Two-stage Treatment Research Articles

Odontogenic Optic Neuropathy, Clinic, Treatment Dynamics: A Case Report

Optic nerve neuropathy due to dental lesions is rare but causes complex persistent functional disorders that are difficult to diagnose. The aim of this case report is to show odontogenic optic neuropathy through treatment tactics and observation of structural dynamics and functional changes of the optic nerve with the help of a clinical case. The consultation of the patient was done as per the Department of Ophthalmology, Ivano-Frankivsk National University, Ukraine. Tests such as computed perimetry, Optically Coherent Tomography (OCT) of the optic nerve, Magnetic Resonance Imaging (MRI) of the brain, Computed Tomography (CT) of the paranasal sinuses and immunological blood tests were performed. The patient gave informed consent to access personal data and use it for scientific purposes. In the case of patient S., the combination of neuritis with lesions of the anterior part of the vascular tract is attributed to the background of multiple caries and prolapse of the teeth of the upper jaw in the sinus. Treatment includes a regimen by a dentist for caries and pulse therapy with corticosteroids. From the result, it was possible to reduce the swelling in the nerve fibers of the right eye by 35% and the left eye by 19%. The average sensitivity threshold in the right eye increased by 79% and in the left eye by 90%. In conclusion, we confirm that odontogenic optic neuropathy is a rare form of optic nerve damage. Two-stage treatment (dental and corticosteroids) reduces the nerve fibers swelling and increases retinal ganglion cells sensitivity.

Papel del biovidrio en el tratamiento de la osteomielitis focal crónica.

Bioactive glass emerges as an alternative to the classic two-stage treatment of chronic focal osteomyelitis. It allows the eradication of the infection in a single surgical act without the need to add a local antibiotic thanks to its mechanism of action, facilitating the filling of the residual bone defect after debridement. A retrospective review of 29 patients treated with bioactive glass was carried out in order to analyze the results and secondary complications. We observed a significant improvement in the analytical parameters, with complete remission of the infection in 80% of the patients. 31% showed wound serum leakage with spontaneous resolution in 55% of patients in the first 7 days after surgery. Therefore, bioactive glass is effective against multiple microorganisms, with good results in recurrence rate and few complications, even though long-term studies are required to confirm these results.

First experience of staged treatment of an infant with heterotaxy syndrome with total anomalous pulmonary vein drainage combined with a single ventricular heart and pulmonary atresia

The combination of monoventricular congenital heart disease with total anomalous pulmonary vein drainage and pulmonary atresia, is a rare pathology and characterized by an extremely severe course with the highest mortality. In the presented work we described a clinical case of the first and successful experience of two-stage treatment of an infant with total anomalous pulmonary vein drainage combined with single ventricular heart disease and pulmonary atresia in the Republic of Kazakhstan. For total anomalous pulmonary vein drainage correction we used a sutureless technique — primary sutureless repair, which is used in our center as a primary one. Due to severe anatomy of the defect, we used unusual area of the distal end of the central systemic-pulmonary artery anastomoses during primary surgery at the mouth of the severed patent ductus arteriosus in the area of pulmonary artery bifurcation, where it is associated with high surgical risks. Taking into account the presence of an additional obstacle to pulmonary blood flow in the form of left branch pulmonary artery orifice stenosis, we performed one-stage dilatation plasty of the pulmonary artery branch bifurcation with autopericardium. During the repeated surgery we faced such a serious complication as aortic damage for the first time, thanks to emergency actions it did not turn out to be fatal. We also managed to perform the most preferable dilation of hypoplastic branches of the pulmonary artery by plasty with the own tissues of the superior vena cava during the formation of Glenn-anastomosis.Received 29 November 2021. Revised 21 December 2021. Accepted 22 December 2021.Informed consent: Informed consent was obtained from the patient's mother for the publication and use of the patient's medical data for scientific purposes.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authorsLiterature review: A.V. MishinDrafting the article: A.V. MishinCritical revision of the article: K.N. Kuatbekov, A.D. SepbayevaSurgical treatment: K.N. Kuatbekov, A.V. Mishin, A.D. Sepbayeva, G.S. Nigay, D.M. KanzhigalinFinal approval of the version to be published: K.N. Kuatbekov, A.V. Mishin, A.D. Sepbayeva, G.S. Nigay, D.M. Kanzhigalin

Decompression of Odontogenic Keratocysts Before Enucleation Reduces the Rate of Recurrence.

The purpose of this study was to determine if 2-stage conservative treatment (decompression followed by enucleation) of odontogenic keratocysts reduced the rate of recurrence compared to single-stage conservative treatment. This was a pooled cohort study composed of both patients identified at our institution and cases reported in the literature. The primary predictor variable was treatment modality (single versus 2-staged conservative treatment). The outcome variable was the overall recurrence rate. A total of 684 patient cases were included in the final pooled sample. The mean age was 39.80years (range: 7-80 years). The mandible (76.8%) was the most common site, with the rest of the lesions manifesting in the maxilla (23.0%). A total of 58.1% of the lesions were unilocular, whereas the remaining 41.9% were multilocular. Two-stage conservative treatment demonstrated a lower recurrence rate (14.5% versus 22.1%; P = 0.029). Decompression is known to reduce lesion size and optimize the favorability of conservative treatment. Furthermore, we propose that 2-staged treatment may also be associated with a lower recurrence rate.

Advanced Research on Polymer Floating Carrier Application in Activated Sludge Reactors.

This research estimates the efficiency of domestic wastewater treatment in the removal of organic pollutants and nitrogen compounds with a two-stage treatment sequence (an activated sludge reactor in the first stage, and a trickling filter in the second stage), and with the application of floating carriers in the activated sludge reactor. The materials “Polyvom”, “Polystyrene” and “Bioballs” were adopted as floating carriers with previously determined filling ratios in the reactor volume of 10%, 20% and 20%, respectively. After the first stage of the study, it was found that the most effective treatment was achieved using the “Polyvom” material. Therefore, only this floating carrier was considered in the second and third stages of the study. Within the stages of the research, lab-scale benches operated under different operation modes of the treatment sequence. At the end of the study, it was possible to achieve the following levels of purification: BOD5 (2.1 mg/L), NH4 (0.4 mg/L), NO2 (1.0 mg/L), and NO3 (25 mg/L). The mean values of the concentrations of BOD, NH4, and NO3 met the requirements, but the concentration of NO2 exceeded the requirements (1.0 mg/L vs. 0.08 mg/L). These results were achieved under a hydraulic retention time in the activated sludge reactor of 8 h, and the MLSS for the free-floating and immobilized activated sludge was 0.2 and 0.9 g/L, respectively.

Structure–Phase Transformations in the Modified Surface of Al-20%Si Alloy Subjected to Two-Stage Treatment

The paper describes the two-stage modification of the surface layer of hypereutectic Al-20%Si alloy that combines electroexplosive alloying by an Al-Y2O system with subsequent irradiation by pulsed electron beam. It is shown that irrespective of the modification mode, a multilayer structure is formed consisting of the following layers: a surface layer and an intermediate layer. The surface layer is a multiphase material, the thickness of which varies within 1 µm. The intermediate layer, the thickness of which varies within 40 µm, is made up of rapid solidification cells formed due to the rapid cooling of molten layer of Al-20%Si alloy. The cells are divided by thin interlayers mostly formed by silicon nanoparticles.

The using of Biphasic calcium sulfate in two-stage treatment of Odontogenic Fibroma of the mandible – Case Report

The using of Biphasic calcium sulfate in two-stage treatment of Odontogenic Fibroma of the mandible – Case Report

A Novel Two-Stage Heat Treatment with Medium-Temperature Aging Influence on Microstructure, Al3(Sc, Zr) Nanoprecipitation, and Application Properties, Enhancing Selective Laser Melting of Al-Mg-Sc-Zr Alloy.

Al–Mg–Sc–Zr alloy fabricated through selective laser melting (SLM) is an additive manufacturing alloy with promising industrial potential. In this study, as-printed specimens were subjected to either single-stage or two-stage heat treatment processes to investigate the effect of temperature from room temperature to high temperature on the specimens’ tensile and fatigue properties to establish a reliable reference for aerospace applications. The tensile test results indicated that the heat treatment contributed to determine the properties of the nanoprecipitate Al3(Sc, Zr) with a strengthening phase, improving tensile strength. Moreover, the dynamics strain aging (DSA) effect vanished as temperature increased. It is noteworthy that the nanoprecipitation was distributed at the boundary of the melting pool after single-stage heat treatment with the highest tensile properties in all tests. In addition, the microstructure observed after the two-stage heat treatment indicated a melting pool interface decomposition, and the nanoprecipitation was homogeneously scattered over the Al matrix, increasing strength and further delaying fatigue crack transmission. Those features build a high-fatigue-resistance foundation. TEM analysis also confirmed the promotion of Sc thermal diffusion and an Al3(Sc, Zr) precipitation transformation mechanism under two-stage heat treatment, corresponding to aforementioned inferences. The SLM Al–Mg–Sc–Zr alloy with two-stage heat treatment brings about balance between tensile properties and fatigue resistance, providing new insight into additive manufacturing with Al alloys.

Two stage treatability and biokinetic study of dairy wastewater using bacterial consortium and microalgae

Purpose of present research work is to perform nutrient removal and evaluate bio-kinetic coefficients of a two-stage dairy wastewater treatment process in batch reactor using bacterial consortium and microalgae Chlorella pyrenoidosa. The research work was performed in laboratory-scale batch reactor. Primary treated real life dairy wastewater after a treatment with a consortium of bacterial population containing carbon oxidation and nitrification bacteria was taken as the feed material for algal treatment process using microalgae C. pyrenoidosa strain. Nitrate nitrogen which was formed during bacterial nitrification still remaining in bacterial pre-treated dairy wastewater along with phosphorus that have been removed by algal treatment using microalgae of C. pyrenoidosa. The present investigation was done for bacterial and algal treatment of dairy plant effluent in a lab-scale batch reactor with acclimatized seeds of both carbon oxidation, nitrification bacteria, microalgae C. pyrenoidosa and also to evaluate various biokinetic coefficients. Around 95% ammonium nitrogen and soluble chemical oxygen demand (SCOD), around 99.67% and 90.25% of Nitrate nitrogen (NO3−-N) and Phosphorus (PO43-- P) removal were achieved corresponding to initial ammonium nitrogen and SCOD of 55 and 720 mg/L, nitrate nitrogen and phosphorus concentration of 54 and 16 mg/L respectively, with an initial inoculum concentration of bacterial consortium of 15%; corresponding to 1500 mg/L and microalgae C. pyrenoidosa of 0.8% v/v; corresponding to 80 mg/L after 24 h and 8 days of detention period in batch reactor respectively. Kinetic study was also carried out to obtain bio-kinetic coefficient for SCOD, ammonium nitrogen, nitrate nitrogen and phosphorus removal using bacterium and microalgae C. pyrenoidosa.

Features of the clinical course and treatment of osteosarcoma in children

The clinical course and treatment of osteosarcoma in 500 patients under the age of 16 are analyzed. The features of the disease at the indicated age include early metastasis and significant local spread of the tumor. The average time to detect metastases was 3.3 months. The epiphyseal cartilage plate is not an obstacle to tumor growth. The defeat of the knee joint was found in 65% of patients. The results of the primary amputation are unsatisfactory. Immediate amputation is indicated only in case of intoxication and the impossibility of carrying out combined treatment. In 52% of children, as a result of irradiation, tumor growth stopped. Radiation treatment at a dose of 60-90 Gy was used only in combination with surgery and chemotherapy, which was used before and after surgery and radiation. In connection with the early dissemination and significant spread of the tumor, a two-stage complex treatment was used.At the first stage, chemotherapy and radiation therapy were performed. In case of refusal of the operation or detection of metastases, such treatment became the main and final one. The second stage is a radical operation performed after 3-6 months in the absence of metastases and stabilization of tumor growth. This tactic facilitates the selection of patients for surgical treatment and avoids mutilation in children with an unfavorable course of the disease.

Selective Oxidation of a Medium-Mn Third Generation Advanced High Strength Steel during Austenitizing and Intercritical Annealing

The effect of the simulated continuous galvanizing line N2−5 vol% H2 process atmosphere oxygen partial pressure (pO2) on the external and internal selective oxidation of a prototype medium-Mn third generation (3G) advanced high strength steel was determined during a two-stage heat treatment cycle (i.e., austenitizing and intercritical annealing) which had previously yielded 3G properties. Thick external oxides (∼200 nm) were observed after the austenitizing heat treatment, regardless of the process atmosphere pO2 employed. An intermediate flash pickling step was successful in reducing the external oxide thickness significantly (to ∼30 nm) along with revealing some extruded metallic Fe nodules on the surface. The austenitizing heat treatment also resulted in a solute-depleted surface layer with a minimum thickness of 2 μm. This solute-depleted layer inhibited the formation of external oxides during intercritical annealing, resulting in a surface similar to that observed after flash pickling comprising a near-pure Fe surface with isolated, nodular external oxides. These surfaces are promising in terms of successful reactive wetting of this prototype medium-Mn steel during subsequent continuous hot-dip galvanizing.

Resection of giant malignant solitary fibrous pleural tumor after interventional embolization: a case report and literature review

BackgroundSolitary fibrous tumor of the pleura (SFTP) is a rare mesenchymal tumor that arises at various sites and typically originates from the pleura. Most patients with SFTPs are asymptomatic, unless the tumor is large. Approximately 20% of SFTP cases are malignant. There are few reports on imaging diagnoses and interventional treatments of SFTP. Here, we report a case of a giant SFTP that exhibited malignant behavior and underwent successful resection after embolization of the main supply artery of the tumor.Case presentationWe report a clinical case of a giant SFTP in a 66-year-old Chinese female patient complaining of chest tightness and cough for more than 2 months. Ten years ago, the patient had undergone a chest CT scan at a local hospital for cough. Computed tomography (CT) had revealed a mass in the right thoracic region, which was misdiagnosed as a pulmonary abscess by CT-guided biopsy. Therefore, the patient did not receive appropriate/complete treatment at that time. She was hospitalized again, because CT showed significant enlargement of the right thoracic mass, which caused her obvious symptoms of discomfort. The pathological results of CT-guided biopsy at our hospital confirmed SFTP. Considering the large size of the tumor and the rich blood supply, some of the main blood vessels were treated with embolization before surgical resection. A large tumor, about 23 cm × 16 cm × 15 cm in size, was then successfully removed by thoracic surgery. The diagnosis of malignant SFTP was confirmed by surgical pathology and immunohistochemistry.ConclusionImaging findings of SFTPs are not characteristic, especially when a tumor is large, the diagnosis is difficult, and the final diagnosis still depends on histological and immunohistochemical examinations. The two-stage surgical treatment described here, which involves first embolization of the main supplying artery of the large tumor and then complete surgical resection, is effective and safe for SFTPs. Whether needle biopsy or vascular embolization is performed, intervention plays a crucial role in the diagnosis and treatment of patients with SFTPs.

Сравнительная оценка результатов комбинированного применения различных методов лечения: кросслинкинга роговицы, имплантации интрастромальных роговичных колец-сегментов и трансэпителиальной топографической фоторефрактивной кератэктомии при лечении кератоконуса

Purpose. Comparative evaluation of the results of combined use of corneal cross-linking (CXL) and implantation of intrastromal corneal ring segments (ICRS) followed by transepithelial topographic photorefractive keratectomy (ТE-topoPRK) in the treatment of keratoconus. Material and methods. The study had been conducted at the National Centre of Ophthalmology named after acad. Zarifa Aliyeva. Within the frames of the first stage of the study during 2016–2019 years: 48 patients (48 eyes) have been operated only with using CXL (first group); 48 patients (48 eyes) – with using only ICRS (second group); and 48 patients (48 eyes) – with using of combination of CXL and ICRS (ICRS first, then CXL after 24 hours) for treatment of keratoconus of II–III stages due to Amsler M. classification. After 8 months, all patients (144 eyes) underwent the second stage of treatment using ТE-topoPRK. Results. Visual acuity and corneal status 8 months later after CXL, ICRS and the combination of CXL with ICRS generally changed significantly, which confirms the achievement of the expected effect. Comparing the studied parameters after the operation in the groups of patients operated on by the CXL, ICRS methods and their combination, a significant difference was revealed only in the value of NCVA (0.22±0.04, 0.46±0.03 и 0.52±0.04; р<0.05). Conclusion. The combined two-stage (with the interval of 8 months) treatment of keratoconus by implantation of intrastromal corneal rings with simultaneous corneal crosslinking followed by topographic photorefractive keratectomy is more effective than the use of these operations without combinations. Key words: crosslinking, corneal segments, keratoconus, topographic photorefractive keratectomy

Impact of Intragastric Balloon Placement on the Stomach Wall: A Prospective Cohort Study.

Endoscopic intragastric balloon (IGB) placement is a minimally invasive treatment for morbid obesity that is sometimes used as a preparatory step before surgical intervention. This study was performed to analyze the changes in the stomach wall induced by IGB placement, with particular emphasis on pathomorphology, inflammatory markers, and tissue growth factors. In total, 30 patients with morbid obesity were prospectively analyzed. A total of 16 patients with body mass index (BMI) ≥ 53kg/m2 underwent two-stage treatment comprising IGB placement followed by laparoscopic sleeve gastrectomy (LSG) (IGB group), while 14 patients underwent one-stage LSG (non-IGB group). The gastric specimens removed during LSG were examined. The two groups were compared regarding the surgical results, microscopic structure and inflammatory process exponents of the stomach wall, and receptors for selected tissue growth factors. The IGB group had a longer median hospital stay than that of the non-IGB group. Compared with the non-IGB group, the IGB group had a thicker stomach wall, more submucosal fibrosis, and increased amounts of growth factors and inflammatory markers. Patients with IGB placement before LSG showed greater changes in the stomach wall than those of patients who received LSG alone. IGB placement was associated with stomach muscle layer thickening, submucosal fibrosis, and increased levels of inflammatory markers and tissue growth factors.

Surgical stabilization of appendicular joints in tuberculous arthritis: its place in treatment of osteoarticular tuberculosis

The objective: to analyze results of stabilizing techniques in the surgical treatment of tuberculous arthritis of appendicular joints, to define their place in treatment of tuberculous arthritis.Subjects and Methods. Data of 8 patients who underwent surgery for tuberculosis of appendicular joints were analyzed during the study. 7 patients suffered from tuberculosis of rare localization: ankle – 3 cases, foot – 1 case, wrist – 3 cases. And 1 patient suffers from tuberculosis of the knee joint, underwent arthrodesis, which eventually failed, had quadriceps fibrosis with no patella. At the time of the study, athroplasty couldn’t be performed in all 8 patients, so stabilizing surgery including arthrodesis was the method of choice. With the active tuberculosis disease and an extensive bone defect of the joint in 5 patients, static cement spacers loaded with anti-tuberculosis drugs were used. Spacers were used both for two-stage surgical treatment (2 cases) and one-stage (3 cases).Results: in all 8 cases, the stable eradication of tuberculosis infection was achieved with a follow-up period from 6 months to 7 years, average duration of follow-up made 2.2 Ѓ} 1.4 years. In 5 patients with tuberculosis of the ankle, foot and former knee joint, the support ability of the extremity was restored. With the stabilization of the wrist in a functionally advantageous position, all 3 patients showed a significant improvement in hand functions. After the spacer was installed, all patients were scheduled for the second stage of the operation but 3 of them achieved a good functional result, thus it was possible to avoid the next stage. The main criterion for stabilizing surgery of joints may be the impossibility of performing arthroplasty in cases of extensive bone defects as well as in case of persistent loss of anatomical structures.

Diagnosis and surgical correction of insufficiency of physiological cardia in hiatal hernia

Background. The purpose of the study was to improve the diagnosis and improving the results of surgical treatment of patients with hiatal hernia (HH) and GERD by applying the developed method of surgical correction of insufficiency of physiological cardia aimed at preserving and restoring the anatomical and topographic relationships of the esophagocardial organs. Materials and methods. In the Department of Digestive Surgery of the State Institution “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine” for the period 2017–2021 conducted a study in 78 patients with HH, including: axial HH (typeI) was 60 (77.0%) patients; paraesophageal (type II)— 9 (11.5%) patients; mixed (type III)— 9 (11.5%) (code for ICD-10— K44). To establish and confirm the diagnosis, patients underwent radiological and endoscopic examination of the esophagus, stomach, duodenum, manometry. Results. In the analysis of complaints of examined patients it can be noted that the most common clinical manifestations in patients with HH and GERD were heartburn in 73 (93.7%), belching in 68 (87.2%) and epigastric pain in 64 (82.0%). The erosions of the lower third of the esophagus was found in 13 (16.7%) patients, while according to the Los Angeles classification in 6 (7.7%) patients had esophagitis grade A, 7 (8.9%) patients— grade B. According to the results of the manometry study, the highest pressure was observed in patients with axial HH and was (13.54±3.32) mm Hg, and the lowest— in patients with GERD and was (9.81±3.18) mm Hg. After a comprehensive examination, 3 (3.8%) patients after confirmation of the diagnosis of HH in combination with Barrett’s esophagus underwent two-stage treatment: the first stage performed argonoplasmic ablation of altered esophageal mucosa, the second stage— antireflux surgery. All of 78 (100%) patients underwent antireflux surgery. Laparoscopic fundoplications were performed: the Nissen fundoplication was performed in 53 (67.9%) patients, Toupet fundoplication in 7 (8.9%) patients and Dor fundoplication in 5 (6.6%) patients, cruroraphy was performed in 100.0%. The 11 (14.1%) patients underwent surgery according to a new method that provides reliable restoration of physiological cardia and preservation of the anatomical relationship of the diaphragm and esophageal-gastric junction and includes cruroraphy and fundoplication. Conclusions. The method of surgical treatment of insufficiency of physiological cardia in HH, proposed by us, aimed at the correction of physiological cardia is less traumatic than known, provides a reliable restoration of the anatomical relationship of the esophagogastric region.

The Fate and Relevance of the Patella in Two-Stage Revision Total Knee Arthroplasty for Periprosthetic Joint Infection

BackgroundIt remains unclear whether reimplantation of a patellar component during a two-stage revision for periprosthetic total knee arthroplasty infection (PJI) affects patient reported outcome measures (PROMs) or implant survivorship. The purpose of this study was to evaluate whether patellar resurfacing during reimplantation confers a functional benefit or increases implant survivorship after two-stage treatment for PJI. MethodsTwo-stage revisions for knee PJI performed by three surgeons at a single tertiary care center were reviewed retrospectively. All original patellar components and cement were removed during resection and the patella was resurfaced whenever feasible during reimplantation. PROMs, implant survivorship, and radiographic measurements (patellar tilt and displacement) were compared between knees reimplanted with a patellar component versus those without a patellar component. ResultsA total of 103 patients met the inclusion criteria. Forty-three patients (41.7%) underwent reimplantation with, and 60 patients (58.3%) without a patellar component. At a mean follow-up of 33.5 months, there were no significant differences in patient demographics or PROMs between groups (P ≥ .156). No significant differences were found in the estimated Kaplan-Meier all-cause, aseptic, or septic survivorship between groups (P ≥ .342) at a maximum of 75 months follow-up. There was no significant difference in the change (pre-resection to post-reimplant) of patellar tilt (P = .504) or displacement (P = .097) between the groups. ConclusionPatellar resurfacing during knee reimplantation does not appear to meaningfully impact postoperative PROMs or survivorship. Given the risk of potential extensor mechanism complications with patellar resurfacing, surgeons may choose to leave the patella without an implant during total knee reimplantation and expect similar clinical outcomes. Level of EvidenceLevel III.

Revascularization of Left Subclavian to Common Carotid Artery Prepares for Covered Stent Implantation in Patients With Complex Aortic Coarctation.

Seven adult patients underwent a two-stage treatment of complex coarctation (CoA), including surgical revascularization of the left subclavian artery (LSA) to left common carotid artery (LCCA), followed by transcatheter covered stent implantation. The majority of patients (5 of 7, 71%) received 1 covered stent (covered Cheatham Platinum stent: 8 zig/45 mm [n = 2], 10 zig/60 mm [n = 1], 10 zig/65 mm [n = 1]; BeGraft: 24/48 mm [n = 2]). In 1 patient (14%), the implantation of 2 covered stents (BeGraft 20/48 mm) was necessary. During a median follow-up of 2.4 years (interquartile range, 0.1 to 4.9 years), complications occurred in 3 of 7 patients (43%), including an asymptomatic but severe stenosis of the LSA bypass (n = 1), a recoarctation with a mild endoleak (n = 1), and a severe endoleak (n = 1). Surgical revascularization of the LSA to the LCCA can successfully prepare for covered stent implantation in complex CoA in adult patients. This two-stage approach was feasible and safe with complications occurring in 3 of 7 patients (43%). All complications were managed by catheter reintervention only.

Cryopreserved Placental Membrane Allograft Reduces the Likelihood of Developing a New or Recurring Foot Ulcer and All-Cause Mortality in Diabetic Patients When Compared with Other Cellular- and Tissue-Based Products.

Objective: To compare outcomes for Medicare patients with diabetic foot ulcer(s) (DFU) receiving cryopreserved placental membrane containing viable cells (vCPM) to other Cellular- and Tissue-Based Products (CTPs). Approach: Patients with DFU and CTP use were selected in Medicare claims (2013-2017) by using a strict definition of DFU with demonstrated diabetes etiology. We compared the effectiveness of vCPM with other CTPs on: (1) reduction of post-treatment ulcer occurrence, and (2) reduction in 1 year mortality. We controlled for selection bias and differential risk characteristics between comparison groups in a two-stage inverse probability treatment weighting model. Results: Overall, 7,869 DFU episodes with CTP use met inclusion criteria: 786 received vCPM, 4,546 received another "cellular" CTP, and 2,537 received "acellular" CTP. For ulcer occurrence, we examined: 30-, 90-, 180-, and 365 days post-treatment. We found a significant reduction in ulcers at each period for vCPM compared with either alternative CTP-results range from a 36.7% percentage point reduction in ulcer occurrence at 30 days compared with cellular CTP, and a 58.5% percentage point reduction at 365 days compared with acellular CTP. Further, the application of vCPM reduces mortality within 1 year by 2.3 percentage points (13-13.8% change) compared with other CTPs. Innovation: This study examines the differences in ulcer occurrence and mortality for Medicare DFU patients receiving vCPM and other CTPs. Our strict DFU definition excludes beneficiaries without foot ulcer with demonstrated diabetes etiology. Conclusion: Among CTPs, vCPM users have reduced ulcer rates (recurrent or new) and reduced all-cause mortality compared with other "cellular" and "acellular" CTPs.

Articulated bipolar vs. non-articulated conventional spacers: A comparative study of results from two-stage treatment of chronic septic arthritis in prosthetic or native hips

IntroductionInfection is a serious complication of 0.2–0.7% of primary total hip arthroplasties (THA) and 1-22% of prosthetic revisions. The objective of our study was to compare two types of spacers (unipolar versus bipolar) for two-stage revisions of periprosthetic hip infections. The primary hypothesis was that bipolar spacers have fewer mechanical complications than unipolar spacers. The secondary hypothesis was that bipolar spacers decrease the rate of septic revisions and promote primary prosthesis reimplantation. Material and methodThis retrospective, monocentric, multi-operator study was carried out between January 2012 and July 2018, including patients operated on for septic arthritis of the native or prosthetic hip (two-stage procedure). The patients were divided into two groups: group A, including the articulated spacers and group B, including the unipolar spacers. We studied the complications of the spacers and the course of the infection over a minimum of two years. Functional status was assessed by the Postel Merle d’Aubigné (PMA) score, the Harris Hip Score (HHS) and pre- and postoperative patient satisfaction scores. ResultsWe collected data for 39 hips from 37 patients (mean age 63, 22 men and 14 women: 16 patients in group A, 21 in group B). We found no mechanical complications in group A versus 12 (52%) in group B. At 2 years, 93.8% of patients in group A no longer had any signs indicative of an active infection, compared with 71.4% in group B. In group A, the median PMA score increased from 5.5 (4–10.5) to 13.5 (12.5–15.5) and the HHS score from 27.5 (17–41.5) to 79 (64.5–89.5), postoperatively. In the final group B, the PMA score increased from 7 (6–9) to 14 (12–16) and the HHS score from 24 (11–41) to 72 (48–82) postoperatively. ConclusionThe use of articulated spacers in THA or septic THA two-stage revision significantly reduces the occurrence of mechanical complications in the short term, as well as the pain between the two procedures. Level of proofIV.