Clinical outcomes of cemented distal femur replacements with allpolyethylene tibial components for oncologic indications

BACKGROUND Endoprosthetic distal femoral replacement(DFR)is a well-established salvage procedure following resection of malignant tumors within the distal femur.Use of an all-polyethylene tibial(APT)component is cost-effective and avoids failure due to locking-mechanism issues and backside wear,but limits modularity and the option for late liner exchange.Due to a paucity of literature we sought to answer three questions:(1)What are the most common modes of implant failure for patients undergoing cemented DFR with APT for oncologic indications?(2)What is the survivorship,rate of all-cause reoperation,and rate of revision for aseptic loosening of these implants?And(3)Is there a difference in implant survivorship or patient demographics between cemented DFRs with APT performed as a primary reconstruction vs those performed as a revision procedure?AIM To assess outcomes of cemented DFRs with APT components used for oncologic indications.METHODS After Institutional Review Board approval,a retrospective review of consecutive patients who underwent DFR between December 2000 to September 2020 was performed using a single-institutional database.Inclusion criteria consisted of all patients who underwent DFR with a GMRS®(Global Modular Replacement System,Stryker,Kalamazoo,MI,United States)cemented distal femoral endoprosthesis and APT component for an oncologic indication.Patients undergoing DFR for non-oncologic indications and patients with metal-backed tibial components were excluded.Implant failure was recorded using Henderson's classification and survivorship was reported using a competing risks analysis.RESULTS 55 DFRs(55 patients)with an average age of 50.9±20.7 years and average body mass index of 29.7±8.3 kg/m2 were followed for 38.8±54.9 mo(range 0.2-208.4).Of these,60.0%were female and 52.7%were white.The majority of DFRs with APT in this cohort were indicated for oncologic diagnoses of osteogenic sarcoma(n=22,40.0%),giant cell tumor(n=9,16.4%),and metastatic carcinoma(n=8,14.6%).DFR with APT implantation was performed as a primary procedure in 29 patients(52.7%)and a revision procedure in 26 patients(47.3%).Overall,twenty patients(36.4%)experienced a postoperative complication requiring reoperation.The primary modes of implant failure included Henderson Type 1(soft tissue failure,n=6,10.9%),Type 2(aseptic loosening,n=5,9.1%),and Type 4(infection,n=6,10.9%).There were no significant differences in patient demographics or rates of postoperative complications between the primary procedure and revision procedure subgroups.In total,12 patients(21.8%)required a revision while 20 patients(36.4%)required a reoperation,resulting in three-year cumulative incidences of 24.0%(95%CI 9.9%-41.4%)and 47.2%(95%CI 27.5%-64.5%),respectively.CONCLUSION This study demonstrates modest short-term survivorship following cemented DFR with APT components for oncologic indications.Soft tissue failure and endoprosthetic infection were the most common postoperative complications in our cohort.

Analysis of Factors Influencing True Blood Loss in Navigated Total Knee Replacements

Title: Analysis of factors influencing true blood loss in navigated total knee replacements. Objectives: To evaluate true blood loss in total knee replacements and analyze the various factors such as gender, BMI, diagnosis, size of implants, duration of surgery, tourniquet usage etc. on calculated blood loss using formula by Nadler et al. All the cases included have been done using navigation system and no comparison with conventional jig based surgeries has been attempted. Methods: Retrospectively data of primary cemented total knee replacements performed from October 2012 to August 2013 were evaluated. All surgeries were performed using navigation system. The data collected included patient sex, height, weight and preoperative haemoglobin and hematocrit. The patients’ postoperative data of haemoglobin, hematocrit and drains were collected. All patients had their CBC done on 2nd post operative day. Any data on transfusions that patients received were also collected. We also collected data regarding the size of implant used. We calculated true blood based on formula given by Nadler, Hidalgo & Bloch. We excluded patients whose data were incomplete or who received tranexamic acid. Patients who needed stems (femoral or tibial) were also excluded from this study. Results: The average true calculated blood loss was 959.44 ml. BMI did not have any effect on blood loss. But larger size implants were associated with more blood loss. Conclusion: The preoperative haemoglobin is one of the most important factors in determining transfusion following the knee replacement. Male gender and larger implants are associated with more blood loss. BMI, diagnosis of OA or RA, tourniquet usage and time have no significant effect on blood loss. Our calculated blood loss compares favourably with published literature.

Replacements of Major Cephalopod Faunas in Late Cambrian and Ordovician in South China

1 Introduction As one of the major groups in the Great Ordovician Biodiversification Event(GOBE),cephalopods may have played a critical role in the marine ecosystem in late Cambrian and Ordovician.Among the few predators in the Ordovician,cephalopods are typified by their big sizes and the development of swimming ability.

Bioprosthetic Valve Size Selection to Optimize Aortic Valve ReplacementSurgical Outcome: A Fluid-Structure Interaction Modeling Study

Aortic valve replacement(AVR)remains a major treatment option for patients with severe aortic valve disease.Clinical outcome of AVR is strongly dependent on implanted prosthetic valve size.Fluid-structure interaction(FSI)aortic root models were constructed to investigate the effect of valve size on hemodynamics of the implanted bioprosthetic valve and optimize the outcome of AVR surgery.FSI models with 4 sizes of bioprosthetic valves(19(No.19),21(No.21),23(No.23)and 25 mm(No.25))were constructed.Left ventricle outflow track flow data from one patient was collected and used as model flow conditions.Anisotropic Mooney–Rivlin models were used to describe mechanical properties of aortic valve leaflets.Blood flow pressure,velocity,systolic valve orifice pressure gradient(SVOPG),systolic cross-valve pressure difference(SCVPD),geometric orifice area,and flow shear stresses from the four valve models were compared.Our results indicated that larger valves led to lower transvalvular pressure gradient,which is linked to better post AVR outcome.Peak SVOPG,mean SCVPD and maximum velocity for Valve No.25 were 48.17%,49.3%,and 44.60%lower than that from Valve No.19,respectively.Geometric orifice area from Valve No.25 was 52.03%higher than that from Valve No.19(1.87 cm2 vs.1.23 cm2).Implantation of larger valves can significantly reduce mean flow shear stress on valve leaflets.Our initial results suggested that larger valve size may lead to improved hemodynamic performance and valve cardiac function post AVR.More patient studies are needed to validate our findings.

Paleocommunity Replacements of Benthic Brachiopod in the Middle-Upper Devonian in the Longmenshan Area,Southwestern China:Responses to Sea Level Fluctuations

Twelve paleocommunities dominated by benthic brachiopod are recognized in the Givetian-Frasnian stages of the Devonian in the Longmenshan area, southwestern China, in which two kinds of brachiopod community replacement are classified. One is the abrupt replacement, represented by abrupt alternation between the Leiorhynchus community and Zhonghuacoelia-Striatopugnax community in the Frasnian Tuqiaozi Formation. The other is the gradual one, developed in the Givetian Guanwushan Formation, which had been completed by the shift of the Independatrypa lemma-Uncinulus heterocostellis-Emanuella takwanensis community via the Sinospongophyllum irregulare-Pseudomicroplasma fongi community to the Clathrocoilona spissa-Hexagonaria composite reef community. According to analyses of the paleocommunities, either the abrupt or gradual paleocommunity replacement of the Middle-Upper Devonian in the Longmenshan area is suggested as a response to the 5th-order sea level fluctuation due to the replacements of the paleocommunities in a tracts-system of depositional sequence. It is supposed that changes of paleocommunity diversity, one of the results of paleocommunity replacement, are depended on the range and magnitude of sea level fluctuation, but there is not a linear relationship between them. Furthermore, a suggestion is proposed that the concept of paleocommunity succession seem to be abandoned in the paleocommunity analysis because it almost never be practiced to recover the information of community succession in the geological record at present.

Effects of different flui replacements on serum HSP70 and lymphocyte DNA damage in college athletes during exercise at high ambient temperatures

Purpose：The aim of this study was to investigate the effects of flui replacement by water or sports drinks on serum heat shock protein 70（HSP70） levels and DNA damage during exercise at a high ambient temperature.Methods：Ten male college athletes with an athletic career ranging from 6 to 11 years were recruited from Yonsei University.The subjects ran on a treadmill at 75% of heart rate reserve during 4 different trials：thermoneutral temperature at 18℃（T）,high ambient temperature at 32℃ without flui replacement（H）,high ambient temperature at 32℃ with water replacement（HW）,and high ambient temperature at 32℃ with sports drink replacement（HS）.During each condition,blood samples were collected at the pre-exercise baseline（PEB）,immediately after exercise（IAE）,and60 min post-exercise.Results：Skin temperature significant y increased during exercise and was significant y higher in H compared to T and HS at IAE.Meanwhile,serum HSP70 was significant y increased in all conditions at IAE compared to PEB and was higher in H compared to T at the former time point.Significant y increased lymphocyte DNA damage（DNA in the tail,tail length,tail moment） was observed in all trials at IAE compared to PEB,and attenuated DNA damage（tail moment） was observed in HS compared to H at IAE.Conclusion：Acute exercise elevates serum HSP70 and induces lymphocyte DNA damage.Fluid replacement by sports drink during exercise at high ambient temperature can attenuate HSP response and DNA damage by preventing dehydration and reducing thermal stress.

Effect of body mass index on functional outcome in primary total knee arthroplasty——a single institution analysis of 2180 primary total knee replacements

AIM To evaluate the effect of body mass index(BMI) on short-term functional outcome and complications in primary total knee arthroplasty. METHODS All patients undergoing primary total knee arthroplasty at a single institution between 2007 and 2013 were identified from a prospective arthroplasty database. 2180 patients were included in the study. Age, gender, BMI, pre- and post-operative functional scores [Western Ontario and Mc Master University Arthritis Index(WOMAC) and SF-36], complications and revision rate were recorded. Patients were grouped according to the WHO BMI classification. The functional outcome of the normal weight cohort(BMI < 25) was compared to the overweight and obese(BMI ≥ 25) cohort. A separate sub-group analysis was performed comparing all five WHO BMI groups; Normal weight, overweight, class 1 obese, class 2 obese and class 3 obese.RESULTS With a mean age of 67.89(28-92), 2180 primary total knee replacements were included. 64.36%(1403) were female. The mean BMI was 31.86(18-52). Ninty-three percent of patients were either overweight or obese. Mean follow-up 19.33 mo(6-60 mo). There was no significant difference in pre or post-operative WOMAC score in the normal weight(BMI < 25) cohort compared to patients with a BMI ≥ 25(P > 0.05). Sub-group analysis revealed significantly worse WOMAC scores in class 2 obese 30.80 compared to overweight 25.80(P < 0.01) and class 1 obese 25.50(P < 0.01). Similarly, there were significantly worse SF-36 scores in class 2 obese 58.16 compared to overweight 63.93(P < 0.01) and class 1 obese 63.65(P < 0.01) There were 32(1.47%) superficial infections, 9(0.41%) deep infections and 19(0.87%) revisions overall with no complications or revisions in the normal weight cohort(BMI < 25).CONCLUSION Post-operative functional outcome was not influenced by BMI comparing normal weight individuals with BMI > 25. Patients should not be denied total knee arthroplasty based solely on weight alone.

Is Robotic Arm Assisted Total Hip Arthroplasty More Bone Preserving than Conventional Hip Replacements and Hip Resurfacing?

Background: Total hip arthroplasty (THA) is a common procedure that is increasingly being performed in younger patients. Deep acetabular reaming will result in more bone loss and the need for large acetabular components to be implanted. It can also lead to impingement, loosening, an altered center of rotation, and intraoperative periprosthetic fracture. The purpose of this study is to determine whether the single ream, robotic arm-assisted (RAA) THA can preserve a greater volume of bone stock compared to conventional hip replacement and resurfacing. Methods: We prospectively recruited 69 patients who had undergone primary THA using the Stryker Trident Acetabular System&reg;in combination with the Stryker RAA System (MAKO)&reg;and compared their mean reaming weight (g) with that of conventional hip replacement and resurfacing, as measured by Brennan et al. Comparison of acetabular reaming during hip resurfacing versus uncemented THA (J Orthop Surg. 2009;17(1): 42-46). Results: The mean reaming weight using the MAKO system was 9.08 g, which was 29% less than the reaming weight using uncemented THA and hip resurfacing of 12.75 g. None of the acetabular cups required screw fixation. During the 35-month follow-up period, there were no complications related to cup placement or positioning. Conclusions: The use of RAA THA results in statistically significant preservation of acetabular bone compared to conventional hip replacement and resurfacing. This approach reflects the increased precision offered by RAA single reaming. Surgeons may consider utilizing RAA THA, particularly in younger patients, to better preserve bone stock as this could potentially impact future revision procedures.

Role of pulsed electromagnetic fields after joint replacements

Although the rate of patients reporting satisfaction is generally high after joint replacement surgery, up to 23% after total hip replacement and 34% after total knee arthroplasty of treated subjects report discomfort or pain 1 year after surgery. Moreover, chronic or subacute inflammation is reported in some cases even a long time after surgery. Another open and debated issue in prosthetic surgery is implant survivorship, especially when related to good prosthesis bone ingrowth. Pulsed Electro Magnetic Fields(PEMFs) treatment, although initially recommended after total joint replacement to promote bone ingrowth and to reduce inflammation and pain, is not currently part of usual clinical practice. The purpose of this review was to analyze existing literature on PEMFs effects in joint replacement surgery and to report results of clinical studies and current indications. We selected all currently available prospective studies or RCT on the use of PEMFs in total joint replacement with the purpose of investigating effects of PEMFs on recovery, pain relief and patients’ satisfaction following hip, knee or shoulder arthroplasty. All the studies analyzed reported no adverse effects, and good patient compliance to the treatment. The available literature shows that early control of joint inflammation process in the first days after surgery through the use of PEMFs should be considered an effective completion of the surgical procedure to improve the patient’s functional recovery.

Computational Comparison of One Piece Metacarpo-Phalangeal/Phalangeal-Phalangeal Total Joint Replacements

Trauma, osteoarthritis and rheumatoid arthritis can destroy the articulating cartilage in small and large joints, especially in the metacarpo [tarso] phalangeal (MCP/MTP) and phalangeal-phalangeal (PIP) joints. Single piece finger prosthetic designs can reduce pain and correct aesthetic issues, with problems on contemporary designs including decreased stability, lack of fixation and loss of functionality. The examined implants are representative models of currently available total joint replacement (TJR) designs for MCP replacement, such as the Swanson one piece implant. These implants have been shown clinically to have a high failure rate (up to 90%), but the cause of failure is unknown. Compressive studies using a 50 N force and medial-lateral loads of 50 N perpendicular to the longitudinal axis of the arms of the implant were individually applied. Due to material failings, lower values had to be used in some cases. Maximum stress values were found for flexion loading;the Swanson approximation had a peak stress of 8.71 GPa at the interface of the joint arm and the flexion center, Neuflex had 0.188 GPa peak stress at the fixation center of the arm, and in the center of the joint, and the Avanta design had a 5.20 GPa peak stress at the flexion center. The location and concentration of stresses on the models correspond to literature searches for clinical data, showing that the main failure mechanism for these implants is due to primary flexion-extension natural movement of the joint.

The influence of lubricant temperature on the wear of total knee replacements

Experimental in vitro simulation can be used to predict the wear performance of total knee replacements.The in vitro simulation should aim to replicate the in vivo loading,motion and environment experienced by the joint,predicting wear and potential failure whilst minimising test artefacts.Experimental wear simulation can be sensitive to envi-ronmental conditions;the environment temperature is one variable which should be controlled and was the focus of this investigation.In this study,the wear of an all‐polymer(PEEK‐OPTIMA™polymer‐on‐UHMWPE)total knee replacement and a conventional cobalt chrome‐on‐UHMWPE implant of similar initial surface topography and geometry were investigated under elevated temperature conditions.The wear was compared to a previous study of the same implants under simulator running temperature(i.e.without heating the test environment).Under elevated temperature conditions,the wear rate of the UHMWPE tibial inserts was low against both femoral component materials(mean<2 mm3/million cycles)and significantly lower(p<0.05)than for investigations at simulator running temperature.Protein precipitation from the lubricant onto the component articulating surfaces is a possible explanation for the lower wear.This study highlights the need to understand the influence of different variables including envi-ronmental temperature to minimise the test artefacts during wear simulation which may affect the wear rates.

When Does Sora Show:The Beginning of TAO to Imaginative Intelligence and Scenarios Engineering

DURING our discussion at workshops for writing“What Does ChatGPT Say:The DAO from Algorithmic Intelligence to Linguistic Intelligence”[1],we had expected the next milestone for Artificial Intelligence(AI)would be in the direction of Imaginative Intelligence(II),i.e.,something similar to automatic wordsto-videos generation or intelligent digital movies/theater technology that could be used for conducting new“Artificiofactual Experiments”[2]to replace conventional“Counterfactual Experiments”in scientific research and technical development for both natural and social studies[2]-[6].Now we have OpenAI’s Sora,so soon,but this is not the final,actually far away,and it is just the beginning.

Emerging strategies for nerve repair and regeneration in ischemic stroke:neural stem cell therapy

Ischemic stroke is a major cause of mortality and disability worldwide,with limited treatment options available in clinical practice.The emergence of stem cell therapy has provided new hope to the field of stroke treatment via the restoration of brain neuron function.Exogenous neural stem cells are beneficial not only in cell replacement but also through the bystander effect.Neural stem cells regulate multiple physiological responses,including nerve repair,endogenous regeneration,immune function,and blood-brain barrier permeability,through the secretion of bioactive substances,including extracellular vesicles/exosomes.However,due to the complex microenvironment of ischemic cerebrovascular events and the low survival rate of neural stem cells following transplantation,limitations in the treatment effect remain unresolved.In this paper,we provide a detailed summary of the potential mechanisms of neural stem cell therapy for the treatment of ischemic stroke,review current neural stem cell therapeutic strategies and clinical trial results,and summarize the latest advancements in neural stem cell engineering to improve the survival rate of neural stem cells.We hope that this review could help provide insight into the therapeutic potential of neural stem cells and guide future scientific endeavors on neural stem cells.

Effects of hormone replacement therapy on mood and sleep quality in menopausal women

BACKGROUND Hormone replacement therapy is an effective treatment strategy for the management of symptoms in naturally menopausal women.However,some patients report experiencing adverse effects.AIM To analyze the effects of hormone replacement therapy in menopausal female patients.METHODS A total of 152 menopausal female patients admitted to the Gynecology Department of the Ganzhou Maternal and Child Health Hospital between January 2021 and December 2023 were divided into the observation group(n=76,conventional treatment+hormone replacement therapy)and the control group(n=76,conventional treatment only)via random casting.The improvement observed in the following items were compared between the groups:Kupperman menopausal index(KMI),emotional state[The Positive and Negative Affect Scale(PANAS)],sleep quality[Self-Rating Scale of Sleep(SRSS)],treatment effectiveness,and treatment safety.RESULTS The modified KMI and SRSS scores of the observation group were lower than those of the control group after three rounds of treatment.The improvement in the PANAS score observed in the observation group was greater than that observed in the control group(P<0.05).The total treatment effectivity rate in the observation group was higher than that in the control group(86.84%vs 96.05%,χ2=4.121,P=0.042).The incidence rate of adverse reactions in the two groups was comparable(6.58%vs 9.21%,χ2=0.361,P=0.547).CONCLUSION Hormone replacement therapy effectively improved the clinical symptoms,actively channeled negative emotions,and improved the quality of sleep in menopausal patients,indicating its effectiveness and safety.

Microglial autophagy in neurogenesis:a new player in Alzheimer's disease

While extensive studies have illuminated the impact of Alzheimer's disease(AD) on neuronal survival,there is growing evidence that abnormal postnatal neurogenesis in early AD brains contributes to disease progression.Postnatal neurogenesis serves as a mechanism to replace dead or damaged neurons.New neurons generated from neural stem cells(NSCs) in the subgranular zone(SGZ) of the dentate gyrus integrate into the existing hippocampal circuit.

Safety and effectiveness of neuromuscular electrical stimulation in cardiac surgery:A systematic review

BACKGROUND Lack of mobilization and prolonged stay in the intensive care unit(ICU)are major factors resulting in the development of ICU-acquired muscle weakness(ICUAW).ICUAW is a type of skeletal muscle dysfunction and a common complication of patients after cardiac surgery,and may be a risk factor for prolonged duration of mechanical ventilation,associated with a higher risk of readmission and higher mortality.Early mobilization in the ICU after cardiac surgery has been found to be low with a significant trend to increase over ICU stay and is also associated with a reduced duration of mechanical ventilation and ICU length of stay.Neuromuscular electrical stimulation(NMES)is an alternative modality of exercise in patients with muscle weakness.A major advantage of NMES is that it can be applied even in sedated patients in the ICU,a fact that might enhance early mobilization in these patients.AIM To evaluate safety,feasibility and effectiveness of NMES on functional capacity and muscle strength in patients before and after cardiac surgery.METHODS We performed a search on Pubmed,Physiotherapy Evidence Database(PEDro),Embase and CINAHL databases,selecting papers published between December 2012 and April 2023 and identified published randomized controlled trials(RCTs)that included implementation of NMES in patients before after cardiac surgery.RCTs were assessed for methodological rigor and risk of bias via the PEDro.The primary outcomes were safety and functional capacity and the secondary outcomes were muscle strength and function.RESULTS Ten studies were included in our systematic review,resulting in 703 participants.Almost half of them performed NMES and the other half were included in the control group,treated with usual care.Nine studies investigated patients after cardiac surgery and 1 study before cardiac surgery.Functional capacity was assessed in 8 studies via 6MWT or other indices,and improved only in 1 study before and in 1 after cardiac surgery.Nine studies explored the effects of NMES on muscle strength and function and,most of them,found increase of muscle strength and improvement in muscle function after NMES.NMES was safe in all studies without any significant complication.CONCLUSION NMES is safe,feasible and has beneficial effects on muscle strength and function in patients after cardiac surgery,but has no significant effect on functional capacity.

Generation of mitochondrial replacement monkeys by female pronucleus transfer

Mutations in mitochondrial DNA(mtDNA)are maternally inherited and have the potential to cause severe disorders.Mitochondrial replacement therapies,including spindle,polar body,and pronuclear transfers,are promising strategies for preventing the hereditary transmission of mtDNA diseases.While pronuclear transfer has been used to generate mitochondrial replacement mouse models and human embryos,its application in non-human primates has not been previously reported.In this study,we successfully generated four healthy cynomolgus monkeys(Macaca fascicularis)via female pronuclear transfer.These individuals all survived for more than two years and exhibited minimal mtDNA carryover(3.8%–6.7%),as well as relatively stable mtDNA heteroplasmy dynamics during development.The successful establishment of this nonhuman primate model highlights the considerable potential of pronuclear transfer in reducing the risk of inherited mtDNA diseases and provides a valuable preclinical research model for advancing mitochondrial replacement therapies in humans.

Multidisciplinary approach toward enhanced recovery after surgery for total knee arthroplasty improves outcomes

Knee osteoarthritis is a degenerative disorder of the knee,which leads to joint pain,stiffness,and inactivity and significantly affects the quality of life.With an increased prevalence of obesity and greater life expectancies,total knee arthroplasty(TKA)is now one of the major arthroplasty surgeries performed for knee osteoarthritis.When enhanced recovery after surgery(ERAS)was introduced in TKA,clinical outcomes were enhanced and the economic burden on the healthcare system was reduced.ERAS is an evidence-based scientific protocol aimed at ameliorating the surgical stress response.ERAS aims to enhance the recovery phase,which encompasses multidisciplinary strategies at every step of perioperative care,including the rehabilitation phase.Implementation of ERAS in TKA aids in reducing the length of hospital stay,improving pain management,reducing perioperative complications,and enhancing patient satisfaction.Multidisciplinary collaboration,integrating the expertise of anesthesiologists,orthopedic surgeons,nursing personnel,and other healthcare professionals,is the cornerstone of ERAS in patients undergoing TKA.

One-step cell biomanufacturing platform:porous gelatin microcarrier beads promote human embryonic stem cell-derived midbrain dopaminergic progenitor cell differentiation in vitro and survival after transplantation in vivo

Numerous studies have shown that cell replacement therapy can replenish lost cells and rebuild neural circuitry in animal models of Parkinson’s disease.Transplantation of midbrain dopaminergic progenitor cells is a promising treatment for Parkinson’s disease.However,transplanted cells can be injured by mechanical damage during handling and by changes in the transplantation niche.Here,we developed a one-step biomanufacturing platform that uses small-aperture gelatin microcarriers to produce beads carrying midbrain dopaminergic progenitor cells.These beads allow midbrain dopaminergic progenitor cell differentiation and cryopreservation without digestion,effectively maintaining axonal integrity in vitro.Importantly,midbrain dopaminergic progenitor cell bead grafts showed increased survival and only mild immunoreactivity in vivo compared with suspended midbrain dopaminergic progenitor cell grafts.Overall,our findings show that these midbrain dopaminergic progenitor cell beads enhance the effectiveness of neuronal cell transplantation.

Which approach of total hip arthroplasty is the best efficacy and least complication?

BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications of hip approaches remains inconclusive.This study conducted an umbrella review to systematically appraise previous meta-analysis(MAs)including conventional posterior approach(PA),and minimally invasive surgeries as the lateral approach(LA),direct anterior approach(DAA),2-incisions method,mini-lateral approach and the newest technique direct superior approach(DSA)or supercapsular percutaneouslyassisted total hip(SuperPath).AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials(RCTs).METHODS MAs were identified from MEDLINE and Scopus from inception until 2023.RCTs were then updated from the latest MA to September 2023.This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score(HHS),dislocation,intra-operative fracture,wound compliData were independently selected,extracted and assessed by two reviewers.Network MA and cluster rank and surface under the cumulative ranking curve(SUCRA)were estimated for treatment efficacy and safety.RESULTS Finally,twenty-eight MAs(40 RCTs),and 13 RCTs were retrieved.In total 47 RCTs were included for reanalysis.The results of corrected covered area showed high degree(13.80%).Among 47 RCTs,most of the studies were low risk of bias in part of random process and outcome reporting,while other domains were medium to high risk of bias.DAA significantly provided higher HHS at three months than PA[pooled unstandardized mean difference(USMD):3.49,95%confidence interval(CI):0.98,6.00 with SUCRA:85.9],followed by DSA/SuperPath(USMD:1.57,95%CI:-1.55,4.69 with SUCRA:57.6).All approaches had indifferent dislocation and intraoperative fracture rates.SUCRA comparing early functional outcome and composite complications(dislocation,intra-operative fracture,wound complication,and nerve injury)found DAA was the best approach followed by DSA/SuperPath.CONCLUSION DSA/SuperPath had better earlier functional outcome than PA,but still could not overcome the result of DAA.This technique might be the other preferred option with acceptable complications.