Aesthetic Results, Functional Outcome and Radiographic Analysis in THA by Direct Anterior, Bikini and Postero-Lateral Approach: Is It Worth the Hassle?

Total hip arthroplasty (THA) can be performed by several approaches such as direct anterior (DAA), direct lateral (DL) and postero-lateral (PL). Our study was conducted to compare among different approaches, such as DAA, bikini (BK) and PL, the aesthetic impact of the scar, differences in the position of prosthetic components and differences in functional rehabilitation outcomes. Materials and methods: Population, composed by 240 patients, was collected among patients treated for primary total hip arthroplasty (THA) from 1 January 2017 to 31 December 2021 and divided by surgical approach. Of these, 160 female patients were included in the current analysis, leaving 58 DAA, 52 BK patients and 50 PL patients. Demographic and clinical parameters were retrospectively collected: age, BMI, time of surgery, length of stay, Harris Hip Score (HHS) before and after surgery at 6 months and patient, intra/post-surgical complications and Patient and Observer Scar Assessment Scale (POSAS). Results and Discussion: Our results showed a better aesthetical result in BK group compared to DAA group and faster rehabilitation with the DAA compared to PL. Optimal cup positioning was reached both in PL approach and DAA approach. DAA showed no increase in complications compared to PL approach and offered a faster recovery. Bikini approach is an alternative to the standard DAA approach and can be proposed for patients where a better aesthetic result is desired in addition to better functional recover

Measurement of the active width in Sr-doped lanthanum manganate Sofc Cathodes using Nano-ct, impedance spectroscopy and Bayesian calibration

Bayesian model-based analysis (BMA) is a method for producing quantitative models of complex physical systems through the comparison between models and experimental data. A model of a porous LSM cathode (symmetrical cell) was applied to impedance data and its parameters estimated via Bayesian calibration. X-ray computed tomography provided microstructural information for the model. The combination of model calibration and microstructural characterization enabled an estimate of the active thickness for a porous LSM electrode. The active width extended only a few nanometers from the surface, strongly suggesting that future models should explicitly resolve the space-charge region

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

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

promising role of extracellular vesicles as biomarkers of acute graft vs host disease

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Bladder‐sparing, combined‐modality approach for muscle‐invasive bladder cancer

AbstractBACKGROUND.The authors evaluated their long‐term experience with combined‐modality, conservative treatment in patients with muscle‐invasive bladder cancer.METHODS.In total, 121 patients with T2, T3, or T4 bladder cancer (mean age, 63 years; ratio of men to women, 3:1) underwent induction by transurethral resection (TUR) of the tumor and received 2 cycles of neoadjuvant chemotherapy followed by radiotherapy (RT) (n = 43 patients) or radiochemotherapy (RCT) (n = 78 patients). Six weeks after RT or RCT, responses were evaluated by restaging TUR. Patients who achieved a complete response (CR) were observed at regular intervals. In patients who had persistent or recurrent invasive tumor, further treatment was recommended.RESULTS.Local response evaluation by restaging TUR was possible in 119 patients, and 102 of those patients (85.7%) achieved a CR. After a median follow‐up of 66 months (range, 6–182 months), no local or distant disease recurrences were observed in 67 of 102 complete responders (65.7%), 17 of 102 complete responders (16.7%) experienced superficial local disease recurrence, and 18 of 102 complete responders (17.6%) had a muscle‐invasive relapse. The 5‐year tumor‐specific, overall, and bladder‐intact survival rates were 73.5%, 67.7%, and 51.2%, respectively. Treatment modality, tumor classification, and resection status after initial TUR had an impact on survival rates (P = .04, P = .02, and P = .02, respectively).CONCLUSIONS.The current results indicated that conservative combined treatment is a reasonable alternative to radical cystectomy in selected patients with muscle‐invasive bladder cancer. Cancer 2008. © 2007 American Cancer Society

Biomarkers of Acute Graft-Versus-Host Disease: Surface Antigens and Micro Rnas in Extracellular Vesicles

Introduction Biomarkers could be crucial to identify patients at high-risk of acute Graft-vs.-Host Disease (aGVHD). Given their involvement in inflammation, Extracellular Vesicles (EVs) may become attractive biomarkers. Moreover, EVs are non-invasively extracted from body fluids. In a preliminary study, we significantly correlated CD146, CD31 and CD140a expression on EVs membranes with the onset of aGVHD (Lia G. Leukemia 2017). Objectives We designed a prospective study to further characterize EVs by their surface antigens and by their content in MicroRNAs. Methods EVs are extracted from serum samples at given time-points (pre-transplant, on day 0, 3, 7, 14, 21, 28, 35, 45 and then monthly up to 1 year) by a protamine-based precipitation method and analyzed by flow-cytometry (Guava EasyCyte Flow Cytometer) for the expression of 13 membrane proteins (CD44, CD138, CD146, KRT18, CD120a, CD8, CD30, CD106, CD25, CD31, CD144, CD86, and CD140a). MicroRNAs (miR100, miR92b, miR155, miR194) are extracted from EVs at pre- transplant and on day 0, 7, 14, 28, and quantified by real time PCR as relative quantification compared to healthy donors after cDNA Reverse Transcription. Logistic Regression Analysis is performed for each marker. Results Thirty-five transplant patients with hematological diseases have so far been enrolled. Seventeen/35 patients (49%) developed grade II-IV aGVHD. Our preliminary findings show that CD146 (melanoma cell adhesion molecule, MCAM-1) and CD44 (homing-associated cell adhesion molecule, H-CAM) were associated with an increased risk of aGVHD (Odds Ratio (OR) 4.3, p=0.008; OR 2.1, p=0.039), whereas CD31 (platelet endothelial cell adhesion molecule, PECAM-1) level was associated with a decreased risk of aGVHD (OR 0.31, p=0.001). Moreover, increased risk of aGVHD was significantly correlated with levels of miR100 (OR 4.66, p=0.004), miR194 (OR 2.2, p=0.01) and miR155 (OR 3.56, p=0.035). Of note, biomarkers associated with aGVHD showed a constant consensual change in signal levels before aGVHD onset (Figure 1). Conclusions An association of 3 EVs membrane antigens and onset of aGVHD was observed. Of note, CD146, CD44 and CD31 belong to the Cell Adhesion Molecule Family and are critical for endothelium and immune cells interactions. The functional role of miR-194 in GVHD pathogenesis remains to be determined while JAK/STAT and TGFβ pathways were shown to be involved in other studies (Gimondi S Exp Hematol, 2016). MiR-100 has been reported to regulate inflammatory neovascularization during GvHD (Leonhardt F, Blood 2013) while miR-155 drives donor T cell expansion and tissue infiltration (Zitzer N, J Immunol 2018, Ranganathan P Blood 2012)

Carnosine Protects Macrophages against the Toxicity of Aβ1-42 Oligomers by Decreasing Oxidative Stress

Carnosine (β-alanyl-L-histidine) is a naturally occurring endogenous peptide widely distributed in excitable tissues such as the brain. This dipeptide has well-known antioxidant, anti-inflammatory, and anti-aggregation activities, and it may be useful for treatment of neurodegenerative disorders such as Alzheimer’s disease (AD). In this disease, peripheral infiltrating macrophages play a substantial role in the clearance of amyloid beta (Aβ) peptides from the brain. Correspondingly, in patients suffering from AD, defects in the capacity of peripheral macrophages to engulf Aβ have been reported. The effects of carnosine on macrophages and oxidative stress associated with AD are consequently of substantial interest for drug discovery in this field. In the present work, a model of stress induced by Aβ1-42 oligomers was investigated using a combination of methods including trypan blue exclusion, microchip electrophoresis with laser-induced fluorescence, flow cytometry, fluorescence microscopy, and high-throughput quantitative real-time PCR. These assays were used to assess the ability of carnosine to protect macrophage cells, modulate oxidative stress, and profile the expression of genes related to inflammation and pro- and antioxidant systems. We found that pre-treatment of RAW 264.7 macrophages with carnosine counteracted cell death and apoptosis induced by Aβ1-42 oligomers by decreasing oxidative stress as measured by levels of intracellular nitric oxide (NO)/reactive oxygen species (ROS) and production of peroxynitrite. This protective activity of carnosine was not mediated by modulation of the canonical inflammatory pathway but instead can be explained by the well-known antioxidant and free-radical scavenging activities of carnosine, enhanced macrophage phagocytic activity, and the rescue of fractalkine receptor CX3CR1. These new findings obtained with macrophages challenged with Aβ1-42 oligomers, along with the well-known multimodal mechanism of action of carnosine in vitro and in vivo, substantiate the therapeutic potential of this dipeptide in the context of AD pathology