Is there clinical evidence to support autologous matrix-induced chondrogenesis (AMIC) for chondral defects in the talus? A systematic review and meta-analysis

BackgroundThe aim of this study is to systematically review the literature on clinical outcomes of patients who have undergone autologous matrix-induced chondrogenesis (AMIC) for treatment of osteochondral lesions of the talus (OCL) and compare the studies’ outcomes.MethodsPubmed and Embase were searched in January 2020 for articles concerning OCL surgery. Studies were included if they had a minimum 1-year follow-up and the primary measures were functional outcomes. The meta-analysis compared the Visual Analogic Score (VAS), the American Orthopedic Foot and Ankle Score (AOFAS), and the Foot Function Index (FFI) between baseline and follow-up of 1?2 years, and 3?5 years. A random effects model was used to evaluate outcome changes.ResultsThe search returned 15 studies, with a total of 492 patients. The VAS improved 4.45 and 4.6 points from baseline to the 1?2 year and 3?5 year follow-up, respectively (p < 0.001). AOFAS improved 31.59 and 32.47 points from baseline to the 1?2 year and 3?5 year follow-up, respectively (p < 0.001). The FFI showed a significant improvement of 30.93 points from baseline to year 3?5 (p < 0.001). A total of 6 patients with revision surgeries have been reported within the follow up period. It was not possible to correlate clinical features like lesion size, surgical approach, and bone marrow stimulation technique to the reported outcome.ConclusionSurgical treatment of OCL via the AMIC procedure provided significant improvement in the functional outcome and pain scores when compared to the pre-operative values. Improvements were observed up to 5 years post-operatively.     

Basismaßnahmen zur Wiederbelebung Erwachsener (Basic Life Support)

Notfall + Rettungsmedizin - Der Europäische Rat für Wiederbelebung hat diese Leitlinie –&nbsp;Basismaßnahmen zur Wiederbelebung&nbsp;– auf Grundlage des...     

Mental health services and the city: a neighbourhood-level epidemiological study

Journal of Public Health - Neighbourhood composition is considered a social determinant of mental health that can be addressed by policymakers to improve outcomes. Deprived neighbourhoods typically...     

Clonal composition and persistence of antigen-specific circulating T follicular helper cells

T follicular helper (T_FH) cells play an essential role in promoting B cell responses and antibody affinity maturation in germinal centers (GC). A subset of memory CD4⁺ T cells expressing the chemokine receptor CXCR5 has been described in human blood as phenotypically and clonally related to GC T_FH cells. However, the antigen specificity and relationship of these circulating T_FH (cT_FH) cells with other memory CD4⁺ T cells remain poorly defined. Combining antigenic stimulation and T cell receptor (TCR) Vβ sequencing, we found T cells specific to tetanus toxoid (TT), influenza vaccine (Flu), or Candida albicans (C.alb) in both cT_FH and non-cT_FH subsets, although with different frequencies and effector functions. Interestingly, cT_FH and non-cT_FH cells specific for C.alb or TT had a largely overlapping TCR Vβ repertoire while the repertoire of Flu-specific cT_FH and non-cT_FH cells was distinct. Furthermore, Flu-specific but not C.alb-specific PD-1⁺ cT_FH cells had a “GC T_FH-like” phenotype, with overexpression of IL21, CXCL13, and BCL6. Longitudinal analysis of serial blood donations showed that Flu-specific cT_FH and non-cT_FH cells persisted as stable repertoires for years. Collectively, our study provides insights on the relationship of cT_FH with non-cT_FH cells and on the heterogeneity and persistence of antigen-specific human cT_FH cells.     

Percutaneous transluminal renal angioplasty in patients with solitary kidney

We report our experience with percutaneous transluminal angioplasty of renal arteries (PTRA) in solitary kidney patients. Our series includes 31 patients (mean age: 52 years). 7 with solitary kidney following surgical nephrectomy and 24 with functioning solitary kidney. PTR indicated in presence of stenoses ranging from 60–95 % of vessel lumen. Procedure, with 29 patients were technically successful and mean values for stenosis dropped from 77 % to 33 %. In order to assess the results technically, changes in arterial blood pressure (according to Martin's classification) and creatinine levels were considered. Of 25 followed-up patients, 13 were cured (52%), 8 improved (32%),and 4 were unchanged (16%%). Complications were observed during procedures in five patients (16. 1 % ), superimposing that of nonsolitary kidney patients. Good revasculariiation, reduction of blood pressure, preservation or even improvement of renal function and low complications, make PTRA the best procedure with solitary kidney patients.     

Expression of the retinoic Acid nuclear receptors (rars) and retinoid x-receptor (rxr) genes in estrogen-receptor positive and negative breast-cancer

Retinoid inhibition of breast carcinoma growth correlates with the estrogen receptor (ER) positivity and elevated retinoic acid nuclear receptor (RARalpha) mRNA levels. We therefore examined retinoid nuclear receptor mRNA levels in patient breast carcinoma biopsy specimens to determine if such a correlation exists between ER positivity and RARalpha mRNA levels. We have now shown that RARalpha mRNA levels are significantly higher in ER positive samples. RARgamma mRNA is expressed at relatively high levels in a majority of the tumor samples independent of the ER-status while RARbeta mRNA was expressed at low levels in only one tumor sample. We also found high RXRalpha mRNA levels in all of the tumor samples examined while RXRgamma mRNA could not be detected. Our study demonstrates that RARalpha mRNA levels are either low or absent in ER-negative patient samples and that RARalpha levels may serve as a potential marker to determine patient responsiveness to RA therapy.     

Bone and hormones. Estrogens and antiestrogens: action on osteoporosis

ESTROGEN INSUFFICIENCY: Estrogens play a cardinal role in bone tissue in women. Estrogen insufficiency leads to accelerated bone loss within 5 to 8 years after menopause. HORMONE SUBSTITUTION THERAPY: Substitution therapy prevents postmenopausic bone loss (lumbar vertebrae, hip, radius) and reduces the risk of osteoporotic fracture. Cohort studies have demonstrated that women given hormone substitution therapy for at least 7 years have a significantly higher bone density than untreated women. Although still controversial, it would appear that the risk of breast cancer increases with prolonged use of hormone substitution therapy. SERM: Observations in patients given tamoxifen, an antiestrogen used in the treatment of breast cancer, have led to the concept of selective estrogen receptor modulators (SERM), a new class of compounds with estrogen agonistic or antagonistic activity, depending on the tissue. Among these molecules, raloxifen has reached advanced clinical testing phases. Phase III trials have demonstrated that raloxifen can prevent bone loss and reduce the risk of vertebral fractures while reducing total cholesterol and LDL-cholesterol in menopaused women without stimulating the endometrium. SERMs are a promising alternative to hormone substitution therapy for the treatment of menopaused women.     

The management of urinary candidiasis in cystectomized patients

Presentation of eight cases of urinary candidiasis in patients who underwent radical cystectomy and were managed using by-pass of the urinary tract, oral antifungal therapy and solutions in the way of intermittent instillation through nephrostomy catheters.     

Trigonocervicoprostatomy. Indications and results from 100 case reports

Trigonocervicotomy is a barely invasive technique for the treatment of infravesical obstruction, first introduced in the 60's by Turner-Warkic and Orandi. To achieve good results with this procedure, the selection criteria must take into account a series of parameters such as age, sexual activity, PSA, prostate weight (below 30 grams) and others. In addition to its low morbidity, a larger percentage of patients preserve ejaculation than with the use of other techniques, also the neck sclerosis rate being lower as seen in all our series and expertise. The efficacy of this technique was studied on 100 patients.