving survival in patients with chronic hepatitis.The GALAD algorithm combines gen-der(biological sex),age,α-fetoprotein(AFP),Lens culinaris agglutinin-reactive fraction of AFP(AFP-L3),and protein in-duced by vitamin K absence or antagonist-II(PIVKA-II)for HCC detection.Similarly,the GAAD algorithm incorporates gender(biological sex),age,AFP,and PIVKA-II.This study aimed to assess the clinical utility of AFP-L3 in the GALAD algorithm and its potential synergies with ultrasound.We compared the clinical performance of GALAD with GAAD;AFP;AFP-L3;and PIVKA-II,with or without ultrasound,in Taiwan residents adults.Methods:A total of 439 serum samples were analyzed using a Cobas®e 601 analyzer(healthy con-trols,n=200;chronic liver disease controls,n=177;HCC cases,n=62).Performance was assessed through receiver operating characteristic curve analyses to calculate the area under the curve.Results:The area under the curve for dif-ferentiating early-stage HCC from patients with chronic liver disease was optimal for PIVKA-II(84.9%),GAAD(79.8%),and GALAD(79.4%),with slightly improved performance for detecting all-stage HCC.Clinical performance was unaffected by disease stage or etiology.Sensitivity for early-stage HCC was highest for GAAD(57.6%)and GALAD(57.6%).Sen-sitivity for each strategy was further enhanced when com-bined with ultrasound,regardless of disease stage or etiology(P<0.01).Conclusions:These findings indicate that the role of AFP-L3 in the GALAD algorithm is minimal,supporting the use of GAAD for HCC detection.A combination of GAAD,GALAD,or PIVKA-II with ultrasound may improve diagnostic efficiency compared with recommended strategies.
