AbstractObjectivesTo provide accurate risk estimates of serious adverse events after elective shoulder replacement surgery for arthritis, including age and sex specific estimates of the lifetime risk ...of revision surgery.DesignPopulation based cohort study.SettingHospital episode statistics for NHS England, including civil registration mortality data.Participants58 054 elective shoulder replacements in 51 895 adults (aged ≥50 years) between April 1998 and April 2017.Main outcome measuresThe lifetime risk of revision surgery, calculated using an actuarial life table approach and the cumulative probability method. Rates of serious adverse events at 30 and 90 days post-surgery: pulmonary embolism, myocardial infarction, lower respiratory tract infection, acute kidney injury, urinary tract infection, cerebrovascular events, and all cause death. Secondary outcome measures were the number of surgeries performed each year and Kaplan-Meier estimates of revision risk at 3, 5, 10, and 15 years.ResultsThe number of shoulder replacements performed each year increased 5.6-fold between 1998 and 2017. Lifetime risks of revision surgery ranged from 1 in 37 (2.7%, 95% confidence interval 2.6% to 2.8%) in women aged 85 years and older to 1 in 4 (23.6%, 23.2% to 24.0%) in men aged 55-59 years. The risks of revision were highest during the first five years after surgery. The risk of any serious adverse event at 30 days post-surgery was 1 in 28 (3.5%, 3.4% to 3.7%), and at 90 days post-surgery was 1 in 22 (4.6%, 4.4% to 4.8%). At 30 days, the relative risk of pulmonary embolism compared with baseline population risk was 61 (95% confidence interval 50 to 73) for women aged 50-64. Serious adverse events were associated with increasing age, comorbidity, and male sex. 1 in 5 (21.2%, 17.9% to 25.1%) men aged 85 years and older experienced at least one serious adverse event within 90 days.ConclusionsYounger patients, particularly men, need to be aware of a higher likelihood of early failure of shoulder replacement and the need for further and more complex revision replacement surgery. All patients should be counselled about the risks of serious adverse events. These risks are higher than previously considered, and for some could outweigh any potential benefits. Our findings caution against unchecked expansion of shoulder replacement surgery in both younger and older patients. The more accurate age and sex specific estimates of risk from this study are long overdue and should improve shared decision making between patients and clinicians.Study registrationClinicalTrials.gov NCT03573765.
This paper explores the Holocene climatic dynamics of South Africa's southern Cape, a region that supports a large proportion of the Greater Cape Floristic Region and contains an array of important ...archaeological sites. While South African climates are generally characterised by marked rainfall seasonality, the southern Cape is currently situated at the interface between tropical and temperate climate systems, resulting in a largely aseasonal rainfall regime. This regime, however, is thought to have been particularly sensitive to past changes in late Quaternary boundary conditions, meaning that variability in either tropical or temperate systems could have significant environmental impacts. Evidence of past climate change, however, remains limited.
We present a 9000-year record of hydroclimatic variability obtained from rock hyrax midden stable nitrogen records, from Papkuilsfontein, on the southern slope of the Anysberg Mountains. Resolved to an average 6-year resolution and spanning the period c. 9050 cal yr BP to 1990 CE, this is the highest resolution Holocene record from southern Africa and presents a unique opportunity for the detailed study of the primary drivers and spatial gradients of Holocene climate change in the southern Cape. The data indicate a long-term decrease in aridity across the Holocene and a pattern of variability that reveals remarkable similarities with records from the South African tropics and El Niño–Southern Oscillation proxies, highlighting the significance of tropical systems as drivers of Holocene climate change in the region. This substantially expands what has been previously considered to be the zone of tropical influence, extending from a coastal phenomenon associated with heat transport via the Agulhas Current to encompass much, if not all, of the Agulhas Plain south of the Cape Fold Mountains. These findings provide a valuable new climatic framework for contextualizing changes in ecological and archaeological records in the southern Cape, and contribute to a more comprehensive understanding of the spatio-temporal dynamics of climate systems in southern Africa.
•Sub-decadal 9000-year record of aridity from South Africa's southern Cape.•Reveals dominance of tropical forcing across the southern Cape and Agulhas Plain.•ENSO variability indicated to be important driver of regional climate change.•Presents high-resolution framework for study of human-environment interactions.
Objective To investigate whether placebo controls should be used in the evaluation of surgical interventions.Design Systematic review.Data sources We searched Medline, Embase, and the Cochrane ...Controlled Trials Register from their inception to November 2013.Study selection Randomised clinical trials comparing any surgical intervention with placebo. Surgery was defined as any procedure that both changes the anatomy and requires a skin incision or use of endoscopic techniques.Data extraction Three reviewers (KW, BJFD, IR) independently identified the relevant trials and extracted data on study details, outcomes, and harms from included studies.Results In 39 out of 53 (74%) trials there was improvement in the placebo arm and in 27 (51%) trials the effect of placebo did not differ from that of surgery. In 26 (49%) trials, surgery was superior to placebo but the magnitude of the effect of the surgical intervention over that of the placebo was generally small. Serious adverse events were reported in the placebo arm in 18 trials (34%) and in the surgical arm in 22 trials (41.5%); in four trials authors did not specify in which arm the events occurred. However, in many studies adverse events were unrelated to the intervention or associated with the severity of the condition. The existing placebo controlled trials investigated only less invasive procedures that did not involve laparotomy, thoracotomy, craniotomy, or extensive tissue dissection.Conclusions Placebo controlled trial is a powerful, feasible way of showing the efficacy of surgical procedures. The risks of adverse effects associated with the placebo are small. In half of the studies, the results provide evidence against continued use of the investigated surgical procedures. Without well designed placebo controlled trials of surgery, ineffective treatment may continue unchallenged.
Determining the timing and drivers of Pleistocene hydrological change in the interior of South Africa is critical for testing hypotheses regarding the presence, dynamics, and resilience of human ...populations. Combining geological data and physically based distributed hydrological modeling, we demonstrate the presence of large paleolakes in South Africa's central interior during the last glacial period, and infer a regional-scale invigoration of hydrological networks, particularly during marine isotope stages 3 and 2, most notably 55 to 39 ka and 34 to 31 ka. The resulting hydrological reconstructions further permit investigation of regional floral and fauna responses using a modern analog approach. These suggest that the climate change required to sustain these water bodies would have replaced xeric shrubland with more productive, eutrophic grassland or higher grass-cover vegetation, capable of supporting a substantial increase in ungulate diversity and biomass. The existence of such resource-rich landscapes for protracted phases within the last glacial period likely exerted a recurrent draw on human societies, evidenced by extensive pan-side artifact assemblages. Thus, rather than representing a perennially uninhabited hinterland, the central interior's underrepresentation in late Pleistocene archeological narratives likely reflects taphonomic biases stemming from a dearth of rockshelters and regional geomorphic controls. These findings suggest that South Africa's central interior experienced greater climatic, ecological, and cultural dynamism than previously appreciated and potential to host human populations whose archaeological signatures deserve systematic investigation.
Abstract Objective Our primary objective was to summarise the known effects of locally administered glucocorticoid on tendon tissue and tendon cells. Methods We conducted a systematic review of the ...scientific literature using the PRISMA and Cochrane guidelines of the Medline database using specific search criteria. The search yielded 50 articles, which consisted of 13 human studies, 36 animal studies and one combined human/animal study. Results Histologically, there was a loss of collagen organisation (6 studies) and an increase in collagen necrosis (3 studies). The proliferation (8 studies) and viability (9 studies) of fibroblasts was reduced. Collagen synthesis was decreased in 17 studies. An increased inflammatory cell infiltrate was shown in 4 studies. Increased cellular toxicity was demonstrated by 3 studies. The mechanical properties of tendon were investigated by 18 studies. Descriptively, 6 of these studies showed a decrease in mechanical properties, 3 showed an increase, while the remaining 9 showed no significant change. A meta-analysis of the mechanical data revealed a significant deterioration in mechanical properties, with an overall effect size of −0.67 (95% CI = 0.01 to −1.33) (data from 9 studies). Conclusions Overall it is clear that the local administration of glucocorticoid has significant negative effects on tendon cells in vitro , including reduced cell viability, cell proliferation and collagen synthesis. There is increased collagen disorganisation and necrosis as shown by in vivo studies. The mechanical properties of tendon are also significantly reduced. This review supports the emerging clinical evidence that shows significant long-term harms to tendon tissue and cells associated with glucocorticoid injections.
Long-term outcome of frozen shoulder Hand, Campbell; Clipsham, Kim; Rees, Jonathan L ...
Journal of shoulder and elbow surgery,
03/2008, Letnik:
17, Številka:
2
Journal Article
Recenzirano
Two-hundred and sixty-nine shoulders in 223 patients with a diagnosis of primary frozen shoulder were studied. The main outcome measure was the Oxford shoulder score. The mean follow-up from symptom ...onset was 4.4 years (range, 2-20 years). The mean age at symptom onset was 53.4 years; with women affected more commonly than men (1.6:1.0).Twenty percent of patients reported bilateral symptoms, but there were no recurrent cases. In the long term, 59% of patients had normal or near normal shoulders and 41% reported some ongoing symptoms. The majority of these persistent symptoms were mild (94%), with pain being the most common complaint. Only 6% had severe symptoms with pain and functional loss.Those with the most severe symptoms at condition onset had the worst long-term prognosis, P < .001.
It has been recognized for nearly a century that human beings are inhabited by a remarkably dense and diverse microbial ecosystem, yet we are only just beginning to understand and appreciate the many ...roles that these microbes play in human health and development. Establishment of the microbiome begins at birth, but many previous studies on infant skin health have focused on Candida species. Little is known on the full microbial composition across different areas and even less is known on how these communities change during disease/inflammatory states. In this clinical study, infants were recruited during periods of diaper dermatitis (DD) and health to characterize the skin microbiome in these two states. Substantial shifts in the skin microbiome were observed across four sites in the diapered area (genitals, intertriginous, buttocks and perianal), as well as during periods of DD. As DD scores increased, there was a shift in relative abundance that demonstrated higher community percentages of faecal coliforms, such as Enterococcus, and lower percentages of Staphylococcus strains. In high‐rash samples, the predominant Staphylococcus species is S aureus, potentially implicating S aureus as a DD aetiological agent. This study provides new information related to the microbiome on infant skin in the diapered area and provides insights into the role of the microbiome in the development of DD.
The toxicity of antiretroviral therapy is an increasingly important issue in the management of patients with human immunodeficiency virus (HIV). With sustained major declines in opportunistic ...complications, HIV infection is increasingly a more chronic disease, and so more drugs are being used in more patients for longer periods. However, permanent and near-perfect adherence to antiretroviral therapy is needed to maximize its long-term benefits. Although adverse reactions to antiretroviral therapy are common, and profoundly affect its clinical efficacy by limiting adherence, many such reactions are poorly studied and analysed, and are under-reported. This article summarizes adverse events associated with antiretroviral therapy, and discusses weaknesses and possible solutions in the study, analysis and reporting of adverse events that could improve antiretroviral drug development.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Abstract Oxidative stress occurs when the production of oxidants surpasses the antioxidant capacity in living cells. Oxidative stress is implicated in a number of pathological conditions such as ...cardiovascular and neurodegenerative diseases but it also has crucial roles in the regulation of cellular activities. Over the last few decades, many studies have identified significant connections between oxidative stress, inflammation and healing. In particular, increasing evidence indicates that the production of oxidants and the cellular response to oxidative stress are intricately connected to the fate of implanted biomaterials. This review article provides an overview of the major mechanisms underlying the link between oxidative stress and the biocompatibility of biomaterials. ROS, RNS and lipid peroxidation products act as chemo-attractants, signalling molecules and agents of degradation during the inflammation and healing phases. As chemo-attractants and signalling molecules, they contribute to the recruitment and activation of inflammatory and healing cells, which in turn produce more oxidants. As agents of degradation, they contribute to the maturation of the extracellular matrix at the healing site and to the degradation of the implanted material. Oxidative stress is itself influenced by the material properties, such as by their composition, their surface properties and their degradation products. Because both cells and materials produce and react with oxidants, oxidative stress may be the most direct route mediating the communication between cells and materials. Improved understanding of the oxidative stress mechanisms following biomaterial implantation may therefore help the development of new biomaterials with enhanced biocompatibility.
Electrospun filaments are leading to a new generation of medical yarns that have the ability to enhance tissue healing through their biophysical cues. We have recently developed a technology to ...fabricate continuous electrospun filaments by depositing the submicron fibres onto a thin wire. Here we investigate the influence of pyridine on the fibre deposition. We have added pyridine to polydioxanone solutions at concentrations ranging from 0 to 100 ppm, increasing the conductivity of the solutions almost linearly from 0.04 uS/cm to 7 uS/cm. Following electrospinning, this led to deposition length increasing from 1 cm to 14 cm. The samples containing pyridine easily underwent cold drawing. The strength of drawn filaments increased from 0.8 N to 1.5 N and this corresponded to a decrease in fibre diameter, with values dropping from 2.7 μm to 1 μm. Overall, these findings are useful to increase the reliability of the manufacturing process of continuous electrospun filaments and to vary their biophysical properties required for their application as medical yarns such as surgical sutures.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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