non-HA Group Research Articles

Healthcare administrators and hypertension at small-to-medium worksites in Okinawa, Japan.

This longitudinal study investigated whether the presence of a person in charge of healthcare at a worksite, termed a healthcare administrator (HA), and not limited to licensed staff, facilitated visits to medical facilities for treatment of newly-identified hypertension after a health checkup. The study included employees at small-to-medium companies in Okinawa, Japan who had systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, no history of hypertension in the last year, and not taking antihypertensive medication. Pre-existing data on worksite characteristics, employees' health checkups, and health insurance claims were collected. The odds ratio (OR) and 95% confidence interval (CI) were calculated for visits in the HA group using a multi-level logistic regression model, with the non-HA group serving as the reference. The cumulative incidence of visits during the 1st month after the health checkup in 2906 participants with newly-identified hypertension employed at 1366 worksites was 2.00% for the non-HA group and 2.97% for the HA group. The OR for visits in the HA group was 1.74 (95% CI, 0.94-3.22) after adjusting for potential confounding factors. When the hypertensive population was stratified using the cut-off values of 150 mmHg for systolic and 95 mmHg for diastolic blood pressure, more hypertensive stratum showed a cumulative incidence of 2.29% in the non-HA group and 4.97% in the HA group, with an adjusted OR of 3.05 (1.12-8.29). The presence of a HA at a worksite was associated with increased early visits to medical facilities by employees for treatment of hypertension.

The Mid-Term Effect of Preservative-Free Artificial Tears Containing Hyaluronic Acid on Dry Eye Incidence after Cataract Surgery: A Retrospective Cohort Study.

The aim of this study is to survey the effectiveness of preservative-free artificial tears containing hyaluronic acid (HA) on post-cataract surgery dry eye disease (DED) prevention. A retrospective cohort study was performed, and patients that received cataract surgeries were divided into either an HA group or non-HA group depending on the artificial tear they used. A total of 37 and 74 eyes were enrolled into the HA and non-HA groups, respectively, after the selection. The primary outcomes are postoperative superficial keratitis and multiple (>3) DED symptoms. The generalized linear model was utilized to calculate the adjusted odds ratio (aOR) and 95% confidence interval (CI) of primary outcomes between the two groups. There were 10 and 2 episodes of superficial keratitis in the non-HA group and HA group, respectively, and the HA group demonstrated a significantly lower incidence of superficial keratitis (p < 0.001). Moreover, 13 and 5 patients developed multiple DED symptoms in the non-HA and HA groups, and the HA group illustrated fewer multiple DED symptoms (p = 0.024). The lower preoperative tear break-up time (TBUT) was correlated with superficial keratitis in the HA group (p = 0.043), while old age, low preoperative TBUT and ocular surface staining were associated with superficial keratitis in the non-HA group (all p < 0.05). Lower preoperative TBUT was correlated with multiple DED symptoms in the HA group (p = 0.020), while female sex, low preoperative TBUT and any DED symptoms were associated with multiple DED symptoms in the non-HA group (all p < 0.05). In conclusion, the usage of preservative-free artificial tears containing HA is associated with lower postoperative DED events.

Levonorgestrel-releasing intrauterine system effects on metabolic variables in PCOS

Background We aimed to determine and compare the reproductive hormone level and metabolic of patients with polycystic ovary syndrome (PCOS) when treated with a levonorgestrel-releasing intrauterine system (LNG-IUS). Objectives Sixty-four women with PCOS (Group A) and sixty-six healthy women inserted with a LNG-IUS for conception (Group B) were recruited from the Department of Obstetrics and Gynecology in Jinhua Hospital Zhejiang University School of Medicine. Method We compared the general characteristics of the cases between the two groups, including age, body mass index (BMI), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), abdominal circumference (AC) and waist circumference (WC). Each patient was evaluated by transvaginal ultrasonography (TVS) to determine the number of oocytes and ovarian volume, and the intima-media thickness (IMT) of the common carotid artery was measured on an ECG image from the left common carotid artery before and six months, 12 months and 24 months after patients were inserted with the LNG-IUS. Hormone levels (follicle stimulating hormone, luteinizing hormone, serum estradiol and total testosterone), serum insulin, sex hormone binding globulin (SHBG), total cholesterol (TC), high density lipoprotein (HDL), and triglyceride (TG), were evaluated before and six months, 12 months and 24 months after patients were inserted with an LNG-IUS. The levels of testosterone (T) in the non-HA (hyperandrogenemia) group and HA group in PCOS group were compared with the baseline. We also compared cases without insulin resistance in the PCOS group with their baseline. Results Prior to LNG-IUS insertion, the PCOS group had significantly higher total testosterone levels (p < 0.05), lower HDL levels (p < 0.05), and a greater ovarian volume (p < 0.05) than the control group. Compared to baseline values, there was a significant increase in fasting glycemia at six months after LNG-IUS insertion (p < 0.05). Mean ovarian volume was significantly smaller than the volume prior to LNG-IUS insertion (p < 0.05); LDL and TC were significantly reduced when compared to baseline evaluation in the PCOS group. The remaining variables did not differ significantly during the 24 months follow-up period. The control group did not show any significant changes when compared to the period before LNG-IUS insertion. When the groups were compared after the 24-month follow-up, WC, AC, FSH, LH, T, SHBG, HDL, FINs, FAI and ovarian volume were significantly different when compared between the two groups (p < 0.05) . Conclusion The LNG-IUS is an effective and safe non-surgical device and the use of this system for 24 months did not result in significant changes in the clinical and metabolic variables in women with PCOS and healthy control females.

Effect of hyperandrogenism on pregnancy outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer

Objective: To explore the effects of hyperandrogenism (HA) on pregnancy outcomes in women with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET). Methods: A retrospective study was conducted on infertile women with PCOS undergoing IVF/ICSI-ET from January 2017 to June 2021 in our center. Patients were divided into HA group and NON-HA group according to the levels of testosterone. Propensity score matching (PSM) was used to balance the influence of female age and IVF/ICSI-ET for patients with gonadotropin-releasing hormone (GnRH)antagonist protocol and GnRH agonist protocol, separately. After the PSM procedure, 191 cases in HA group and 382 cases in NON-HA group, were included. Hormone levels and pregnancy outcomes were compared in the two groups. Results: The female age was comparable in two groups [HA: (29.6±3.7) vs NON-HA: (29.5±3.6), P=0.665]. The basal luteinizing hormone [(10.82±6.73) vs (7.76±5.30) IU/L], testosterone [(3.27±0.97) vs (1.60±0.59) nmol/L], free androgen index (7.13 vs 2.77), anti-mullerian hormone [(11.37±5.74) vs (9.67±4.67) ng/ml], fasting glucose [(5.18±0.49) vs (5.06±0.42) mmol/L], 1h glucose [(9.34±2.42) vs (7.99±2.21) nmol/L], 2 h glucose [(7.66±2.17) vs (6.64±1.84) nmol/L], 2 h insulin [(129.81±145.49) vs (97.51±86.92) mU/L], total cholesterol [(5.35±0.89) vs (4.92±0.92) mmol/L], triglycerides [(1.55±1.28) vs (1.33±0.77) mmol/L], and low density lipoprotein cholesterol levels [(3.38±0.66) vs (3.14±0.71) mmol/L] were significantly higher in HA group, compared with NON-HA group (P<0.05). The initiated gonadotropin dose was higher in HA group than that in NON-HA group [(126.96±33.65) vs (137.60±38.12) U, P=0.001], but moderate-severe ovarian hyperstimulation syndrome (OHSS) rate was similar in two groups (P>0.05). The rates of implantation, clinical pregnancy, miscarriage, and live birth were comparable between the two groups (P>0.05). Also, in the subgroups, the rates of implantation, clinical pregnancy, live birth, and miscarriage were similar in HA group and NON-HA group. Conclusions: The risks of hormonal abnormality and glucose-lipid metabolic disorder were higher in PCOS women with HA, whereas satisfactory pregnancy outcomes could be achieved under proper ovarian stimulation undergoing IVF/ICSI-ET.

Risk of nerve injury during elbow arthroscopy: ultrasonographic evaluation of preoperative patients

To clarify the real risk of nerve injury during elbow arthroscopy, the distances of the radial and median nerves to the elbow joint were investigated using ultrasonography in patients who underwent surgery. A total of 35 patients who underwent arthroscopic surgery of the elbow were investigated. The distances of the nerves to the capsule and bony landmarks were measured using ultrasonography. The radial nerve distances were measured at the capitellum, joint space, radial head, and radial neck levels. The median nerve distances were measured at the trochlear, joint space, and coronoid process levels. The patients were divided into 2 groups: nine patients in the hydrarthrosis (HA) group and 26 patients in the non-hydrarthrosis (non-HA) group. HA was defined as the intra-articular effusion on magnetic resonance imaging scans. The radial nerve ran closer to the capsule at the radial neck level in the HA group than in the non-HA group (2.0mm vs. 5.9mm, P<.01). In the non-HA group, the radial nerve ran closer to the radial head than in the HA group (6.3mm vs. 8.5mm, P=.01). The median nerve ran closer to the capsule at the trochlear level in the HA group than in the non-HA group (5.2mm vs. 8.8mm, P<.01). Nerves at a distance of ≤2mm from the capsule were found in 7 patients at the radial neck of the radial nerve and in 2 patients at the trochlear region of the median nerve in the HA group. In the non-HA group, they were found in 3 patients at the radial head and in 1 patient at the joint space of the radial nerve. The dangerous locations for nerve injury during elbow arthroscopy vary according to hydrarthrosis, and this risk should be recognized during arthroscopic surgery.

The impact of hyperandrogenism on the outcomes of ovulation induction using gonadotropin and intrauterine insemination in women with polycystic ovary syndrome.

ObjectiveThis study aimed to investigate the impact of hyperandrogenism (HA) on the outcomes of ovulation induction (OI) using gonadotropin and intrauterine insemination (IUI) in patients with polycystic ovary syndrome (PCOS).MethodsThis was a retrospective cohort study including 415 patients undergoing OI using gonadotropin and IUI treatment between January 2018 and December 2020 at a single infertility center. Baseline characteristics, clinical and laboratory parameters, and pregnancy outcomes were investigated.ResultsAmong the study population, there were 105 hyperandrogenic (25.3%) and 310 non-hyperandrogenic patients (74.7%). The live birth rate was lower in the HA group than in the non-HA group, but this difference did not reach statistical significance due to the limited sample size (14.3% vs. 21.0%, relative risk=0.68; 95% CI, 0.41–1.14, p=0.153). No predictive factors for live birth were identified through logistic regression analysis. ConclusionHA did not negatively affect the outcomes of OI using gonadotropin and IUI cycles in Vietnamese women with PCOS. The result may not be applicable elsewhere due to the large variation in the characteristics of women with PCOS across races and populations.

A randomized prospective study comparing migration of hydroxyapatite and non-hydroxyapatite coated glenoid components using radiostereometric analysis

BackgroundPrimary shoulder arthroplasty can significantly improve quality of life; however, the glenoid baseplate remains the most common component to loosen, which may result in implant failure and subsequent revision surgery. Radiostereometric analysis (RSA) is considered the gold standard for accurate measurement of micro-motion between implant and bone. The aims of this study were to compare migration of the Lima SMR porous titanium hydroxyapatite (HA) coated and non-hydroxyapatite (non-HA) coated glenoid components through a prospective, randomized 2-arm trial using RSA, whilst also comparing clinical and functional outcomes. MethodsTwenty patients were randomized into 2 equal (HA and non-HA coated) groups with all patients undergoing primary anatomic shoulder arthroplasty, at which time tantalum beads were also inserted. RSA imaging was performed immediately postoperatively, then at 3, 6, 12, and 24 months postprocedure. These images were digitized and analyzed using model-based RSA software. All patients completed Oxford Shoulder Score (OSS), American Shoulder and Elbow Surgeons (ASES) score, Constant Score (CS) and Visual Analogue Scale (VAS) pain scores pre-and postoperatively at the aforementioned time points. Unpaired t-tests were used for clinical outcome data; Mann-Whitney U tests were used for RSA data. Significance levels were set at P < .05. ResultsMean age for the HA group was 72.3 years; 69.5 years for the non-HA group. Mean follow-up for both groups was above 36 months. No significant differences in glenoid migration were observed at each of the postoperative time points; the only exception being at 12 months (non-HA group displaying significantly greater rotation in the z-axis). The HA group displayed fractionally more translation in the x- and z-axes at all time points (not significant). Rotation in the z-axis was marginally greater at all postoperative time points in the non-HA group. Median total migration values revealed greater motion for the non-HA group at 3, 6, and 12 months (not significant). All clinical outcome measures improved significantly within each group; no statistical differences were observed between the groups for any outcome measure. One patient in each group underwent revision surgery to reverse shoulder arthroplasty due to unexplained pain (HA group) and cuff failure (non-HA group) only. Radiolucent lines were noted in 2 patients who are still under follow-up. ConclusionThis study has revealed promising early results of both HA coated and non-HA coated implants, however, hydroxyapatite coating of glenoid components does not significantly improve outcome scores nor provide extra stability compared to non-hydroxyapatite coated implants at 2 years postprocedure. Level of evidenceLevel II; Randomized Controlled Trial

Do Hearing Aids Help Prevent Cognitive Decline?

Do Hearing Aids Help Prevent Cognitive Decline?

Risk of Postoperative Hyperalgesia in Adult Patients with Preoperative Poor Sleep Quality Undergoing Open-heart Valve Surgery.

PurposeStudies have reported that preoperative poor sleep quality could decrease the pain threshold in patients undergoing noncardiac surgery. However, the risk of postoperative hyperalgesia (HA) in cardiac surgery patients with preoperative poor sleep quality remains unclear.Patients and MethodsWe retrospectively collected clinical data from patients undergoing open-heart valve surgery between May 1 and October 31, 2019, in Fuwai Hospital (Beijing). We assessed preoperative sleep quality and postoperative pain severity using the Pittsburgh sleep quality index (PSQI) and numerical pain rating scale (NPRS), respectively. A PSQI of six or greater was considered to indicate poor sleep quality, and a NPRS of four or greater was considered to indicate HA. Multivariable logistic regression analysis was used to study the risk of postoperative HA in patients with preoperative poor sleep quality.ResultsWe divided 214 eligible patients into two groups based on postoperative HA; HA group: n=61 (28.5%) and nonHA group: n=153 (71.5%). Compared with nonHA patients, patients with postoperative HA showed a higher percentage of history of smoking, 17 (11.1%) vs 15 (24.6%) and alcohol abuse, 5 (3.3%) vs 6 (9.8%), higher intraoperative dose of sufentanil (median, 1.02 vs 1.12 μg/kg/h), and longer duration of ventilation with tracheal catheter (median, 760 vs 934 min). Preoperative poor sleep quality was associated independently with an increased risk of postoperative HA (adjusted odds ratio [AOR]: 2.66; 95%CI: 1.31–5.39, P=0.007). Stratification by history of smoking revealed a stronger risk of postoperative HA in nonsmoking patients with preoperative poor sleep quality (AOR: 3.40; 95%CI: 1.51–7.66, P=0.003). No risk was found in patients who had history of smoking (AOR: 0.83; 95%CI: 0.14–4.75, P=0.832).ConclusionPreoperative poor sleep quality is an independent risk factor for postoperative HA in adult patients undergoing open-heart valve surgery who had no history of smoking.

Influence of Hydroxyapatite Coating for the Prevention of Bone Mineral Density Loss and Bone Metabolism after Total Hip Arthroplasty: Assessment Using 18F-Fluoride Positron Emission Tomography and Dual-Energy X-Ray Absorptiometry by Randomized Controlled Trial.

Background Hydroxyapatite- (HA-) coated implants tend to achieve good osteoinductivity and stable clinical results; however, the influence of the coating on the prevention of bone mineral density (BMD) loss around the implant is unclear. The purpose of this randomized controlled trial was to evaluate the effectiveness of HA-coated implants for preventing BMD loss and to determine the status of bone remodeling after total hip arthroplasty (THA), making comparisons with non-HA-coated implants. Methods A total of 52 patients who underwent primary THA were randomly allocated to HA and non-HA groups. BMD was measured by dual-energy X-ray absorptiometry (DEXA) at 1 week postoperation to form a baseline measurement, and then 24 weeks and 48 weeks after surgery. The relative change in BMD was evaluated for regions of interest (ROIs) based on the Gruen zone classifications. 18F-fluoride positron emission tomography (PET) was performed at 24 weeks postsurgery, and the maximum standardized uptake values (SUVmax) were evaluated in the proximal (HA-coated) and distal (non-HA-coated) areas in both groups. Results There were significant differences in BMD loss in ROIs 3 and 6 (p = 0.03), while no significant difference was observed in ROI 7 at either 24 or 48 weeks postsurgery. There was no significant correlation between PET uptake and BMD (24 or 48 weeks) in either group. Conclusion The influence of a HA coating in terms of BMD preservation is limited. No significant correlation was found between BMD and SUVmax measured by PET, either with or without the use of a HA coating.

Health anxiety in medical employees: A multicentre study.

ObjectiveThe aim of this study was to explore health anxiety (HA) in a sample of hospital medical employees and to identify factors that influence HA.MethodsA consecutively recruited sample of 1702 medical employees with or without HA was obtained from 13 hospitals across China. Participants’ demographic and clinical characteristics were collected using a standardized protocol and data collection procedure. Subjects were divided into a HA and non-HA group according to their scores on the Chinese version of the Short Health Anxiety Inventory. Comparisons between groups were conducted and binary logistic regression was used to identify risk factors of HA.ResultsTotal HA prevalence was 30.14%. There were significant differences between the HA and non-HA groups in number of working years, hospital category, sex, marital status, family income, personality, physical disease and education degree. Working in a specialist hospital, being female, being married, low income, introversion, graduate education or above and presence of physical disease were risk factors of HA.ConclusionsHA is common in medical employees. More investigation of the long-term impact of HA is warranted.

Hippocampal atrophy disrupts the language network but not hemispheric language lateralization.

It is still unclear how temporal lobe epilepsy (TLE) with and without hippocampal atrophy (HA) affects cortical language distribution. We aimed to investigate the role of the hippocampus on language lateralization, activation pattern, and functional connectivity (FC) in patients with TLE. We investigated 93 patients with TLE-divided into right HA (RHA), left HA (LHA), and negative magnetic resonance imaging (MRI) (non-HA)-and 101 controls using a semantic-language functional MRI (fMRI) task and the Boston Naming Test (BNT). Groups did not differ in the frequency of atypical language lateralization (LL), which correlated differently with handedness in each brain region and group. Blood-oxygen-level dependend (BOLD) activation patterns and region of interest (ROI)-to-ROI FC differed between LHA and controls, as well as between LHA and non-HA patients. In the task activation pattern analysis, there was a decrease in the activation of patients with LHA relative to controls, exactly in the left hippocampus. However, non-HA patients had increased FC relative to controls in the left superior temporal gyrus region. Seed-to-voxel FC demonstrated greater differences between patients and controls and smaller differences among patient groups. The non-HA group was similar to controls, except for increased BOLD activation and increase FC in the superior temporal gyri. RHA and LHA differed from controls in BNT. BNT correlated with fMRI activation in RHA and non-HA groups. LHA affected naming performance, fMRI semantic task activation pattern, and FC more than RHA and non-HA. Contrary to our expectations, LHA did not increase the frequency of atypical LL. Regardless of the side, HA impacts negatively on the language network but not on hemispheric language lateralization.

Coexisting hypogastric aneurysms worsen the outcomes of endovascular treatment by the iliac branch devices within the pELVIS Registry

ObjectiveHypogastric aneurysms (HAs) frequently coexist with aortoiliac aneurysms (AIAs). However, the presence of an HA is a contraindication to endovascular aneurysm treatment by iliac branch devices (IBDs) because of the risk of distal sealing-related endoleaks. No robust evidence exists in the published literature, and therefore we sought to evaluate the performance of IBDs in the presence of HAs within a multicenter registry of nine vascular centers. MethodsClinical and radiographic information of 804 patients with AIAs treated by IBDs was retrospectively reviewed and analyzed using prearranged, defined, and documented protocols. The treatment period was between January 2005 and April 2017. ResultsHA was present in 315 (32.6%) of the overall 910 deployed IBDs. Mean radiologic follow-up was 32 months. The incidence of incomplete aneurysm exclusion and type I endoleak was 3% in the HA group vs 0.7% in the non-HA group (P = .019). The 5-year freedom from IBD-related type I endoleak was 93% vs 98% in the HA group vs the non-HA group, respectively (P = .006). Subgroup analysis of the HA group revealed that use of a single distal bridging stent graft vs multiple bridging devices led to higher rate of type I endoleak (9.6% vs 2.8%; P = .031), branch occlusions (8.3% vs 0.9%; P = .009), and buttock claudication (7.6% vs 1.9%; P = .038). ConclusionsThis series of AIAs with HAs is the largest reported. It shows that HAs coexisting with AIAs, when treated with IBDs, have significantly worse outcomes. Lengthening the distal landing zone with more than one bridging stent graft into the distal healthy hypogastric artery or one of its main branches improves outcomes.

Body mass index and basal androstenedione are independent risk factors for miscarriage in polycystic ovary syndrome

BackgroundThere is limited literature investigating the effects of body mass index (BMI) and androgen level on in vitro fertilization (IVF) outcomes with a gonadotropin-releasing hormone (GnRH)-antagonist protocol in polycystic ovary syndrome (PCOS). Androgen-related variation in the effect of body mass index (BMI) on IVF outcomes remains unknown.MethodsIn this retrospective study, 583 infertile women with PCOS who underwent IVF using the conventional GnRH-antagonist protocol were included. Patients were divided into four groups according to BMI and androgen level: overweight- hyperandrogenism(HA) group, n = 96, overweight-non-HA group, n = 117, non-overweight-HA group, n = 152, and non-overweight-non-HA group, n = 218.ResultsA significantly higher number of oocytes were retrieved, and the total Gn consumption as well Gn consumption per day was significantly lower, in the non-overweight groups than in the overweight groups. The number of available embryos was significantly higher in the HA groups than in the non-HA groups. Clinical pregnancy rate was of no significant difference among four groups. Live-birth rates in the overweight groups were significantly lower than those in non-overweight-non-HA group (23.9, 28.4% vs. 42.5%, P<0.05). The miscarriage rate in overweight-HA group was significantly higher than that in non-overweight-non-HA group (45.2% vs. 14.5%, P<0.05). Multivariate logistic regression analysis revealed that BMI and basal androstenedione (AND) both acted as significantly influent factors on miscarriage rate. The area under the curve (AUC) in receiver operating characteristic (ROC) analysis for BMI and basal AND on miscarriage rate were 0.607 (P = 0.029) and 0.657 (P = 0.001), respectively, and the cut-off values of BMI and basal AND were 25.335 kg/m2 and 10.95 nmol/L, respectively.ConclusionsIn IVF cycles with GnRH-antagonist protocol, economic benefits were seen in non-overweight patients with PCOS, with less Gn cost and more retrieved oocytes. BMI and basal AND were both significantly influential factors with moderate predictive ability on the miscarriage rate. The predictive value of basal AND on miscarriage was slightly stronger than BMI.

Infertile polycystic ovary syndrome patients undergoing in vitro fertilization with the gonadotropin-releasing hormone-antagonist protocol: role of hyperandrogenism

This retrospective cohort study is to assess the effects of hyperandrogenism (HA) in polycystic ovary syndrome (PCOS) patients with gonadotropin-releasing hormone (GnRH)-antagonist protocol during in vitro fertilization (IVF). Total 892 infertile Patients between 20 and 35 years of age with normal body mass index (BMI, 18.50 −24.99 kg/m2), including those with tubal factor infertility (control, n = 318), PCOS infertility with HA (HA PCOS, n = 244), and PCOS infertility without HA (non-HA PCOS, n = 330), were included. Number of retrieved oocytes was significantly higher and total Gonadotropin consumption was significant lower in the HA PCOS group, whereas abortion rate was significantly higher and live birth rate was significantly lower in the HA PCOS group, compared with the control and non-HA PCOS groups. In the HA PCOS group, the number of available embryos tended to be higher with no significance. The GnRH-antagonist protocol is more suitable for HA PCOS patients, with lower cost and more number of embryos available for transfer. Due to the high abortion rate and low live birth rate, a freeze-all approach might be a preferable option for HA PCOS patients so as to create a buffer for reducing androgen levels before transferring freeze-thawed embryos.

Superior 11-Year Survival but Higher Polyethylene Wear of Hydroxyapatite-Coated Mallory-Head Cups

Hydroxyapatite (HA) coating of implant surfaces is believed to improve longevity of uncemented total hip arthroplasty (THA). However; it is speculated that HA particles may cause third body wear of the polyethylene (PE) liner with subsequent osteolysis and aseptic loosening of implants. We performed a retrospective comparison of two patient populations with cementless Mallory-Head acetabular components. The patients were identified in the Danish hip arthroplasty Registry (DHR); 77 patients had HA-coated cups and 73 patients had non-HA coated cups. Anteroposterior (AP) radiographs were analysed for PE wear, osteolysis was quantified and survival of the acetabular components was compared. The mean follow-up was 11 years. There were no cup revisions in the HA group and 7 cup revisions in the non-HA group (P<0.01). The reason for revision in all cases was aseptic loosening of both stem and cup. The amount of osteolysis was significantly increased around cups in the non-HA group. The two-dimensional linear PE wear-rate of 0.18 mm/year was higher (P<0.001) in the group with HA coated cups compared with 0.12 mm/year in the group with non-HA coated cups. The mean age was lower (P=0.001) in the HA group (57 years) compared with the non-HA group (63 years). After 11.1 years of follow-up non-HA coated cups had a higher revision rate. Increased PE wear with HA-coated cups did not have a negative influence on the revision rate, but may result in a need for revision surgery over time.

The Hydroxyapatite-Tapered Stem: Any Added Value?

Hydroxyapatite (HA) coating has been used as a biological adjuvant for noncemented femoral stem fixation. This is a long-term concise report of a previously published prospective, randomized clinical trial, comparing plasma sprayed porous noncemented stems with and without an HA coating, with focus on wear and survivorship. Between July 1991 and October 1994, 177 patients (199 hips) underwent noncemented Ranawat-Burstein (RB) Metaphyseal-Diaphyseal fit total hip replacement in a prospective randomized clinical trial. At the 5-year follow-up, the incidence of trochanter and/or thigh pain was 12% in the HA group and 24% in the non-HA group. After the mean follow-up of 17.7 ± 0.8 years, there were 3 revisions in the HA group, 1 for fracture and 2 for poly wear. There were 4 revisions in the non-HA group, 1 for infection and 3 for poly wear. There was no revision for femoral loosening in either groups. The Kaplan–Meier survivorship for failure for mechanical reasons in the HA group and non-HA group were 97.9% and 97.1%, respectively, which was not statistically significant. Noncemented femoral stems with HA coating have excellent survivorship without any substantial deleterious effect or increase in wear.

Factors for Predicting Positive Results for Anti-HAV IgM Retesting Among Initially Seronegative Patients

The standard diagnostic tool for acute hepatitis A is detection of anti-hepatitis A virus (HAV) immunoglobulin M (IgM). However, a negative result for anti-HAV IgM can be obtained in the early phase of infection. Among clinically suspicious seronegative patients, diagnosis of hepatitis A is sometimes recorded on retesting. This study included patients who had attended the Kyung Hee University East-West Neo Medical Center from November 2006 to October 2008. We evaluated 27 patients (15 men, 12 women) who had undergone repeated anti-HAV IgM testing. Thirteen patients were diagnosed with hepatitis A after retesting, and 14 with non-hepatitis A (non-HA). High initial cutoff index (COI) for anti-HAV IgM (≥0.5), low serum total bilirubin (<1.4 mg/dl), and low platelet count (<165 × 10(3)/μl) were related to a positive result for anti-HAV IgM retesting, although this association was not statistically significant on multivariate analysis. In the HA group, 7 of 13 patients had an initial COI for anti-HAV IgM of >0.5 compared with none of 14 patients in the non-HA group. Initial COI for anti-HAV IgM, serum total bilirubin, and platelet count were helpful for predicting positive results for retesting among initially seronegative patients.

Sports-Related Posttraumatic Migraine

Symptoms and neurocognitive functioning were compared in athletes with no headache (non-HA group), athletes complaining of HA (HA group), and athletes with posttraumatic migraine (PTM group), in a study of 261 high school and college athletes (mean age, 16.36+/-2.6 years) at University of Pittsburgh Medical Center; University of North Carolina, Chapel Hill; and Florida Neuroscience Institute, Orlando.

Posttraumatic migraine characteristics in athletes following sports-related concussion

The object of this study was to compare symptom status and neurocognitive functioning in athletes with no headache (non-HA group), athletes complaining of headache (HA group), and athletes with characteristics of posttraumatic migraine (PTM group). Neurocognitive tests were undertaken by 261 high-school and collegiate athletes with a mean age of 16.36 +/- 2.6 years. Athletes were separated into three groups: the PTM group (74 athletes with a mean age of 16.39 +/- 3.06 years), the HA group (124 athletes with a mean age of 16.44 +/- 2.51 years), and the non-HA group (63 patients with a mean age of 16.14 +/- 2.18 years). Neurocognitive summary scores (outcome measures) for verbal and visual memory, visual motor speed, reaction time, and total symptom scores were collected using ImPACT, a computer software program designed to assess sports-related concussion. Significant differences existed among the three groups for all outcome measures. The PTM group demonstrated significantly greater neurocognitive deficits when compared with the HA and non-HA groups. The PTM group also exhibited the greatest amount of departure from baseline scores. The differences among these groups can be used as a basis to argue that PTM characteristics triggered by sports-related concussion are related to increased neurocognitive dysfunction following mild traumatic brain injury. Thus, athletes suffering a concussion accompanied by PTM should be examined in a setting that includes symptom status and neurocognitive testing to address their recovery more fully. Given the increased impairments observed in the PTM group, in this population clinicians should exercise increased caution in decisions about treatment and when the athlete should be allowed to return to play.