Synthetic Bone Substitutes and Mechanical Devices for the Augmentation of Osteoporotic Proximal Humeral Fractures: A Systematic Review of Clinical Studies

Different augmentation techniques have been described in the literature in addition to the surgical treatment of proximal humeral fractures. The aim of this systematic review was to analyze the use of cements, bone substitutes, and other devices for the augmentation of proximal humeral fractures

Arthroscopically assisted reduction and internal fixation (ARIF) versus open reduction and internal fixation (ORIF) for lateral tibial plateau fractures: a comparative retrospective study

Background: This study aims to explore if the arthroscopically assisted reduction and internal fixation (ARIF) technique is superior to the traditional open reduction and internal fixation (ORIF) technique in the treatment of tibial lateral plateau fractures. Methods: Forty patients with tibial plateau fractures (Schatzker type I–III) treated with ARIF or ORIF from 2012 to 2017 were included in this retrospective study. All patients received pre-operative radiographs and CT scans. The patients were divided into two groups (ARIF or ORIF). All patients had a minimum follow-up of 12 months and an average follow-up of 44.4 months. The clinical and radiographic outcomes were evaluated according to the Knee Society Score (KSS) and the modified Rasmussen radiological score. Results: Satisfactory clinical and radiological results were found in 39 out of 40 (97.5%) patients. KSS and modified Rasmussen radiological score were significantly better in ARIF group. The mean KSS was 92.37 (± 6.3) for the ARIF group and 86.29 (± 11.54) for the ORIF group (p < 0.05). The mean modified Rasmussen radiographic score was 8.42 (± 2.24) for the ARIF group and 7.33 (± 1.83) for the ORIF group (p = 0.104). Worst clinical and radiological results were related to concomitant intra-articular lesions (p < 0.05). Meniscal tears were found and treated in 17 out of 40 (42.5%) patients. The overall complication rate was 10%. Conclusions: Both ARIF and ORIF provided a satisfactory outcome for the treatment of Schatzker I–III tibial plateau fractures. However, ARIF led to better clinical results than ORIF. No statistically significant differences were found in perioperative complications, radiological results, and post-traumatic knee osteoarthritis. Level of evidence: Level II

The Treatment of Acute Diaphyseal Long-bones Fractures with Orthobiologics and Pharmacological Interventions for Bone Healing Enhancement: A Systematic Review of Clinical Evidence

The healing of long bones diaphyseal fractures can be often impaired and eventually end into delayed union and non-union. A number of therapeutic strategies have been proposed in combination with surgical treatment in order to enhance the healing process, such as scaffolds, growth factors, cell therapies and systemic pharmacological treatments. Our aim was to investigate the current evidence of bone healing enhancement of acute long bone diaphyseal fractures

Targeted Extracellular Vesicle Gene Therapy for Modulating Alpha-Synuclein Expression in Gut and Spinal Cord

The development of effective disease-modifying therapies to halt Parkinson’s disease (PD) progression is required. In a subtype of PD patients, alpha-synuclein pathology may start in the enteric nervous system (ENS) or autonomic peripheral nervous system. Consequently, strategies to decrease the expression of alpha-synuclein in the ENS will be an approach to prevent PD progression at pre-clinical stages in these patients. In the present study, we aimed to assess if anti-alpha-synuclein shRNA-minicircles (MC) delivered by RVG-extracellular vesicles (RVG-EV) could downregulate alpha-synuclein expression in the intestine and spinal cord. RVG-EV containing shRNA-MC were injected intravenously in a PD mouse model, and alpha-synuclein downregulation was evaluated by qPCR and Western blot in the cord and distal intestine. Our results confirmed the downregulation of alpha-synuclein in the intestine and spinal cord of mice treated with the therapy. We demonstrated that the treatment with anti-alpha-synuclein shRNA-MC RVG-EV after the development of pathology is effective to downregulate alpha-synuclein expression in the brain as well as in the intestine and spinal cord. Moreover, we confirmed that a multidose treatment is necessary to maintain downregulation for long-term treatments. Our results support the potential use of anti-alpha-synuclein shRNA-MC RVG-EV as a therapy to delay or halt PD pathology progression

Diamond detectors for dose and instantaneous dose‐rate measurements for ultra‐high dose‐rate scanned helium ion beams

Background The possible emergence of the FLASH effect—the sparing of normal tissue while maintaining tumor control—after irradiations at dose-rates exceeding several tens of Gy per second, has recently spurred a surge of studies attempting to characterize and rationalize the phenomenon. Investigating and reporting the dose and instantaneous dose-rate of ultra-high dose-rate (UHDR) particle radiotherapy beams is crucial for understanding and assessing the FLASH effect, towards pre-clinical application and quality assurance programs. Purpose The purpose of the present work is to investigate a novel diamond-based detector system for dose and instantaneous dose-rate measurements in UHDR particle beams. Methods Two types of diamond detectors, a microDiamond (PTW 60019) and a diamond detector prototype specifically designed for operation in UHDR beams (flashDiamond), and two different readout electronic chains, were investigated for absorbed dose and instantaneous dose-rate measurements. The detectors were irradiated with a helium beam of 145.7 MeV/u under conventional and UHDR delivery. Dose-rate delivery records by the monitoring ionization chamber and diamond detectors were studied for single spot irradiations. Dose linearity at 5 cm depth and in-depth dose response from 2 to 16 cm were investigated for both measurement chains and both detectors in a water tank. Measurements with cylindrical and plane-parallel ionization chambers as well as Monte-Carlo simulations were performed for comparisons. Results Diamond detectors allowed for recording the temporal structure of the beam, in good agreement with the one obtained by the monitoring ionization chamber. A better time resolution of the order of few μs was observed as compared to the approximately 50 μs of the monitoring ionization chamber. Both diamonds detectors show an excellent linearity response in both delivery modalities. Dose values derived by integrating the measured instantaneous dose-rates are in very good agreement with the ones obtained by the standard electrometer readings. Bragg peak curves confirmed the consistency of the charge measurements by the two systems. Conclusions The proposed novel dosimetric system allows for a detailed investigation of the temporal evolution of UHDR beams. As a result, reliable and accurate determinations of dose and instantaneous dose-rate are possible, both required for a comprehensive characterization of UHDR beams and relevant for FLASH effect assessment in clinical treatments

The Management of Bone Defects in Revision Knee Arthroplasty: The Role of Porous Metal Cones and 3D-Printed Cones

Worldwide, the number of revisions to total knee arthroplasty procedures is increasing. Revision surgery is a challenging procedure, required for the management of bone loss after removal of the first implant. Although further long-term follow-up studies are needed, the use of cones in revisions of total knee arthroplasty yields reliability in fixation and stability to restore joint lines, especially in challenging surgeries with poor bone stock. The introduction of 3D-printed cones in revision surgery seems to be advantageous for AORI type III bone defects, especially in reducing intraoperative complications and procedure times. The aim of this study is to review the currently available literature to analyse clinical outcomes, complications, and radiographical results with the use of metaphyseal tantalum cones and new 3D-printed cones for the management of bone defects in the revision of total knee arthroplasty

Propuesta de estrategias en las cuentas por cobrar para mejorar la liquidez de la empresa Representaciones Malca E.I.R.L. Utcubamba 2017

El objetivo general de la presente investigación fue elaborar una propuesta de estrategias en las cuentas por cobrar para mejorar la liquidez de la empresa Representaciones Malca E.I.R.L. Utcubamba 2017, considerando como hipótesis que: si se implementa una propuesta de estrategias en las cuentas por cobrar entonces se mejorará la liquidez de la empresa Representaciones Malca E.I.R.L. Utcubamba 2017. La metodología se basó en una investigación de tipo descriptivo, propositivo de diseño no experimental, transversal, así mismo, se utilizó el método deductivo inductivo y el método del análisis para llegar a las conclusiones generales de la investigación; la recolección de datos se realizó a través de un cuestionario y análisis financiero. Los resultados evidenciaron que durante el año 2016 existió un mayor nivel de liquidez en comparación con el año actual, lo que demuestra la tendencia negativa de la empresa en el manejo de sus recursos económicos y financieros, así como la disminución de sus ingresos en comparación con sus obligaciones internas y externas, por otra parte se logró determinar que la empresa durante el 2017 no logra cubrir sus deudas, pues por cada sol de deuda dispone de S/0.38 para pagarlo, es decir, no está en condiciones de pagar la totalidad de sus pasivos a corto plazo. Se concluye que el diseño de una propuesta de estrategias en las cuentas por cobrar para mejorar la liquidez de la empresa Representaciones Malca E.I.R.L, es necesaria pues actualmente no existe una planificación ni mucho menos una serie de acciones estratégicas que se enfoquen en recuperar las cuentas por cobrar, el estudio demuestra que la empresa carece de políticas estandarizadas de otorgamiento de créditos, no dispone de personal suficiente para el área de recuperación de cuentas por cobrar, carece de una planificación y responsables de las ventas al crédito, lo que influye en su bajo nivel de liquidez

Propuesta de estrategias en las cuentas por cobrar para mejorar la liquidez de la empresa Representaciones Malca E.I.R.L. Utcubamba 2017

El objetivo general de la presente investigación fue elaborar una propuesta de estrategias en las cuentas por cobrar para mejorar la liquidez de la empresa RepresentacionesMalca E.I.R.L. Utcubamba 2017, considerando como hipótesis que: si se implementa una propuesta de estrategias en las cuentas por cobrar entonces se mejorará la liquidez de la empresa Representaciones Malca E.I.R.L. Utcubamba 2017. La metodología se basó en una investigación de tipo descriptivo, propositivo de diseño no experimental, transversal, así mismo, se utilizó el método deductivo inductivo y el método del análisis para llegar a las conclusiones generales de la investigación; la recolección de datos se realizó a través de un cuestionario y análisis financiero. Los resultados evidenciaron que durante el año 2016 existió un mayor nivel de liquidez en comparación con el año actual, lo que demuestra la tendencia negativa de la empresa en el manejo de sus recursos económicos y financieros, así como la disminución de sus ingresos en comparación con sus obligaciones internas y externas, por otra parte se logró determinar que la empresa durante el 2017 no logra cubrir sus deudas, pues por cada sol de deuda dispone de S/0.38 para pagarlo, es decir, no está en condiciones de pagar la totalidad de sus pasivos a corto plazo. Se concluye que el diseño de una propuesta de estrategias en las cuentas por cobrar para mejorar la liquidez de la empresa Representaciones Malca E.I.R.L, es necesaria pues actualmente no existe una planificación ni mucho menos una serie de acciones estratégicas que se enfoquen en recuperar las cuentas por cobrar, el estudio demuestra que la empresa carece de políticas estandarizadas de otorgamiento de créditos, no dispone de personal suficiente para el área de recuperación de cuentas por cobrar, carece de una planificación y responsables de las ventas al crédito, lo que influye en su bajo nivel de liquidez