Effectiveness,Patient Satisfaction,and Cost Reduction of Virtual Joint Replacement Clinic Follow-Up of Hip and Knee Arthroplasty

BackgroundTotal hip and knee arthroplasties are increasingly performed operations, and routine follow-up places huge demands on orthopedic services. This study investigates the effectiveness, patients’ satisfaction, and cost reduction of Virtual Joint Replacement Clinic (VJRC) follow-up of total hip arthroplasty and total knee arthroplasty patients in a university hospital. VJRC is especially valuable when in-person appointments are not advised or feasible such as during the COVID-19 pandemic.MethodsA total of 1749 patients who were invited for VJRC follow-up for knee or hip arthroplasty from January 2017 to December 2018 were included in this retrospective study. Patients were referred to VJRC after their 6-week postoperative review. Routine VJRC postoperative review was undertaken at 1 and 7 years and then 3-yearly thereafter. We evaluated the VJRC patient response rate, acceptability, and outcome. Patient satisfaction was measured in a subgroup of patients using a satisfaction survey. VJRC costs were calculated compared to face-to-face follow-up.ResultsThe VJRC had a 92.05% overall response rate. Only 7.22% required further in-person appointments with only 3% being reviewed by an orthopedic consultant. VJRC resulted in an estimated saving of £42,644 per year at our institution. The patients’ satisfaction survey showed that 89.29% of the patients were either satisfied or very satisfied with VJRC follow-up.ConclusionVJRC follow-up for hip and knee arthroplasty patients is an effective alternative to in-person clinic assessment which is accepted by patients, has high patient satisfaction, and can reduce the cost to both health services and patients.     

Complications of Küntscher intramedullary nailing in a child: a case report

A fracture of the femur in a 7-year-old boy who was treated with retrograde Küntscher nailing is described. The follow-up period was 8 1/2 years. Deep infection, physeal injury of the femoral head, and trochanteric epiphysiodesis were serious consequences of the surgery.     

Prognostic prediction in patients with metastatic renal cell carcinoma treated with sorafenib based on expression levels of potential molecular markers in radical nephrectomy specimens

ObjectivesTo investigate the expression levels of multiple molecular markers in radical nephrectomy specimens from patients with metastatic renal cell carcinoma (RCC) treated with sorafenib in order to identify factors predicting susceptibility to this agent.Materials and methodsThis study included 45 consecutive patients undergoing radical nephrectomy for clear cell RCC who were diagnosed as having metastatic diseases refractory to cytokine therapy and subsequently treated with sorafenib. Expression levels of 19 molecular markers involved in the regulation of apoptosis, cell cycle, signal transduction, and angiogenesis in primary RCC specimens were measured by immunohistochemical staining.ResultsThere was no molecular marker having significant impact on the prediction of response to sorafenib. However, progression-free survival (PFS) was significantly associated with the expression levels of Bcl-xL and platelet-derived growth factor receptor (PDGFR)-α in addition to the presence of bone metastasis and C-reactive protein level on univariate analysis. Of these significant factors, PDGFR-α expression and the presence of bone metastasis appeared to be independently related to PFS by multivariate analysis. Furthermore, there were significant differences in PFS according to positive numbers of these 2 independent risk factors; that is, disease progression occurred in 2 of 7 patients who were negative for risk factor, 19 of 34 positive for a single risk factor, and 6 of 6 positive for both risk factors.ConclusionsCollectively, these findings suggest that it would be useful to consider expression levels of potential molecular markers, particularly PDGFR-α, as well as clinical parameters to select metastatic RCC patients likely to benefit from treatment with sorafenib.     

Three‐dimensional transesophageal echocardiography incremental value in a rare case of a bileaflet tricuspid valve

Detailed assessment of the tricuspid valve using two‐dimensional echocardiography is always challenging, as only two of three leaflets can be seen at a time. Three‐dimensional echocardiography can provide the enface view of the tricuspid valve that allows simultaneous visualization of all of the three leaflets. In a 42‐year‐old male patient scheduled for pulmonary endarterectomy, 3DTEE showed that the tricuspid valve is bileaflet, with one septal and another lateral leaflet. There were two commissures, one of them is anteriorly positioned and the other one is posterior. Our findings were confirmed intra‐operatively by direct surgical visualization of the tricuspid valve.     

Recent Concepts in Bone Grafting and Banking

In recent years the need for an appropriate grafting material for orthognathic, orthopaedic, and reconstructive surgery has been constantly increasing. Autografts have been used but not without unacceptable risks, including donor site morbidity such as pneumothorax, and the unavailability of safely procured bone in children. Consequently, great efforts have been made to explore the potential of allografts and xenografts. At present, the surgeon is faced with a wide variety of bone grafting material from bone banks, besides autografts. None of these choices fulfills all the requirements of an ideal graft. This paper attempts to present the different aspects of bone grafting, as well as the available banked bone materials and their prospective uses.     

Green and ecofriendly bio-removal of methylene blue dye from aqueous solution using biologically activated banana peel waste

Using of bio-wastes in dye adsorption is one of the greenest influential applied techniques for the removal of dyestuff from the industrial effluents and it considered as waste management. In the current study, banana peel waste (BPW) was used as an inexpensive and eco-friendly adsorbent for methylene blue (MB) dye. Mechanical pretreatment of BPW was carried out and followed by biological activation using Rhizopus microspores. MB dye was adsorbed by mechanically pretreated BPW (mBPW) by 31%. Moreover, the day nine fermented BPW fibers (mbBPW) is the best time for R. microspores to complete activation, where adsorption ratio reached to about 96.5%. Likewise, enzymes activity was recorded the highest activity after this period of fermentation, where enzymes activity of cellulase, xylanase, lignin peroxidase, poly phenol oxidase and laccase were 0.75, 0.68, 0.38, 0.55 and 0.32 U/ml, respectively. The FT-IR, SEM and BET were used to observe the effect of treatment on the BPW. Otherwise, the kinetics study is illustrated that the adsorption of MB with mbBPW fitted with pseudo-first-order kinetic models. However, the adsorption parameters indicated that the Langmuir model is better to describe the adsorption of dye with excellent maximum adsorption capacity 991 mg/g. In conclusion, biologically activated BPW is very efficient for dye adsorption as well as waste management.     

Potential efficacy of garlic lock therapy in combating biofilm and catheter-associated infections; experimental studies on an animal model with focus on toxicological aspects

BackgroundLife-threatening central venous catheter-related infections are primarily initiated by biofilm formation on the catheter surface. Antibiotic lock therapy is recommended for eradicating intraluminal biofilm. In the era of antibiotic resistance, antibiotics of natural origins provide an effective and cheap option for combating resistant strains. Garlic especially stole the spotlight because of its impressive antimicrobial effectiveness against such superbugs.AimIs to estimate the potential use of fresh garlic extract (FGE) as a lock agent against multi-drug resistant (MDR) bacteria.MethodsThe agar well diffusion and broth microdilution techniques were employed to test the antimicrobial activities of FGE against five MDR strains; E. coli, Pseudomonas aeruginosa (P. aeruginosa), Klebsiella pneumoniae (K. pneumoniae), Serratia marscens (S. marscens) and Methicillin-resistant Staphylococcus aureus (MRSA). Then the protective and therapeutic efficiencies of FGE against bacterial biofilms were in-vitro evaluated; at concentrations of 100, 75, 50 and 25%; in tissue culture plate (TCP) and on the polyurethane (PU) sheets using the crystal violet (CV) assay and colony-forming unit (CFU), respectively. Scanning electron microscopy (SEM) was also used to confirm eradication of biofilms on PU sheets. Finally, systemic and deep tissue infections by P. aeruginosa and MRSA were induced in mice that were then treated by FGE at either 100 or 200 mg/kg for seven days. Where the antibacterial activity was assessed by tissue and blood culturing at the end of the treatment period. Biochemical, hematological and histological parameters were also investigated.ResultsFGE exhibited potent in-vitro and in-vivo antibacterial and antibiofilm activities against MDR strains. It not only didn’t exhibit toxicological effects at the hematological and the histological levels but also provided protective effects as demonstrated by the significant drop in the biochemical parameters.ConclusionFGE has the potential to be used as a prophylactic and/or therapeutic lock agent against biofilm-associated infections caused by MDR bacteria.