Three-dimensional(3D)-printed titanium cups used in primary total hip arthroplasty(THA)were developed to combine the benefits of a low elastic modulus with a highly porous surface.The aim was to improve local vascular...Three-dimensional(3D)-printed titanium cups used in primary total hip arthroplasty(THA)were developed to combine the benefits of a low elastic modulus with a highly porous surface.The aim was to improve local vascularization and bony ingrowth,and at the same time to reduce periprosthetic stress shielding.Additive manufacturing,starting with a titanium alloy powder,allows serial production of devices with large interconnected pores(trabecular titanium),overcoming the drawbacks of tantalum and conventional manufacturing techniques.To date,3D-printed cups have achieved dependable clinical and radiological outcomes with results not inferior to conventional sockets and with good rates of osseointegration.No mechanical failures and no abnormal ion release and biocompatibility warnings have been reported.In this review,we focused on the manufacturing technique,cup features,clinical outcomes,open questions and future developments of off-the-shelf 3D-printed titanium shells in THA.展开更多
Background:The role of prophylactic levosimendan in coronary surgery has not been established conclusively.Methods:Postoperative outcomes of 139 patients(mean age,68.2±9.6 years)having preoperative left ventricul...Background:The role of prophylactic levosimendan in coronary surgery has not been established conclusively.Methods:Postoperative outcomes of 139 patients(mean age,68.2±9.6 years)having preoperative left ventricular ejection fraction(LVEF)≤40%and undergoing isolated coronary surgery(2013-2017)were reviewed retrospectively.In 42(30.2%)patients(L-group),an intravenous infusion of levosimendan was started 24 hours before operation.The remaining 97(69.8%)patients were the control group(C-group).A comparison between the two groups regarding outcome of surgery was performed also after propensity matching.Results:Although the risk profile in L-patients was higher than in C-patients(median European System for Cardiac Operative Risk Evaluation II,10.5%vs.6.5%,P=0.013)due to higher prevalence of New York Heart Association class III-IV,LVEF≤30%,and preoperative intra-aortic balloon pump,in-hospital mortality was equivalent(4.8%vs.3.1%,P=0.48).However,low cardiac output,multiple blood transfusion,and any major complication early after surgery were more frequent in L-patients.After one-to-one propensity matching,which resulted in 15 pairs with similar baseline characteristics the use of levosimendan was associated with a trend towards an increased blood use(P=0.077),a higher frequency of any major complication(P=0.053),and lower peak serum levels of cardiac troponin I(P=0.088).No intergroup differences concerning mid-term survival or outcomes were found even for matched patients.Conclusions:When compared with traditional inotropes alone,prophylactic use of levosimendan showed clear benefits/drawbacks neither concerning immediate nor mid-term outcomes after coronary surgery.There could be any advantage in terms of myocardial preservation.展开更多
文摘Three-dimensional(3D)-printed titanium cups used in primary total hip arthroplasty(THA)were developed to combine the benefits of a low elastic modulus with a highly porous surface.The aim was to improve local vascularization and bony ingrowth,and at the same time to reduce periprosthetic stress shielding.Additive manufacturing,starting with a titanium alloy powder,allows serial production of devices with large interconnected pores(trabecular titanium),overcoming the drawbacks of tantalum and conventional manufacturing techniques.To date,3D-printed cups have achieved dependable clinical and radiological outcomes with results not inferior to conventional sockets and with good rates of osseointegration.No mechanical failures and no abnormal ion release and biocompatibility warnings have been reported.In this review,we focused on the manufacturing technique,cup features,clinical outcomes,open questions and future developments of off-the-shelf 3D-printed titanium shells in THA.
文摘Background:The role of prophylactic levosimendan in coronary surgery has not been established conclusively.Methods:Postoperative outcomes of 139 patients(mean age,68.2±9.6 years)having preoperative left ventricular ejection fraction(LVEF)≤40%and undergoing isolated coronary surgery(2013-2017)were reviewed retrospectively.In 42(30.2%)patients(L-group),an intravenous infusion of levosimendan was started 24 hours before operation.The remaining 97(69.8%)patients were the control group(C-group).A comparison between the two groups regarding outcome of surgery was performed also after propensity matching.Results:Although the risk profile in L-patients was higher than in C-patients(median European System for Cardiac Operative Risk Evaluation II,10.5%vs.6.5%,P=0.013)due to higher prevalence of New York Heart Association class III-IV,LVEF≤30%,and preoperative intra-aortic balloon pump,in-hospital mortality was equivalent(4.8%vs.3.1%,P=0.48).However,low cardiac output,multiple blood transfusion,and any major complication early after surgery were more frequent in L-patients.After one-to-one propensity matching,which resulted in 15 pairs with similar baseline characteristics the use of levosimendan was associated with a trend towards an increased blood use(P=0.077),a higher frequency of any major complication(P=0.053),and lower peak serum levels of cardiac troponin I(P=0.088).No intergroup differences concerning mid-term survival or outcomes were found even for matched patients.Conclusions:When compared with traditional inotropes alone,prophylactic use of levosimendan showed clear benefits/drawbacks neither concerning immediate nor mid-term outcomes after coronary surgery.There could be any advantage in terms of myocardial preservation.
