Revisional Cochlear Implant Surgeries in Adults

Introduction: Cochlear implant (CI) surgery allows hearing reestablishment among individuals with severe to profound hearing loss. However, only few patients will need a surgical reassessment. Objectives: To verify the incidence of surgical reassessment among adult patients;to verify the reasons that led the second surgery to be performed;to verify the efficacy—and audiological outcomes—of revisional surgery. Method: A longitudinal retrospective cohort study was carried out with the review of medical records, of adult patients, with bilateral severe to profound sensorineural hearing loss who underwent to revisional surgery, from 2004 to 2016 at a CI Center, in Brazil. Results: One hundred fifty-eight CI surgeries were performed among 137 adult patients. Fourteen revisional surgeries were performed among 10 patients: five surgeries were due by displacement of the internal unit;one because of having excessive subcutaneous tissue;one due to non-progression of the electrodes during the initial surgery, one late tympanic membrane perforation, one late facial palsy and, one due to a suture dehiscence in the surgical incision with exposure of the internal unit. Conclusions: The incidence of surgical reassessment among adult CI patients was 8.9%. All implanted patients that underwent a new surgical approach maintained an improved auditory threshold after revisional CI surgery.

Analysis of the causes of primary revision after unicompartmental knee arthroplasty: A case series

BACKGROUND Unicompartmental knee arthroplasty(UKA)has great advantages in the treatment of unicompartmental knee osteoarthritis,but its revision rate is higher than that of total knee arthroplasty.AIM To summarize and analyse the causes of revision after UKA.METHODS This is a retrospective case series study in which the reasons for the first revision after UKA are summarized.We analysed the clinical symptoms,medical histories,laboratory test results,imaging examination results and treatment processes of the patients who underwent revision and summarized the reasons for primary revision after UKA.RESULTS A total of 13 patients,including 3 males and 10 females,underwent revision surgery after UKA.The average age of the included patients was 67.62 years.The prosthesis was used for 3 d to 72 months.The main reasons for revision after UKA were improper suturing of the surgical opening(1 patient),osteophytes(2 patients),intra-articular loose bodies(2 patients),tibial prosthesis loosening(2 patients),rheumatoid arthritis(1 patient),gasket dislocation(3 patients),anterior cruciate ligament injury(1 patient),and medial collateral ligament injury with residual bone cement(1 patient).CONCLUSION The causes of primary revision after UKA were gasket dislocation,osteophytes,intra-articular loose bodies and tibial prosthesis loosening.Avoidance of these factors may greatly reduce the rate of revision after UKA,improve patient satisfaction and reduce medical burden.

Highly Aromatic Norditerpenoid Heterodimers and Monomers from Trigonostemon fragilis

Four new norditerpenoid heterodimers with different dimerization patterns-namely,trigofragiloids A-C(denoted as compounds 1-3)and(+)-and(-)-trigofragiloid D(compound 4)-and three new phenanthrenone norditerpenoids-namely,trigofragiloids E-G(compounds 5-7)-were isolated from Trigonostemon fragilis.Compounds 1 and 2 feature a novel heterodimeric carbon skeleton formed by the conjugation of a tetra-norditerpenoid and an ennea-norditerpenoid;they have been identified as class 2 atropisomers by means of quantum chemical calculations.Compound 3 is an unprecedented phenylpropanoid-norditerpenoid adduct with a new dimerization pattern.Compounds(+)-and(-)-4 are the first example of S-shaped 1,4-dioxane-fused norditerpenoid dimers.Inspired by the structure elucidation of compound 4,two co-occurring analogues,actephilol A and epiactephilol A,were structurally revised as a pair of geometrical isomers and were identified as two pairs of enantiomers,(+)-and(-)-8 and(+)-and(-)-9,respectively.Their structures were characterized using a combined method.Notably,compound 7 exhibits remarkable adenosine triphosphate-citrate lyase(ACLY)inhibition with a halfmaximal inhibition concentration(IC50)value of(0.46±0.11)lmol·L^(-1),as active as the positive control BMS-303141,and a molecular docking study offers deep insight into the interaction between compound 7 and ACLY.

Insights into complications after unicompartmental knee arthroplasty

Zhao's study,offers a comprehensive analysis of unicompartmental knee arthroplasty(UKA)revision indications.The study provides a detailed,case-by-case analysis of the factors leading to knee revision surgery in 13 patients.Not only elucidates the complexities of UKA revisions but also underscores the importance of continuous improvement in surgical techniques and the adoption of innovative technologies.

Dislocation of primary total hip arthroplasty:Analysis of risk factors and preventive options

Total hip arthroplasty(THA)is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease.However,dislocation continues to be a troublesome complication after THA,as it is a leading cause of revision and is associated with substantial social,health,and economic costs.It is a relatively rare,usually early occurrence that depends on both the patients’characteristics and the surgical aspects.The most recent and important finding is the special attention to be given preoperatively to spinopelvic mobility,which is closely related to the incidence of dislocation.Consequently,clinical and radiographic assessment of the lumbar spine is mandatory to identify an altered pelvic tilt that could suggest a different positioning of the cup.Lumbar spinal fusion is currently considered a risk factor for dislocation and revision regardless of whether it is performed prior to or after THA.Surgical options for its treatment and prevention include the use of prostheses with large diameter of femoral head size,dual mobility constructs,constrained liners,and modular neck stems.

Gouty destruction of a patellar tendon reconstruction and novel revision reconstruction technique: A case report

BACKGROUND Gout is a disease characterized by hyperuricemia,and resultant deposition of uric acid crystals in tissues.While typically manifested as intraarticular crystals or tophi,gout can also cause pathology at entheses.Gouty deposition within tendinous structures put them at risk for traumatic and degenerative rupture.Furthermore,allografts can also be at risk of rupture in the setting of severe gout.We present the case of a 56-year-old female with severe gouty disease who sustained a re-rupture of a patellar tendon allograft reconstruction.CASE SUMMARY A 56-year-old female presented to clinic after feeling her left knee pop and collapse beneath her while descending stairs.She had a history of tophaceous gout and left patellar tendon rupture with reconstruction and multiple revisions over the course of 19 years.This patient presented with pain and extensor lag.A magnetic resonance image demonstrated a ruptured patellar tendon allograft reconstruction and avulsion fracture at the tibial tubercle.The patient was treated with a novel intervention of Achilles allograft with bone block in a unique configuration with a dermal allograft incorporated into the reconstruction.She was made non-weight bearing in the operative extremity in extension for the first four weeks postoperatively and was then progressed to active flexion over the course of eight weeks.At twelve weeks,she was able to fully extend her operative knee and at five months she was resuming her normal activities and exercises.CONCLUSION Failed patellar tendon reconstruction due to gouty infiltration is treated with dermal allograft augmented Achilles tendon reconstruction with bone block.

Mid-term survival of the Optimys short stem: A prospective case series of 500 patients

BACKGROUND In recent years,there has been an increase in the number of total hip arthroplasty procedures in the younger patient population.This active group has higher expectations of their prosthesis in comparison to the older population,and there is a greater physical demand for the prosthesis.Short femoral stems were in-troduced to retain proximal bone stock and joint biomechanics and became more common to implant in this specific population.Currently,the long-term survival and functional outcomes of various short stems are still being investigated in different clinics.AIM To determine the 5-year survival of the Optimys hip stem.METHODS This was a prospective multicenter cohort study of 500 patients conducted in two hospitals in the Netherlands.All patients received the Optimys short stem(Mathys Ltd,Bettlach,Switzerland).The primary outcome measure was survival of the hip stem,with revision as the endpoint.The secondary outcome measurements included patient-reported outcome measures(PROMs).Kaplan-Meier analysis was used to calculate the 5-year survival rate.Log-minus-log transformation was performed to calculate the 95%confidence interval(95%CI).Mixed model analyses were performed to assess the course of the PROMs during the 1st 2 years after surgery.Analyses were modeled separately for the 1st and 2nd years to calculate the yearly change in PROMs during both follow-up periods with accompanying 95%CIs.RESULTS The mean age of the total 500 patients was 62.3 years(standard deviation:10.6)and 202 were male(40%).At a median follow-up of 5.5 years(interquartile range:4.5-6.7),7 patients were deceased and 6 revisions were registered,for infection(n=3),subsidence(n=2)and malposition(n=1).This resulted in an overall 5-year survival of 98.8%(95%CI:97.3-99.5).If infection was left out as reason for revision,a stem survival of 99.4%(95%CI:98.1-99.8)was seen.Baseline questionnaires were completed by 471 patients(94%),317 patients(63%)completed the 1-year follow-up questionnaires and 233 patients(47%)completed the 2-year follow-up.Both outcome measures significantly improved across all domains in the 1st year after the operation(P<0.03 for all domains).In the 2nd year after surgery,no significant changes were observed in any domain in comparison to the 1-year follow-up.CONCLUSION The Optimys stem has a 5-year survival of 98.8%.Patient-reported outcome measures increased significantly in the 1st postoperative year with stabilization at the 2-year follow-up.

Mid-term clinical outcomes of the uncemented Robert Mathys pressfit cup

BACKGROUND The use of uncemented cups during total hip arthroplasty(THA)has gained popularity in recent years.The Robert Mathys(RM)pressfit cup,an uncemented monoblock implant is expected to preserve bone density due to its composition and external surface,while reducing backside wear with its monoblock construction.These factors should lead to a high survival rate of the implant.AIM To evaluate the mid-term survival and functional outcome of the RM Pressfit cup in a large study population.METHODS Between 2011 and 2020,we included 1324 patients receiving a primary THA using the RM pressfit cup.Final clinical follow-up was performed at 2 years postoperatively with the Dutch arthroplasty register used to assess implant status thereafter.Revision for acetabular failure and reason for revision were reported to evaluate implant survival,while the hip disability and osteoarthritis outcome score(HOOS)scores were used to assess functional outcome.RESULTS The mean age at surgery was 64.9 years.The mean follow-up was 4.6 years.Of the 1324 THAs performed,13 needed cup revisions within 5 years after index THA:5 due to aseptic loosening,6 due to infection,2 due to dislocation and 2 due to other causes.This resulted in a 5-year cup survival of 98.8%(95%CI:98.1-99.5).Nine of the cup revisions occurred within the first year after index THA.HOOS scores increased significantly in all domains during the first year and levelled out during the second year.CONCLUSION In the present study,the RM pressfit cup demonstrated excellent clinical outcomes at mid-term follow-up;however,future studies are needed to assess the long-term outcomes of this acetabular implant.

Bone graft incorporation failure with inappropriate limb load transfer can lead to aseptic acetabular loosening of metal-on-metal prosthesis: A case report

BACKGROUND Aseptic acetabular loosening can result from various factors that can be categorized into groups:patient-related,surgeon-related and implant-related.We present a case of a 63-year-old patient who at first underwent a total hip arthro-plasty(THA)using a metal-on-metal bearing due to hip arthrosis.Follow-up visits revealed no complications after the procedure.Two years after the THA,acetabular component loosening occurred due to subsequent trauma of the opposite hip,necessitating a revision THA using a ceramic-on-ceramic bearing.CASE SUMMARY We aim to illustrate a rare case where the primary reason for undergoing THA revision was not only incomplete bone graft incorporation but also improper limb load distribution.Following the revision arthroplasty,a 9-year follow-up visit revealed improvements in all evaluation measures on questionnaire compared to the state before surgery:Harris Hip Score(before surgery:15;after surgery:95),Western Ontario and McMaster Universities Arthritis Index(before surgery:96;after surgery:0),and Visual Analogue Scale(before surgery:10;after surgery:1).CONCLUSION Opposite-hip trauma caused a weight transfer to the limb after a THA procedure.This process led to a stress shielding effect,resulting in acetabular component loosening.

Chinese Adaptation and Psychometric Properties of the Belief in a Just World Scale for College Students

This study aims to revise the Belief in a Just World Scale(BJWS)for Chinese college students and test its reliability and validity(construct validity,convergent and divergent validity).Two samples of 546 and 595 college students were selected,respectively,using stratified cluster random sampling.Item analysis,exploratory factor analysis(EFA),confirmatory factor analysis(CFA),reliability analysis and convergent and divergent validity tests were carried out.The results showed that the 13 items of the BJWS have good item discrimination.The corrected item–total correlation in the general belief in a just world subscale was found to range from 0.464 to 0.655,and that in the personal belief in a just world subscale was 0.553 to 0.715.The internal consistency coefficients of the revised version of the BJWS and its subscales are good.The EFA and CFA results show that the structure and items of the revised scale are the same as those of the original scale.Belief in a just world was found to have significant positive correlations with gratitude and empathy,and has a significant negative correlation with anxiety,thereby exhibiting good convergent and divergent validity.Therefore,the Chinese revised version of the BJWS has good reliability and validity.

Is there sufficient evidence to support the use of antibiotic holiday just before the second stage of an infected total hip or knee arthroplasty revision surgery?

The practice of implementing an antibiotic holiday before the second stage of hip or knee arthroplasty is currently controversial due to limited evidence for this approach,as per the International Consensus Meeting 2018 on Musculoskeletal Infection.A greater understanding of this issue could augment the quality of Alrayes and Sukeik’s mini-review(2023)on diagnosing,managing,and treating periprosthetic knee infections.However,a significant lack of literature exists concerning the optimal duration for the antibiotic holiday,calling for more research before establishing any clinical guidelines.

New Data on Coal, Gypsum, Iron and Silica Sand Deposits and Geochemical Exploration (Pakistan): Revision of 25 Years History of Dinosaur Discoveries from Pakistan

Discoveries of many coal seams at depths by drilling carried by Geological Survey of Pakistan in Sor Range and Harnai Gochina, extended the coal seams at depth which is challenge for mine owners to exploit feasibly. Bed to bed gypsum samplings (and their chemical analyses) of huge gypsum deposits from Sulaiman foldbelt is a base for industrialist and also planers to develop cement and gypsum industries to increase export and foreign exchange for the development of area and Pakistan. Low and high grade sedimentary iron deposits, silica sand and uranium host rocks and their extensions in Sulaiman and Kirthar foldbelts are presented. Anomalies of a few base metals arise as a result of geochemical exploration carried at part of Loralai District of Balochistan. Theropod dinosaurs were frequent in India, while Poripuchian titanosaurs (Sauropoda, Dinosauria) were frequent in Pakistan. Besides some ichnotaxa, many bone taxa such as 1 titanosauriform, 14 titanosaurian sauropod (including one new titanosaur), and 3 theropod dinosaurs are established from Pakistan. Among these 12 titanosaur species and 3 theropod species are named in about 10 km2 area of Vitakri dome and 2 titanosaur species are named in about a few hundred square meter area of Mari Bohri (Kachi Bohri) which is about 10 km westward from Vitakri dome. Pakistan is a unique country which discoverd 14 diversified titanosaurs in a short area and also in a short period (67 - 66 million years ago/Ma). About 400 bones found from a few meter thick upper part of upper shale horizon of latest Maastrichtian Vitakri Formation which is base for titanosaur taxa. Cranial material is in low fraction (but include significant diverse snouts), caudal vertebrae are prominent, the cervicals, dorsals and sacrals have significant numbers, forelimb and hind limb bones have balanced fraction. Humeri, femora and tibiae are most common. To know the position of Pakistani titanosaurs among titanosaurs and sauropods, there is a need to extend list of characters for phylogenetic analyses. This broad feature list should include main characters of titanosaurs from Pakistan and also from global world.

共贺中国标准化研究院建院60周年

Founded in 1963,China National Institute of Standardization(CNIS)mainly focuses on the research into the standardization development strategies,fundamental theories,principles and methods as well as standards systems.It also carries out the standardization scientific research,experimental verification,test and evaluation,standards development,revision and promotion,and transformation and application of science&technology achievements.CNIS has played an active role as a public welfare research institute,providing technical support for the work of State Administration for Market Regulation(SAMR),other ministries and local governments.

Establishment of Cosmetics Standardization Technical Committee

On May 6th,2024,National Medical Products Administration issued Announcement on the Establishment of Cosmetics Standardization Technical Committee(No.53 of 2024).According to the announcement,National Medical Products Administration is about to establish Cosmetics Standardization Technical Committee,aiming at furthering implementing Regulations on Supervision and Administration of Cosmetics,and promoting the formulation and revision of the cosmetics standard(including toothpaste).

United States Healthcare Data Breaches: Insights for NIST SP 800-66 Revision 2 from a Review of the NIST SP 800-66 Revision 1

Healthcare security and privacy breaches are occurring in the United States (US), and increased substantially during the pandemic. This paper reviews the National Institute of Standards and Technology (NIST) publication base as an effective solution. The NIST Special Publication 800-66 Revision 1 was an essential standard in US healthcare, which was withdrawn in February 2024 and superseded by SP 800-66 Revision 2. This review investigates the academic papers concerning the application of the NIST SP 800-66 Revision 1 standard in the US healthcare literature. A systematic review method was used in this study to determine current knowledge gaps of the SP 800-66 Revision 1. Some limitations were employed in the search to enforce validity. A total of eleven articles were found eligible for the study. Consequently, this study suggests the necessity for additional academic papers pertaining to SP 800-66 Revision 2 in the US healthcare literature. In turn, it will enhance awareness of safeguarding electronic protected health information (ePHI), help to mitigate potential future risks, and eventually reduce breaches.

Treatment of periprosthetic knee infection and coexistent periprosthetic fracture:A case report and literature review

BACKGROUND Periprosthetic joint infection(PJI) and periprosthetic fracture(PPF) are among the most serious complications following total knee arthroplasty. Herein, we present one patient with these two complications with details on the characteristics, treatment strategy, and outcome.CASE SUMMARY A 69-year-old female patient who suffered from PJI and PPF following total knee arthroplasty was treated by a two-stage revision surgery. After thorough foreign material removal and debridement, we used a plate that was covered with antibiotic-loaded bone cement to link with a hand-made cement spacer to occupy the joint space and fix the fracture. Although the infection was cured, the fracture did not heal and caused bone defect due to the long interval between debridement and revision. In the revision surgery, a cemented stem and cortical allogenic splints were used to reconstruct the fracture and bone defect. At the final followup 27 mo after revision, the patient was satisfied with postoperative knee functions with satisfactory range of motion(104°) and Hospital for Special Surgery knee score(82 points). The radiographs showed no loosening of the prosthesis and that the bone grafts healed well with the femur.CONCLUSION Our two-stage revision surgery has proved to be successful and may be considered in other patients with PJI and PPF.

Unicompartimental knee arthroplasty metallosis treated with uni-onuni revision:A case report

BACKGROUND Metallosis is the result of metallic wear debris in the soft tissues and is associated to both local and systemic inflammatory response.Metallosis has been reported after total hip and total knee arthroplasty(TKA),but rarely after a unicompartimental knee arthroplasty(UKA).In the context of UKA metallosis,surgeons often opt for revision using a TKA.However,in this paper,the authors successfully treated UKA revising the metal back only.CASE SUMMARY Prior to treat our patient we conducted a literature research through which we identified eleven cases of metallosis after UKA,ten(90.9%)were treated revising using though a TKA.Only one case was managed through a uni-on-uni revision,reporting high knee function.Our patient complained worsening pain and function after a snap occurred at 16 mo after UKA implantation.At 18 mo following surgical debridment and uni-on-uni revision surgery,our patient exhibited a relevant improvement in Oxford Knee Score and a reduction of metal ion levels in the blood.CONCLUSION Our study highlights that in case of metallosis after UKA,the treatment may be based on surgical debridement and just revising the mobilized components.

Transoral outlet reduction:Outcomes of endoscopic Roux-en-Y gastric bypass revision in 284 patients at a community practice

BACKGROUND Transoral outlet reduction(TORe)is a minimally invasive endoscopic revision of Roux-en-Y gastric bypass(RYGB)for weight recurrence;however,little has been published on its clinical implementation in the community setting.AIM To characterize the safety and efficacy of TORe in the community setting for adults with weight recurrence after RYGB.METHODS This is a retrospective cohort study of argon plasma coagulation and purse-string suturing for gastric outlet reduction in consecutive adults with weight recurrence after RYGB at a single community center from September 2020 to September 2022.Patients were provided longitudinal nutritional support via virtual visits.The primary outcome was total body weight loss(TBWL)at twelve months from TORe.Secondary outcomes included TBWL at three months and six months;excess weight loss(EWL)at three,six,and twelve months;twelve-month TBWL by obesity class;predictors of twelve-month TBWL;rates of post-TORe stenosis;and serious adverse events(SAE).Outcomes were reported with descriptive statistics.RESULTS Two hundred eighty-four adults(91.9%female,age 51.3 years,body mass index 39.3 kg/m^(2))underwent TORe an average of 13.3 years after RYGB.Median pre-and post-TORe outlet diameter was 35 mm and 8 mm,respectively.TBWL was 11.7%±4.6%at three months,14.3%±6.3%at six months,and 17.3%±7.9%at twelve months.EWL was 38.4%±28.2%at three months,46.5%±35.4%at six months,and 53.5%±39.2%at twelve months.The number of follow-up visits attended was the strongest predictor of TBWL at twelve months(R^(2)=0.0139,P=0.0005).Outlet stenosis occurred in 11 patients(3.9%)and was successfully managed with endoscopic dilation.There was one instance of post-procedural nausea requiring overnight observation(SAE rate 0.4%).CONCLUSION When performed by an experienced endoscopist and combined with longitudinal nutritional support,purse-string TORe is safe and effective in the community setting for adults with weight recurrence after RYGB.

Two-stage revision in periprosthetic knee joint infections

Periprosthetic joint infection(PJI)following total knee arthroplasty is one of the most catastrophic and costly complications that carries significant patient wellness as well as economic burdens.The road to efficiently diagnosing and treating PJI is challenging,as there is still no gold standard method to reach the diagnosis as early as desired.There are also international controversies with respect to the best approach to manage PJI cases.In this review,we highlight recent advances in managing PJI following knee arthroplasty surgery and discuss in depth the two-stage revision method.

Redefinition of the Odorrana versabilis Group,with a New Species from China(Anura,Ranidae,Odorrana)

Taxonomic studies of the Odorrana versabilis group have been consistently disorganized,and they have often been incorrectly associated with an abandoned subgenus or genus Bamburana in existing literature.In this study,we conducted an integrative taxonomic analysis using molecular phylogenetic analysis of two mitochondrial gene fragments(16S rRNA and CO1)and morphological examination of 41 specimens collected during herpetological surveys in southern China.Our results confirmed the monophyly of O.versabilis group which exhibited distinct morphological traits.We also identified a cryptic lineage sister with O.exiliversabilis.Additionally,our study revealed that O.trankieni was nested within O.nasuta.Consequently,we redefined the morphological characteristics of the O.versabilis group,described a new species in this group,O.confusa sp.nov.,and proposed that O.trankieni be considered a junior synonym of O.nasuta.One of the most significant findings of this study was the observation of distinct morphological changes in adult males across all species within the O.versabilis group between the non-breeding and breeding seasons.This study contributes to research on various aspects of Asian amphibian fauna,including taxonomy,ecology,evolution,and physiology.