Tissue Irritation Research Articles

Ekstraartiküler Proksimal Falanks Kırıklarında Kapalı Redüksiyon ve Kirschner Teli Tespitin Klinik ve Radyolojik Sonuçları

Aim: In this study, we aim to discuss the radiological and clinical results of closed reduction and Kirschner wire fixation we performed on 16 cases with extra-articular unstable proximal phalangeal fracturesMaterials and Methods: Clinical and radiological data of 16 patients with closed, unstable (transverse or short oblique), extra-articular proximal phalangeal fractures to whom we performed closed reduction and fixation with Kirschner wire in Erzurum Regional Training and Research Hospital Orthopedics and Traumatology Clinic and Hand Surgery Clinic between 2014-2017 were retrospectively reviewedResults: Functional results of the patients are evaluated; mean active MP joint flexion was 78.75 (60-90) degrees, proximal IP joint flexion was 77.5 (65-100) degrees, distal IP joint flexion was 73.4 (60-80) degrees and mean TAM was 230 (170-270) degrees. Mean passive MP joint flexion was evaluated as 81.25 (60-90) degrees, mean proximal IP joint flexion as 83 (60-100) degrees and mean distal IP joint flexion as 74 (65-90) degrees. The grip strength was measured as 36 (23-50) kgW in the fractured hand and the healthy hand comparison was 40 (30-50) kgW. Statistically, there was no significant difference between the two groups in terms of grip strength (p<0.05). VAS mean was 1.25 (0-5), DASH mean was 10.5 (2-34), the mean distance between finger pulp and finger curve was 6.25 (0-23) mm. Belsky score was excellent in 4 patients, good in 9 patients and poor in 3 patients (Table 2). Two patients underwent tenolysis due to PIP joint contracture. Sudeck atrophy was observed in 1 patient for an average of 8 weeks. We achieved improvement with physical therapy, contrast bathing and medical treatment. There were no complications such as non-union, late union, superficial and deep infection, tenosynovitis. Our patients did not develop material extraction due to soft tissue and skin irritation. Radiologic evaluation of the follow up direct X-ray graphies revealed no displacement, angulation, and rotational deformities.Conclusion: The proximal phalanx is 'small in size' for the body and 'functioning big' for the upper limb. Fractures of the proximal phalanges can be fixed with Kirshner wires after failed stabilization with closed reduction and brace fixation. It is a practical method which has satisfactory outcomes and has a relatively low cost.

InternalBrace Has Biomechanical Properties Comparable to Suture Button but Less Rigid than Screw in Ligamentous Lisfranc Model

Category:Midfoot/Forefoot, TraumaIntroduction/Purpose:Lisfranc injuries occurring between the medial cuneiform and base of the 2nd metatarsal require anatomic fixation. Suture button and screws are standard techniques for fixation, but the screw may decrease physiologic motion, whereas suture buttons may cause increased soft tissue irritation and iatrogenic cartilage damage. Potential benefits of the InternalBrace include physiologic motion, decreased iatrogenic damage, collagen ingrowth, limited bony erosion and decreased soft tissue irritation. In light of these potential benefits, no studies have investigated the biomechanical properties of the InternalBrace in a Lisfranc injury model. However, it is unknown whether there is significant difference in the biomechanical properties of the IB compared to the screw, or SB during load to failure, and cyclical loading.Methods:Three groups of sawbones were fixed together with either a 3.5 mm screw, SB, or IB, composed of a curved button, fibertape, and 4.75 mm biotenodesis screw. Sawbone constructs were held in a mechanical testing system (Model 809, MTS Systems Corp, Minneapolis MN). The first three groups of 10 were loaded in axial tension at 0.5mm/sec until failure to determine load-displacement data. Yield, stiffness, ultimate strength (US), yield energy, post-yield energy and ultimate strength energy were calculated. Three more groups of 8 constructs were loaded in-vitro at cyclical physiologic loads until displacement of 1.5 mm occurred. Constructs were first loaded for 10,000 cycles at 69 N (estimate for 50% body weight or assisted walking). Surviving specimens were loaded at 138 N (normal walk) for an additional 10,000 cycles and then 207 N (jog) for an additional 10,000 cycles. Displacement was recorded. The biomechanical properties were then compared between groups.Results:When loaded in axial tension at 0.5mm/sec until failure, the screw was found to be the stiffest construct (2,240 N/mm), while the InternalBrace (200 N/mm) was stiffer than the suture button (133 N/mm). Qualitatively, the InternalBrace was also found to hold load more consistently and for larger displacement prior to failure when compared to the suture button. Cyclic loading was performed with 10,000 cycles of 69 N, 138 N, and 207 N. The screw had the greatest resistance to fatigue. The InternalBrace maintained stiffness as well or better than the suture button, but the fatigue life was shorter than that of the suture button.Conclusion:To our knowledge, the biomechanical properties of the IB have not been compared to screw and SB for ligamentous lisfranc injuries. This study gives valuable information about the mechanical integrity of InternalBrace and supports continued use. However, further studies are warranted before making conclusions regarding early weight bearing.

Third-Generation Minimally Invasive Chevron Akin Osteotomy for Hallux Valgus.

Multiple operative techniques have been developed for hallux valgus with varying success. The most recent developments in minimally invasive surgery have evolved into the third-generation minimally invasive chevron Akin (MICA) osteotomy. Good results have been shown from originator centers, but this is one of the first series from a nonoriginator center, and the first to use a validated patient-reported outcome measure. Forty consecutive patients undergoing third-generation MICA for hallux valgus were included. Primary outcome measures included Manchester-Oxford Foot Questionnaire (MOXFQ) and American Orthopaedic Foot & Ankle Society (AOFAS) scores and Coughlin satisfaction rates at 12 months. Secondary outcome measures included radiographic parameters, complications, and recurrence rates. At 12 months, the MOXFQ score improved from 58 to 10 and the AOFAS score improved from 48 to 93, with 70% of patients reporting excellent outcomes and 30% good ones. Two cases started as mild, 29 cases as moderate, and 9 cases as severe as defined by radiographic criteria. Hallux valgus angles improved from 32 degrees to 12 degrees, and intermetatarsal angles improved from 13 degrees to 7 degrees. There were 4 cases of Akin screw removal for soft tissue irritation. There were no other complications, including recurrence. The third-generation MICA technique was a safe and effective approach to treating hallux valgus. Further research should focus on long-term outcomes and comparative data with other commonly performed operative techniques. Level IV, case series.

Selection of Site for Administration of Intramuscular Injection to Adult Patients by Nurses: A Cross-Sectional Study

Objective: This study was carried out to determine the sites which are selected by nurses to use in the intramuscular medicine applications and the factors affecting the selection of the injection sites.Methods: The population of this descriptive and cross-sectional type of study was composed of 250 nurses working in two hospitals in Istanbul, the sample was composed of 171 nurses selected by stratified random sampling method. Data were collected with ‘Structured Questionnaire Form’.Results: The average age of the nurses was found to be 26.27±7.46 years, it was determined that 40.4% of them applied injection very often and they preferred dorsogluteal site to apply injection with a ratio of 83.6%. When the knowledge level of nurses about the complications that may occur depending injection site, it was seen that some nurses did not consider complications such as pain, nerve, bone and vascular injury, infection, necrosis, tissue irritation, nodules or stiffness, abscess and hematoma in the deltoid site. On the other hand, it was learnt that they had a risk of developing sciatic nerve damage in the ventrogluteal site. The unit, which the nurses work and the experience period in that unit affects the site selection in injection application. As a result, nurses often prefer the dorsogluteal site in injection. Conclusion: The nurses’ knowledge about the complications that may ocur in the sites chosen for injection by them is insufficient and there are factors affecting the selection of the site.

Anatomy of clavicle in the Indian population and its applicability in pre-contoured plating.

Fractures of the clavicle are traditionally treated non-operatively, but with the increase of high-energy trauma, there has been an increase in the operative management of these fractures. Controversy exists on the type of fixation for middle third clavicle fractures. The anatomically pre-contoured plates are low-profile mechanically sound plates which do not cause much soft tissue irritation. To characterise the clavicular morphology through computerised tomography and determine the applicability of pre-contoured plates for our population. In this study, the mean total length was 145.31mm and the apex of superior clavicle bow was located 38.15mm from the acromial end, thereby giving a zone of 107.16mm for plating. In the 107.16mm of platable zone, the zone of ideal fracture location was 43.16mm. Superior anterior plates had a good fit in 89.3% of the CT subset, whereas superior plates had a good fit in only 71.6% of the population. Superior anterior pre-contoured clavicle plates have approximately 98% good to fair compatibility for clavicles in the South Indian population without any need for further intra-operative moulding.

The modified anterior ellipsoidal cap titanium cable tension band for comminuted patellar fractures.

The purpose of this study was to assess the outcomes in a series of patients, who underwent cerclage and figure-of-eight tension band wiring using a single titanium cable for comminuted patellar fractures. We describe a modified tension band technique using a single titanium cable to create an ellipsoidal cap structure that combines the circumferential and figure-of-eight wrapping in the fixation of closed Association for the Study of Internal Fixation/Orthopaedic Trauma Association 34C2 and 34C3 patellar fractures. We retrospectively reviewed 25 patients (16 males and 9 females, mean age 54 years) who underwent the described fixation technique between 2015 and 2017. Postoperative function was evaluated using the Böstman score. At the mean follow-up of 25 months (range 17-39 months), the mean Böstman score was 27.3 ± 2.6 points (range 23-30). Eighteen patients (72%) had excellent results (score ≥28); seven patients (28%) had good results (score 20-27); and no patients had an unsatisfactory result (score < 20). All surgical incisions healed without major wound complications. Two patients reported minor complications (soft tissue irritation, cellulitis). No patients demonstrated loss of reduction or implant failure during the follow-up period. The modified anterior ellipsoidal cap tension band using a single titanium cable created an effective tension band structure in the treatment of comminuted patella fractures. It is a simple operative technique that produced a stable fixation construct, which allowed early functional rehabilitation and weight-bearing with a high rate of excellent outcomes at 2 years after surgery.

Tissue Friendly Pendulum: Soft Liner to prevent Tissue Irritation

Palatal mucosal irritation is commonly encountered with the Pendulum appliance. The efficiency of soft liners in reducing tissue irritation has been well documented in the field of prosthodontics. The following article describes an innovative technique where soft liner can be used to reduce palatal mucosal irritation caused by pendulum appliance.

Pyogenic granuloma after a non-sutured transconjunctival blepharoplasty in the lower eyelid

Pyogenic granuloma (PG) is a vasoproliferative inflammatory response composed of granulation tissue. The pathogenesis is not entirely clear. Pyogenic granuloma was found involving the skin or mucosal surfaces, and it is associated with tissue irritation or inflammation. Pyogenic granuloma as a complication after blepharoplasty is uncommon. The treatment is simple and saves the patients from the discomfort caused by the lesion. Surgical excision is effective in patients who do not improve with a local application of steroids. We describe two cases of uncommon pyogenic granuloma occurring after lower transconjunctival blepharoplasty, with no suture and alert ophthalmologists and oculoplastic surgeons to the possibility of encountering and treating these lesions. Level of Evidence: Level V, therapeutic/diagnostic study.

Gradient-Induced Mechanical Vibration of Neural Interfaces During MRI.

Resonant vibrations of implanted structures during a magnetic resonance imaging (MRI) procedure pose a risk to the patient in the form of soft tissue irritation and degradation of the implant. In this paper, the mechanical behavior of implant structures in air, water, and viscoelastic materials was explored. The static and dynamic transfer functions of various test samples in air and immersed in both water and hydrogels were analyzed. The laser-based acquisition method allowed for high-angular-resolution (10 μDeg) and high-dynamic-range (0-6 kHz) measurements. Additional MRI experiments were conducted to investigate the dependence of vibration strength on magnetic resonance (MR) sequence parameters in combination with the obtained transfer functions. The largest forces were found to be in the micronewton to millinewton range, which is comparable to forces applied during implantation. Of additional concern was the damping introduced by viscoelastic tissue, which was less than expected, leading to an underdamped system. In contrast to current wisdom, the imaging experiments demonstrated drastically different vibration amplitudes for identical gradient slew rates, but different timing parameters TR, mainly due to resonant amplification. The results showed that a safe force-free MR procedure depends not only on the gradient slew rate, but also and more drastically on the choice of secure timing parameters. These findings delineate design improvements to achieve longevity of implants and will lead to increased patient safety during MRI. A prudent choice of mechanical characteristics of implanted structures is sufficient to avoid resonant excitation due to mismatched MR sequence parameters.

Cardiac Pulsatility– and Respiratory-Induced Deformations of the Renal Arteries and Snorkel Stents After Snorkel Endovascular Aneurysm Sealing

Purpose: To quantify deformations of renal arteries and snorkel stents after snorkel endovascular aneurysm sealing (Sn-EVAS) resulting from cardiac pulsatility and respiration and compare these deformations to patients with untreated abdominal aortic aneurysms (AAA) and snorkel endovascular aneurysm repair (Sn-EVAR). Materials and Methods: Ten Sn-EVAS patients (mean age 75±6 years; 8 men) were scanned with cardiac-gated, respiration-resolved computed tomography angiography. From 3-dimensional geometric models, changes in renal artery and stent angulation and curvature due to cardiac pulsatility and respiration were quantified. Respiration-induced motions were compared with those of 16 previously reported untreated AAA patients and 11 Sn-EVAR patients. Results: Renal artery bending at the stent end was greater for respiratory vs cardiac influences (6°±7° vs −1°±2°, p<0.025). Respiration caused a 3-fold greater deformation on the left renal artery as compared with the right side. Maximum curvature change was higher for respiratory vs cardiac influences (0.49±0.29 vs 0.24±0.17 cm−1, p<0.025), and snorkel renal stents experienced similar maximum curvature change due to cardiac pulsatility and respiration (0.14±0.10 vs 0.19±0.09 cm−1, p=0.142). When comparing the 3 patient cohorts for respiratory-induced deformation, there was significant renal branch angulation in untreated AAAs, but not in Sn-EVAR or Sn-EVAS, and there was significant bending at the stent end in Sn-EVAR and Sn-EVAS. Maximum curvature change due to respiration was ~10-fold greater in Sn-EVAR and Sn-EVAS compared to untreated AAAs. Conclusion: The findings suggest that cardiac and respiratory influences may challenge the mechanical durability of snorkel stents of Sn-EVAS; similarly, however, respiration may be the primary culprit for tissue irritation, increasing the risk for stent-end thrombosis, especially in the left renal artery. The bending stiffness of snorkel stents in both the Sn-EVAR and Sn-EVAS cohorts damped renal branch angulation while it intensified bending of the artery distal to the snorkel stent. Understanding these device-to-artery interactions is critical as they may affect mechanical durability of branch stents and quality and durability of treatment.

Complications of Low-Profile Plate Fixation of Phalanx Fractures.

Background: Phalanx fractures are common, and plate fixation can be used to treat difficult fractures. Major complications have been reported in up to 64% of phalanx fractures treated with plate fixation, with stiffness being the most common. Low-profile anatomic plates (LPAP) have been designed to decrease soft tissue irritation and postoperative stiffness. The objective of this study was to determine whether the use of LPAP has decreased complications in plate fixation of phalanx fractures. Methods: A retrospective chart review was performed of patients with phalanx fractures treated with open reduction and internal fixation (ORIF) using LPAP at a single institution from January 1, 2010, to January 25, 2018. Twenty-three patients with 23 phalanx fractures treated with LPAP were included. The primary outcome was the presence of a complication. Results: Of the 23 patients, 12 patients (52.2%) had a postoperative complication. Nine patients (39.1%) required return to the operating room, with 7 (30.4%) returning for removal of hardware and tenolysis/capsulotomy. Two patients (8.7%) had superficial infections, one requiring irrigation and debridement. The other infection resolved clinically after 2 courses of oral antibiotics, with the fracture going on to nonunion. One patient had delayed wound healing treated prophylactically with cephalexin; although the wound healed, the patient developed a boutonniere deformity requiring surgery. There were 2 malunions (8.7%), one requiring revision surgery and the other electing for nonoperative management. All but one fracture progressed to union. Conclusions: ORIF with LPAP consistently achieves fracture union for phalanx fractures, but it does not appear that LPAP reduce the high complication rate.

Application of self-prepared Kirschner wire retractor reduction and internal fixation through ulnar dorsal approach for the treatment of Bennett fractures

Objective To explore the clinical efficacy of self-prepared Kirschner wire retractor reduction and internal fixation through ulnar dorsal approach in the treatment of Bennett fractures. Methods From July 2014 to February 2018, 13 patients with Bennett fractures were treated. The first carpometacarpal ulnar dorsal approach was designed to expose the fracture and articular surface. The reduction was performed using self-prepared Kirschner wire retractor, and then the fracture was fixed with Kirschner wires. Early functional exercise was performed after the operation, and Kirschner wire was removed after 4 to 6 weeks. Results All the patients were follow-up for 6 to 24 months postoperatively with an average of 14.6 months. All the incisions achieved primary healing. Bone healing was achieved in all the patients, and the pre-traumatic activity was restored 10 weeks after the operation. The VAS score ranged from 0 to 3 with an average of 1.46. The function of affected finger was evaluated by total active motion (TAM) assessment and the results were rated as excellent in 11 cases and good in 2 cases. One patient had redness and swelling in the needle track, while the other patients had no complications such as infection of the needle track, irritation of surrounding soft tissue, loosening of Kirschner needle and re-dislocation of joint. Conclusion The method of reduction and fixation of Bennett fractures through ulnar dorsal approach using self-prepared Kirschner wire retractor proves to be simple and reliable, which is worthy of clinical application. Key words: Fractures,bone; Treatment outcome; Internal fixator; Reduction

Temperature-dependent in Situ Gel of Clotrimazole: an Experimental Study

The in-situ gel-forming polymeric formulations offer sustained and prolonged action in comparison to conventional drug delivery systems. To formulate and evaluate in situ vaginal gel of clotrimazole. Poloxamer 407 (20%) was slowly added to freezing water (5°C) with constant stirring. The prepared dispersion was refrigerated for 5 h, the different concentrations of polymers were added for preliminary batches. Differential scanning calorimetry (DSC) and Fourier transform infrared spectroscopy (FTIR) were performed for clotrimazole-excipients compatibility study. The final batch was prepared and evaluated for physicochemical parameters, in vitro clotrimazole release, in vitro antifungal activity, and in vivo vaginal tissue irritation test. The compatibility study showed no chemical interaction between clotrimazole and excipients used. The evaluation parameters showed that clotrimazole release was in the range of 8 to 10 h, gelling temperature was in the range of 27-35°C, gelling time was in the range of 28-34 sec, pH was in the range of 4.4-4.8, and viscosities were in the range of 16.4-182.6 cP (solution form) and 10,500-20,756 cP (gel form). The zone of inhibitions for clotrimazole pure drug, the marketed vaginal gel of clotrimazole, and optimized gel formulation was 9.15±0.75 mm, 14.35±1.12 mm, and 18.85±1.56 mm, respectively (p < 0.0001, q = 5.98). An optimized gel formulation was not irritant to vaginal tissue. It was possible to formulate effective in situ vaginal gel for control release action of clotrimazole. IIC.

Clinical Application and Outcomes of Upper Extremity Double Plating.

Dual plating in fractures of the upper extremity is well established for the distal humerus. The indication for the use of dual plating has been expanded over the last few years. While dual plating was originally frequently used in revisions of non-unions, it is nowadays also used in primary fixation of diverse complex fractures of the upper extremity. The high biomechanical fixation strength of dual plating is advantageous in regions with high bending and torsional stresses, such as the humeral shaft. An additional anterior plate provides high fixation strength and reduces the risk of loss of reduction in complex proximal humeral fractures and allows for direct fixation of lesser tuberosity fragments. Low-profile plates have been introduced for complex proximal ulna fractures. In dual plating the improved mechanical stability is combined with a reduced risk of implant related soft tissue irritations. The present article provides an overview of current indications for dual plating of upper extremity fractures and outlines technical aspects as well as advantages over conventional fixation techniques.

Uji Mutu Ekstrak Daun Sirsak (Annona muricata Linn.) Yang Di Ekstraksi Secara Maserasi Dengan Pelarut Etanol 70%

Background : Gastric ulcer is wound to the mucosal layer (epithelial layer) of the stomach and mucosal irritation of 5 mm or more in diameter with depth down to submucosa. The basic pathogenesis of gastric ulcers in when there is an imbalance of aggressive factor enhancement. Non-steroidal antiinflammantory drug can cause stomach ulcers in two ways, either directly or topical irritation of the epithelial tissue and inhibit the endogeneous system of gastrointestinal mucosa of prostaglandins. In this case inhibition of prostaglandin systhesis is the dominant factor of peptic ulcers by NSAIDs.&#x0D; Objectives : The purpose of this study was to determine the effct of NSAID drug administration on the formation of peptic ulcers and to know the difference in the rate of formation of peptic ulcers from each class.&#x0D; Method : Sampel method mice performed surgery on the stomach is done in Pharmacology Laboratory of Pharmacy Institute Deli Husada Deli Tua.&#x0D; Results : The results of this study indicate that faster drugs cause gastric ulcers with a degree of redness are Aspirin 4.03 mm, 2.01 mm mefenamat and 1.02 mm Diclofenac Sodium while Ibuprofen mwdication does not cause peptic ulcers.&#x0D; Conclusion : The results of this study it can be concluded that Aspirin administration with doses of 21 mg/kg faster causes gastric ulcers from other NSAID groups such as Mefenamat with a dose of 21 mg/kg BW, Diclofenac sodium at a dose of 2 mg/kg while administration, Ibuprofen for ten days does not couse ulcers in the stomach of experimetal animals.

SUN-LB070 Who Killed the Pituitary?

Background: Pituitary apoplexy can be caused by factors like surgery, pregnancy, drugs including anticoagulants and bromocriptine. Chemotherapy as a causal factor, however, has not often been noted in literature. To our knowledge, there are only 2 case reports implicating chemotherapy drugs as a cause of pituitary apoplexy. 1 Case: 72 year old male with recently discovered squamous cell lung cancer, presented to clinic for assessment of incidental pituitary mass noted on staging imaging. Initial labs showed hypogonadotropic hypogonadism with normal PRL, TSH and HPA axis. Transphenoidal biopsy of mass showed no metastasis. Subsequently, he was started on carboplatin and paclitaxel for lung cancer. Initial course was complicated by deep venous thrombosis treated with enoxaparin. After his sixth chemotherapy cycle, he presented with sudden onset headache and diplopia consistent with sixth cranial nerve palsy. Initial CT head was negative for hemorrhage and stable, though hypoenhancing sellar mass. Sixth nerve palsy was initially thought to be due to microvascular ischemic event. Labs at this time were notable for undetectable PRL, low TSH (0.03 uIU/ml, N 0.35-4.9 uIU/ml), declining ACTH (14 to 9 pg/ml, N 6-50 pg/ml). He developed significant hyponatremia, concerning for central adrenal insufficiency, requiring urgent treatment with stress dose steroids. Pituitary MRI newly showed enlarging sellar mass, defect in dura and retroclival collection, later thought to be necrotic material from apoplectic pituitary. Surgical intervention was deferred as ophthalmology exam showed no pituitary compromise. After 12 days, he was readmitted with atraumatic bilateral subdural hematomas (SDHs) prompting enoxaparin cessation. Imaging at this time also showed decreased size of the mass. Follow up imaging showed resolution of SDHs with interval reduction of mass size. On final review, his presentation was suspected to be secondary to pituitary apoplexy due to chemotherapy in conjunction with enoxaparin, causing retroclival necrotic tissue and meningeal irritation leading to atraumatic SDHs. Given absence of hemorrhage on initial imaging and known vasculopathic effects of agents like carboplatin (analog of cisplatin), chemotherapy induced apoplexy cannot be excluded. In addition, although rapid regression after pituitary apoplexy has been reported rarely, chemotherapy may have a role in rapid shrinkage post apoplexy. 2 Conclusion: This case highlights potential role of chemotherapy in conjunction with anticoagulation in causing pituitary apoplexy and rapid pituitary tumor shrinkage. Reference: 1. Jang, Je Hun et al. Extensive Pituitary Apoplexy after Chemotherapy in a Patient with Metastatic Breast Cancer Brain tumor research and treatment vol. 6,1: 43-46 2. Jackson, D. L et al. Rapid pituitary apoplexy regression: what is the time course of clot resolution? Case reports in radiology, 2015 Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Clinical application of intraosseous internal fixation in ankle-foot arthrodesis

Objective To investigate the short-to medium-term therapeutic effects of a new internal fixation device, intraosseous internal fixation (IO-FIX), in the foot-ankle arthrodesis. Methods From August 2016 to December 2018, 32 patients (40 feet) underwent foot-ankle arthrodesis with IO-FIX at De-partment of Orthopaedic Surgery, The Ninth People’s Hospital of Shanghai.They were 6 males and 26 fe-males, aged from 23 to 83 years (61.7±15.1 years).There were 28 cases (36 feet) of hallux valgus, 2 cases (2 feet) of ankle arthritis, one case (1 foot) of ankle rheumatoid arthritis and one case (1 foot) of naviculocuneiform arthrosis.The therapeutic effects were assessed in terms of imaging evaluation, American Orthopaedic Foot and Ankle Society (AOFAS) score, fusion rate and full weight-bearing time. Results The follow-up ranged from 3.0 to 31.3 months (mean, 12.6 months).The total fusion rate was 95.0%(38/40); the total AOFAS score increased significantly from preoperative 41.9±9.5 to postoperative 86.9±4.7 (P< 0.05).The 28 patients (36 feet) with hallux valgus achieved a successful fusion rate of 97.2%(35/36) and full weight-bearing at 8 weeks after operation.Their fusion time ranged from 45 to 64 days (57.1 days).Their metatarsophalangeal angle was decreased significantly from 52.1°±13.5° preoperatively to 13.4°±4.9° postoperatively and their 1-2 intermetatarsal angle significantly from 14.5°±2.4° to 8.9°±2.4° (P<0.05). Their AOFAS ankle-hindfoot score was improved significantly from 41.8±9.9 to 87.0±4.8 (P<0.05). All the 3 cases of ankle arthrodesis achieved good bone union and full weight-bearing within 12 weeks and their AOFAS ankle-hindfoot score was improved significantly from preoperative 43.4±3.5 to 86.3±3.5 at the final follow-up. Conclusion In foot-ankle joint arthrodesis, due to advantages of stable fixation, zero profile, limited soft tissue irritation, reinforced bone bridge and easy reproducibility, IO-FIX can lead to satisfactory short-to mid-term therapeutic effects. Key words: Foot; Arthrodesis; Internal fixators

Pengaruh Kecepatan Pembentukan Tukak Lambung Terhadap Pemberian Berbagai Golongan NSAID Pada Tikus Jantan

Background : Gastric ulcer is wound to the mucosal layer (epithelial layer) of the stomach and mucosal irritation of 5 mm or more in diameter with depth down to submucosa. The basic pathogenesis of gastric ulcers in when there is an imbalance of aggressive factor enhancement. Non-steroidal antiinflammantory drug can cause stomach ulcers in two ways, either directly or topical irritation of the epithelial tissue and inhibit the endogeneous system of gastrointestinal mucosa of prostaglandins. In this case inhibition of prostaglandin systhesis is the dominant factor of peptic ulcers by NSAIDs.&#x0D; &#x0D; Objectives : The purpose of this study was to determine the effct of NSAID drug administration on the formation of peptic ulcers and to know the difference in the rate of formation of peptic ulcers from each class.&#x0D; &#x0D; Method : Sampel method mice performed surgery on the stomach is done in Pharmacology Laboratory of Pharmacy Institute Deli Husada Deli Tua.&#x0D; &#x0D; Results : The results of this study indicate that faster drugs cause gastric ulcers with a degree of redness are Aspirin 4.03 mm, 2.01 mm mefenamat and 1.02 mm Diclofenac Sodium while Ibuprofen mwdication does not cause peptic ulcers.&#x0D; &#x0D; Conclusion : The results of this study it can be concluded that Aspirin administration with doses of 21 mg/kg faster causes gastric ulcers from other NSAID groups such as Mefenamat with a dose of 21 mg/kg BW, Diclofenac sodium at a dose of 2 mg/kg while administration, Ibuprofen for ten days does not couse ulcers in the stomach of experimetal animals.

Clinically Asymptomatic Patients Show a High Bacterial Colonization Rate of Osteosynthetic Implants Around the Knee but Not the Hip

BackgroundPatients with osteosynthetic implants around the hip and knee show higher infection rates after joint arthroplasty. Our aim was to evaluate the bacterial colonization of any osteosynthetic implants around the hip and knee in patients without clinical signs of infection. MethodsConsecutive patients with osteosynthetic implant removal because of related soft tissue irritations or before elective total joint arthroplasty of the hip and knee were prospectively included. Patients with signs of infection were excluded. Based on sonication fluid cultures, implants were classified according to microbial growth as negative (no growth), contaminated (nonsignificant growth), or colonized (significant growth). ResultsSonication cultures were positive in 54 of 203 implants (27%), including 8 of 34 (24%) after orthopedic and 46 of 169 (27%) after traumatological surgery. Of 203 sonication cultures, 22 (11%) grew significant bacterial counts. Most common microorganisms were coagulase-negative staphylococci (46%). Implants around the knee showed a significantly higher rate of positive sonication cultures compared with those around the hip (14% vs 2%, P = .017). ConclusionsWe detected high bacterial implant colonization rates regardless of the initial type of surgery. Predominant pathogens were staphylococci, the most common causative agents of periprosthetic joint infections. Positive sonication results do not necessarily lead to postoperative surgical complications and thus do not equal infection. It remains unclear if patients with evidence of bacterial implant colonization show a higher risk of periprosthetic joint infection after adjacent subsequent total joint arthroplasty. Nevertheless, surgeons should be aware of a significantly higher colonization rate of implants around the knee and take this into consideration when total knee arthroplasty is scheduled in patients with osteosynthetic devices.

Antidotes for Acute Cannabinoid Intoxication

The cannabis constituent Δ9‐tetrahydrocannabinol (THC), now being legalized for recreational and medical use, exerts its psychotropic effects (marijuana “high”) via CB1 receptor activation. Synthetic psychoactive cannabinoids (SPCs) such as JWH‐018, illegally sold as “designer drugs”, mimic the effects of THC, a CB1 partial agonist, with higher potency, acting via CB1 receptors. Although acute toxicity is benign for consuming high doses of THC, patients admitted to the ER may exhibit symptoms of hyperemesis, irritation of conjunctival and bronchial tissue, along with impaired cognition and motor skills. SPCs act as full CB1R agonists wherein clinical manifestations associated with their consumption include, neurotoxicity represented by several negative behavioral outcomes, and even death. While such adverse events may differ among patients, current adjunctive treatments include intubation, use of benzodiazepines, antipsychotics, antihistamines, adenosine, and hypnotics, along with i.v. saline, and supportive care. Currently, there are no effective treatments available for directly blocking and reversing the effects of cannabinoid poisoning. To address this critical public‐health issue, we have initiated a drug discovery program to develop antidotes that can counteract the intoxicating/adverse effects of CB1 activation and be therapeutically useful in an emergency setting. Although CB1 antagonists such as rimonabant appear to be promising pharmacotherapeutics, this class of drugs are known to produce nausea and unacceptable pro‐depressant effects. We have now discovered a novel class of potent, selective and brain penetrant CB1 antagonists, displaying better safety profiles as compared to rimonabant. In male CD‐1 mice, these novel CB1 antagonists represented by AM11503 (10 mg/kg, i.v), antagonized the hypothermic effect induced by THC (30 mg/kg, i.p.) and was equipotent to rimonabant (10 mg/kg, i.v.) in rapidly normalizing (≤ 60 min, post‐antagonist) the hypothermia induced by an acute dose of JWH‐018 (6 mg/kg, i.p). To mimic an ER‐like situation, antagonists were given i.v., 60 min post‐ JWH‐018, where the agonist effect is at its maximum. AM11503 (10 mg/kg, i.v or 18 mg/kg, i.p) displayed no side‐effects when compared to rimonabant and AM251, which, at similar doses, induced significant stereotypic behavior (pruritic responses). Remarkably, when tested for their ability to block the neurotoxic effects of SPCs, AM11503 (10 mg/kg, i.v.) fully blocked tremors and convulsions induced by “suprapharmacological” doses of JWH‐018 (18 mg/kg, i.p). Lead optimization efforts along with safety and efficacy studies are further underway. Here, we established proof‐of‐concept and present preliminary data towards developing the first specific antidote for cannabinoid intoxication.Support or Funding InformationSupported by NIDA/NIH grant DA045882 (to KV)This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.