The Effect of Tourniquet Use and Sterile CO2 Gas Bone Preparation on Cement Penetration in Primary Total Knee Arthroplasty

Introduction Tourniquetless total knee arthroplasty (TKA) is experiencing resurgence in popularity due to potential pain control benefits. Further, optimal cement technique and implant fixation remain paramount to long-term cemented TKA success, as aseptic loosening continues to be a leading cause of revision. The purpose of this study was to determine how tourniquet use and/or novel bone preparation using sterile, compressed carbon dioxide (CO2) gas affected cement penetration in TKA. Methods A retrospective review was performed on 303 consecutive primary TKAs with the same implant in three groups: (1) a tourniquet without sterile CO2 compressed gas used for bone preparation, (2) no tourniquet with CO2 gas, and (3) tourniquet use and CO2 gas bone preparation. Cement penetration was measured on radiographs by two independent, blinded raters across seven zones defined by the Knee Society Radiographic Evaluation System. Results The three groups did not differ on age, BMI, or sex (p≥0.1). Cement penetration was greater in six of seven zones with significantly greater cement penetration in three zones (Tibial AP Zone 2, Femoral Lateral Zones 3A and 3P) in groups that utilized CO2 gas bone preparation compared to the tourniquet only group (p≤0.039). Conclusion Bone prepared with CO2 gas showed significantly more cement penetration in three zones with greater cancellous bone. The results suggest use of CO2 gas bone preparation may achieve greater cement penetration than using a tourniquet with lavage only

Un comienzo nuevo

Victoria Rodrigo, PhD- Serie Leamos’ EditorProfessor of Spanish World Languages and Cultures DepartmentGeorgia State Universityhttps://scholarworks.gsu.edu/wcl_leamos/1016/thumbnail.jp

Neuronal CTCF Is Necessary for Basal and Experience-Dependent Gene Regulation, Memory Formation, and Genomic Structure of BDNF and Arc

SummaryCCCTC-binding factor (CTCF) is an organizer of higher-order chromatin structure and regulates gene expression. Genetic studies have implicated mutations in CTCF in intellectual disabilities. However, the role of CTCF-mediated chromatin structure in learning and memory is unclear. We show that depletion of CTCF in postmitotic neurons, or depletion in the hippocampus of adult mice through viral-mediated knockout, induces deficits in learning and memory. These deficits in learning and memory at the beginning of adulthood are correlated with impaired long-term potentiation and reduced spine density, with no changes in basal synaptic transmission and dendritic morphogenesis and arborization. Cognitive disabilities are associated with downregulation of cadherin and learning-related genes. In addition, CTCF knockdown attenuates fear-conditioning-induced hippocampal gene expression of key learning genes and loss of long-range interactions at the BDNF and Arc loci. This study thus suggests that CTCF-dependent gene expression regulation and genomic organization are regulators of learning and memory

Four sub-Saturns with dissimilar densities: windows into planetary cores and envelopes

We present results from a Keck/HIRES radial velocity campaign to study four sub-Saturn-sized planets, K2-27b, K2-32b, K2-39b, and K2-108b, with the goal of understanding their masses, orbits, and heavy-element enrichment. The planets have similar sizes (RP=4.5-5.5 ), but have dissimilar masses (MP=16-60 ), implying a diversity in their core and envelope masses. K2-32b is the least massive (MP = 16.5 ± 2.7 M) and orbits in close proximity to two sub-Neptunes near a 3:2:1 period commensurability. K2-27b and K2-39b are significantly more massive at MP = 30.9 ± 4.6 M and MP = 39.8 ± 4.4 M, respectively, and show no signs of additional planets. K2-108b is the most massive at MP = 59.4 ± 4.4 M, implying a large reservoir of heavy elements of about ≈50 . Sub-Saturns as a population have a large diversity in planet mass at a given size. They exhibit remarkably little correlation between mass and size; sub-Saturns range from ≈6-60 M, regardless of size. We find a strong correlation between planet mass and host star metallicity, suggesting that metal-rich disks form more massive planet cores. The most massive sub-Saturns tend to lack detected companions and have moderately eccentric orbits, perhaps as a result of a previous epoch of dynamical instability. Finally, we observe only a weak correlation between the planet envelope fraction and present-day equilibrium temperature, suggesting that photo-evaporation does not play a dominant role in determining the amount of gas sub-Saturns accrete from their protoplanetary disks

Characterizing K2 Candidate Planetary Systems Orbiting Low-Mass Stars II: Planetary Systems Observed During Campaigns 1-7

We recently used near-infrared spectroscopy to improve the characterization of 76 low-mass stars around which K2 had detected 79 candidate transiting planets. 29 of these worlds were new discoveries that had not previously been published. We calculate the false positive probabilities that the transit-like signals are actually caused by non-planetary astrophysical phenomena and reject five new transit-like events and three previously reported events as false positives. We also statistically validate 17 planets (7 of which were previously unpublished), confirm the earlier validation of 22 planets, and announce 17 newly discovered planet candidates. Revising the properties of the associated planet candidates based on the updated host star characteristics and refitting the transit photometry, we find that our sample contains 21 planets or planet candidates with radii smaller than 1.25 R⊕, 18 super-Earths (1.25–2 R⊕), 21 small Neptunes (2–4 R⊕), three large Neptunes (4–6 R⊕), and eight giant planets (>6 R⊕). Most of these planets are highly irradiated, but EPIC 206209135.04 (K2-72e, 1.29^(+0.14)_(-0.13) R⊕), EPIC 211988320.01 (R_p = 2.86^(+0.16)_(-0.15) R⊕), and EPIC 212690867.01 (2.20^(+0.19)_(-0.18) R⊕) orbit within optimistic habitable zone boundaries set by the "recent Venus" inner limit and the "early Mars" outer limit. In total, our planet sample includes eight moderately irradiated 1.5–3 R⊕ planet candidates (F_p ≾ 20 F⊕) orbiting brighter stars (Ks < 11) that are well-suited for atmospheric investigations with the Hubble, Spitzer, and/or James Webb Space Telescopes. Five validated planets orbit relatively bright stars (Kp < 12.5) and are expected to yield radial velocity semi-amplitudes of at least 2 m s^(−1). Accordingly, they are possible targets for radial velocity mass measurement with current facilities or the upcoming generation of red optical and near-infrared high-precision RV spectrographs

Efficacy and tolerability of evolocumab vs. ezetimibe in patients with muscle-related statin intolerance: the GAUSS-3 randomized clinical trial

Importance: Muscle-related statin intolerance is reported by 5% to 20% of patients. Objective: To identify patients with muscle symptoms confirmed by statin rechallenge and compare lipid-lowering efficacy for 2 nonstatin therapies, ezetimibe and evolocumab. Design, Setting, and Participants: Two-stage randomized clinical trial including 511 adult patients with uncontrolled low-density lipoprotein cholesterol (LDL-C) levels and history of intolerance to 2 or more statins enrolled in 2013 and 2014 globally. Phase A used a 24-week crossover procedure with atorvastatin or placebo to identify patients having symptoms only with atorvastatin but not placebo. In phase B, after a 2-week washout, patients were randomized to ezetimibe or evolocumab for 24 weeks. Interventions: Phase A: atorvastatin (20 mg) vs placebo. Phase B: randomization 2:1 to subcutaneous evolocumab (420 mg monthly) or oral ezetimibe (10 mg daily). Main Outcome and Measures: Coprimary end points were the mean percent change in LDL-C level from baseline to the mean of weeks 22 and 24 levels and from baseline to week 24 levels. Results: Of the 491 patients who entered phase A (mean age, 60.7 [SD, 10.2] years; 246 women [50.1%]; 170 with coronary heart disease [34.6%]; entry mean LDL-C level, 212.3 [SD, 67.9] mg/dL), muscle symptoms occurred in 209 of 491 (42.6%) while taking atorvastatin but not while taking placebo. Of these, 199 entered phase B, along with 19 who proceeded directly to phase B for elevated creatine kinase (N = 218, with 73 randomized to ezetimibe and 145 to evolocumab; entry mean LDL-C level, 219.9 [SD, 72] mg/dL). For the mean of weeks 22 and 24, LDL-C level with ezetimibe was 183.0 mg/dL; mean percent LDL-C change, −16.7% (95% CI, −20.5% to −12.9%), absolute change, −31.0 mg/dL and with evolocumab was 103.6 mg/dL; mean percent change, −54.5% (95% CI, −57.2% to −51.8%); absolute change, −106.8 mg/dL (P &lt; .001). LDL-C level at week 24 with ezetimibe was 181.5 mg/dL; mean percent change, −16.7% (95% CI, −20.8% to −12.5%); absolute change, −31.2 mg/dL and with evolocumab was 104.1 mg/dL; mean percent change, −52.8% (95% CI, −55.8% to −49.8%); absolute change, −102.9 mg/dL (P &lt; .001). For the mean of weeks 22 and 24, between-group difference in LDL-C was −37.8%; absolute difference, −75.8 mg/dL. For week 24, between-group difference in LDL-C was −36.1%; absolute difference, –71.7 mg/dL. Muscle symptoms were reported in 28.8% of ezetimibe-treated patients and 20.7% of evolocumab-treated patients (log-rank P = .17). Active study drug was stopped for muscle symptoms in 5 of 73 ezetimibe-treated patients (6.8%) and 1 of 145 evolocumab-treated patients (0.7%). Conclusions and Relevance: Among patients with statin intolerance related to muscle-related adverse effects, the use of evolocumab compared with ezetimibe resulted in a significantly greater reduction in LDL-C levels after 24 weeks. Further studies are needed to assess long-term efficacy and safety