Black-White Differences in Hip Geometry

Previous studies have demonstrated that reduced thickness of the femoral neck and shaft cortex, a wider intertrochanteric region and a longer hip axis length were predictive of hip fracture among Caucasian women. We hypothesized that racial differences in these features of hip geometry may contribute to explaining the differences in hip fracture incidence between women of African origin and Caucasian women. We measured the cortical thickness and bone widths in 132 African-American women and 43 Nigerian women who were pair-matched on height (± 3 cm), age (± 5 years) and weight (± 3 kg) to 175 Caucasian women. Measures of cortical thickness were greater among women of African origin than Caucasian. Women of African origin had smaller bone widths and a shorter hip axis length than Caucasians. Several of these differences were independent of bone mineral density except for the cortical thickness of the femoral shaft. We conclude that women of African origin have thicker cortical bone of the hip, a shorter hip axis length and smaller intertrochanteric widths than Caucasians. Based on a model developed from hip fractures among Caucasian women, we predict that these observed racial differences could contribute to approximately a 25% decrease risk of hip fracture among blacks.     

Aging Differences in Ethnic Skin

Aging is an inevitable and complex process that can be described clinically as features of wrinkles, sunspots, uneven skin color, and sagging skin. These cutaneous effects are influenced by both intrinsic and extrinsic factors and often are varied based on ethnic origin given underlying structural and functional differences. The authors sought to provide updated information on facets of aging and how it relates to ethnic variation given innate differences in skin structure and function. Publications describing structural and functional principles of ethnic and aging skin were primarily found through a PubMed literature search and supplemented with a review of textbook chapters. The most common signs of skin aging despite skin type are dark spots, loss of elasticity, loss of volume, and rhytides. Skin of color has many characteristics that make its aging process unique. Those of Asian, Hispanic, and African American descent have distinct facial structures. Differences in the concentration of epidermal melanin makes darkly pigmented persons more vulnerable to dyspigmentation, while a thicker and more compact dermis makes facial lines less noticeable. Ethnic skin comprises a large portion of the world population. Therefore, it is important to understand the unique structural and functional differences among ethnicities to adequately treat the signs of aging.Aging is a complex process in all human societies reflecting biological, environmental, and genetic influences. It is multidimensional, comprising physical, psychological, and social change that is also influenced by cultural and societal standards. The cutaneous effects can be described clinically as features of wrinkles, sunspots, uneven skin color, and sagging skin that are often varied based on ethnic origin.1 In addition to inherited genetic traits, a multitude of other factors can modify the aging process, such as hormonal status and climatic, working, social, and cultural conditions.2The association of youth and beauty is well accepted in modern day society. The human desire for homogenous skin color and texture, absence of wrinkles and sagginess, and lustrous hair has fueled the cosmetic and surgical industries. Botulinum toxin, blepharoplasty, and soft-tissue fillers are among the many popular cosmetic treatments that enable the improvement in wrinkles, eyelid sagginess, and volume loss, respectively. Women who possess a youthful appearance are consistently rated as more attractive than older-appearing women.3-9 In a cross-cultural study, across five populations, women were perceived as more attractive to the extent that their predicted ages were less than their actual ages.3 Even when interviewers are explicitly instructed to adjust for age and sex of participants, looks of younger people are rated more favorably than those of older people.10 Studies on skin color and texture have demonstrated that humans have a preference for younger-appearing skin that is viewed as both healthier and more attractive.11-14 Skin texture studies have shown that the effects of skin color distribution can account for up to 20 years of perceived age.11 Understanding the fundamentals of mature skin is important to an aging population where individuals are living longer and expected to be productive into later years, while holding the strong desire to maintain a youthful appearance.Aging can be described clinically as features of wrinkles, sunspots, uneven skin color, and sagging skin. These cutaneous effects are influenced by both intrinsic and extrinsic factors and often are varied based on ethnic origin given underlying structural and functional differences. There are slight differences in the definitions of ethnicity and race; nonetheless, they are often used interchangeably in the medical literature. Ethnicity typically refers to broader groups of populations with a common culture and/or language, while race often represents a specific population in terms of genetic resemblance.15 In this article, the authors refer to ethnic skin as the broad range of skin phenotypes and complexions that characterize persons with darkly pigmented skin including those of African, African American, Asian, and Latino/Hispanic descent.     

Differences in Spinopelvic Characteristics Between Hip Osteoarthritis Patients and Controls

BackgroundThis study of patients with hip primary osteoarthritis and a matched, asymptomatic, volunteers (controls) group aimed to determine spinopelvic differences between the two groups and their consequences for total hip arthroplasty.Methods104 patients (52 in each group) had their sagittal spinopelvic parameters (lumbar lordosis angle, sacral slope, pelvic tilt, pelvic incidence, and the pelvic-femoral angle) measured in the standing, relaxed-seated, and deep-flexed seated positions. Spinopelvic movement was calculated as the change between the different positions, and individual spinopelvic mobility was classified in accordance with the change in pelvic tilt as previously described (ΔPT: stiff (<10°), normal (10-30°), and hypermobile (>30°)).ResultsTransitioning from the standing to relaxed-seated position, patients demonstrated 13? less hip flexion (P < .001), 12? more posterior pelvic tilt (P = .006), and 6? more lumbar flexion (P = .038) compared with controls. Transitioning from the standing to deep-flexed seated position, patients demonstrated 18? less hip flexion (P < .001), accompanied by a posterior and not an anterior pelvic tilt as in the controls (7? ± 14 vs ?6? ± 17; P < .001). Patients showed a higher percentage of spinopelvic hypermobility (19% vs 2%; P = .008).ConclusionThe reduced ability of flexion in the arthritic hip, leads to posterior pelvic tilt in the relaxed-seated position. This is associated with a likely compensatory increased lumbar flexion to keep an upright position. Therefore, spinopelvic hypermobility has to be defined as pathologic. When moving to the deep-flexed seated position, decreased flexion of the arthritic hip prevents the pelvis from tilting anteriorly while the lumbar spine performs a compensatory flexion by approximately the same amount compared with controls.Level of EvidenceLevel II, diagnostic study.     

Differences in Risk Factor Patterns Between Cervical and Trochanteric Hip Fractures

The two types of hip fracture – cervical and trochanteric femoral fractures – are generally considered together in etiologic studies. However, women with a trochanteric fracture may be more osteoporotic than those with cervical hip fractures, and have higher post-fracture mortality. To explore differences in risk factor patterns between the two types of hip fracture we used data from a large population-based case–control study in Swedish women, 50–81 years of age. Data were collected by questionnaire, to which more than 80% of subjects responded. Of the cases included, 811 had had a cervical fracture and 483 a trochanteric fracture during the study period; these cases were compared with 3312 randomly selected controls. Height and hormonal factors appeared to affect the risk of the two types of hip fracture differently. For every 5 cm of current height, women with a cervical fracture had an adjusted odds ratio (OR) of 1.23 (95% CI 1.15–1.32) compared with an OR of 1.06 (95% CI 0.97–1.15) for women with trochanteric fractures. Later menopausal age was protective for trochanteric fractures (OR 0.95, 95% CI 0.91–0.99 per 2 years) but no such association was found for cervical fractures. Compared with never smokers, current smokers had an OR of 1.48 (95% CI 1.12–1.95) for trochanteric fractures and 1.22 (95% CI 0.98–1.52) for cervical fractures. Current hormone replacement therapy was similarly protective for both fracture types, but former use substantially reduced risk only for trochanteric fractures: OR 0.55 (95% CI 0.33–0.92) compared with 1.00 (95% CI 0.71–1.39) for cervical fractures. These risk factor patterns suggest etiologic differences between the fracture types which have to be considered when planning preventive interventions. Received: 22 March 1999 / Accepted: 28 May 1999     

Differences in Post-Operative Outcome Between Conversion and Primary Total Hip Arthroplasty

Background

The demand for conversion of prior hip surgery to total hip arthroplasty (conversion THA) is likely to increase as a function of increasing US hip fracture burden in addition to its application in managing other conditions. Thus, outcome analysis is warranted to better inform value-based reimbursement schemes in the era of bundled payments.

腹股沟皮瓣修复术治疗手及前臂皮肤烧伤瘢痕的临床效果

目的 探讨腹股沟皮瓣修复术治疗手及前臂皮肤烧伤瘢痕的临床效果。方法 选取2020年 1月-2021年12月邯郸邯钢医院烧伤整形科收治的100例手及前臂皮肤烧伤瘢痕患者为研究对象,按照随机 数字表法分为观察组和对照组,各50例。对照组给予股外侧皮瓣修复术治疗,观察组给予腹股沟皮瓣修复 术治疗,比较两组皮瓣断蒂时间、皮瓣存活情况、皮瓣感染情况、临床疗效、创面周围炎症情况及烧伤组 织恢复情况。结果 观察组皮瓣存活率、皮瓣断蒂时间、皮瓣感染率均优于对照组（P＜0.05）;观察组治 疗总有效率为96.00%,高于对照组的80.00%（P＜0.05）;观察组治疗后2、3、4、5周创面周围炎症评分均 高于对照组（P＜0.05）;两组治疗后肢体功能恢复评分、皮肤修复评分均高于治疗前,且观察组高于对照 组（P＜0.05）。结论 腹股沟皮瓣修复术治疗手及前臂皮肤烧伤瘢痕的临床效果确切,可有效提高皮瓣存 活率,控制创面周围炎症反应,降低皮瓣感染发生几率,从而改善肢体功能及皮肤情况,有利于促进患者 快速恢复。     

Sex Differences in Serum C-Reactive Protein Course after Total Hip Arthroplasty

BackgroundGender-specific medicine has become an important part in investigating the course of various diseases. C-reactive protein (CRP) is used as an inflammatory marker for detecting inflammations and even infections after total hip arthroplasty (THA). The general course of CRP after THA is well known, but there is controversy about its association with sex. Therefore, we aimed to investigate if there is an influence of sex on the CRP after THA in the first 10 days after operation in a complication-free course in male and female patients and to re-evaluate the specific postoperative CRP course with its maximum on the second to third postoperative days.MethodsWe retrospectively reviewed patients who had been treated with THA due to primary osteoarthritis through the same approach using an equal model of a cementless stem and a cup and complication-free between 2013 and 2016. Patients with active inflammation, rheumatoid arthritis, secondary arthrosis, active cancer disease, and documented postoperative complications were not included. The CRP values before THA and up to 10 days after THA were recorded and tested for sex discrepancy. Factor analyses were performed, and CRP values were adjusted for confounders (age, operation time, diabetes mellitus, and body mass index [BMI]).ResultsA total of 1,255 patients (728 women and 527 men) were finally analyzed. Men were younger and had a longer operation time and a higher BMI compared to women. The prevalence of overweight was higher in men, while obesity (BMI > 40 kg/m²), diabetes mellitus, renal failure, and American Society of Anaesthesiologists status showed no significant difference between men and women. Men had significantly higher CRP values than women between the 2nd and the 7th postoperative days, with the largest difference on the 4th postoperative day (men, 130.48 mg/L; women, 87.26 mg/L; p = 0.018).ConclusionsBased on the results of more precise sex-specific evaluation of the postoperative CRP course after THA, the present study showed for the first time that there was a gender discrepancy in the CRP course after complication-free THA in the first 7 postoperative days. Furthermore, this study confirmed the postoperative CRP course with its maximum on the third postoperative day.     

Gender Differences for Hip and Knee Arthroplasty: Complications and Healthcare Utilization

IntroductionThe influence of patient gender on complications and healthcare utilization remains unexplored. The purpose of the present study was to determine if patient gender significantly affected outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA).MethodsRetrospective cohort study of THA and TKA patients was performed using the Nationwide Inpatient Sample from 2002 to 2011. Only patients who underwent elective procedures and those with complete perioperative data were included. Multivariate logistic regression was used to compare the rates of adverse events between male and female cohorts while controlling for baseline characteristics.ResultsA total of 6,123,637 patients were included in the study (31.2% THA and 68.8% TKA). The cohort was 61.1% female. While males had a lower rate of any adverse event (odds ratio [OR] = 0.8, P < .001), urinary tract infection (OR = 0.4, P < .001), deep vein thrombosis/pulmonary embolism (OR = 0.9, P < .001), and blood transfusion (OR = 0.5, P < .001), male gender was associated with statistically significant increases in the rates of death (OR = 1.6, P < .001), acute kidney injury (OR = 1.6, P < .001), cardiac arrest (OR = 1.7, P < .001), myocardial infarction (OR = 1.6, P < .001), pneumonia (OR = 1.1, P < .001), sepsis (OR = 1.6, P < .001), surgical site infection (OR = 1.4, P < .001), and wound dehiscence (OR = 1.4, P < .001).ConclusionMales had increased rates of many individual adverse events. Females had higher rates of urinary tract infection, which translated to an overall higher rate of adverse events in females because of the rarity of the other individual adverse events.     

Femoral Morphologic Differences in Subtypes of High Developmental Dislocation of the Hip

Background  

Previous studies show the shape of the femur in developmental dislocation of the hip (DDH) becomes more abnormal with increasing subluxation. Two kinds of high dislocations associated with DDH have been observed in clinical practice, one with (Type C1) and one without (Type C2) a false acetabulum. The presence or absence of a false acetabulum in high dislocated hips is associated with different loading patterns and could influence the development and shape of the proximal femur.     

Wound Complications Are Affected by Different Skin Closure Methods in Primary Hip and Knee Arthroplasty

BackgroundThere is a lack of consensus on optimal skin closure and dressing strategies to reduce early wound complication rates after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).MethodsAll 13,271 patients at low risk for wound complications undergoing primary, unilateral THA (7,816), and TKA (5,455) for idiopathic osteoarthritis at our institution between August 2016 and July 2021 were identified. Skin closure, dressing type, and postoperative events related to wound complications were recorded during the first 30 postoperative days.ResultsThe need for unscheduled office visits to address wound complications was more frequent after TKA than THA (2.74 versus 1.78%, P < .001), and after direct anterior versus posterior approach THA (2.94 versus 1.39%, P < .001). Patients who developed a wound complication, had a mean of 2.9 additional office visits. Compared to the use of topical adhesives, skin closure with staples had the highest risk of wound complications (odds ratio 1.8 [1.07-3.11], P = .028). Topical adhesives with polyester mesh had higher rates of allergic contact dermatitis than topical adhesives without mesh (1.4 versus 0.5%, P < .0001).ConclusionWound complications after primary THA and TKA were often self-limited but increased burden on the patient, surgeon, and care team. These data, which suggest different rates of certain complications with different skin closure strategies, can inform a surgeon on optimal closure methods in their practice. Adoption of the skin closure technique with the lowest risk of complications in our hospital would conservatively result in a reduction of 95 unscheduled office visits and save a projected $585,678 annually.     

家兔阴茎皮肤和阴茎背神经躯体感觉神经元的示踪定位

目的:明确家兔阴茎感觉神经躯体纤维来源及其节段性分布规律。方法:健康成年雄性新西兰家兔8只,随机均分为A、B两组,采用辣根过氧化物酶(HRP)逆行神经示踪技术,A组用微量注射器将50%HRP多点注射于阴茎皮下,B组注射于右侧阴茎背神经近侧断端内,留针时间30 m in,动物存活5 d后,4%多聚甲醛心脏灌注,取出腰骶段脊髓及相应背根神经节(DRG),对躯体传入和传出纤维来源的节段分布进行观察。结果:A组S2~S4节段脊神经节内出现大量HRP阳性标记感觉神经元,以S2和S4为多,呈明显节段性分布,各节段阳性神经元计数分别为:S2(215.0±10.2)、S3(242.2±8.3)、S4(109.7±8.4),组间差异具有统计学意义(P<0.01)。B组同侧S2-S4节段脊髓灰质前角腹外侧部出现部分阳性标记细胞,同侧S2~S4DRG内也出现了大量的HRP阳性细胞。结论:家兔阴茎皮肤感觉神经躯体传入和传出纤维投射来源与阴茎背神经一致,均源自骶髓前角及相应的脊神经节,并呈现明显的节段性分布。     

Inguinal hernia repair: time interval between surgical repair and recurrence

This study seeks to evaluate the time interval between initial inguinal hernia repair and the appearance of recurrent hernia in patients undergoing re-operation. Recurrent hernia was identified in 94 (6.4%) of 1,474 patients having undergone initial hernia repair at our institution. Recurrence appeared within two years in 40 patients (42%). Recurrences were noted beyond five years in 32 patients (34%), and after 20 years in 18 patients (19%). 75% of recurrences had occurred within 15 years. We conclude that almost two-thirds of recurrences occur later than five years after the initial intervention and a quarter occur at an interval of more than fifteen years. Most studies underestimate hernia recurrence due to an insufficient period of post-operative observation.     

组织扩张与机械牵拉对皮肤组织表达硫氧还蛋白影响的初步研究

目的 探讨硫氧还蛋白(TXN)在扩张皮肤组织与正常皮肤组织中的表达差异.方法 选取近两年在我院行额部扩张器取出术的患者13例,收集患者额部扩张器张力最大点(扩张组)以及颞部行附加切口处(对照组)的全层皮肤.免疫组织化学染色、Western blot检测TXN蛋白在扩张皮肤组织及正常皮肤组织中的表达.结果 免疫组织化学检测发现,扩张皮肤组织中TXN阳性细胞明显多于正常皮肤组织(P＜0.05);Western blot检测发现,扩张皮肤组织中TXN表达高于正常皮肤组织.结论 扩张皮肤组织中TXN蛋白表达高于正常皮肤组织,为进一步研究TXN在组织扩张中的作用提供理论基础.     

Gender and Race/Ethnicity Differences in Hip Fracture Incidence,Morbidity, Mortality,and Function

Background  

Hip fracture is an international public health problem. Worldwide, approximately 1.5 million hip fractures occur per year, with roughly 340,000 in the United States in individuals older than 65 years. In 2050, there will be an estimated 3.9 million fractures worldwide, with more than 700,000 in the United States. However, whether there are disparities in morbidity, mortality, and function between men and women or between races/ethnicities is unclear.