Abstract Thorough radiographic evaluation is necessary for perioperative assessments in revision total knee arthroplasty. There has been a large degree of variability in reporting these findings ...within the peer-reviewed literature. Our purpose was to evaluate studies that radiographically assessed alignment in the coronal and sagittal plane, patella alignment and thickness, presence and characterization of implant interface, and radiolucency. Secondly, we reviewed studies using a standardized reporting system to evaluate radiographic findings (the Knee Society Roentgenographic Evaluation and Scoring System) and the number of times it was referenced. Only 62% of studies evaluated all radiographic parameters, 57% to 91% assessed each metric, and 55% used standardized reporting systems. This emphasizes the need for a uniform evaluation method to ensure consistent radiographic assessment and optimal standard of care.
In this randomized, multicenter, controlled, double‐blind, sequential trial, 381 patients undergoing primary total knee replacement were randomly assigned to receive subcutaneous injections of either ...3500 IU anti‐factor Xa of bemiparin sodium, first dose 6 h after surgery, or 40 mg of enoxaparin, first dose 12 h before surgery, followed by daily doses for 10 ± 2 days, for the prophylaxis of venous thromboembolism. The primary efficacy endpoint was venous thromboembolism up to postoperative day 10 ± 2, defined as deep vein thrombosis detected by mandatory bilateral venography, documented symptomatic deep vein thrombosis and/or documented symptomatic pulmonary embolism. The primary safety endpoint was major bleeding. Eighty‐seven percent of all randomized patients (333 of 381 patients) were evaluable for efficacy. The incidence of venous thromboembolism was 32.1% (53 of 165 patients) in the bemiparin group and 36.9% (62 of 168 patients) in the enoxaparin group. The absolute risk difference was 4.8% in favor of bemiparin 95% confidence interval (CI), −15.1% to 5.6%; non‐inferiority P‐value: 0.02; superiority P‐value: 0.36. The incidence of proximal deep vein thrombosis was 1.8% (three of 165 patients) in the bemiparin group and 4.2% (seven of 168 patients) in the enoxaparin group. Major bleeding occurred in six patients (three in each group). There were no deaths during the study. This trial shows that bemiparin started postoperatively is as effective and safe as enoxaparin started preoperatively in the prevention of venous thromboembolism in patients undergoing total knee replacement.
Background. The use of natural health products in prostate cancer (PrCa) is high despite a lack of evidence with respect to safety and efficacy. Fish-derived omega-3 fatty acids possess ...anti-inflammatory effects and preclinical data suggest a protective effect on PrCa incidence and progression; however, human studies have yielded conflicting results. Methods. A search of OVID MEDLINE, Pre-MEDLINE, Embase, and the Allied and Complementary Medicine Database (AMED) was completed for human interventional or observational data assessing the safety and efficacy of fish-derived omega-3 fatty acids in the incidence and progression of PrCa. Results. Of 1776 citations screened, 54 publications reporting on 44 studies were included for review and analysis: 4 reports of 3 randomized controlled trials, 1 nonrandomized clinical trial, 20 reports of 14 cohort studies, 26 reports of 23 case-control studies, and 3 case-cohort studies. The interventional studies using fish oil supplements in patients with PrCa showed no impact on prostate-specific antigen levels; however, 2 studies showed a decrease in inflammatory or other cancer markers. A small number of mild adverse events were reported and interactions with other interventions were not assessed. Cohort and case-control studies assessing the relationship between dietary fish intake and the risk of PrCa were equivocal. Cohort studies assessing the risk of PrCa mortality suggested an association between higher intake of fish and decreased risk of prostate cancer–related death. Conclusions. Current evidence is insufficient to suggest a relationship between fish-derived omega-3 fatty acid and risk of PrCa. An association between higher omega-3 intake and decreased PrCa mortality may be present but more research is needed. More intervention trials or observational studies with precisely measured exposure are needed to assess the impact of fish oil supplements and dietary fish-derived omega-3 fatty acid intake on safety, PrCa incidence, treatment, and progression.
Background
Critically ill patients with diabetes mellitus (DM) are at increased risk of in‐hospital complications and the optimal glycemic target for such patients remains unclear. A more liberal ...approach to glucose control has recently been suggested for patients with DM, but uncertainty remains regarding its impact on complications.
Methods
We aimed to test the hypothesis that complications would be more common with a liberal glycemic target in ICU patients with DM. Thus, we compared hospital‐acquired complications in the first 400 critically ill patients with DM included in a sequential before‐and‐after trial of liberal (glucose target: 10‐14 mmol/L) vs conventional (glucose target: 6‐10 mmol/L) glucose control.
Results
Of the 400 patients studied, 165 (82.5%) patients in the liberal and 177 (88.5%) in the conventional‐control group were coded for at least one hospital‐acquired complication (P = 0.09). When comparing clinically relevant complications diagnosed between ICU admission and hospital discharge, we found no difference in the odds for infectious (adjusted odds ratio aOR for liberal‐control: 1.15 95% CI: 0.68‐1.96, P = 0.60), cardiovascular (aOR 1.40 95% CI: 0.63‐3.12, P = 0.41) or neurological complications (aOR: 1.07 95% CI: 0.61‐1.86, P = 0.81), acute kidney injury (aOR 0.83 95% CI: 0.43‐1.58, P = 0.56) or hospital mortality (aOR: 1.09 95% CI: 0.59‐2.02, P = 0.77) between the liberal and the conventional‐control group.
Conclusion
In this prospective before‐and‐after study, liberal glucose control was not associated with an increased risk of hospital‐acquired infectious, cardiovascular, renal or neurological complications in critically ill patients with diabetes.
Some developmental responses of wild-type and mutant strains of Arabidopsis thaliana to ethylene have been investigated (shoot and root elongation, isodiametric cell expansion, plumular hook angle, ...ethylene biosynthesis, peroxidase activity). One such mutant (eti 5) shows little or no response to ethylene at concentrations up to 10000 μl 1−1 in any test; the other mutants show reduced responses. The ability of germinated seedlings to emerge through sand is directly proportional to their sensitivity to ethylene. It is suggested that this finding supports the hypothesis that increased ethylene production in response to mechanical impedance is involved, via its effects on stem thickening and hook closure, in the emergence process.
The crystal and magnetic structures of the Ruddlesden-Popper related iron oxyhalides, Sr3Fe2O5X2, X = Cl and Br and the mixed B site material Sr3FeCoO5Cl2 have been studied using neutron powder ...diffraction. The materials consist of double layers of Fe(Co)O5 square pyramids separated along the z-direction by SrX rocksalt layers. Neutron powder diffraction data were collected at room temperature and 2 K for Sr3Fe2O5Br2 and Sr3FeCoO5Cl2, whilst the thermal dependence of both the nuclear structure and the long range magnetic order of Sr3Fe2O5Cl2 in the range 17 K < T < 625 K has been studied, allowing the materials TNeeI = 590 K to be determined. All three phases adopt G-type antiferromagnetic spin structures, with the moments confined within the xy-plane. The materials possess low temperature moments mu = 4.40(4)mg, mu = 4.07(6) muB and mu = 2.11(4) muB for Sr3Fe2O5Cl2, Sr3Fe2O5Br2 and Sr3FeCoO5Cl2, respectively, indicating the presence of high spin iron (III) in all compounds.
Background:
The long-term prognosis and risk factors for quality of life and disability after anterior cruciate ligament (ACL) reconstruction remain unknown.
Hypothesis/Purpose:
Our objective was to ...identify patient-reported outcomes and patient-specific risk factors from a large prospective cohort at a minimum 10-year follow-up after ACL reconstruction. We hypothesized that meniscus and articular cartilage injuries, revision ACL reconstruction, subsequent knee surgery, and certain demographic characteristics would be significant risk factors for inferior outcomes at 10 years.
Study Design:
Therapeutic study; Level of evidence, 2.
Methods:
Unilateral ACL reconstruction procedures were identified and prospectively enrolled between 2002 and 2004 from 7 sites in the Multicenter Orthopaedic Outcomes Network (MOON). Patients preoperatively completed a series of validated outcome instruments, including the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), and Marx activity rating scale. At the time of surgery, physicians documented all intra-articular abnormalities, treatment, and surgical techniques utilized. Patients were followed at 2, 6, and 10 years postoperatively and asked to complete the same outcome instruments that they completed at baseline. The incidence and details of any subsequent knee surgeries were also obtained. Multivariable regression analysis was used to identify significant predictors of the outcome.
Results:
A total of 1592 patients were enrolled (57% male; median age, 24 years). Ten-year follow-up was obtained on 83% (n = 1320) of the cohort. Both IKDC and KOOS scores significantly improved at 2 years and were maintained at 6 and 10 years. Conversely, Marx scores dropped markedly over time, from a median score of 12 points at baseline to 9 points at 2 years, 7 points at 6 years, and 6 points at 10 years. The patient-specific risk factors for inferior 10-year outcomes were lower baseline scores; higher body mass index; being a smoker at baseline; having a medial or lateral meniscus procedure performed before index ACL reconstruction; undergoing revision ACL reconstruction; undergoing lateral meniscectomy; grade 3 to 4 articular cartilage lesions in the medial, lateral, or patellofemoral compartments; and undergoing any subsequent ipsilateral knee surgery after index ACL reconstruction.
Conclusion:
Patients were able to perform sports-related functions and maintain a relatively high knee-related quality of life 10 years after ACL reconstruction, although activity levels significantly declined over time. Multivariable analysis identified several key modifiable risk factors that significantly influence the outcome.
An anterior cruciate ligament (ACL) tear is a common knee injury, particularly among young and active individuals. Little is known, however, about the societal impacts of ACL tears, which could be ...large given the typical patient age and increased lifetime risk of knee osteoarthritis. This study evaluates the cost-effectiveness of ACL reconstruction compared with structured rehabilitation only.
A cost-utility analysis of ACL reconstruction compared with structured rehabilitation only was conducted with use of a Markov decision model over two time horizons: the short to intermediate term (six years), on the basis of Level-I evidence derived from the KANON Study and the Multicenter Orthopaedic Outcomes Network (MOON) database; and the lifetime, on the basis of a comprehensive literature review. Utilities were assessed with use of the SF-6D. Costs (in 2012 U.S. dollars) were estimated from the societal perspective and included the effects of the ACL tear on work status, earnings, and disability. Effectiveness was expressed as quality-adjusted life years (QALYs) gained.
In the short to intermediate term, ACL reconstruction was both less costly (a cost reduction of $4503) and more effective (a QALY gain of 0.18) compared with rehabilitation. In the long term, the mean lifetime cost to society for a typical patient undergoing ACL reconstruction was $38,121 compared with $88,538 for rehabilitation. ACL reconstruction resulted in a mean incremental cost savings of $50,417 while providing an incremental QALY gain of 0.72 compared with rehabilitation. Effectiveness gains were driven by the higher probability of an unstable knee and associated lower utility in the rehabilitation group. Results were most sensitive to the rate of knee instability after initial rehabilitation.
ACL reconstruction is the preferred cost-effective treatment strategy for ACL tears and yields reduced societal costs relative to rehabilitation once indirect cost factors, such as work status and earnings, are considered. The cost of an ACL tear over the lifetime of a patient is substantial, and resources should be directed to developing innovations for injury prevention and for altering the natural history of an ACL injury.
Context.
Despite recent observational and theoretical advances in mapping the magnetic fields associated with molecular clouds, their three-dimensional (3D) morphology remains unresolved. ...Multi-wavelength and multi-scale observations will allow us to paint a comprehensive picture of the magnetic fields of these star-forming regions.
Aims.
We reconstructed the 3D magnetic field morphology associated with the Perseus molecular cloud and compared it with predictions of cloud-formation models. These cloud-formation models predict a bending of magnetic fields associated with filamentary molecular clouds. We compared the orientation and direction of this field bending with our 3D magnetic-field view of the Perseus cloud.
Methods.
We used previous line-of-sight and plane-of-sky magnetic field observations as well as Galactic magnetic field models to reconstruct the complete 3D magnetic field vectors and morphology associated with the Perseus cloud.
Results.
We approximated the 3D magnetic field morphology of the cloud as a concave arc that points in the decreasing longitude direction in the plane of the sky (from our point of view). This field morphology preserves a memory of the Galactic magnetic field. In order to compare this morphology to cloud-formation model predictions, we assume that the cloud retains a memory of its most recent interaction. After incorporating velocity observations, we find that the line-of-sight magnetic field observations are consistent with predictions of shock-cloud-interaction models.
Conclusions.
To our knowledge, this is the first time that the 3D magnetic fields of a molecular cloud have been reconstructed. We find the 3D magnetic field morphology of the Perseus cloud to be consistent with the predictions of the shock-cloud-interaction model that describes the formation mechanism of filamentary molecular clouds.
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