Consensus Statement from the Consensus Conference on Bilateral Total Knee Arthroplasty Group

Background

Controversy exists regarding many aspects of decision making pertaining to same-day versus staged bilateral TKA (BTKAs), including patient selection, perioperative management decisions, and other important choices.

Questions/purposes

In the absence of suitable randomized trials, we sought to determine areas of consensus among national experts on the following questions: (1) What are the comparative risks of same-day BTKAs compared with unilateral TKA (UTKA) and staged BTKAs? (2) Who should be considered an appropriate candidate for same-day BTKAs? (3) What constitutes appropriate workup and perioperative management for BTKAs? (4) What is the optimal time between procedures if same-day BTKAs are not deemed appropriate? (5) Are there orthopaedic or rehabilitation considerations for BTKAs that might outweigh medical contraindications?

Methods

In the setting of a consensus conference of national experts in orthopaedic surgery, anesthesiology, perioperative medicine, and epidemiology, the major questions surrounding same-day BTKAs were addressed by using an extensive literature review and the modified Delphi process. The process concluded with a meeting of participants and formulation of consensus statements.

Results

Eighty-one percent of participants agreed that BTKAs are more invasive and complex procedures associated with increased risk for perioperative adverse events compared with UTKA in an unselected group of patients. The consensus group agreed that physicians and hospitals should consider using more restrictive patient selection criteria and exclude those with a modified cardiac risk index greater than 3 to mitigate the potentially increased risk. The majority of the group agreed that perioperative assessment and management should reflect the higher level of acuity of same-day BTKAs. Eighty-one percent of participants agreed that if a patient is not deemed a candidate for same-day BTKAs, a second TKA should be scheduled no sooner than 3 months after the first. The entire group agreed that when there is a conflict between the orthopaedic need and the medical adequacy of same-day BTKAs, the medical concern for the patient’s safety should prevail over the orthopaedic need.

Conclusions

Experts perceived that same-day BTKAs increase medical risk, and thus a systematic approach to the management of patients should be taken to minimize complications.

Electronic supplementary material

The online version of this article (doi:10.1007/s11999-013-2976-9) contains supplementary material, which is available to authorized users.     

The influence of the polymerization approach on the catalytic performance of novel porous poly (ionic liquid)s for green synthesis of pharmaceutical spiro-4-thiazolidinones

Although poly (ionic liquids) (PILs) have attracted great research interest owing to their various applications, the performance of nanoporous PILs has been rarely developed in the catalysis field. To this end, a micro–mesoporous PIL with acid–base bifunctional active sites was designed and fabricated by two different polymerization protocols including hydrothermal and classical precipitation polymerization in this paper. Based on our observations, hydrothermal conditions (high temperature and pressure) enabled the proposed sonocatalyst to possess a great porous structure with a high specific surface area (S_BET: 315 m² g⁻¹) and thermal stability (around 450 °C for 45% weight loss) through strengthening cross-linking. In a comparative study, the preferred nanoporous PIL was selected and utilized as the sonocatalyst in a multicomponent reaction of isatins, primary amines, and thioglycolic acid. In the following, a variety of new and known pharmaceutical spiro-4-thiazolidinone derivatives were synthesized at room temperature and obtained excellent yields (>90%) within short reaction times (4–12 min) owing to the substantial synergistic effect between ultrasound irradiation and magnetically separable catalyst.

Sustainable synthesize of a new mesoporous poly (ionic liquid) as acid–base bifunctional catalyst for environmental being preparation of monospiro derivatives has been developed.     

Optimal topology design and distributed formation control of multiagent systems with complex-weights directed networks

In this article, we consider the optimal topology design and distributed formation control problem of multiagent systems (MAS) with complex-weighted directed topology. First, a framework is proposed to associate optimal topology of MAS to a constrained optimization problem with a complex Laplacian matrix, which is independent of the agent dynamics. The main contribution of the proposed approach compared with existing results is that the proposed approach does not require the calculation of the stabilizing matrix such that the closed-loop system is asymptotically stable, and a unique set of complex weights that satisfy associated cooperative conditions can be chosen. Then, a distributed formation control protocol is proposed to enable all agents to achieve the control goal. Finally, some numerical example results are provided to demonstrate the effectiveness of the proposed scheme.     

Methylphenidate vs. resperidone in treatment of methamphetamine dependence: A clinical trial

Background and aims

Currently, there is no widely accepted evidence-based pharmacotherapy regime for the treatment of psychostimulant dependence. Yet, different pharmacological approaches have been tried in the treatment of MA addiction. The present study was conducted to compare efficiency of methylphenidate which is relatively easily accessible in our country, with resperidone for this purpose.

Methods

Eighty-six patients with MA dependence according to criteria defined by DSM IV-TR were divided into two groups. Patients in group R were given oral resperidone 1 mg daily for 1 week; then 2 mg daily in a divided dose for 3 weeks. Patients in group M were given oral methylphenidate 10 mg daily for 2 weeks, 7.5 mg daily for 1 week, then 5 mg daily for 1 week. They were evaluated for drug craving, psychological, neurologic and somatic symptoms at the start and end of the study.

Findings

Both drugs were useful for lowering drug craving in patients; however resperidone was more effective (6.31 ± 8.31 vs.19.6 ± 12.45 cravings per week, respectively). The effects of resperidone were more notable in lowering frequency and intensity of psychiatric, neurologic, cardiac and somatic symptoms of the patients after discontinuation of MA abuse; however methylphenidate was effective too; though with a lower potency.

Conclusion

The present study confirmed that both methylphenidate and resperidone can successfully be used for treatment of MA dependence, in order to reduce drug craving and psychological, neurologic, and somatic problems in patients. However, the efficacy of methylphenidate was estimated to be less than that of resperidone for this purpose.     

Revision Knee Arthroplasty for Bone Loss: Choosing the Right Degree of Constraint

Revision total knee arthroplasty (TKA) in the setting of bone deficiency requires varied levels of constraint to restore knee stability. However, the outcomes between different levels remain controversial. Clinical outcomes for 183 AORI Type I knees, 168 Type II knees and 124 Type III knees utilizing posterior stabilized (PS), unlinked constrained (UC) or hinged prostheses were evaluated with standardized clinical assessment tools and radiographic results over an average of 7.4 years. PS yielded superior knee scores in AORI Type I patients (P < 0.05), UC in Type II and III aseptic patients (P < 0.05), and a hinge was preferred in septic Type II or III knees (P < 0.05). Revision TKA conducted with increased constraint appears effective in the setting of increased bone deficiency.     

The Impact of Patellar Resurfacing in Two-Stage Revision of the Infected Total Knee Arthroplasty

Evidence for optimal management of the patellofemoral joint in revision surgery for the infected TKA is limited. We reviewed 69 infected TKAs undergoing two-stage revision. Fifty four patellae were resurfaced, 11 had patelloplasty performed, two were augmented with trabecular metal, one had impaction grafting, and one knee underwent patellectomy. Average follow-up was 4.5 years. The patients that received patellar resurfacing at re-implantation experienced statistically significant improvements in KSS pain score, functional KSS, and patellar score (P < 0.03). One further patient treated with impaction grafting improved significantly in terms of pain and function. Patients treated with patelloplasty, trabecular metal augmentation, or patellectomy did not have significant improvements in clinical or functional outcome. Patient age, use of dynamic vs. static spacer, use of extensor mechanism release, and differences in Charlson index did not seem to statistically affect outcome. We recommend that every effort should be made to minimize patellar bone loss in first stage resection, as inability to resurface the patella at time of reimplantation may adversely affect patient outcome.     

The application of tissue-engineered preputial matrix and fibrin sealant for urethral reconstruction in rabbit model

Background

To introduce the role of fibrin sealant and preputial acellular matrix (PAM) as a new source of inert collagen matrix for urethral reconstruction.

Methods

A ventral urethral segmental defect was created in 24 male rabbits divided into four groups. In group 1 (G1), urethrotomy was closed in layers. In group 2 (G2), closure was followed by applying fibrin sealant. In groups 3 (G3) and 4 (G4), urethroplasty was performed with a patch graft of PAM, and in G4, fibrin sealant was also applied. Serial urethrography was performed before and after the operation. Then, the animals were euthanized, and their urethra was excised 1, 3, and 9 months postoperatively for further electron microscopic examination, terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) technique, and immunohistochemical (IHC) staining with CD34, CD31, desmin, SMA, and α-actin.

Results

In G1 and G2, the fistula repair failed in all the time points. In G3 and G4, serial urethrography confirmed the maintenance of a wide urethral caliber without signs of strictures or extravasations. Satisfactory vascularity was observed in G3 and G4 during the whole study, which was more significant in G4 after 9 months of follow-up. The presence of a complete transitional cell layer was confirmed over the graft in G3 and G4 in all time points. IHC staining confirmed the effectiveness of fistula repair in G3 and G4, 3 months postoperatively.

Conclusion

This rabbit model showed that PAM combined with fibrin sealant may herald a reliable option for repairing segmental urethral defects.     

Agreement between DSM-IV and ICD-10 criteria for opioid use disorders in two Iranian samples

The aim of this study was to determine the agreement between the two systems in opioid users in the general population and a clinical sample. Two series of data were used in this study. The first was the data of 236 home-residing opioid abusers aged 15–64, who had previously participated in the Iran Mental Health Survey (IranMHS) in 2011, and the second was the data of 104 general psychiatry patients from inpatient or outpatient wards of two psychiatry hospitals in Tehran. Opioid use disorders were evaluated with CIDI-version 2.1. The disorders were assessed in all participants who used opioid substances for at least 5 times during the past 12 months. In the sample from the general population, the agreement between the two systems on the diagnosis of dependence was excellent (0.81). The agreement between the two systems on the diagnosis of abuse and harmful use was 0.41. In the clinical sample, the agreement between the two systems on the diagnosis of dependence or any opioid use disorder was 0.96 and 0.93, respectively. The agreement between abuse and harmful use was 0.9 and − 0.02 with and without regarding hierarchy, respectively. The inter-rater reliability of both DSM-IV and ICD-10 systems for all diagnosis was more than 0.95. The results of the diagnosis of dependence in the two systems had a weak concordance with treatment. The diagnostic criteria of DSM-IV and ICD-10 regarding dependence are very similar and the diagnosis produced by each system is concordant with the other system. However, the two systems have noticeable discrepancies in the diagnosis of abuse and harmful use. The discrepancies result from their conceptual differences and necessitate further revision in the definition of these disorders in the two systems.     

Upregulation of Interleukin-6 in HPV-Positive Breast Cancer Patients

Background: Interleukin-6 (IL-6) is a well-known proinflammatory cytokine with tumor promoting capacity in various forms of malignancies including breast cancer (BC). Data highlighted the substantial role of HPV in the pathogenesis of BC. Compelling evidence suggests the contribution of HPV in carcinogenesis through triggering inflammatory cytokines such as IL-6. Objective: Here, we assessed the correlation between the presence of HPV infection and the status of IL-6 expression and serum level in BC. Methods: 72 tissue specimens including tumoral (Case; n=36) and their adjacent normal tissues (Control; n=36) were used. Nested-PCR and Real-Time PCR were employed to identify HPV DNA and assess the expression of IL-6, respectively. In addition, 72 sera samples from BC patients (n=36) and an age-matched healthy control group (n=36) were taken to measure the IL-6 serum level by ELISA. Results: Overall, the HPV DNA was detected in 19.4% (14/72) of samples. 33.33% (12/36) of cases and 5.5% (2/36) of the controls were found to be positive for HPV (P=0.003). The overexpression of IL-6 was observed in HPV+ samples compared to HPV- samples (P=0.05). However, the concentration of IL-6 serum level was remarkably different between patients and normal controls (P=0.0001). Intriguingly, IL-6 serum level was connected to the advanced clinical stage (III/IV), high grade (II/III), metastasis and, ER+ status of patients. Conclusions: Our finding indicated that the overexpression of the IL-6 may be connected to HPV infection in BC. Furthermore, the results reinforced the clinical significance and prognostic value of the serum IL-6 in BC patients.     

Can we rely on public data as a source of information for cancer registry in developing countries?

BACKGROUND/AIMS: Although a "hospital-based cancer registry" is important in improving patient care, a "population-based cancer registry" with emphasis on epidemiology is important in allocating health care resources and prioritizing public health programs. Because of its reliance on retrieved clinical and para-clinical documents, there is some limitation in registering all cancer incidents in this system, especially in developing countries. In this study we examined the possibility of using public data as a complementary source of information for recording cancers in a population-based cancer registry. METHODS: Along with the annual census in rural areas, a survey was performed in Golestan province in March 2004 to identify public awareness about cancer incidents in the community. Individuals were questioned about history of cancer in their close relatives during the last two years. Those who reported cancer in their relatives were also asked to name the main organ of involvement. A similar list was retrieved from the cancer registry at the Ministry of Health in Gorgan, and cases with upper GI (esophagus and gastric) cancer diagnosis from 21 March 2002 through 20 March 2004 were selected for this study. Finally, these two lists were compared for examining accuracy of the collected data. RESULTS: We included 137 cases in our study with rural residence and known addresses. Only 35 (25.5%) cases were reported by the relatives and among them only 20 (57.1%) relatives correctly reported the tumor location. Although we found a difference in accurate reporting of cancer incidents by year of diagnosis (more correct cases reported during the second versus the first year), the difference was not statistically significant between the two years. CONCLUSION: In this study, we examined the possibility of using public awareness about cancer incidents as a complementary source of information for a population-based cancer registry. We found that this approach is not ideal for reducing limitations. Therefore, we recommend a nationwide cancer registry to record all cancer-related information at the time of diagnosis. This strategy will reduce the need for performing retrospective surveys in collecting cancer-related information.