Cementless Total Hip Arthroplasty After an Iatrogenic Subtrochanteric Fracture due to Hardware Removal: A Case Report

Introduction: Total hip arthroplasty (THA) after proximal femoral fixation is a challenging procedure due to possible hardware-related complications. Case presentation: A 78-year-old female with hip osteoarthritis had a proximal femoral osteotomy fixed using a blade plate in the same femur 41 years ago. A two-step approach was planned. After a challenging hardware removal, an iatrogenic subtrochanteric fracture below the degenerated hip occurred after three months. THA with a tapered long stem was successfully performed with no need for additional osteosynthesis, and good results were seen two years later. Discussion: THAs in subtrochanteric fractures are technically demanding but feasible in selected cases. Hardware removal before THA implantation may carry important risks, and the surgical team should be prepared to perform arthroplasty in case of complications. Conclusion: THA in a subtrochanteric fracture below hip osteoarthritis is a feasible option in selected cases

Direct Anterior Approach in Total Hip Arthroplasty for Severe Crowe IV Dysplasia: Retrospective Clinical and Radiological Study

Background and Objectives: total hip arthroplasty (THA) for Crowe IV hip dysplasia poses challenges due to severe leg shortening, muscle retraction and bone stock issues, leading to an increased neurological complication, and revision rate. The direct anterior approach (DAA) is used for minimally invasive THA but its role in Crowe IV dysplasia is unclear. This retrospective study examines if DAA effectively restores hip biomechanics in Crowe IV dysplasia patients with <4 cm leg length discrepancy, managing soft tissue and yielding functional improvement, limb length correction, and limited complications. Materials and Methods: 19 patients with unilateral Crowe IV hip osteoarthritis and <4 cm leg length discrepancy undergoing DAA THA were reviewed. Surgery involved gradual soft tissue release, precise acetabular cup positioning, and stem placement without femoral osteotomy. Results: results were evaluated clinically and radiographically, with complications recorded. Follow-up revealed significant Harris Hip Score and limb length discrepancy improvements. Abductor muscle insufficiency was present in 21%. The acetabular component was accurately placed, centralizing the prosthetic joint's rotation. Complications occurred in 16% of cases, including fractures, nerve issues, and infection. DAA in THA showcased positive outcomes for hip function, limb length, and biomechanics in Crowe IV dysplasia. Conclusions: the technique enabled accurate cup positioning and rotation center adjustment. Complications were managed well without implant revisions. DAA is a viable option for Crowe IV dysplasia, restoring hip function, biomechanics, and reducing limb length discrepancy. Larger, longer studies are needed for validation

Isotopic constraints on contamination processes in the Tonian Goiás Stratiform Complex

The Tonian Goiás Stratiform Complex (TGSC, Goiás, central Brazil), is one of the largest mafic-ultramafic layered complexes in the world, emplaced during the geotectonic events that led to the Gondwana accretion. In this study, we present trace elements and in-situ U/Pb-Lu-Hf analyses of zircons and 87Sr/86Sr ratios of plagioclases from anorthosites and gabbros of the TGSC. Although formed by three isolated bodies (Cana Brava,Niquelândia and Barro Alto), and characterized by a Lower and Upper Sequence (LS and US), our new U/Pb zircon data confirm recent geochemical, geochronological, and structural evidences that the TGSC has originated from a single intrusive body in the Neoproterozoic. New Hf and Sr isotope ratios construe a complex contamination history for the TGSC,with different geochemical signatures in the two sequences. The low Hf and high Sr isotope ratios of the Lower Sequence (εHf(t) from−4.2 down to −27.5; 87Sr/86Sr=0.706605–0.729226), suggest the presence of a crustal component and are consistent with contamination from meta-pelitic and calc-silicate rocks found as xenoliths within the Seuence. The more radiogenic Hf isotope ratios and low Sr isotope composition of the Upper Sequence (εHf(t) from 11.3 down to −8.4; 87Sr/86Sr=0.702368–0.702452), suggest a contamination from mantle-derived metabasalts in agreement with the occurrences of amphibolite xenoliths in the US stratigraphy. The differential contamination of the two sequences is explained by the intrusion of the TGSC in a stratified crust dominated bymetasedimentary rocks in its deeper part andmetavolcanics at shallower levels. Moreover, the differential thermal gradient in the two crystallizing sequences might have contributed to the preservation and recrystallization of inherited zircon grains in the US and total dissolution or magmatic overgrowth of the LS zircons via melt/rock reaction processes

Femoral Head Autograft to Manage Acetabular Bone Loss Defects in THA for Crowe III Hips by DAA: Retrospective Study and Surgical Technique

Introduction: The pathologic anatomy of Crowe III is characterized by the erosion of the superior rim of acetabulum, with a typical bone defect in its supero–lateral portion. The performance of a total hip arthroplasty requires the management of the acetabular bone defect, and femoral head autograft can be a valid option to optimize implant coverage. Material and Methods: In all, eight Crowe III patients (nine hips), seven of which having unilateral hip affected, and one with bilateral involvement by secondary osteoarthritis in DDH; maximum limb length discrepancy (LLD) of 3.5 cm in unilateral patients. All were operated on by direct anterior approach. Patients were evaluated in terms of clinical, surgical, and radiological (center-edge, horizontal coverage, cup inclination) parameters. Results: Cup placement was implanted with a mean of 39.5 ± 7.5°. Stem alignment showed average 1.5 ± 2.3° in valgus. LLD showed an overall average preoperative of −29.5 ± 10.5 mm at the affected side, with a significant improvement to −2.5 ± 6.4 mm (p = 0.023). The mean initial coverage evaluated like a percentage of the horizontal bone host was 52.1 ± 7.1%, while the mean final coverage at the last post-operative X-ray from femoral autograft bone was 97.0 ± 4.5% with an average improvement of 44.5%. Average CE improved from −9.5 ± 5.2° (CE I) to the immediate post-operative (CE II) of 40.6 ± 8.2°. At the final follow up, CE III showed a mean of 38.6 ± 6.2°, with an average decrease of 2.0°. Discussion: Acetabular bone defect in Crowe III DDH patients undergoing THA by DAA, can be efficiently managed by massive autograft femoral head, which allowed an adequate and long-lasting coverage of the implant, with cup positioning at the native acetabulum

Weight of risk factors for mortality and short-term mortality displacement during the COVID-19 pandemic.

Background: We conducted a population-based cohort study to estimate mortality before, during and after the COVID-19 peak and to compare mortality in 2020 with rates reported in previous years, with a view to helping decision makers to apply containment measures for high-risk groups. Methods: All deaths were collected between 2015 and 2020 from municipal registry database. In 2020, weeks 1-26 were stratified in three periods: before, during and after the COVID mortality peak. The Poisson Generalized Linear regression Model showed the “harvesting effect”. Three logistic regressions for 8 dependent variables (age and comorbidities) and a t-test of  differences described all-cause mortality risk factors in 2019 and 2020 and differences between COVID and non-COVID patients. Results: A total of 47,876 deaths were collected. All-cause deaths increased by 38.5% during the COVID peak and decreased by 18% during the post-peak period in comparison with the average registered during the control period (2015-19), with significant mortality displacement in 2020. Except for chronic renal injuries in subjects aged 45-64 years, diabetes and chronic cardiovascular diseases in those aged 65-84 years, and neuropathies in those aged >84 years, the weight of comorbidities in deaths was similar or lower in COVID subjects than in non-COVID subjects. Discussions: Surprisingly, the weight of comorbidities in death, compared to weight in non-COVID subjects allows you to highlight some surprising results such as COPD, IBD and Cancer. The excess mortality that we observed in the entire period were modest in comparison with initial estimates during the peak, owing to the mild influenza season and the harvesting effect starting from the second half of May.   &nbsp

The Palliative Prognostic (PaP) Score without Clinical Evaluation Predicts Early Mortality among Advanced NSCLC Patients Treated with Immunotherapy

Background: An acceptable risk-benefit ratio may encourage the prescription of immune checkpoint inhibitors (ICI) near the late stage of life. The lung immune prognostic index (LIPI) was validated in advanced non-small cell lung cancer (NSCLC) patients treated with ICIs. The palliative prognostic (PaP) score without clinical prediction of survival (PaPwCPS) predicts early mortality probability in terminal cancer patients. Methods: We performed a retrospective study including 182 deceased advanced NSCLC patients, treated with single-agent ICI at our Institution. Two prognostic categories of high and low mortality risk were identified through ROC curve analysis for PaPwCPS and LIPI scores. Results: Most were >65 years of age (68.3%) and received second-line ICI (61.2%). A total of 29 (15.9%) and 131 (72.0%) patients died within 30 and 90 days from treatment start, respectively. A total of 81 patients (44.5%) received ICI during the last month of life. Baseline PaPwCPS and LIPI scores were assessable for 78 patients. The AUC of ROC curves was significantly increased for PaPwCPS as compared with LIPI score for both 30-day and 90-day mortality. A high PaPwCPS score was associated in multivariate analysis with increased 30-day (HR 2.69, p = 0.037) and 90-day (HR 4.01, p < 0.001) mortality risk. A high LIPI score was associated with increased 90-day mortality risk (p < 0.001). Conclusion: We found a tendency towards ICI prescription near the late stage of life. The PaPwCPS score was a reliable predictor of 30- and 90-day mortality

Burden and prevention of HPV. Knowledge, Practices and Attitude Assessment Among Pre-adolescents and their Parents in Italy

Despite infections due to HPV nowadays represent the most common sexually transmitted diseases worldwide with recognized effective and safe preventive strategies, knowledge, attitudes; however, awareness on HPV is considerably low. The present study has two main objectives: 1. To conduct a literature review to analyze the evolution of preventive tools, the complexity of the vaccine choice process, and the challenges posed by HPV vaccine hesitancy and refusal among pre-adolescents and their parents; 2. To assess knowledge, practices and attitudes toward HPV infection and vaccination in a sample of Italian pre-adolescents and their parents. The observational study was carried out through the use of two anonymous and self-administered pre- and post-intervention questionnaires dedicated to the target populations. Between the administrations of the pre- and post-intervention questionnaires, an educational intervention on ITV infection and related diseases, and prevention strategies was conducted. All participants demonstrated suboptimal knowledge and positive attitudes in the pre-intervention questionnaire. Higher levels of knowledge and attitudes were observed among pre-adolescents thatused social networks and had heard of sexually transmitted diseases at home/school/physician and from parents and also who had heard of HPV from General Practitioners, Gynecologists, family members and newspapers. A significant increase in HPV vaccination awareness was observed among pre-adolescents after the educational sessions. Health education programs aimed at increasing knowledge, attitudes and awareness on HPV are needed to implement the outcomes of HPV immunization programs, especially if supported by the physicians involved in counselling and recommendation processes

Which Patients with Chronic Periprosthetic Joint Infection Are Less Suitable to Successful Two Stage Exchange Arthroplasty Surgery? A Retrospective Clinical Trial

Which Patients with Chronic Periprosthetic Joint Infection Are Less Suitable to Successful Two Stage Exchange Arthroplasty Surgery? A Retrospective Clinical Tria

PRELIMINARY U-Pb LA-ICPMS ZIRCON ANALYSES FROM THE GOIAS COMPLEXES: SHRIMP COMPARISON AND INTRUSION AGE

Cana Brava, Niquelàndia and Barro Alto are three mafic-ultramafic layered intrusions (from N to S) which form a - 350 km, NNE-trend belt within the Brasilia Belt (Goiés state, Brazil). Presently, their intrusion ages and geologica! evolution are stili debated. The Niquelàndia and Barro Alto complexes are forrned by two main sequences: the upper sequence and the lower one. Some authors suggest that the two sequences represent two separate intrusions: the upper sequence would be a Mesoproterozoic intrusion at - 1.3 Ga, whereas the lower sequence a Neoproterozic one at - 790 Ma. According to this interpretation, the two sequences were re-crystallized by Neoproterozoic metamorphism and exhumed and juxtaposed during the Brazilian event of formation of the Gondwana continent. Another model suggests that the two sequences are part of the same intrusion, which occurred during the Neoproterozoic and was exhumed during the Brazilian event. New U-Pb SHRIMP-II zircon analyses were perforrned at the Universidade de Sào Paulo from samples from Cana Brava and Barro Alto, the two least-known complexes in order to clarify the sequence of events that led to their forrnation. Analyses were then replicated at the CIGS of the Università di Modena e Reggio Emilia using a X Series" quadrupole ICP-MS coupled with a New Wave UP-213 Nd:YAG laser ablation system. Zircons were sampled through a 40 micron spot (static mode), using a He flux of 0.6 l/min, with an energy density of - 6 J/cm2. Daily instrument calibration was perforrned with the NIST 610 standard, monitoring also the oxide production rate {232Th160/232Th << 0.01 %). Laser-induced elemental fractionation was corrected by repeated analyses of the standard zircon TEMORA2 (Black et al., 2004). A secondary reference materia! (zircon CZ3) was used to check the precision and accuracy of the corrections. Our LA-ICP-MS data are preliminary, but very promising being the accuracy of the measured ratio within the SHRIMP variability. We are currently working to improve the precision of our methodology, which however is now comparable with literature LA-ICP-MS data (propagated 2SE - 2-6%; Horstwood et al., 2008). Overall, the isotopic data of Cana Brava and Barro Alto complexes previde for a coeval Neoproterozoic intrusion age at - 790 Ma. These ages are consistent with those reported in literature for Niquelàndia. Mesoproterozoic ages, consistent with the forrnation age of the metavolcanic-metasedimentary sequence in magmatic contaci with the complexes, were found in inherited zircon cores. Our data clearly show that the Goiàs complexes are formed by single bodies intruded during the Neoproterozoic at -790 Ma and that the hypothesis of two separate intrusions juxtaposed by tectonic must be discarded

Reduction of the microbial load in meat maturation rooms with and without alkaline electrolyzed water fumigation

Dry-aging is a process during which meat is stored within maturation chambers at low temperatures and low relative humidity, resulting in improved tenderness and flavor development. The cuts are exposed to the atmosphere by hanging them or setting them on racks in the maturation chamber without any protective packaging. Animals and humans are usually the major sources of bacterial food contamination in the meat industry, but other routes might be involved. Therefore, procedures to reduce or eliminate pathogens from surfaces are crucial for an effective hazard analysis critical control point program in the food industry and other environments. This study aimed to assess the survival of Listeria monocytogenes, Escherichia coli, Salmonella spp., and Staphylococcus aureus on the inner surface of dry aging chambers. Moreover, we tested the efficacy of alkaline electrolyzed water (REW) for its eventual application within a procedure aimed at reducing foodborne pathogens during meat storage. Environmental conditions inside the dry aging cabinet determine a reduction of circa 3 log CFU/cm2 of the considered microorganisms on the inner surface in 24 hours. Additionally, the nebulization of alkaline electrolyzed water with the smoking system increased the count reduction in 24 hours due to environmental conditions for L. monocytogenes (~1 log CFU/cm2) and for S. aureus (~2 log CFU/cm2). In this context, the use of REW can be justified for routine cleaning procedures of the surfaces, with the added value of being safe to handle, not containing environmental pollutants, and making it unnecessary to rinse surfaces due to its instability