Is Cross-Linked Polyethylene an Improvement Over Conventional Ultra-High Molecular Weight Polyethylene in Total Knee Arthroplasty?

Background

Reducing polyethylene (PE) wear by increasing the cross-linking encouraged surgeons to hope for increased total knee arthroplasty (TKA) survival rates. Different methods of manufacturing cross-linked polyethylene (XLPE) were introduced, following promising in vitro results. Is there a measurable effect of cross-linking on TKA survival?

Evaluation of the impact of migraine and episodic tension-type headache on the quality of life and performance of a university student population

OBJECTIVE: To determine the prevalence of migraine and episodic tension-type headache (ETTH) among university students as well as its impact on academic performance and quality of life. BACKGROUND: Headache is a very common symptom in clinical practice. The reduced capacities due to migraine can be profound, and more studies are needed to evaluate, in particular, school performance. Few studies have been conducted to evaluate the impact of tension-type headache on work productivity, quality of life, and the impact of headache on school performance. METHODS: A total of 1022 students were interviewed. Two questionnaires were utilized, a standard one that permitted a diagnosis of migraine or ETTH according to the criteria of the International Headache Society and a second one consisting of a battery of tests on quality of life. RESULTS: A total of 256 students (25%) had migraine and 336 (32.9%) reported ETTH. When in pain, migraineurs demonstrated a 62.7% decrease in productivity while studying, compared with a 24.4% decrease in those with ETTH. Fifty percent of migraineurs tried to study despite the pain, compared with 53.2% of those with ETTH. With respect to all other items tested, there was a significantly higher impairment in the presence of migraine than in the presence of ETTH and in the presence of the latter compared with a control situation. CONCLUSIONS: The present study confirms the profound impact of headache on the performance of university students, with this impact much more evident among migraineurs but also important among students with ETTH.     

Decreasing the minimal duration of the attack to 1 hour: is this sufficient to increase the sensitivity of the ICHD-II diagnostic criteria for migraine in childhood?

Abstract We applied the second edition of the International Classification of Headache Disorders (ICHD-II) in 417 children (age range, 2–12 years) with chronic headaches attending a pediatric headache clinic. The initial diagnosis was made according to the ICHD-II while the final diagnosis was, based on the longitudinal intuitive clinical diagnosis (LICD), deemed to be the gold standard. The diagnosis of migraine without aura had a sensitivity of 52%, a specificity of 100% and a positive predictive value of 100%; for the diagnosis of migraine (at the one-digit level) these values were 87%, 100% and 100%, respectively. The ICHD-II criteria for migraine without aura have high specificity but low sensitivity in childhood, even considering the minimal duration of the attacks to be 1 hour. Other factors, such as the existence of subgroup 2.4 (probable tension-type headache), are responsible for the low sensitivity of ICHD-II criteria for the diagnosis of migraine without aura in patients of this age group.     

Novel cinnamon-laden nanofibers as a potential antifungal coating for poly(methyl methacrylate) denture base materials

Clinical Oral Investigations - To modify the surface of denture base material by coating it with cinnamon-laden nanofibers to reduce Candida albicans (C. albicans) adhesion and/or proliferation....     

pH and calcium ion release evaluation of pure and calcium hydroxide-containing Epiphany for use in retrograde filling

Objective

Hydroxyl (OH^-) and calcium (Ca⁺⁺) ion release was evaluated in six materials: G1) Sealer 26, G2) White mineral trioxide aggregate (MTA), G3) epiphany, G4) epiphany + 10% calcium hydroxide (CH), G5) epiphany + 20% CH, and G6) zinc oxide and eugenol.

Material and Methods

Specimens were placed in polyethylene tubes and immersed in distilled water. After 3, 6, 12, 24, and 48 h, 7, 14, and 28 days, the water was assessed for pH with a pH meter and for Ca⁺⁺ release by atomic absorption spectrophotometry.

Results

G1, G2, G4, and G5 had the highest pH until 14 days (p<0.05). G1 presented the highest Ca⁺⁺ release until 6 h, and G4 and G5, from 12 h through 14 days. Ca⁺⁺ release was greater for G1 and G2 at 28 days. G6 released the least Ca⁺⁺.

Conclusion

MTA, Sealer 26, epiphany, and epiphany + CH release OH ^- and Ca⁺⁺ ions. Epiphany + CH may be an alternative as retrofilling material.     

Study of the effectiveness of bronchial clearance in subjects with upper spinal cord injuries: examination of a rehabilitation programme involving mechanical insufflation and exsufflation

STUDY DESIGN: Randomized controlled trial. OBJECTIVES: To establish whether the use of mechanical insufflation/exsufflation leads to a significant improve in tracheostomy subjects with upper spinal cord injuries (C1-C7), ASIA classification grade A and bronchial hyper secretion the following parameters: forced vital capacity (FVC), forced exspiratory volume on the first second (FEV1), FEV1/FVC, peak exspiratory flow (PEF), arterious pressure of O(2) (Pa O(2)), arterious pressure of CO(2) (Pa CO(2)), pH, saturation of O(2) (Sa O(2)). SETTING: Spinal Cord Unit, Montecatone Rehabilitation Institute, Imola, Italy. METHODS: The patients were split into two groups: the experimental group (EG) and the control group (CG). Each patient was given 10 treatments: the EG was given manual respiratory kinesitherapy associated with mechanical insufflation/exsufflation with inhale and exhale pressure between 15 cm H(2)O and 45 cm H(2)O, while the CG was only given manual kinesitherapy. The treatment sessions covered the necessary amount of time in order to achieve sufficient clearance. The study has been approved by the local ethic committee. The patients were informed before being enrolled in that study and gave their written consent. RESULTS: At the end of the treatment associated with the mechanical insufflation/exsufflation, the EG showed a significant increase in FVC, FEV1 and PEF, although it was not possible to compare the latter with the CG. The other parameters were also subject to variations, although not statistically significant. The CG did not show signs of any significant change. CONCLUSION: The use of mechanical insufflation/exsufflation in subjects with the aforementioned characteristics is shown to be an effective adjunct to manual respiratory kinesitherapy, since it makes it possible to achieve adequate bronco-pulmonary clearance, even removing thick, deep secretions and making it possible to insufflate any areas affected by atelectasis.     

Combined reconstruction of the anterolateral ligament in chronic ACL injuries leads to better clinical outcomes than isolated ACL reconstruction

Purpose

To evaluate the results of combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction in patients with chronic ACL injury. It was hypothesized that patients who underwent combined ACL and ALL reconstruction would exhibit less residual laxity and better clinical outcomes.

Methods

Two groups of patients were evaluated and compared retrospectively. Both groups consisted only of patients with chronic (more than 12 months) ACL injuries. Patients in group 1 underwent anatomical intra-articular reconstruction of the ACL and patients in group 2 underwent anatomic intra-articular ACL reconstruction combined with ALL reconstruction. The presence of associated meniscal injury, the subjective International Knee Documentation Committee (IKDC) and Lysholm functional outcome scores in the postoperative period, KT-1000 evaluation, the presence of residual pivot shift and graft rupture rate were evaluated.

Results

One hundred and one patients who underwent reconstruction of chronic ACL injuries were evaluated. The median follow-up was 26 (24–29) months for group 1 and 25 (24–28) months for group 2. There were no significant differences between groups regarding gender, age, duration of injury until reconstruction, follow-up time or presence of associated meniscal injuries in the preoperative period. Regarding functional outcome scores, patients in group 2 presented better results on both the IKDC (p?=?0.0013) and the Lysholm (p?<?0.0001) evaluations. In addition, patients in group 2 had better KT-1000 evaluation (p?=?0.048) and a lower pivot shift rate at physical examination, presenting only 9.1% positivity versus 35.3% in the isolated ACL reconstruction (p?=?0.011). Regarding re-ruptures, group 1 presented 5 (7.3%) cases, and group 2 presented no cases.

Conclusion

The combined ACL and ALL reconstruction in patients with chronic ACL injury is an effective and safety solution and leads to good functional outcomes with no increase in complication rate. The clinical relevance of this finding is the possibility to indicate this type of procedure when patients present with more than 12 months after injury for surgery.

Level of evidence

Level III.