Tissue Irritation Research Articles

Decoding the Pathophysiology of Non-alcoholic Fatty Liver Disease Progressing to Non-alcoholic Steatohepatitis: A Systematic Review.

Non-alcoholic fatty liver disease (NAFLD) is the most common hepatic manifestation of metabolic syndromes, and its roots are strongly associated with obesity and insulin resistance. The excess fat induces inflammatory pathways by tissue irritation and progresses to non-alcoholic steatohepatitis (NASH), fibrosis, and has emerged as the most frequent cause of hepatocellular cancer (HCC). This systematic review was structured per the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The evidence was obtained from 13 research articles published in PubMed, Google Scholar, and Science Direct databases, including cross-sectional, case-control, prospective cohort studies, meta-analysis, and systematic reviews. The inclusion/exclusion criteria of free articles, published in English involving humans of mid-age in the last five years were applied. This review highlights findings in 7781 individuals, including non-NAFLD, NAFLD, and NASH positive individuals based on anthropometric measurement, blood samples, FibroScan, flow cytometry, and liver biopsy. The results underscored that the onset of inflammation set on the background of NAFLD starts NASH; the understanding and control of inflammation will help us design definitive biomarkers and treatment modalities. The complex pathogenesis and comparatively slow advancement but high morbidity have led investigators to understand the nuts and bolts for early management and prevention. Lipotoxicity and dysbiosis stimulate the immune system to generate cytokines and chemokines and decline in adipokines. The role of proteinase3 (PR3) and antitrypsin (ATT) ratio and biliverdin reductase (BVR) compel the exploration for non-invasive tests for definitive therapy.

Rectal bioavailability of amoxicillin sodium in rabbits: Effects of suppository base and drug dose

In this paper, rectal absorption and tissue tolerance of amoxicillin sodium (AS) suppositories prepared in a hydrophilic base, polyethylene glycol (PEG) or lipophilic base, Suppocire® NA 15 (SNA 15), were investigated. Following in vitro characterization, including drug distribution in the suppository bases, drug-base interactions and drug release, pharmacokinetics were investigated in rabbits to determine absolute bioavailability (F) at two dose levels (100 mg and 200 mg). Both types of suppositories were found uniform in weight and content. Powder X-ray diffraction (XRD) and differential scanning calorimetry indicated that AS existed as solid dispersion or anhydrous crystalline dispersion in both suppositories at different ratios without changing melting points of the bases. This was supported by Fourier transform infrared (FTIR) spectroscopy and scanning electron microscopy conjugated with energy dispersive X-ray (SEM/EDX). In dissolution medium, melting and spreading of SNA 15 and dissolution of PEG suppositories accounted for their different drug release kinetics and mean dissolution time (MDT). A rapid and complete amoxicillin absorption (F close to 100%) with a double peak pharmacokinetic profile was observed alongside minimal signs of tissue irritation in rabbits treated with SNA 15 suppositories at both dose levels. In contrast, the F of amoxicillin from PEG suppositories was 59%, increasing to 77.3% as AS dose doubled from 100 mg to 200 mg, reflected in the slower release predominately controlled by erosion of the base. An in vitro – in vivo correlation was observed (MDT vs F; p < 0.01). AS was stable in SNA 15 suppositories at least for three months at 20 ± 0.2 °C. This research highlighted the advantages of SNA 15 suppositories over the PEG suppositories in providing rapid and complete rectal absorption of AS and tissue compatibility.

Is YouTube an adequate patient resource about orthodontic retention? A cross-sectional analysis of content and quality

The study aimed to evaluate the content and quality of information offered by YouTube for patients seeking information related to orthodontic retainers. YouTube was searched using the keyword "orthodontic retainers" from Google Trends. From the first 120 results, 97 videos were selected to be analyzed. Videos were rated for quality by video information and quality index (VIQI) and the global quality scale (GQS). Videos were classified as low- and high-content groups using a 10-point score considering several retainer-related topics. Mann-Whitney U tests, chi-square tests, and Pearson correlation coefficients were used for statistical evaluations. Most YouTube videos were uploaded by dentists/specialists (62.9%). We classified 12 videos as high content and 85 as low content. Instructions on the use of the orthodontic retainer was the most commonly covered topic (42.3%), followed by the effect on oral hygiene (38.1%), definition (37.1%), procedure of preparing orthodontic retainers (33.0%), and procedure of positioning (30.9%). A lower percentage of videos (6.2%) mentioned soft tissue irritation. The high-content video group had a significantly higher median value of GQS score and VIQI (P<0.001). The correlation between GQS and VIQI was strong (r=0.698; P<0.01). The content of YouTube videos for orthodontic retainers could not be considered as an adequate source of information for patients on orthodontic retainers. Most videos included instructions on the use of orthodontic retainers, but fewer videos mentioned the effect on speech performance and soft tissue irritations.

An overview of effective and potential new conservative interventions in patients with frozen shoulder.

Frozen shoulder (FS) is a pathology that is difficult to understand and difficult to manage. Over the last ten years, contradictory and new evidence is provided regarding the recovery and its natural course. This narrative review provides new information about the diagnosis and conservative treatment of patients with FS and ongoing research hypotheses that might provide new insights in the pathology and treatment options. FS has a characteristic course. People with Diabetes Mellitus and thyroid disorders have a higher risk of developing a FS. The diagnosis FS is based on pattern recognition and physical examination. Additionally, 'rule-in' and 'rule-out' criteria can be used to increase the likelihood of the frozen shoulder diagnosis. Recommended and most common physical therapy interventions are mobilization techniques and exercises, in which tissue irritability can guide its intensity. In addition, physical therapy is often complementary with patient education and pharmacotherapy. The latest evidence-based practice related to FS is proprioceptive neuromuscular facilitation and mirror therapy. In addition, interventions like pain neuroscience education, high-intensity interval training and lifestyle changes are still hypothetical. Finally, better insight in the involvement of biochemical processes, function of myofibroblasts and matrix metalloproteinases can provide better understanding in the pathophysiology and will be addressed in current review.

P-056. Profound changes in hemodynamics proving late-onset PE being of maternal origin

In this paper, rectal absorption and tissue tolerance of amoxicillin sodium (AS) suppositories prepared in a hydrophilic base, polyethylene glycol (PEG) or lipophilic base, Suppocire® NA 15 (SNA 15), were investigated. Following in vitro characterization, including drug distribution in the suppository bases, drug-base interactions and drug release, pharmacokinetics were investigated in rabbits to determine absolute bioavailability (F) at two dose levels (100 mg and 200 mg). Both types of suppositories were found uniform in weight and content. Powder X-ray diffraction (XRD) and differential scanning calorimetry indicated that AS existed as solid dispersion or anhydrous crystalline dispersion in both suppositories at different ratios without changing melting points of the bases. This was supported by Fourier transform infrared (FTIR) spectroscopy and scanning electron microscopy conjugated with energy dispersive X-ray (SEM/EDX). In dissolution medium, melting and spreading of SNA 15 and dissolution of PEG suppositories accounted for their different drug release kinetics and mean dissolution time (MDT). A rapid and complete amoxicillin absorption (F close to 100%) with a double peak pharmacokinetic profile was observed alongside minimal signs of tissue irritation in rabbits treated with SNA 15 suppositories at both dose levels. In contrast, the F of amoxicillin from PEG suppositories was 59%, increasing to 77.3% as AS dose doubled from 100 mg to 200 mg, reflected in the slower release predominately controlled by erosion of the base. An in vitro – in vivo correlation was observed (MDT vs F; p < 0.01). AS was stable in SNA 15 suppositories at least for three months at 20 ± 0.2 °C. This research highlighted the advantages of SNA 15 suppositories over the PEG suppositories in providing rapid and complete rectal absorption of AS and tissue compatibility.

Managing a Facial Talon: A Rare Morphological Variation on Maxillary Permanent Central Incisor

Talon cusp or Eagle's Talon is a developmental anomalous structure that is thought to arise due to evagination of the coronal surface of a tooth before the commencement of calcification. The facial form of talon cusp is a rare morphological variation occurred on the facial surface of incisors that are often associated with clinical problems such as poor esthetic, soft tissue irritation, and caries susceptibility. We report a case of facial talon cusp on permanent maxillary right central incisor in a 9-year-old girl who visited our department with esthetic concern. The patient was managed with a minimally invasive approach by selective grinding followed by the application of fluoride varnish at a regular interval. Direct resin-based composite restoration performed to achieve esthetic rehabilitation, demonstrated satisfactory clinical and radiographic treatment outcomes.

Fixation stability and implant-associated complications in periacetabular osteotomy: a comparison of screw and K-wire fixation

AimsThe aim of this study was to compare the fixation stability and complications in patients undergoing periacetabular osteotomy (PAO) with either K-wire or screw fixation.Patients and methodsWe performed a retrospective study to analyze a consecutive series of patients who underwent PAO with either screw or K-wire fixation. Patients who were treated for acetabular retroversion or had previous surgery on the ipsilateral hip joint were excluded. 172 patients (191 hips: 99 K-wire/92 screw fixation) were included. The mean age at the time of PAO was 29.3 years (16–48) in the K-wire group and 27.3 (15–45) in the screw group and 83.9% were female. Clinical parameters including duration of surgery, minor complications (soft tissue irritation and implant migration) and major complications (implant failure and non-union) were evaluated. Radiological parameters including LCE, TA and FHEI were measured preoperatively, postoperatively and at 3-months follow-up.ResultsDuration of surgery was significantly reduced in the K-wire group with 88.2 min (53–202) compared to the screw group with 119.7 min (50–261) (p < 0.001). Soft tissue irritation occurred significantly more often in the K-wire group (72/99) than in the screw group (36/92) (p < 0.001). No group showed significantly more implant migration than the other. No major complications were observed in either group. Postoperative LCE, TA and FHEI were improved significantly in both groups for all parameters (p = < 0.0001). There was no significant difference for initial or final correction for the respective parameters between the two groups. Furthermore, no significant difference in loss of correction was observed between the two groups for the respective parameters.ConclusionK-wire fixation is a viable and safe option for fragment fixation in PAO with similar stability and complication rates as screw fixation. An advantage of the method is the significantly reduced operative time. A disadvantage is the significantly higher rate of implant-associated soft tissue irritation, necessitating implant removal.Level of evidenceIII, retrospective trial.

Comparison of total patellectomy and osteosynthesis with tension band wiring in patients with highly comminuted patella fractures: a 10\u201320-year follow-up study

BackgroundThe purpose of this study was to evaluate and compare the long-term clinical outcomes between the total patellectomy and osteosynthesis with tension band wiring in patients with highly comminuted patella fractures.MethodsBetween January 1987 and December 2003, this retrospective study included a total of 35 patients (mean age, 51.4±16.8 years) with a minimum of 10 years follow-up period, comprising 29 males and 6 females, who were divided into the total patellectomy group (17 patients) or the open reduction and internal fixation (ORIF) group (18 patients) in the Third Affiliated Hospital of Hebei Medical University. We retrospectively collected patient demographics and data on the type of trauma, fracture type, and postoperative complications. Clinical outcomes including knee range of motion (ROM), 36-Item Short-Form Health Survey (SF-36) score [including physical component score (PCS) and mental component score (MCS)], Knee Injury and Osteoarthritis Outcome Score (KOOS), and Kujala score were evaluated and compared between the two groups. Biodex System dynamometer was used to quantitatively evaluate quadriceps femoris muscle power following measurement of peak torque.ResultsThe mean follow-up periods of the total patellectomy group and the ORIF group were 17.2±5.6 and 16.8±4.9 years, respectively. There were no significant differences between the two groups of patient demographics in terms of the number of patients, age, sex, injury side, time to surgery, type of trauma, and fracture classification (p>0.05). Total patellectomy was comparable to osteosynthesis with tension band wiring in terms of ROM [injured knee: 120.4±3.1° vs 118.6±3.3°; uninjured knee: 126.5±2.8° vs 127.3±1.7°; both p>0.05], peak torque [Injured knee: 96.2±2.3 vs 97.3±2.6, N· m; Uninjured knee: 107.6±2.1 vs 106.3±1.8, N· m; both p>0.05], SF-36 score [PCS: 64.1±18.0 vs 61.5±17.9; MCS: 55.1±13.8 vs 54.3±12.4; both p>0.05], KOOS score [76.3±12.1 vs 73.4±11.7; p>0.05], and Kujala score [67.6±11.8 vs 70.8±11.9; p>0.05] at the final follow-up, while total patellectomy had significantly shorter operation time than ORIF group (47.5±12.1 vs 68.8±22.3, min, p<0.05). In the total patellectomy group, complications occurred in 6 of 17 cases (35.3%), and all occurred with calcification. In the ORIF group, complications occurred in 12 of 18 cases (66.7%), including 2 cases of infection (11.1%), 1 case of non-union (5.6%), 2 cases of implant failure (11.1%), 2 cases of soft tissue irritation (11.1%), and 5 cases of patellofemoral arthritis (27.8%).ConclusionsTotal patellectomy technique was a safe and reliable alternative treatment for treating patients with highly comminuted patella fractures when anatomically reduction and rigid fixation were difficult, although it caused relatively higher rates of calcification.

Comparison of double-strand braided polyester sutures tension band (Nice knot) with cable tension band in transverse patellar fractures

BackgroundThe tension band technique is the most common method for internal fixation of transverse patellar fractures. Titanium cable and high-strength sutures have been successfully applied in this treatment; however, few studies have compared the Nice knot technique using sutures with the standard cable technique. Whether the suture technique (Nice knot) provides preferable results compared with those of the cable technique is unclear. MethodsForty patients with transverse patellar fractures participated in this study. Twenty patients underwent sutures tension band fixation (Nice knot), and the others were managed with cable tension bands. All patients were followed up at 1, 3, 6, and 12 months. Pain was measured by VAS scores, flexion and extension of the knee were measured in degrees by goniometry, and knee function was evaluated using the Böstman clinical grading scale. ResultsThe two groups had equal distributions in age, gender, injured side, and fracture classification. The mean operation time in the suture group was shorter (55.75±9.77 minutes versus 64.25±9.63 minutes). The VAS score was comparable in the two groups at the 1-month, 3-month, and 6-month follow-ups; however, the score was lower at 12 months postoperatively in the suture group (P=0.037). No significant difference was found in flexion, extension, Böstman score, or fracture healing time in either group (P>0.05). Postoperative complications were higher in the cable group (9 versus 2) (P = 0.031) but were mostly related to symptomatic soft tissue irritation. ConclusionThe suture tension band technique using braided polyester nonabsorbable sutures tied with Nice knot was as effective as the cable tension band technique for transverse patellar fracture management. However, more convenient operations, less cost and fewer complications were found in suture fixation (Nice knot).

Personalised high tibial osteotomy has mechanical safety equivalent to generic device in a case\u2013control in silico clinical trial

BackgroundDespite favourable outcomes relatively few surgeons offer high tibial osteotomy (HTO) as a treatment option for early knee osteoarthritis, mainly due to the difficulty of achieving planned correction and reported soft tissue irritation around the plate used to stablise the osteotomy. To compare the mechanical safety of a new personalised 3D printed high tibial osteotomy (HTO) device, created to overcome these issues, with an existing generic device, a case-control in silico virtual clinical trial was conducted.MethodsTwenty-eight knee osteoarthritis patients underwent computed tomography (CT) scanning to create a virtual cohort; the cohort was duplicated to form two arms, Generic and Personalised, on which virtual HTO was performed. Finite element analysis was performed to calculate the stresses in the plates arising from simulated physiological activities at three healing stages. The odds ratio indicative of the relative risk of fatigue failure of the HTO plates between the personalised and generic arms was obtained from a multi-level logistic model.ResultsHere we show, at 12 weeks post-surgery, the odds ratio indicative of the relative risk of fatigue failure was 0.14 (95%CI 0.01 to 2.73, p = 0.20).ConclusionsThis novel (to the best of our knowledge) in silico trial, comparing the mechanical safety of a new personalised 3D printed high tibial osteotomy device with an existing generic device, shows that there is no increased risk of failure for the new personalised design compared to the existing generic commonly used device. Personalised high tibial osteotomy can overcome the main technical barriers for this type of surgery, our findings support the case for using this technology for treating early knee osteoarthritis.

COVID-19 Testing in Young Individuals and Pandemics Monitoring: Low Susceptibility to the Infection and Lack of Positive Results

COVID-19 Testing in Young Individuals and Pandemics Monitoring: Low Susceptibility to the Infection and Lack of Positive Results

Effectiveness of orthopedic implant removal surgery in patients with no implant-related symptoms after fracture union of isolated lower extremity shaft fractures: patient-centered evaluation.

Routine orthopedic implant removal surgery (OIRS) in patients with no implant-related symptoms after union is controversial. Various factors, such as various fracture sites, fracture types, and accompanying fractures at other sites, act as error variables in the evaluation of routine OIRS. The purpose of this study is to evaluate the benefits of orthopedic implant removal surgery (OIRS) in patients with no implant-related symptoms such as infection and soft tissue irritation after union of isolated lower extremity shaft fractures from a patient-centered evaluation MATERIALS AND METHODS: Eighty-four patients who achieved fracture union after internal fixation of femoral shaft or tibial shaft fractures (March 2004 to December 2018) and who showed no implant-related symptoms were evaluated retrospectively. Minimum post-OIRS follow-up period was 1 year. Thirty-eight patients were treated with intramedullary nail and 13 were treated with plate and screws for femoral shaft fracture. Twenty patients were treated with intramedullary nail and 13 were treated with plate and screws for tibial shaft fracture. All patients subsequently underwent OIRS. Quality of life (QoL) and lower extremity pain using visual analogue scale (VAS) were evaluated 1 day before OIRS. Patient satisfaction with the OIRS, VAS, and QoL were assessed at least 1 year after OIRS using the SF-36 questionnaire. The physical component score, mental component score, and scores of all eight domains showed significant improvement after OIRS (p < 0.01). Patients with femoral shaft fractures tended to have lower pre- and post-OIRS SF-36 scores than those with tibial shaft fracture. Among patients with femoral shaft fracture, SF-36 scores were comparable in the nail and plate groups. Among patients with tibial shaft fracture, nail group showed relatively better QoL than the plate group, before and after OIRS in spite of several complications such as formation of scar tissue, nerve damage, and refracture. Patients with no implant-related symptoms showed significant improvement in QoL and satisfaction after OIRS. This suggests that OIRS is beneficial from the patients' evaluation. Therapeutic Level II.

A 4-year study of the use of the short metacarpal cast in the management of metacarpal shaft fractures

We report on our experience of using a short, moulded metacarpal cast over a 4-year period in the non-surgical management of metacarpal shaft fractures. Between 6 April 2015 and 6 April 2019, 117 patients were treated using this method. The majority were male, and the mean age was 24.6 years. The most common mechanism of injury was a punch injury (73 patients, 62%). Fifteen patients (13%) were treated for multiple metacarpal fractures. Immediately after cast removal, 68% had a full range of finger movement and 68% were pain free. Few required formal hand therapy. Fifteen patients experienced minor complications, primarily soft tissue irritation from the cast and non-limiting extensor lag. The moulded short metacarpal cast is an effective non-surgical treatment for angulated extra-articular metacarpal fractures of the diaphysis and diametaphyseal junction.Level of evidence: IV.

Indirect reduction technique via Nice knot for transverse fracture of patella

To assess the outcomes in indirect reduction technique via Nice knot for transverse patellar fractures. The clinical data of 25 patients with transverse patellar fractures meeting the inclusion criteria between January 2017 and December 2018 were retrospectively analyzed. The patients were divided into trial group ( n=13) and control group ( n=12) according to different intraoperative reduction methods. No significant difference was found in gender, age, affected side, cause of fracture, classification, or the time from injury to operation between the two groups ( P>0.05). In the trial group, No.2 suture was used to cross the quadriceps tendon and patellar tendon to construct the Nice knot, then the suture was tightened to make the distal and proximal fracture segments contact in an indirect reduction pattern. Depend on Nice knot's sliding compression and self-stabilizing function, the suture mesh created an anterior tension band as a temporary fixation. In the control group, Weber's clamp was used to hold the fracture segments directly and fixed temporarily. After reduction, terminal fixation was conducted using a titanium Kirschner wire with titanium cable in both groups. The operation time, intraoperative blood loss, follow-up time, fracture healing time, and complications were recorded and compared in the two groups. At last follow-up, the knee function was evaluated according to the Böstman scoring criteria for efficacy in patellar fractures. The operation time in the trial group was significantly shorter than that in the control group ( t=-2.165, P=0.041). There was no significant difference of intraoperative blood loss between the two groups ( t=0.514, P=0.612). The incisions of the two groups healed by first intention. All the patients were followed up 12-16 months, with an average of 14.4 months, no significant difference was found in the follow-up time between the two groups ( t=-0.309, P=0.760). One patient in the control group developed soft tissue irritation symptoms at 1 day after operation, and no special treatment was given, the symptoms disappeared at 2 months after operation. The fractures of the two groups healed at the 12-week follow-up. During the follow-up, there was no complication such as loosening and fracture of titanium cables and tendon tissue calcification. At last follow-up, the Böstman score presented no significant difference between the two groups ( t=-0.086, P=0.932). In the trial group, an 80-year-old female patient was evaluated as good (score, 27) due to atrophy of the quadriceps femoris, leg weakness, and affected stair climbing, and the rest 24 patients were all evaluated as excellent. The indirect reduction with Nice knot can shorten the operation time in the treatment of transverse patellar fractures, and obtain good effectiveness.

Osseointegration

Osseointegration is a technique that confers a number of advantages to amputees dissatisfied with traditional socket prostheses. An osseointegrated implant consists of a bone-anchored device attached to a patient’s residual limb, and a transdermal component, which connects the external prosthesis. By anchoring into bone, an osseointegrated prosthesis provides direct skeletal attachment, allowing for improved mobility and coordination, gait which more closely approximates a native limb, better proprioception, and obviation of the problems associated with the traditional socket—residuum interface, including poor socket fit and soft tissue irritation. Both the bony and soft tissue work of osseointegration warrant careful consideration. We recommend collaboration between rehabilitation, orthopedic, and plastic surgery teams at each step of the process.

English

BACKGROUND Patella is a sesamoid bone that plays an important role in the extensor apparatus of the knee joint. Fractures of the patella constitute about 1 % of all fractures. Definitive treatment of the patellar fractures depends on the type of fracture, displacement, joint congruity, and intactness of the extensor apparatus. There is significant controversy about the surgical options for displaced patellar fractures. Although conventionally tension band wiring using K-wires (TBW-K wire) is a common procedure, tension band wiring using cancellous screws (TBW-CCS) is gaining popularity. A study was undertaken to compare outcomes between the two procedures (TBW-CCS &amp; TBW-K wire). METHODS A prospective randomised study was planned. Inclusion &amp; exclusion criteria were laid down. Institutional ethical committee clearance was obtained. 68 consenting patients with transverse patellar fractures underwent surgery (TBW-CCS or TBWK wire) after randomisation. Demographic, clinical, and radiological assessment was done. Bostman score was used as an outcome measure. Statistical analysis was done. RESULTS 85.5 % of cancellous screw group patients had excellent outcome scores as against 41.2 % in the K wire group. The difference was statistically significant. 5.8 % of patients in the cancellous group complained of implant prominence as against 17.6 % in the K wire group which was statistically significant as well. Patients in TBW-CCS had a statistically significant difference in Bostman scores at 6 weeks, 3 months, and 6 months. CONCLUSIONS Tension band wiring with cannulated cancellous screws is a safe and reliable technique in the management of transverse patellar fractures with fewer chances of implant failure and soft tissue irritation. Based on our study, tension band wiring with cannulated cancellous screws is a better method to treat transverse fractures of the patella when compared to the modified tension band wiring technique using K-wire. KEYWORDS Patella, Transverse Fracture, Tension Band Wiring, Cancellous Screws

Partial hardware removal in guided growth surgery: A convenient strategy?

BackgroundTension band plates (TPBs) are frequently used in guided growth (CG) surgeries. Recently, the concept of removing the metaphyseal screw only to stop the growth modulating effect rather than completely removing the implant, has gained popularity. Although this strategy would have certain potential advantages, the associated risks are unknown. The aim of this study is to report the experience of three institutions with this strategy. MethodsA database was compiled with the demographic information of patients treated by guided growth using TBPs between January 2014 and January 2019 at three institutions. The cases where only the metaphyseal screw was removed were identified. The records were reviewed to analyze the indications, demographic data, characteristics of the procedure, complications and need for additional procedures. ResultsWe reviewed 28 partial hardware removals, performed in 10 patients (all male). Initial surgery was indicated for angular deformity (N=6), and leg-length discrepancy (N=4). The average age at the time of surgery was 9.5±2.9 years (range 4–13 years). Three procedures were performed on the distal femur, 3 on the proximal tibia, 2 on the distal tibia, and 20 combined. The average follow-up was 23.3±11 months (range 12–52 months). We observed recurrence of deformities in 7 of 28 (22%) limbs that required re-insertion of the metaphyseal screw. Two patients presented complications from the procedure: soft tissue irritation (N=1) and angular deformity (N=1). Both patients required unplanned surgery. DiscussionPartial hardware removal in guided growth surgery could favor the presentation of complications. The benefits of this strategy must be considered against the possible undesired effects generated by its application. Study designTherapeutic study (Level IV).

Synthesis and evaluating of carbon nanoallotrope‐biomacromolecule gel composites as drug delivery systems

AbstractThis work was done to assess the role of precursors (agro and graphite) on performance of carbon nanoallotropes‐biomacromolecules composite as drug delivery for controlling the release of niacin. In this respect graphene oxide and bagasse‐based carbon oxide were synthesized and chelated with chitosan (Cs‐GO and Cs‐Co). These gel composites were characterized by many techniques [morphology, differential scanning calorimetry, Fourier‐transform infrared spectroscopy, swelling, encapsulation efficiency (EE) and loading (L) % of niacin. Another series of experiments was carried out for studying the role of replacing part of carbon nanoallotrope by carboxymethyl cellulose (CMC) on performance of produced drug carries, these systems were coded as Cs‐GO‐CMC and Cs‐Co‐CMC. The data showed that, the Cs‐GO gel composite provided maximum release of NA, at 5 h, for pH's simulated gastric and intestinal fluids; pH. 2.1 and pH 7.4 (1120 mg/L and 757 mg/L). The incorporation of CMC is not acceptable as it provided low drug release together with burst release of NA‐drug, and consequently possible caused tissue irritation or toxicity in the human body. The Cs‐GO and Cs‐CO systems with relatively low drug loading were recommended for their better controllability system to NA release, which prolonging benefit of human with niacin. The NA release from all investigated gels followed Fickian and non‐Fickian diffusion mechanisms.

Use of Suture Tapes Versus Conventional Sutures for Arthroscopic Rotator Cuff Repairs: A Systematic Review and Meta-analysis

Background: Various suture materials are available for arthroscopic rotator cuff repair. More recently, suture tapes have become popular as they are perceived to be easier to use with less soft tissue irritation. However, little is known about their biomechanical and clinical properties compared with conventional sutures in rotator cuff repairs. Purpose: To perform a systematic review and meta-analysis on whether suture tapes are biomechanically superior to conventional sutures in arthroscopic rotator cuff repairs and whether this translates to superior functional outcomes and a lower incidence of retears. Study Design: Meta-analysis. Methods: The Cochrane Controlled Register of Trials, PubMed, Medline, and Embase were used to perform a systematic review and meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms: (rotator cuff repair OR arthroscopic rotator cuff repair) AND (“tape” OR “wire” OR “cord” OR “suture”). Data pertaining to certain biomechanical properties (contact area, contact pressure, gap formation, load to failure, and stiffness), retears, and patient-reported outcome measures (PROMs) were extracted. The pooled outcome data were analyzed by random- and fixed-effects models. Results: After abstract and full-text screening, 7 biomechanical and 6 clinical studies were included. All biomechanical studies were on animals, with 91 suture tapes and 91 conventional sutures compared. Suture tapes had higher contact pressure (mean difference [MD], 0.04 MPa; 95% CI, 0.01-0.08; P = .02), higher load to failure (MD, 52.62 N; 95% CI, 27.34-77.90; P < .0001), greater stiffness (MD, 4.47 N/mm; 95% CI, 0.57-8.38; P = .02), and smaller gap formation (MD, −0.30 mm; 95% CI, −0.45 to −0.15; P < .0001) compared with conventional sutures. From the clinical analysis of the 681 rotator cuff repairs treated with a suture tape (n = 380) or conventional suture (n = 301), there were no differences in retear rates between the groups (16% vs 20% suture tape and wire, respectively; P = .26) at a mean of 11.2 months. Qualitatively, there were no differences in PROMs between the groups at a mean of 36.8 months. Conclusion: Although biomechanically superior, suture tapes showed similar retear rates and postoperative function to conventional sutures. However, higher-quality clinical studies are required to investigate whether there are no true differences.

Análisis de la relación entre factores laborales y extralaborales con sintomatología osteomuscular en miembros superiores de trabajadores administrativos

IntroductionMusculoskeletal disorders in the upper limbs remain prevalent. Although there is research on intra-occupational factors, few studies have determined the participation of non-occupational factors. ObjectiveTo analyse occupational and non-occupational risk factors of the administrative workers of a public entity and their relationship with symptoms in the upper limbs. MethodAn analytical study was performed. Fifty-seven workers were administered the Nordic Kourinka questionnaire, tests to identify soft tissue irritations, a questionnaire to identify the frequency of extra-occupational activities and a checklist for jobs that inquired about occupational factors. Cramer's V coefficient was applied to identify relationships between symptoms and work factors and Spearman's Rho to determine relationships between extra-occupational activities and duration of symptoms. ResultsA statistical relationship was found between marital status and symptoms at the elbow and right wrist level (Cramer's V=.332; P<.05), (Cramer's V=.359; P<.05). Perception of uncomfortable temperatures in the workplace and symptoms in the right elbow (Cramer's V=.313; P<.05). Forced postures in elbows and symptoms in right elbow (Cramer's V=.350; P<.05). A directly proportional relationship was found between duration of discomfort at the wrist joint level and frequency in the use of the computer outside the working day (Rho=.313; P=.05). ConclusionsRelationship is found between symptoms reported at the elbow and wrist joint level with demographic variables and factors present in the environment and the task. Directly proportional correspondence is identified between duration of symptoms and frequency of extra-occupational activities.