Dual mobility: A choice for primary total hip arthroplasty?

Dual-mobility sockets were introduced in the United States in 2010. The smaller inside diameter head offered the potential advantage of lower wear and the larger outside diameter head offered the potential advantage of improved stability. Initially, indications were advocated for patients with increased instability risk. However, with larger diameter metal-on-metal articulations falling out of favor, the indications for dual-mobility components are expanding. The author has used this design in over 400 primary THAs with only one dislocation. One loose cup was revised. Dislocation of the smaller femoral head from the larger polyethylene head remains a theoretical risk with DM designs.     

Literacy-Free 12 Step Expressive Arts Curriculum Enhances Engagement and Treatment Outcomes for Dually Diagnosed Substance Use and Mental Health Disorders

ABSTRACT

This study evaluated the efficacy of the Literacy-Free 12 Step Expressive Arts Therapy© curriculum in enhancing personal change and treatment outcomes for populations dually diagnosed with substance use and mental health disorders. It supplemented standard rehabilitation treatment for 47 individuals in a U.S. facility by incorporating 12 Step guidelines, cognitive behavioral therapy, rational emotive behavior therapy, and expressive arts activities. Pre-session and post-session participant ratings revealed positive increases for commitment to recovery, attitude toward making lifestyle changes, and hopefulness. Compared to 101 inpatients at the same facility, curriculum participants evidenced less drop-out, higher treatment completion, and greater personal investment in recovery.     

Legacy Interventions With Patients with Co-Occurring Disorders: Legacy Definitions,Life Satisfaction,and Self-Efficacy

Background: Individuals with co-occurring disorders tend to avoid interaction with others. To instill hope, legacy intervention aims to highlight past experiences while managing life stressors for a positive outlook. Participants take part in legacy activities—crafting tangible projects and recording one's life events—in order to actualize a personal sense of legacy. Objectives: This pre-posttest research tested whether legacy intervention in a partial hospital program (PHP) on reframing past experiences through creative activities could increase life satisfaction and self-efficacy among adults with co-occurring substance misuse and mental health symptoms. Method: Eighty consented patients with co-occurring disorders were randomly assigned to two groups with 62 participants continuing: 37 in legacy intervention (LI) and 25 in partial hospital program only (PHP-only). LI participants were engaged in both PHP and legacy activities. Ten group sessions were held over the course of five weeks for cohorts of 10–15 adult patients in each intervention. Sense of legacy was measured to ensure that LI patients received the appropriate legacy dosage. Results: With RANOVA analyses between and among three time points, life satisfaction was significantly higher in the LI group with group interaction effect over time. In terms of self-efficacy, both groups showed positive changes but no significant difference could be found between the two groups over time and the interaction (time X group) effect was not significant. Importance: The legacy definitions gathered from the LI group were consistent with existing literature and showed three additional themes: children's involvement, concreteness, and life continuation after death.     

Thrombelastographic hypercoagulability and antiplatelet therapy after coronary artery bypass surgery (TEG-CABG trial): a randomized controlled trial

A hypercoagulable state has, in observational studies, been associated with increased risk of thromboembolic events. The aim of this trial was to study whether dual antiplatelet therapy (DAPT) with clopidogrel in addition to aspirin could reduce the rate of graft occlusions, thromboembolic events, and death compared to aspirin monotherapy in hypercoagulable patients undergoing coronary artery bypass surgery. A total of 1683 patients were screened for eligibility, among which 165 patients were randomized and 133 patients underwent multislice computed tomography scan to evaluate their grafts. Thrombelastography (TEG) and multiplate aggregometry were performed before and after surgery, and again at three months follow up. TEG hypercoagulability was defined as the maximum amplitude above 69 mm. At three months follow up, 17 out of 66 (25.7%) DAPT patients and 15 of 67 (22.4%) aspirin patients had significant graft stenosis or occlusions (p = 0.839). Saphenous vein grafts (SVGs) were stenosed or occluded in 15 (22.7%) patients in the DAPT group and 7 (10.4%) in the aspirin group (p = 0.167). Thromboembolic events and death after the second postoperative day (when clopidogrel was started) were numerically, but not statistically, lower in the DAPT group, 3 (3.8%) vs. 8 (9.9%), p = 0.211. In univariate logistic regression analysis, only postoperative day 4 platelet response to aspirin measured with multiplate was correlated with graft occlusion, OR 1.020 [1.002–1.039], p = 0.033. This is the first trial to test the hypothesis of intensified antiplatelet therapy in hypercoagulable patients. Due to the low enrollment and high loss to follow up, our results can only be viewed as hypothesis generating. We found a high rate of graft occlusions in this patient population. Our results were not suggestive of that DAPT improved saphenous vein graft patency. A trend was observed in patients on DAPT toward fewer MI and deaths. Postoperative response to aspirin therapy was found to be associated with early SVG occlusion.     

Advances in Percutaneous Coronary Interventions for Elderly Patients

Coronary heart disease (CHD) is one of the leading causes of morbidity and the most common cause of death in older adults. Paradoxically, elderly patients tend to be systematically excluded from randomized-controlled cardiovascular trials, which complicates decision-making in this population. Management of CHD in the elderly is frequently more difficult in virtue of chronic comorbid conditions and aging-intrinsic dynamics. Despite these challenges, the number of elderly and very elderly patients undergoing percutaneous coronary interventions (PCI) is increasing. Elderly patients in many registries and large clinical series exhibit even a greater benefit from interventional procedures than younger patients, but they have a higher rate of overall complications. We present an overview of the current available evidence of PCI in older adults with stable and unstable CHD, including comparisons between drug-eluting and bare-metal stents, transfemoral and transradial access, and methods of revascularization. Adjuvant antiplatelet and antithrombotic therapies are also discussed.     

“一带一路”广西云南重点口岸蚊类监测分析

目的通过“一带一路”重点口岸蚊虫专项监测,了解西南口岸蚊虫种群构成及变化,为口岸蚊媒传染病防控提供科学依据。方法分别在2018年、2019年夏季于广西东兴、云南瑞丽和磨憨3个口岸,采用灯诱法、吸蚊器法采集成蚊,形态鉴定后,记录蚊种和数量。结果2018年、2019年3个口岸共捕获成蚊90156只,经鉴定隶属3亚科7属31种:按蚊属11种共9645只,占10.70%;库蚊属10种共71312只,占79.10%;伊蚊属6种共4597只,占5.10%;阿蚊属1种共1852只,占2.05%;曼蚊属1种2658只,占2.95%;轲蚊属1种2只,占0.002%;巨蚊属1种90只,占0.10%。3个口岸的蚊种为:东兴16种、瑞丽13种、磨憨23种。2018年共捕获成蚊7属28种,2019年共捕获成蚊6属19种,但黑点库蚊(磨憨1只)、埃及伊蚊(瑞丽1只)、多斑按蚊(磨憨30只)只在2019年监测到。三带喙库蚊在东兴口岸占78.29%(17300只),瑞丽口岸占94.24%(36310只),磨憨口岸占52.43%(15481只)。结论应将蚊虫专项监测与本底监测相结合,防止乙脑、疟疾、登革热等蚊媒传染病的跨境传播。     

Abnormal Regional Body Fat Distribution Also Exists in Non-Obese Subjects with High Blood Pressure

A cross-sectional analysis was performed to explore the relationship between regional body fat distribution and blood pressure in non-obese subjects with different status of blood pressure. Dual-energy X-ray absorptiometry was performed to measure fat mass. Obesity was defined as present body fat ≥25% in males and ≥35% in females. The ratio of leg fat mass to total fat mass (L/T) decreased gradually while the ratio of trunk fat mass to total fat mass (Tr/T) increased gradually with the increasing blood pressure for both genders in non-obese subjects (P < .01), which was consistent with the change in obese ones; and the blood pressure status in the low Tr/T + high L/T group was better than that in the high Tr/T + low L/T group, obviously. After adjustment for confounding factors, blood pressure was still positively related with Tr/T but negatively associated with L/T in non-obese groups. A multiple linear regression analysis showed that L/T was the major negative factors of blood pressure in the non-obese population. Abnormal fat distribution also exists in non-obese subjects with high blood pressure; compared to trunk fat, leg fat may be a more important factor against blood pressure.     

Former Substance Users Working as Counselors. A Dual Relationship

All helping professionals risk participation in “dual relationships.” But in the case of former substance users working as counselors, specific dilemmas and problems are accentuated. A qualitative analysis highlights some of the ethical and personal dilemmas faced by these counselors. The data are derived from an interview study initiated in 2000 in Denmark on former substance users with 4–8 years of abstinence. Through an analysis of interview data from a larger group of former substance users, it became evident that those working as counselors experienced specific dilemmas and problems. The current article is based on individual reports of five counselors with recovery status.