Long-Term Functional Outcomes and Quality of Life at Minimum 10-Year Follow-Up After Fixed-Bearing Unicompartmental Knee Arthroplasty and Total Knee Arthroplasty for Isolated Medial Compartment Osteoarthritis

BackgroundThe aim of this study is to compare the long-term functional outcome and quality of life between total knee arthroplasty (TKA) and fixed-bearing unicompartmental knee arthroplasty (UKA) for the treatment of isolated medial compartment osteoarthritis.MethodsBetween 2000 and 2008, a total of 218 patients underwent primary UKA at our tertiary hospital. A TKA group was matched through 1:1 propensity score matching and adjusted for age, gender, body mass index, preoperative knee flexion, and function scores. All patients had medial compartment osteoarthritis. The patients were assessed with the range of motion, Knee Society Knee Score and Knee Society Function Score, Oxford Knee Score, Short Form-36 physical component score (PCS) and mental component score preoperatively, at 6 months, 2 years, and 10 years. Patients’ satisfaction, expectation fulfillment, and minimal clinically important difference were analyzed.ResultsThere were no differences in baseline characteristics between groups after propensity score matching (P > .05). UKA had greater knee flexion at all time points. Although the Knee Society Function Score was superior in UKA by 5.5, 3, and 4.3 points at 6 months, 2 years, and 10 years, respectively (P < .001), these differences did not exceed the minimal clinically important difference (Knee Society Knee Score 6.1). There were no significant differences in the Oxford Knee Score and Short Form-36 physical component score/mental component score. At 10 years, similar proportions of UKA and TKA were satisfied (90.8% vs 89.9%, P = .44) and had expectation fulfillment (89.4% vs 88.5%, P = .46). Between 2 and 10 years, all function scores deteriorated significantly for both groups (P < .01).ConclusionUKA and TKA are excellent treatment modalities for isolated medial compartment osteoarthritis, with similar functional outcomes, quality of life, and satisfaction at 10 years.     

Change in Body Mass Index after Simultaneous Bilateral Total Knee Arthroplasty: Risk Factors and Its Influence on Functional Outcomes

BackgroundPrevious studies evaluating weight changes following total knee arthroplasty (TKA) were performed on heterogenous cohorts. However, no study has evaluated weight changes in a cohort of simultaneous-bilateral TKA (SB-TKA) patients. This study aimed to evaluate the prevalence of patients who lost or gained weight, determine if postoperative weight change influences functional outcome, and identify predictors of weight change after SB-TKA.MethodsProspectively collected registry data of 560 patients who underwent SB-TKA were reviewed. Patients were assessed preoperatively, at 6 months, and 2 years using the Knee Society Score, Oxford Knee Score, Short-Form 36, and range of motion. Change in body mass index (BMI) >5% was used to categorize patients into 3 groups: lost, maintained, or gained weight. Analysis of variance, Kruskal-Wallis test, and chi-squared test were used to compare functional outcomes between groups. Multivariable logistic regression evaluated predictors for postoperative weight changes.ResultsAt 2 years, 59% of patients maintained weight, 28% of patients gained weight, and 13% of patients lost weight. All groups experienced similar improvements in functional outcomes, rates of minimal clinically important difference attainment, and patient satisfaction (P > .05). Older patients were more likely to gain weight (P < .05). Patients with higher preoperative BMI were more likely to gain weight (P < .05) and less likely to lose weight (P < .05). Patients with greater preoperative comorbidities were less likely to lose weight (P < .05).ConclusionUp to 41% of patients experience significant weight changes after SB-TKA. Older patients with higher preoperative BMI were more likely to gain weight, while higher preoperative BMI with more comorbidities were less likely to lose weight following SB-TKA; however, postoperative weight changes do not appear to affect functional outcomes.Level of EvidenceIII, therapeutic study.     

Regulation of delayed-type hypersensitivity. VI. Antigen-specific suppressor T cells and suppressor factor for delayed-type hypersensitivity to histocompatibility antigens

Mice develop highly significant levels of delayed-type hypersensitivity (DTH) to major and minor histocompatibility antigens when injected s.c. with lymphoid cells from X-irradiated allogeneic donors. However, when mice are inoculated i.v. with a high dose of X-irradiated allogeneic lymphoid cells, they not only fail to develop DTH to the allogeneic cells, but their ability to respond to an immunogenic challenge of the alloantigens is also significantly depressed. This suppression is adoptively transferable by antigen-specific suppressor T cells and not by immune serum. Cell surface phenotypic analysis shows that the primary suppressor cells for alloantigens are Thy-1+, Lyt-1+2-, and Ia-, whereas the secondary suppressor cells appearing after boosting injection are Thy-1+, Lyt-1+2+, and Ia-. These suppressor T (Ts) cells localize in the lymphoid organs shortly after their induction and are largely absent from the spleen or lymph node 1 month later. However, "suppressor memory" can be recalled by an immunogenic dose of alloantigens which would normally induce DTH effector cells rather than suppressor cells in naive mice. When the suppressor cells were cultured in vitro for 48 hr, the supernatant contained suppressive activity. It appears likely that the manifestation of the suppressor cells is via soluble, antigen-specific suppressor factor(s), the production of which is dependent on viable T cells.     

Diffusion-dependence of pulmonary gas mixing at 5.5 and 9.5 ATA

Gas-phase diffusivity is inversely proportional to pressure, so mixing of inspired gas in the lung can be expected to be poor in hyperbaric environments. Subjects performed multiple-breath wash-in of a mixture (4% each of SF6, Ar, Ne, and He; 21% O2, 63% N2) at 1.5, 5.5, and 9.5 ATA. At the higher pressures there were marked differences of concentrations between the indicator gases, measured by mass spectrometer at the mouth during a single expiration. Compared to heavier gases, light gases fell from dead space concentration to the "alveolar" level sooner, had a flatter plateau, and had a lower average expired concentration, indicating that more of the light gases were retained in the Functional Residual Capacity (FRC) after the breath. However, wash-in rates for the indicators were about the same; a rapid initial rate for He diminished so that it was about the same as the SF6 rate, because in later breaths a back pressure developed for He. The findings illustrate the basic principle that the amount of gas that diffuses from one location to another in a container depends not only on diffusivity, but also in an interdependent manner on concentration gradient, time for diffusion, and configuration of the container.     

内窥镜鼻内视神经管减压治疗重症球后视神经炎

目的 观察内窥镜经鼻内视神经管减压治疗重症球后视神经炎的疗效.方法 回顾分析1995年-2007年经眼科药物治疗16-20d其疗效欠佳转来我科的10例16眼资料(其中4例单眼,6例双眼),仅对视力极差的10例10眼施行减压治疗.结果 对10眼视力无光感-30cm数指减压治疗.术后继续药物治疗16-20d,视力恢复到0.3-0.7.经1-8年观察视力0.5-1.0,眼底视乳头色泽正常,而未手术的6眼,视力无光感-20cm数指,眼底视乳头苍白萎缩,血管细小,呈鲜明对比,疗效迥然不同.结论 经眼科药物治疗16-20d,视力仍无光感-眼前数指,CT,MRI检查,排除颅内病变而球后视神经明显增粗的重症病例,应行减压治疗,可恢复较好的视力.     

COVID-19-associated mucormycosis and treatments

In the current pandemic, COVID-19 patients with predisposing factors are at an increased risk of mucormycosis, an uncommon angioinvasive infection that is caused by fungi with Mucor genus which is mainly found in plants and soil. Mucormycosis development in COVID-19 patient is related to various factors, such as diabetes, immunocompromise and neutropenia. Excessive use of glucocorticoids for the treatment of critically ill COVID-19 patients also leads to opportunistic infections, such as pulmonary aspergillosis. COVID-19 patients with mucormycosis have a very high mortality rate. This review describes the pathogenesis and various treatment approaches for mucormycosis in COVID-19 patients, including medicinal plants, conventional therapies, adjunct and combination therapies.     

Effects of Iron Supplementation on Testicular Function and Spermatogenesis of Iron-Deficient Rats

Iron deficiency is the most common micronutrient deficiency in the world. Previous studies have shown that iron deficiency increases oxidative stress and decreases antioxidant enzymes, and studies of male infertility indicated that oxidative stress may affect male reproductive functions. The aim of this study was to investigate the effects of iron supplementation on spermatogenesis and testicular functions in iron-deficient rats. Three-week-old male Sprague Dawley (SD) rats were randomly divided into two groups: an iron-adequate control (AI group, 35 ppm FeSO₄) and an iron-deficient group (ID group, <5 ppm FeSO₄). After three weeks, the iron-deficient group was divided into an original iron-deficient group and five iron-supplemented groups, the latter fed diets containing different doses of FeSO₄ (6, 12, 18, 24, and 35 ppm). After five weeks, blood and testis tissue were analyzed. We presented as median (interquartile range, IQR) for continuous measurements and compared their differences using the Kruskal–Wallis test followed by the Mann–Whitney U test among groups. The results showed that as compared with the AI group, the ID group had significantly lower serum testosterone and poorer spermatogenesis (The medians (QR) were 187.4 (185.6–190.8) of AI group vs. 87.5 (85.7–90.4) of ID group in serum testosterone, p < 0.05; 9.3 (8.8–10.6) of AI group vs. 4.9 (3.4–5.4) of ID group in mean testicular biopsy score (MTBS], p < 0.05); iron supplementation reversed the impairment of testis tissue. In the testosterone biosynthesis pathway, iron supplementation improved the lowered protein expressions of hydroxysteroid dehydrogenases caused by iron deficiency. Additionally, decreased activities of glutathione peroxidase and catalase, and increased cleaved-caspase 8 and caspase 3 expression, were found in the iron-deficient rats. The iron-supplemented rats that received > 12 ppm FeSO₄ exhibited improvements in antioxidant levels. In conclusion, iron supplementation can abrogate testis dysfunction due to iron deficiency through regulation of the testicular antioxidant capacity.     

Combined enzymatic hydrolysis and herbal extracts fortification to boost in vitro antioxidant activity of edible bird’s nest solution

Objective Edible bird’s nest (EBN) is a popular traditional tonic food in Chinese population for centuries. Malaysia is one of the main EBN suppliers in the world. This study aims to explore the best strategy to boost the antioxidant potential of EBN solution. Methods In this study, the raw EBN (4%, mass to volume ratio) was initially enzymatic hydrolyzed using papain enzyme to produce EBN hydrolysate (EBNH), then spray-dried into powdered form. Next, 4% (mass to volume ratio) of EBNH powder was dissolved in ginger extract (GE), mulberry leaf extract (MLE) and cinnamon twig extract (CTE) to detect the changes of antioxidant activities, respectively. Results Results obtained suggest that enzymatic hydrolysis significantly reduced the viscosity of 4% EBN solution from (68.12 ± 0.69) mPa.s to (7.84 ± 0.31) mPa.s. Besides, the total phenolic content (TPC), total flavonoid content (TFC), total soluble protein, DPPH scavenging activity and ferric reducing antioxidant power (FRAP) were substantially increased following EBN hydrolysis using papain enzyme. In addition, fortification with GE, MLE and CTE had further improved the TPC, TFC, DPPH scavenging activity and FRAP of the EBNH solution. Among the samples, MLE-EBNH solution showed the most superior antioxidant potential at (86.39 ± 1.66)% of DPPH scavenging activity and (19.79 ± 2.96) mmol/L FeSO4 of FRAP. Conclusion This study proved that combined enzymatic hydrolysis and MLE fortification is the best strategy to produce EBN product with prominent in vitro antioxidant potential. This preliminary study provides new insight into the compatibility of EBN with different herbal extracts for future health food production.     

Finite Element Analysis of Steel Plates with Rectangular Openings Subjected to Axial Stress

Steel plates with openings are among the important ship structural components used in the ship’s hull to withstand the hydrostatic forces of the ocean, which cause sagging and hogging moments at the ship’s bottom. The existence of openings on plates can cause structural rupture, stress concentration and a decrease in ultimate strength. This research is aimed at investigating the influence of selected parameters on the ultimate capacity of steel plates with rectangular holes subjected to axial stress, using ANSYS finite element analysis (FEA) under its non-linear static structural programme. The main parameters investigated in this paper are the plate thickness, opening aspect ratio, number of openings, position of openings, and the boundary condition of the plate. The influence of these parameters on the stress of plates and their deformation was evaluated. The comparison of the numerical simulation with the well-established analytical method using the Navier solution and Roark’s Formulas showed a good agreement.