Iatrogenic nerve injury in primary and revision reverse total shoulder arthroplasty

INTRODUCTION Iatrogenic nerve injury in orthopedic surgery can impair functional outcomes. During the last years, a steady increase in the number of performed reverse total shoulder arthroplasties has been reported and complications associated with this procedure are continuously described. Neurological complications, however, remain underreported. The aims of this study were to calculate the incidence of iatrogenic nerve injury after primary and revision reverse total shoulder arthroplasty in a large patient cohort, as well as identify associated patient-and surgery-related risk factors. MATERIALS AND METHODS A retrospective review of our institution's internal Reverse Total Shoulder Arthroplasty (RTSA) database from September 2005 to December 2019 was undertaken and 34 patients with iatrogenic nerve injuries were identified, resulting in a neurological complication rate of 2.6%. Group comparisons between patients with nerve injuries (n = 34) and the remaining cohort without nerve injuries (n = 1275) were performed to identify patient- and surgery-related risk factors. RESULTS Of the 34 cases with iatrogenic nerve injury, damage to terminal nerve branches occurred in 21 patients, whereas a brachial plexus lesion was diagnosed in the other 13. Nerve revision surgery was necessary in four patients. At final follow-up 13 patients (45%) had residual motor deficits and 17 (59%) had residual sensory deficits. Higher numbers of previous surgeries of the affected shoulder correlated with subsequent nerve injury (p = 0.035). Operative time was significantly longer in patients, who developed a neurologic deficit, showing a correlation between duration of surgery and occurrence of nerve injury (p = 0.013). Patients with neurologic complications were significantly younger than patients without nerve damage (median 68 vs. 72 years, p = 0.017). CONCLUSIONS In specialists' hands reverse total shoulder arthroplasty is a rather safe procedure regarding the risk of neurologic injury. However, multiple previous surgeries of the affected shoulder increase the risk of neurological complications. Cases with post-operative neurologic compromise are rare and usually recover well, with few patients suffering long-term functional deficits from iatrogenic nerve injury. LEVEL OF EVIDENCE Level III, retrospective cohort study

Effect of Al substitution on structural and electrical properties of Bi1.6Pb0.4Sr2CaCu2-x Mx O8+δ superconducting ceramics

In this work we study the effect on structural and electrical properties of superconducting compound Bi1.6Pb0.4Sr 2CaCu2-y My O8+δ were M=Al (with y=0-0.6). The samples were prepared by the solid-state reaction method. The samples have been characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM), direct current (DC) resistivity versus temperature ρ(T) and alternative current (AC) susceptibility measurements. Structural analysis shows that the crystalline lattice structure of the prepared sample belongs, mainly, to the superconductive tetragonal phase Bi(Pb)2212. The SEM micrographs show that in the undoped sample the grain size has a random distribution with few grains greater than 5 μm. The grains are very dense and well connected. A quite different microstructure is obtained for the doped samples of which grains are more connected with a flat characteristic shape of Bi(Pb)2212 superconductors. All samples exhibit a superconducting character and Tc and the superconducting volume fraction decrease with increasing rate of aluminum

Anti-angiogenic effects of pterogynidine alkaloid isolated from Alchornea glandulosa

<p>Abstract</p> <p>Background</p> <p>Angiogenesis, a complex multistep process that comprehends proliferation, migration and anastomosis of endothelial cells (EC), has a major role in the development of pathologic conditions such as inflammatory diseases, tumor growth and metastasis. Brazilian flora, the most diverse in the world, is an interesting spot to prospect for new chemical leads, being an important source of new anticancer drugs. Plant-derived alkaloids have traditionally been of interest due to their pronounced physiological activities. We investigated the anti-angiogenic potential of the naturally occurring guanidine alkaloid pterogynidine (Pt) isolated from the Brazilian plant <it>Alchornea glandulosa</it>. The purpose of this study was to examine which features of the angiogenic process could be disturbed by Pt.</p> <p>Methods</p> <p>Human umbilical vein endothelial cells (HUVEC) were incubated with 8 μM Pt and cell viability, proliferation, apoptosis, invasion and capillary-like structures formation were addressed. Nuclear factor κB (NFκB), a transcription factor implicated in these processes, was also evaluated in HUVEC incubated with Pt. Quantifications were expressed as mean ± SD of five independent experiments and one-way analysis of variance (ANOVA) followed by the Dunnet test was used.</p> <p>Results</p> <p>A significant decrease in proliferation and invasion capacity and an effective increase in apoptosis as assessed by bromodeoxyuridine (BrdU), double-chamber and terminal transferase dUTP nick end labeling (TUNEL) assay, respectively, have been found. Pt also led to a drastic reduction in the number of capillary-like structures formation when HUVEC were cultured on growth factor reduced-Matrigel (GFR-Matrigel) coated plates. In addition, incubation of HUVEC with Pt resulted in reduced NFκB activity.</p> <p>Conclusion</p> <p>These findings emphasize the potential use of Pt against pathological situations where angiogenesis is stimulated as tumor development.</p

Landslide susceptibility assessment in Constantine region (NE Algeria) by means of statistical models

The purpose of the present study was to compare the prediction performances of three statistical methods, namely, information value (IV), weight of evidence (WoE) and frequency ratio (FR), for landslide susceptibility mapping (LSM) at the east of Constantine region. A detailed landslide inventory of the study area with a total of 81 landslide locations was compiled from aerial photographs, satellite images and field surveys. This landslide inventory was randomly split into a testing dataset (70%) for training the models, and the remaining (30%) was used for validation purpose. Nine landslide-related factors such as slope gradient, slope aspect, elevation, distance to streams, lithology, distance to lineaments, precipitation, Normalized Difference Vegetation Index (NDVI) and stream density were used in the landslide susceptibility analyses. The inventory was adopted to analyse the spatial relationship between these landslide factors and landslide occurrences. Based on IV, WoE and FR approaches, three landslide susceptibility zonation maps were categorized, namely, “very high, high, moderate, low, and very low”. The results were compared and validated by computing area under the receiver operating characteristic (ROC) curve (AUC). From the statistics, it is noted that prediction scores of the FR, IV and WoE models are relatively similar with 73.32%, 73.95% and 79.07%, respectively. However, the map, obtained using the WoE technique, was experienced to be more suitable for the study area. Based on the results, the produced LSM can serve as a reference for planning and decision-making regarding the general use of the land

Aggregate culture: A more accurate predictor of microcystin toxicity for risk assessment

Aggregate or spheroid culture has emerged as a more biologically relevant method for screening pharmaceutical compounds and understanding exact mechanism of action. Here in, the aggregate approach applied to the freshwater toxins, microcystins, further unearths exact mechanism(s) of toxicity and provides a markedly improved in vitro predictor of toxicity. Microcystins result in acute intoxication by binding covalently to protein phosphatase 1/2A, resulting in hepatocellular necrosis, hemorrhaging and death. Hepatocellular uptake by organic anion transporting polypeptides (OATPs), in addition to other intracellular sequelae, is considered essential for toxicity. In aggregate HepG2, expression of OAT1B1 and OATP1B3 significantly increased relative to monolayer culture. Uptake of two fluorescently labeled substrates significantly increased in aggregates compared with monolayer, confirmed by inhibition of uptake with known competitive substrates. Increased reaction oxygen species (ROS) production occurred following a three-hour exposure of microcystin LR at concentrations from 100 nM to 100 μM, with reversal by ROS scavengers, in contrast with no response in monolayers. These results suggest monolayer culture inadequately predict intracellular effects of microcystins and support evidence that aggregate culture more closely approximates in vivo form and function. The approach results in more reliable prediction of microcystin toxicity in vitro