A meta-analysis of randomized controlled trials

Purpose: The aim of this meta-analysis is to examine the efficacy and safety of intra-articular tranexamic acid (TXA) when compared to intravenous (IV) route. Methods: The literature search was conducted using PubMed, Cochrane Library, MEDLINE, EMBASE and China National Knowledge Infrastructure (CNKI). All randomized controlled trials evaluating the effectiveness of topical route and IV route of TXA administration were included. Results: Eight randomized clinical trials comprising of 857 patients were included in this analysis. We found no statistically significant difference in terms of total blood loss, drain output, transfusion requirement, thromboembolic complication, tourniquet time and surgical duration. Conclusion: Topical TXA has a similar efficacy to IV-TXA in reducing total blood loss, drain output, transfusion rate and haemoglobin drop without any increase in thromboembolic complications

Outcome after tantalum rod implantation for treatment of femoral head osteonecrosis: 26 hips followed for an average of 3 years

Background and purpose Tantalum rod implantation has recently been proposed for treatment of early stages of femoral head osteonecrosis. The purpose of our study was to report the early results of its use in pre- and post-collapse stages of the disease

Phylogenetic Analysis of Ophioglossaceae Utilizing Low-Copy, Nuclear Genes

The fern family Ophioglossaceae is relatively small, with ten genera and around 112 species currently recognized. The family is known for its long, independent evolutionary trajectory resulting in significant morphological differences from other living ferns. Moreover, the family is believed to be descendants of Paleozoic ferns making them one of most ancient, primitive group of plants lineages extant today. In comparison to other ferns the members of Ophioglossaceae have relatively simple morphology with few stable characters on which to build robust classifications. Chloroplast DNA phylogenies of the family have supported the monophyly of most genera, and established hypotheses of evolutionary relationships within the family. Here we used a representative multicontinental sample set across the family to assess generic relationships. We amplified, cloned, and sequenced a transducin-like, low-copy, nuclear gene for 27 accessions representing 24 species in Ophioglossaceae including an outgroup. The nuclear region amplified was ~650 bp. We compared the resulting nuclear parsimony and likelihood phylogeny to published chloroplast DNA-based phylogenies. The nuclear and chloroplast DNA phylogenies supported the monophyly of a ‘botrychioid’ lineage composed of Botrychium s.s., Sceptridium, Japanobotrychium, and Botrypus. However, all three phylogenies differed in the placement of the earliest diverging lineages (i.e., Ophioglossum s.s., Ophioderma, Chieroglossa, Mankyua, and Helminthostachys). All genera except Ophioglossum s.s. and Botrypus were supported as monophyletic groups

A Review of PMMA Bone Cement and Intra-Cardiac Embolism

Percutaneous vertebroplasty procedure is of major importance, given the significantly increasing aging population and the higher number of orthopedic procedures related to vertebral compression fractures. Vertebroplasty is a complex technique involving the injection of polymethylmethacrylate (PMMA) into the compressed vertebral body for mechanical stabilization of the fracture. Our understanding and ability to modify these mechanisms through alterations in cement material is rapidly evolving. However, the rate of cardiac complications secondary to PMMA injection and subsequent cement leakage has increased with time. The following review considers the main effects of PMMA bone cement on the heart, and the extent of influence of the materials on cardiac embolism. Clinically, cement leakage results in life‐threatening cardiac injury. The convolution of this outcome through an appropriate balance of complex material properties is highlighted via clinical case reports

Vascularized compared with nonvascularized fibular grafting for the treatment of osteonecrosis of the femoral head

Background: We are not aware of any clinical studies in the literature comparing the results of vascularized and non- vascularized fibular grafting for the treatment of osteonecrosis of the femoral head. The purpose of this study was to compare the clinical results of free vascularized fibular grafting with those of nonvascularized fibular grafting. Methods: Two hundred patients (220 hips) with osteonecrosis of the femoral head were treated with free vascularized fibular grafting at the University of Pittsburgh Medical Center, and ninety-nine patients (123 hips) were treated with nonvascularized fibular grafting at the Kyungpook National University Hospital in Korea. From these populations, two groups of fifty hips each, followed for a minimum of three years (average, five years), were matched by the stage, size, and etiology of the lesion and by the mean preoperative Harris hip score. A retrospective case-control study of these groups was then performed to compare the postoperative Harris hip scores as well as the prevalences of radiographic progression and collapse of the femoral head following free vascularized fibular grafting with those measures following nonvascularized fibular grafting. Results: The mean Harris hip score improved for 70% of the hips treated with free vascularized fibular grafting: seventeen hips (34%) were rated excellent, fourteen (28%) were rated good, nine (18%) were rated fair, and ten (20%) were rated poor. The mean Harris hip score improved for 36% of the hips treated with nonvascularized fibular grafting: five hips (10%) were rated excellent; nine (18%), good; sixteen (32%), fair; and twenty (40%), poor. The rate of survival at seven years for the Stage-I and II hips (precollapse) was 86% after treatment with free vascularized fibular grafting compared with 30% after nonvascularized fibular grafting. Conclusions: The results of this study strongly suggest that vascularized fibular grafting is associated with better clinical and radiographic results. Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence

A Review of PMMA Bone Cement and Intra‐Cardiac Embolism

Percutaneous vertebroplasty procedure is of major importance, given the significantly increasing aging population and the higher number of orthopedic procedures related to vertebral compression fractures. Vertebroplasty is a complex technique involving the injection of polymethylmethacrylate (PMMA) into the compressed vertebral body for mechanical stabilization of the fracture. Our understanding and ability to modify these mechanisms through alterations in cement material is rapidly evolving. However, the rate of cardiac complications secondary to PMMA injection and subsequent cement leakage has increased with time. The following review considers the main effects of PMMA bone cement on the heart, and the extent of influence of the materials on cardiac embolism. Clinically, cement leakage results in life‐threatening cardiac injury. The convolution of this outcome through an appropriate balance of complex material properties is highlighted via clinical case reports