Mean Clinical Score Research Articles

Total talar prosthesis with and without ankle ligament reconstruction using the three-dimensional computer-aided design and computer numerical control manufacturing techniques.

Severe damage and bone loss of the talus are problematic issues because of its unique shape, function, and characteristics. This present study’s objective is to propose the process of customized total talar prosthesis manufacturing, using three-dimensional (3D) Computer-Aided Design (CAD) with Computer Numerical Control (CNC) production along with evaluation of the results of total talar prosthesis replacement with or without ankle ligament reconstruction in patients with severe conditions of talus. The case series included five patients (mean age: 27.6 years) with severe talar loss or damage. The mean follow-up time was 17.8±8.4 months. Related complications were: i) mild subsidence in 1 patient (20%) and ii) periprosthetic fracture in another patient (20%). The mean clinical scores including VAS-FA and SF-36 were improved following surgeries. Customized total talar prosthesis appears to provide satisfactory outcomes for the treatment of severe talar loss or damage at a short-term follow-up.

Meniscal polyurethane scaffold plus cartilage repair in post meniscectomy syndrome patients without malalignment improves clinical outcomes at mid-term follow-up

BackgroundThe aim of this study is to report the mid-term follow-up results of a prospective cohort of patients who underwent a polyurethane (PU) meniscal scaffold implantation for post meniscectomy syndrome (PMS), without limb realignment procedures. MethodsProspective study in patients with PU meniscal scaffolds implanted during 2014–2016. Limb realignment procedures excluded. Clinical outcomes were prospectively evaluated pre-operatively and every year post-operatively using patient-reported outcome scores (KOOS, VAS, Lysholm and IKDC). Post-operative radiologic evaluation was done using 3.0 T magnetic resonance imaging (MRI). Meniscal scaffold extrusion, signal intensity, tibio-femoral cartilage degeneration progression and complications were analyzed. ResultsFourteen patients with an average age of 25.8 years (range: 17–47) received a PU scaffold (8 lateral and 6 medial). Associated procedures were done in all patients, with an osteochondral allograft transplantation (OAT) being the most common. Mean follow up was 51.6 (range: 39–66) months. Post-operative mean clinical outcomes scores showed significantly improved results compared to the pre-operative scores. Lysholm scores increased from 62.4 to 80.2 (P = 0.0023), KOOS from 68.9 to 80 (P = 0.0083) and VAS for pain decreased from 5.3 to 3.1 (P = 0.0024). Average post-operative IKDC score was 67.7. There were 8 cases of complete extrusion (>3 mm). The mean extrusion value was 4.0 mm (range: 3–6 mm). Three patients showed signs of a ruptured meniscal scaffold. One patient showed progression of the cartilage degenerative process. ConclusionThe use of a PU scaffold, associated with other surgical procedures in the knee, especially chondral repair, had a significant improvement in clinical outcomes compared to the baseline status, at an average of 51.6 months follow-up in patients suffering from PMS. Although imaging results show a high proportion of implant extrusion, this does not appear to imply a worsening in clinical outcomes in the short term. Level of evidenceIV. Case series.

Do Rockwood frailty score and Charlson comorbidity index help to risk stratify outpatient versus inpatient management of acute decompensated heart failure?

Abstract Introduction Acute decompensated heart failure (ADHF) is associated with frailty and co-morbidities which influence prognosis. The Rockwood Frailty Score (RFS) and age-adjusted Charlson co-morbidity index (CCI) have been used to predict outcomes in hospitalised ADHF patients. Purpose To describe the relationship of CCI, RFS and clinical risk score -Get With The Guidelines Score (GWTG) with mortality in ADHF treated as outpatients (OP) versus hospitalised inpatients (IP). Methods This retrospective analysis compared 2 cohorts of consecutive ADHF patients - hospitalised in-patients (IP) versus outpatients (OP) who were treated with bolus intravenous diuretics in a specialist heart failure nurse delivered OP HF unit (Ambulatory HF Unit -AHFU) with input from various specialties (renal, palliative, ascitic, pleural teams) from Nov 16 to Dec 17. Mean follow-up duration was similar for both groups (IP=19.5±4.1 months; OP=19.3±3.9 months, p=0.6). Mortality was compared at 1, 3 and 12 months based on RFS (no frailty <5, mild to moderate frailty 5/6, severe frailty - 7 to 9). Results were expressed as mean±SD and analysed using One-Way ANOVA and Chi-squared with Fisher's exact test test. Results 410 consecutive patients (482 admissions) were hospitalised (inpatients -IP) and 231 OP (289 OP visits) were treated in the AHFU. IP group had significantly higher mean CCI (IP=6.55±2; OP=6.10±1.9; p=0.006) and mean RFS (IP 5.2±1.2; OP 4.9±1.1; p=0.002). Mean Clinical Risk Score GWTG was similar (IP=38.9±7.2; OP=38.4±6.6; p=0.44). Mean survival was significantly lower in IP (IP=378±270 days; OP=437±228; P=0.003). As shown in the table higher RFS predicts increased mortality risk (1 month, 3 month and 12 month). Conclusions Rockwood Frailty Score predicts mortality in ADHF and assessment of RFS can play an important role in risk stratifying and decision-making in addition to clinical risk-scores, with regards to suitability for outpatient treatment of ADHF. Funding Acknowledgement Type of funding source: None

Local curvature mismatch may worsen the midterm functional outcomes of osteochondral allograft transplantation.

This study aimed to determine the magnitude of local curvature matching in the sagittal plane between an implanted graft and the condylar region receiving the graft and to analyze its effect on clinical outcomes in patients undergoing osteochondral allograft transplantation (OCA). Patients who underwent knee OCA between 2016 and 2019 without circumferential step-off and were matched with a donor in accordance with the conventional matching process were included. The magnitude of donor-host local curvature matching was measured using postoperative sagittal magnetic resonance imaging data with Syngo (Siemens Medical Solutions, Forchheim, Germany) and GeoGebra (GeoGebra GmbH, Linz, AU) software. In addition to radiological evaluation, ROC analysis was performed to compare the patient-reported outcome measures (PROMs) obtained during the 2-year follow-up period among the patients in the SagA group, who had a graft match in the sagittal plane; SagB group, who had low convexity of the graft in the sagittal plane; and SagC group, who had high convexity of the graft in the sagittal plane in accordance with the determined indices. The study included 27 patients who fulfilled the inclusion criteria, and the mean clinical scores of the SagC group were not statistically significantly higher than those of the other groups at any timepoint during the follow-up. The mean Tegner, IKDC, total KOOS and SF-12 physical and mental health scores of the SagC group were lower than those of the other two groups at various follow-up time points, particularly at month 24 (p < 0.05). There were no significant differences between the SagA and SagB groups in the PROMs at any of the follow-up time points (n.s.). The significant differences observed between the SagC group and the other groups in the mean KOOS scores for function in daily living and function in sport and recreation were also observed between the SagA and SagB groups at the follow-ups (p < 0.05). During OCA, a local curvature mismatch between the donor and the host involving large graft convexity may have a negative impact on midterm clinical outcomes. A preoperative analysis of the convexity relationship between the defect site and the graft region in the hemicondylar allograft to be used may enhance donor-host matching. The local analysis method described in the current study may also facilitate graft supply by ensuring donor-host matching without condyle-side and size matching. III.

Human placental extract attenuates neurological symptoms in the experimental autoimmune encephalomyelitis model of multiple sclerosis-a putative approach in MS disease?

BackgroundDifferent studies have demonstrated the anti-inflammatory effects of human placental extract both in vivo and in vitro. Considering the chronic inflammatory nature of multiple sclerosis (MS) disease, we examined whether or not the administration of human placental extract is able to attenuate the neurological symptoms detected in experimental autoimmune encephalomyelitis (EAE) model of MS.MethodsThe injected myelin oligodendrocyte glycoprotein (MOG) induced EAE in mice, and treatment began from day 4 post-injection by intraperitoneal administration of 20 mg/kg human placental extract, repeated every other day up to day 31 post-injection. At the end of the treatment, luxol fast blue (LBS) staining and hematoxylin and eosin (H&E) staining were performed to evaluate the demyelination of neurons and inflammatory responses, respectively. Further assessed were the serum concentrations of IL-23 and IL-27.ResultsThe administration of human placental extract was able to significantly reduce the mean clinical score in EAE mice, decrease the pro-inflammatory process and attenuate neural demyelination. Moreover, while the serum concentration of IL-23 was significantly diminished in the EAE mice receiving human placental extract compared to the non-treated EAE group, IL-27 concentration was significantly increased.ConclusionsOur findings demonstrated the administration of human placental extract could significantly attenuate the neurological symptoms in the EAE model of MS in part through modulating the serum levels of IL-23 and IL-27 and enhancing neuroprotection and myelin repair.

Vagus Nerve Stimulation in Patients Receiving Maintenance Therapy With Electroconvulsive Therapy: A Series of 10 Cases.

Electroconvulsive therapy (ECT) is a mainstay in both acute and long-term management of difficult-to-treat depression. However, frequent acute courses of ECT or prolonged maintenance ECT treatment may increase adverse-effect burden and/or reduce patient acceptability. Therefore, we investigated the effectiveness of adjunctive vagus nerve stimulation (VNS) therapy as an alternative strategy for long-term maintenance treatment in ECT-responsive patients. This retrospective chart review identified maintenance ECT patients with unipolar (n = 5) and bipolar depression (n = 5) from 2 large hospital systems who had a history of ECT response, but the patients had significant residual incapacitating symptoms or increasing concerns regarding the burden associated with ECT and opted to receive adjunctive VNS therapy. The patients were followed for 2 years after VNS implantation. Response and remission were defined as Clinical Global Impression-Severity scale scores of ≤2 and 1, respectively, obtained at 1- and 2-year postimplantation compared with just before VNS implantation. One-year postimplantation, 6 of 10 had responded of which 5 met remission criteria. All 10 patients benefited from adjunctive VNS therapy with either fewer hospitalizations and/or ECT sessions. Seven of 10 stopped maintenance ECT by the end of year 1; an additional patient stopped maintenance ECT by year 2. No patients required an acute course of ECT during the 2-year follow-up. There was a statistically significant reduction (P < 0.0001) in mean (SD) Clinical Global Impression-Severity scale scores between baseline (5.4 [0.51]) and the 1-year postimplantation (2.1 [1.37]) time points, and between baseline and the 2-year postimplantation (2.3 [1.16]) time points, whereas no difference existed between the 1- and 2-year postimplantation time points. Vagus nerve stimulation therapy may be a useful maintenance strategy in patients with difficult-to-treat depression receiving maintenance ECT.

Effects of team-based learning about postpartum haemorrhage on learning outcomes and experience of midwifery students in Indonesia: A pilot study.

AimThis pilot study aimed to evaluate the effects of team‐based learning about postpartum haemorrhage on the learning outcomes and experience of midwifery students in Indonesia.DesignOne‐group pre‐test–post‐test study.MethodsThis study enrolled 64 midwifery students as participants from an Indonesian health polytechnic school. This group attended two team‐based learning class sessions (90 min weekly for 2 weeks) on postpartum haemorrhage. Student learning outcomes and experience were assessed quantitatively.ResultsThe mean knowledge score (0–100) was significantly higher at post‐test (mean = 85.9, SD 9.8) than at pre‐test (mean = 61.4, SD 12.9) (p < .001). There was a significant difference in the mean clinical reasoning score (12–60) between post‐test (mean = 35.4, SD 5.8) and pre‐test (mean = 21.3, SD 7.9) (p < .001). Most students (98.4%) engaged in classroom activities.

Internal fixation of acetabular quadrilateral plate fractures in elderly\xa0patients: Could the fracture reduction quality affect their\xa0functional recovery?

BackgroundOsteoporotic acetabular fractures frequently involve the quadrilateral plate (QP), a flat and thin bone constituting the medial wall of the acetabulum. This study aims to assess the impact of the quality of osteoporotic QP fractures reduction on the patients’ functional recovery, at 24 months follow-up.MethodsPatients referring with osteoporotic QP fractures to our Level I trauma centre were prospectively recruited. Inclusion criteria: patients aged 60 years old or older; osteoporosis, defined as Dual-energy X-ray Absorptiometry (DXA) T-score ≤ − 2.5; acute acetabular fracture; anatomic or good fracture reduction according to Matta on postoperative CT. Exclusion criteria: moderate cognitive impairment (defined as Mini-Mental State Examination < 19); a history of malignant neoplasm; concomitant fractures in other sites; traumatic head injury; lower limb joint prostheses; patient not able to walk independently before trauma; poor fracture reduction, according to Matta, on postoperative CT. All the QP fractures were surgically managed. After surgery, the reduction of each QP fracture was classified as anatomical (displacement 0–1 mm), good (displacement 2–3 mm) and poor (displacement > 3 mm) on postoperative CT. Based on this classification: patients with a poor fracture reduction were excluded from this study, patients with an anatomical reduction were recruited in Group-A and patients with a good reduction in Group-B. All the patients underwent a clinical and radiographic 24-months follow-up.Results68 patients (males 38; females 30; mean age 68.6 years old; range 60–79) were finally included in in the study. No cases of open fractures or concomitant pelvic ring fractures were observed. Based on the post-operative CT, 39 patients showed an anatomic fracture reduction (Group-A) while the remaining 29 patients revealed a good fracture reduction (Group-B). Complication rates and mean clinical scores showed no significant differences between groups, at 24-months follow-up.ConclusionsIn this study, the functional recovery at 24 months follow-up showed no significant differences in elderly patients with QP fracture undergoing anatomical reconstruction (displacement 0–1 mm) compared to patients receiving a good QP fracture reconstruction (displacement ≤ 3 mm).

Alterations of peripheral nerve excitability in an experimental autoimmune encephalomyelitis mouse model for multiple sclerosis

BackgroundExperimental autoimmune encephalomyelitis (EAE) is the most commonly used and clinically relevant murine model for human multiple sclerosis (MS), a demyelinating autoimmune disease characterized by mononuclear cell infiltration into the central nervous system (CNS). The aim of the present study was to appraise the alterations, poorly documented in the literature, which may occur at the peripheral nervous system (PNS) level.MethodsTo this purpose, a multiple evaluation of peripheral nerve excitability was undertaken, by means of a minimally invasive electrophysiological method, in EAE mice immunized with the myelin oligodendrocyte glycoprotein (MOG) 35-55 peptide, an experimental model for MS that reproduces, in animals, the anatomical and behavioral alterations observed in humans with MS, including CNS inflammation, demyelination of neurons, and motor abnormalities. Additionally, the myelin sheath thickness of mouse sciatic nerves was evaluated using transmission electronic microscopy.ResultsAs expected, the mean clinical score of mice, daily determined to describe the symptoms associated to the EAE progression, increased within about 18 days after immunization for EAE mice while it remained null for all control animals. The multiple evaluation of peripheral nerve excitability, performed in vivo 2 and 4 weeks after immunization, reveals that the main modifications of EAE mice, compared to control animals, are a decrease of the maximal compound action potential (CAP) amplitude and of the stimulation intensity necessary to generate a CAP with a 50% maximum amplitude. In addition, and in contrast to control mice, at least 2 CAPs were recorded following a single stimulation in EAE animals, reflecting various populations of sensory and motor nerve fibers having different CAP conduction speeds, as expected if a demyelinating process occurred in the PNS of these animals. In contrast, single CAPs were always recorded from the sensory and motor nerve fibers of control mice having more homogeneous CAP conduction speeds. Finally, the myelin sheath thickness of sciatic nerves of EAE mice was decreased 4 weeks after immunization when compared to control animals.ConclusionsIn conclusion, the loss of immunological self-tolerance to MOG in EAE mice or in MS patients may not be only attributed to the restricted expression of this antigen in the immunologically privileged environment of the CNS but also of the PNS.

A surgical reduction technique for posterior cruciate ligament avulsion fracture in total knee arthroplasty: a comparison study

BackgroundPosterior cruciate ligament (PCL) avulsion fracture of the tibia is an uncommon but serious complication during primary cruciate-retaining total knee arthroplasty (TKA). The first objective of this report was to conduct a retrospective cohort study to investigate the incidence and potential risk factors of PCL avulsion fracture in primary cruciate-retaining TKA. The second objective was to assess the functional outcomes of the knee after reduction of PCL avulsion fracture.MethodsFrom January 2014 to January 2016, 56 patients who experienced PCL avulsion fracture of the tibia in primary cruciate-retaining TKA were included in the study group. Patients in this group underwent reduction of avulsion fracture. In this period, we selected 224 patients (control group) for comparison. Patients in this group also underwent the same TKA, but no PCL avulsion fracture occurred. The range of motion of the knee and Knee Society Scores were assessed. The Forgotten Joint Score was used to analyze the ability to forget the joint. Differences were considered statistically significant at p < 0.05.ResultsIn our series, the incidence of PCL avulsion fracture was 4.6%. There were no significant differences (p > 0.05) with regard to the preoperative or postoperative range of motion of the knee, final 4-year mean clinical score in the study and control groups 92.4 ± 2.7 and 93.6 ± 1.9, respectively, and mean functional scores of 85.1 ± 1.8 and 87.1 ± 1.2, respectively.ConclusionsThe incidence of PCL avulsion fracture of the tibia is relatively high. Older age and female gender were the two risk factors of fracture in primary cruciate-retaining TKA. Reduction of PCL avulsion fracture with a high-strength line can achieve good stability and function of the knee.

Kinetics of single and dual simultaneous infection of pigs with swine influenza A virus and porcine reproductive and respiratory syndrome virus.

BackgroundSimultaneous viral infections exhibit the phenomenon of viral interference, but understanding of the effect of one virus on another is limited.ObjectiveEvaluate and compare clinical characteristics, immune and acute phase response, viral shedding and viral load in pigs singly and doubly inoculated with swine influenza A virus (swIAV) and porcine reproductive and respiratory syndrome virus (PRRSV).AnimalsFifty‐four 7‐week‐old piglets.MethodsClinical status and gross lung lesions were scored. Titration of swIAV was carried out in Madin‐Darby canine kidney cells. The PRRSV RNA was quantified using a commercial qPCR kit. Antibodies were detected by hemagglutination inhibition assay and commercial ELISA. A lymphocyte proliferation assay was used to measure antigen‐specific T‐cell responses. Acute phase proteins were determined using ELISA.ResultsNo differences were found between mean clinical scores, swIAV and PRRSV shedding, and magnitude of the humoral and T‐cell response between single‐inoculated and dual‐inoculated groups. Concentrations of C‐reactive protein and haptoglobin increased in PRRSV‐inoculated and coinoculated groups, whereas serum amyloid A concentration was increased in groups inoculated or coinoculated with swIAV. Mean swIAV TCID50 titers in the lungs did not differ significantly between coinoculated and swIAV single‐inoculated pigs. A significantly higher mean copy number of PRRSV was found in the lungs of PRRSV only‐inoculated pigs at 2 day postinoculation (DPI). From 4 DPI, no significant differences in PRRSV load were identified.Conclusions and Clinical ImportanceCoinfection of pigs with swIAV and PRRSV did not potentiate clinical signs, lung lesions, immune response, and replication of the viruses in the respiratory tract.

A Comparative Study to Assess Effect of Hypertonic Saline (3%Nacl) versus Salbutamol Nebulization Therapy on Breathing Pattern among the Children Suffering with Lower Respiratory Tract Infection Admitted to the Selected Hospitals of Central Gujarat

Background of the study: In the contemporary epoch, In India there is a rapid health transition with major and increasing burden of chronic non communicable diseases, supremely hypertension, cancer, diabetes mellitus, chronic lung disease and stroke and increased age was one the cardinal cause of elevated blood pressure. Objectives: 1) to assess breathing pattern of children suffering with lower respiratory tract infection after nebulization therapy with hypertonic saline (3%Nacl). 2) To assess breathing pattern of children suffering with lower respiratory tract infection after nebulization therapy with salbutamol. 3) To compare the effect of hypertonic saline (3%Nacl) and Salbutamol nebulization therapy on breathing pattern of children suffering with lower respiratory tract infection.4) To find out the association between selected demographic variables and breathing pattern of children suffering with lower respiratory tract infection after nebulization therapy with hypertonic saline (3%Nacl) and salbutamol. Methodology: A comparative study was carried out by selecting 86 children which were suffering with LRTI through non probability purposive sampling technique. Demographic data was collected by questionnaire as well as breathing pattern was assessed by modified clinical severity score. Result: The study finding shows that the mean clinical severity score 1.4283 with hypertonic saline nebulization therapy was lesser than the mean clinical severity score 1.8469 with salbutamol nebulization therapy with the mean difference of was 0.4186. ANOVA calculated; P value is 0.000which less than 2.91 (df 2, level of significant 0.05).so, that H0 is rejected. This indicates that the hypertonic saline (3% Nacl) is effective to improve breathing pattern compare to salbutamol nebulization therapy. Conclusion: The research study concluded that hypertonic saline(3% Nacl) nebulization therapy is more effective compare to salbutamol nebulization therapy.

Therapeutic effects of extracellular vesicles from human adipose-derived mesenchymal stem cells on chronic experimental autoimmune encephalomyelitis.

Since in cell therapy, there are always concerns about immune rejection, genetic disability, and malignancies, special attention has been paid to extracellular vesicles (EVs) which are secreted by mesenchymal stem cells (MSCs). In the present study, we assessed and compared the therapeutic effects of human adipose-derived mesenchymal stem cells (hADSC) and hADSC-EVs from adipose tissue on experimental autoimmune encephalomyelitis (EAE). After induction of EAE in C57Bl/6 mice, they were treated with hADSCs, hADSC-EVs, or vehicle intravenously. The clinical score of all mice was recorded every other day. Mice were killed at Day 30 and splenocytes were isolated for proliferation assay and determination of the frequency of Treg cells by flow cytometry. Leukocyte infiltration by hematoxylin and eosin, percentages of demyelination areas by luxol fast blue, and mean fluorescence intensity of oligodendrocyte transcription factor 2 (OLIG2) and myelin basic protein (MBP) by immunohistochemistry were assessed in the spinal cord. Our results showed that the maximum mean clinical score and myelin oligodendrocyte glycoprotein-induced proliferation of splenocytes in hADSC- and hADSC-EV-treated mice were significantly lower than the control mice (p < .05). We also demonstrated that the frequency of CD4+ CD25+ Foxp3+ cells was significantly higher in the spleen of hADSC-treated mice than EAE control mice (p = .023). The inflammation score and the percentages of demyelination areas in hADSC- and hADSC-EV-treated groups significantly declined compared with the untreated control group (p < .05). We also showed that there was no significant difference in MFI of MBP and OLIG2 in the spinal cord of studied groups. Overall, we suggest that intravenous administration of hADSC-EVs attenuates the induced EAE through diminishing proliferative potency of T cells, mean clinical score, leukocyte infiltration, and demyelination in a chronic model of multiple sclerosis.

Evaluation of lung ultrasound with clinical congestion score in diagnosis and clinical outcome of patients with acute left ventricular failure prospective study

Background: Congestive cardiac failure (CCF) is often a worldwide phenomenon and usually affects millions of people years and is accompanied with high mortality. The present study is undertaken to evaluate the usefulness of Lung Ultrasound Scan in diagnosis and to identify its role as a marker of clinical outcome in patients with Acute LVF.Methods: A prospective analytical study was undertaken among the patients diagnosed as acute left ventricular failure who were admitted in tertiary care hospital. About 45 patients were enrolled by convenient sampling. The severity of acute LVF will be assessed using Clinical Congestion Score (CCS) and Lung Ultrasound Scan (LUS) based degree of congestion within 6 hours of admission, day 01 of admission and 24 hours before discharge.Results: The mean clinical congestion score was 5.36 at the time of admission. The Kerley B line at the time of admission was 15.93. The mean Kerley B line was 20.41 in the patients with clinical congestion score of more than 3.The mean Kerley B score after 24 hours of discharge was 19.69 and 5.69 during discharge among the patients with severe LV dysfunction. The mean Kerley B line score was higher at the time of admission which was statistically significant at the time of admission and within 24 hours after admission in patients with readmission.Conclusions: The mean clinical congestion scores and Kerley B lines were higher during the admission which rapidly decreased before discharge. There was a positive correlation between the Clinical congestion scores and Kerley B lines.

Arthroscopy-Assisted Corrective Osteotomy, Reduction, Internal Fixation and Strut Allograft Augmentation for Tibial Plateau Malunion or Nonunion.

Purpose: The purpose of this study was to present the results of arthroscopy-assisted corrective osteotomy (AACO), reduction, internal fixation, and strut allograft augmentation for tibial plateau malunion or nonunion. Methods: Fifty-eight patients, mean age 49 ± 11.9 years old, with tibial plateau malunion (n = 44) or nonunion (n = 14), were included in this study. There were 19 Schatzker type II fractures (32.7%), 2 type III fractures (3.4%), 7 type IV fractures (12%), 20 type V fractures (34.5%), and 10 type VI fractures (17.2%). The mean follow-up period was 46.2 ± 17.6 months. Clinical and radiologic outcomes were scored by the Rasmussen system. Articular depression was measured from computed tomography. Secondary osteoarthritis was diagnosed when radiographs showed a narrowed joint space in the injured knee at follow-up. Results: Mean clinical score improved from 15.4 ± 3.9 (pre-revision) to 23.2 ± 4.5 (post-revision). Mean radiologic score improved from 7.7 ± 2.5 (pre-revision) to 12.0 ± 3.9 (post-revision). Fifty-six fractures achieved successful union. The average union time was 19.6 ± 7.5 weeks. Post-revision, 81% had good or excellent clinical results and 62% had good or excellent radiological results. Secondary osteoarthritis (OA) was noted in 91% of all injured knees, where 25.8% were mild OA, 25.8 % were moderate OA, and 38% were severe OA. There were 6 cases of deep infection (10.3%) and 1 case of wound edge necrosis (1.7%). Five cases were converted to total knee replacement after the index surgery with an average period of 13.5 months (range 8–24 months). Conclusions: Arthroscopy-assisted corrective osteotomy, reduction, internal fixation, and strut allograft augmentation can restore tibial plateau malunion/nonunion with well-documented radiographic healing and good clinical outcomes.

A Prospective, Randomized, Double-blind, Placebo-controlled Study of Orbital Radiotherapy for Graves’ Ophthalmopathy

Although widely used for more than 85 years, the efficacy of radiotherapy for Graves' ophthalmopathy (GO) has not been established convincingly. To evaluate the efficacy of radiotherapy for GO. Prospective, randomized, internally controlled, double-blind clinical trial in a tertiary care academic medical center. The patients were ethnically diverse males and females over age 30 seen in a referral practice. The patients had moderate, symptomatic Graves' ophthalmopathy (mean clinical activity score, 6.2) but no optic neuropathy, diabetes, recent steroid treatment, previous decompression, or muscle surgery. Forty-two of 53 consecutive patients were enrolled after giving informed consent and fulfilling study entry criteria. Eleven eligible patients declined to participate because of inconvenience, desire for alternative therapy, or concern about radiation. One randomly selected orbit was treated with 20 Gy of external beam therapy; sham therapy was given to the other side. Six months later, the therapies were reversed. Every 3 months for 1 year, we measured the volume of extraocular muscle and fat, proptosis, range of extraocular muscle motion, area of diplopia fields, and lid fissure width. Effective treatment for GO will modify one or more of these parameters. No clinically or statistically significant difference between the treated and untreated orbit was observed in any of the main outcome measures at 6 months. At 12 months, muscle volume and proptosis improved slightly more in the orbit that was treated first. In this group of patients, representative of those for whom radiotherapy is frequently recommended, we were unable to demonstrate any beneficial therapeutic effect. The slight improvement noted in both orbits at 12 months may be the result of natural remission or of radiotherapy, but the changes are of marginal clinical significance.

308-nm excimer laser: a hopeful and optional therapy for pityriasis versicolor

Background Pityriasis Versicolor (PV) is known as a superficial fungal infection. It is suggested that resistant strains to azoles may be developed and hence, the treatment would be difficult. This study aimed to evaluate the efficacy of excimer laser (308 nm) as an alternative therapy for PV. Materials and methods This is a prospective intra-patient left-to-right, randomized, placebo-controlled study conducted on 26 patients with bilateral lesions which are not responding to the PV standard treatment. Patients were randomly assigned to right or left-side therapy for a duration of 8 weeks with either excimer laser (308 nm three times weekly) or topical placebo. Clinical assessment and mycological evaluation were performed before the initiation of treatment and at the fourth and eighth week of therapy. Results A decrease in the mean clinical score of cases was recorded from 7.1 at the baseline evaluation to 1.56 after 4 weeks and to 1.96 after 8 weeks of treatment. At week 4, there was a statistically significant reduction in the clinical scores compared with pretreatment scores and with the placebo group (p < .001). Conclusion 308-nm excimer laser can be considered as a hopeful and optional therapy for PV.

Radiological subsidence and acetabular erosion after tapered uncemented hemiarthroplasty in femoral neck fractures a 10- to 13- year follow-up study

BackgroundContemporary uncemented hemiarthroplasties are being used after displaced femoral neck fractures, however, their functional and radiological results remain controversial.The aim of this study was to evaluate the clinical and radiological results of a tapered uncemented stem combined with a uni- or bipolar hemiarthroplasty after a minimum follow-up of ten years. Patients and Methods135 patients underwent uncemented hip hemiarthroplasty after a displaced femoral neck fracture between 2004 and 2007. Their mean age was 81.5 years old (range, 70 to 90). 38 patients were evaluated with a minimum follow-up of ten years. We analysed the complications and the postoperative clinical result according to the Merle D´Aubigné and Postel scale. Radiological femoral type according to Dorr et al., femoral canal filling and the appearance of stem loosening, subsidence and acetabular erosion according to Baker et al., were also assessed. ResultsThere were two early periprosthetic femoral fractures. The mean clinical score was 15.8 (range, 9 to 17). Six hips were converted to a total hip arthroplasty due to acetabular erosion, and three stems were revised due to an infection, a late periprosthetic fracture and one aseptic loosening. The survival rate for any cause was 85.4% (Confidence interval (CI) 76 – 92.4%). The survival rate for revision surgery on the acetabular side at 10 years was 92.6% (CI 85 – 100%) and on the femoral side was 97.6% (CI 94.4 – 100%). 14 hips showed non-progressive radiological subsidence and 9 acetabular erosion. Stem subsidence was related to a femoral canal filling < 80% (p = 0.035) and acetabular erosion to a cylindrical femur (p = 0.024). ConclusionBone fixation can be obtained with a contemporary uncemented stem in hemiarthroplasty for patients over 70 years old with a femoral neck fracture. Acetabular erosion was frequent after ten years, however, the rate of revision surgery was low.

The clinical outcome of the Metha short hip stem: a systematic scoping review.

Short femoral stems were designed to bridge the gap between conventional straight design stems and hip resurfacing prostheses in total hip arthroplasty (THA). A number of clinical trials have been recently conducted to assess the clinical and safety profile of the cementless, colarless, tapered Metha short hip stem in young or active middle-aged individuals. A systematic scoping review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. 4 reviewers independently conducted the search using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms "short" AND "hip" AND "stem". From the initial 773 studies we finally chose 12 studies after applying our inclusion-exclusion criteria. The number of operated hips that were included in these studies was 5048 (mean BMI range: 22.7-35.2, mean age range: 44.4-60.4 years, mean follow-up range: 2-9 years). The mean modified Coleman methodology score was 52.3/100, while it ranged from 31/100 to 63/100. All mean clinical outcome scores that were used in the studies illustrated significant postoperative improvement when compared with the respective initial values. The revision rate of the Metha stem for component-related reasons was 2.5%, while the rate of major complications not requiring revision of the Metha stem was 2.8%. The Metha stem performs well in young or active middle-aged THA patients. Further studies are required for the assessment of the long-term results.

Evaluation of neurobehavioral abnormalities and immunotoxicity in response to oral imidacloprid exposure in domestic chickens (Gallus gallus domesticus)

ABSTRACTDomestic chickens (Gallus gallus domesticus) were exposed to imidacloprid by gavage once daily for 7 consecutive days at 0, 0.03, 0.34, 3.42, 10.25, and 15.5 mg/kg/day (n = 20 per group; 5 6-week-old males, 5 6-week-old females, 5 9-week-old males, and 5 9-week-old females). The severity and duration of neurobehavioral abnormalities were recorded. Components of the innate and adaptive immune system were assessed with 7 standard functional assays. Temporary neurobehavioral abnormalities were observed in a dose-dependent manner, including muscle tremors, ataxia, and depressed mentation. Based upon mean clinical severity scores, the no observed adverse effect level (NOAEL) was 3.42 mg/kg/day, and the lowest observed adverse effect level (LOAEL) was 10.25 mg/kg/day. The effective dose value for the presence of any neurobehavioral abnormalities in 50% of the test group (ED50) was 4.62 ± 0.98 mg/kg/day. The ED50 for an adjusted score that included both severity and duration of neurobehavioral abnormalities was 11.24 ± 9.33 mg/kg/day. These ED50 values are equivalent to a 1 kg bird ingesting 29 or 70 imidacloprid treated soybean seeds respectively. Immunotoxicity was not documented, possible causes include the assays were insensitive, relevant immune functions were not examined, or imidacloprid is not immunotoxic at this dosing schedule in this species. Neurobehavioral abnormalities were a more sensitive indicator of the sublethal effects of imidacloprid than immunotoxicity.