Bicruciate-retaining total knee arthroplasty: What's new?

Primary total knee arthroplasty (TKA) is a widespread procedure to address end stage osteoarthritis with good results, clinical outcomes, and long-term survivorship. Although it is frequently performed in elderly, an increased demand in young and active people is expected in the next years. However, a considerable dissatisfaction rate has been reported by highly demanding patients due to the intrinsic limitations provided by the TKA. Bicruciate-retaining (BCR) TKA was developed to mimic knee biomechanics, through anterior cruciate ligament preservation. First-generation BCR TKA has not gained popularity due to its being a challenging technique and having poor survival outcomes. Thanks to implant design improvement and surgeon-friendly instrumentation, second-generation BCR TKA has seen renewed interest. This review will focus on surgical indications, kinematical basis, clinical results and latest developments of second-generation BCR TKA

Cardiovascular magnetic resonance characterization of peri-infarct zone remodeling following myocardial infarction

<p>Abstract</p> <p>Background</p> <p>Clinical studies implementing late gadolinium-enhanced (LGE) cardiovascular magnetic resonance (CMR) studies suggest that the peri-infarct zone (PIZ) contains a mixture of viable and non-viable myocytes, and is associated with greater susceptibility to ventricular tachycardia induction and adverse cardiac outcomes. However, CMR data assessing the temporal formation and functional remodeling characteristics of this complex region are limited. We intended to characterize early temporal changes in scar morphology and regional function in the PIZ.</p> <p>Methods and results</p> <p>CMR studies were performed at six time points up to 90 days after induction of myocardial infarction (MI) in eight minipigs with reperfused, anterior-septal infarcts. Custom signal density threshold algorithms, based on the remote myocardium, were applied to define the infarct core and PIZ region for each time point. After the initial post-MI edema subsided, the PIZ decreased by 54% from day 10 to day 90 (<it>p </it>= 0.04). The size of infarct scar expanded by 14% and thinned by 56% from day 3 to 12 weeks (<it>p </it>= 0.004 and <it>p </it>< 0.001, respectively). LVEDV increased from 34.7. ± 2.2 ml to 47.8 ± 3.0 ml (day3 and week12, respectively; p < 0.001). At 30 days post-MI, regional circumferential strain was increased between the infarct scar and the PIZ (-2.1 ± 0.6 and -6.8 ± 0.9, respectively;* <it>p </it>< 0.05).</p> <p>Conclusions</p> <p>The PIZ is dynamic and decreases in mass following reperfused MI. Tensile forces in the PIZ undergo changes following MI. Remodeling characteristics of the PIZ may provide mechanistic insights into the development of life-threatening arrhythmias and sudden cardiac death post-MI.</p

A new device to seal large coronary aneurysms: a case report

<p>Abstract</p> <p>Introduction</p> <p>Coronary artery aneurysm is an uncommon disease. It is defined as a coronary artery dilatation, exceeding the diameter of the normal adjacent segment or the diameter of the patient's largest coronary vessel by 1.5 to 2 times. Coronary artery aneurysms are typically diagnosed by coronary angiography. The prognosis of coronary artery aneurysm is not well known and the management is challenging.</p> <p>Case presentation</p> <p>A 68-year-old Italian-Caucasian man presented to our hospital with angina. Coronary angiography revealed a large coronary aneurysm of the right coronary artery, which was successfully treated by the percutaneous implantation of an MGuard™stent.</p> <p>Conclusion</p> <p>This case report provides evidence that coronary artery aneurysms, even if very large, can be safely treated by MGuard™stent implantation. We strongly emphasize the high flexibility and good deliverability of this device, which leads to the complete exclusion of the aneurysm mediated by the process of endothelization of its thin mesh sleeves.</p

Research and Innovation for and with Adolescent Young Carers to Influence Policy and Practice—The European Union Funded “ME-WE” Project

Young carers are children and adolescents who provide care to other family members or friends, taking over responsibilities that are usually associated with adulthood. There is emerging but still scarce knowledge worldwide about the phenomenon of young carers and the impact of a caring role on their health, social and personal development spheres. This paper provides an overview of the main results from the ME-WE project, which is the first European research and innovation project dedicated to adolescent young carers (AYCs) (15–17 years). The project methods relied on three main activities: (1) a systematization of knowledge (by means of a survey to AYCs, country case studies, Delphi study, literature review); (2) the co-design, implementation and evaluation of a primary prevention intervention addressing AYCs’ mental health (by means of Blended Learning Networks and a clinical trial in six European countries); (3) the implementation of knowledge translation actions for dissemination, awareness, advocacy and lobbying (by means of national and international stakeholder networks, as well as traditional and new media). Project results substantially contributed to a better understanding of AYCs’ conditions, needs and preferences, defined tailored support intervention (resilient to COVID-19 related restrictions), and significant improvements in national and European policies for AYCs

Avaliação in vitro de um novo filtro de veia cava

OBJETIVO: O objetivo do estudo foi avaliar a eficácia de um novo filtro de veia cava, de baixo perfil, na retenção de coágulos em modelo in vitro. MÉTODO: O filtro consiste em dois cones opostos pelo ápice. O cone distal é formado por oito hastes de aço inoxidável, que têm a função de retenção dos êmbolos. O cone proximal é constituído de quatro hastes, cuja função é ancorar e centralizar. Os filtros foram introduzidos e fixados no interior de um tubo de PVC transparente de 25, 30 e 35 mm de diâmetro interno, em posição vertical, e conectados com um sistema pulsátil de fluxo (bomba peristáltica). Foi utilizado, para veículo, um reservatório com solução salina (0,9%) com 40% de glicerina, mantido em temperatura ambiente. Confeccionaram-se trombos com sangue bovino em tubos plásticos de 3, 4,5 e 6 mm de diâmetro e, posteriormente, foram segmentados nas medidas de 10, 15, 20 e 30 mm de comprimento, totalizando 12 diferentes tamanhos. Realizaram-se 100 liberações para cada tipo de êmbolo e tamanho das cânulas, totalizando 3.600 eventos. Foram feitos lançamentos seqüenciais com cinco êmbolos, sendo 10 para cada tamanho de êmbolo e cânulas, totalizando 360 eventos. Fez-se avaliação da capacidade de retenção dinâmica utilizando os três diferentes tamanhos de cânulas com 100 eventos cada, totalizando 300 eventos. RESULTADOS: Detectou-se que o diâmetro e comprimento dos êmbolos, assim como diâmetros da cânula, podem comprometer a eficácia do filtro. A média de captura de êmbolos pelos filtros foi de 80,5% nas cânulas de 35 mm, 88,7% para cânulas de 30 mm e 86,6% para cânulas de 25 mm. CONCLUSÃO: Conclui-se que a eficácia desse filtro sofre interferência relacionada ao tamanho dos êmbolos e diâmetro da cânula

Stem cell therapy for myocardial regeneration: mechanisms and current clinical applications

Ischemic heart disease is a major public health problem in the industrialized and developing world. Despite advances in myocardial reperfusion strategies and novel pharmacological approaches, ther apies directed towards the deleterious consequences of acute and chronic myocardial ischemic damage remain limited. In recent years the biological dogma of the heart as a "postmitotic organ" has been challenged. Myocyte replication and myocardial regeneration have been documented in the human heart after myocardial infarction and in chronic ischemic heart failure. In addition, experimental animal studies and clinical trials suggest that the transfer of stem and progenitor cells into the myocardium has a favorable impact on tissue perfusion and contractile performance. Neovascularization and myocyte formation have been described. Differentiation of administered stem cells, cell fusion and release of paracrine signals by injected stem cells are currently discussed as underlying mechanisms. Recently, the mobilization of endogenous cardiac stem cells is debated as a potential target of cardiac repair. This intriguing new knowledge generated by basic and clinical scientists will lay the foundation for novel therapeutic strategies in the near future and change clinical practice in cardiology. In this commentary, we briefly review the characterization of the variety of stem cell populations used for cardiac repair, discuss the potential mechanisms of cardiac regenerative therapy, and evaluate the current clinical applications of this innovative approach to treat ischemic heart disease