Viabilni i smrznuti transplantat meniska. Rana klinička i radiološka evaluacija

Aim: To perform a clinical and imaging short term evaluation of viable and frozen meniscus allografts. Methods and materials: Between 2005 and 2006, 12 meniscal allograft transplantations were performed in our institution. The study population consisted of 5 men and 7 women with a mean age of 36.4 years (range 17.1-42.5). Six patients received a viable allograft and six a deep-frozen one. All allografts were harvested from donors who died after a short disease. All patients were operated with an open surgical technique (medial or lateral arthrotomy) and soft tissue fixation with secure anterior and posterior horn fixation, performed by one senior surgeon. All patients were scored pre-operatively, at 6 weeks, 3 months, 6 months, 1 and 2 years postoperatively. Three questionnaires were used to score the patients clinically (KOOS, modified HSS and SF-36 questionnaire). Every patient received radiographs pre-operatively and at 6 months and 1 year. Results: Clinically, there was no difference in patient self-reported results through questionnaires or in a questionnaire based on clinical examination. There was no significant progress in joint space narrowing on weight bearing and Rosenberg view radiographs. Conclusion: Our results suggest that there are no clinical significant differences between the viable and the deep frozen subgroup after two years.Cilj: Učiniti ranu kliničku i radiološku evaluaciju vijabilnog i smrznutog transplantata meniska. Metoda i materijali: Tijekom 2005. i 2006. godine, u našoj ustanovi izvedeno je 12 alotransplantacija meniska. U studiju je bilo uključeno 5 muškaraca i 7 žena, s prosječnom dobi od 36,4 godina (raspon od 17,1 do 42,5). U šest pacijenata presađen je vijabilni transplantat, u šest duboko smrznuti transplantat. Svi transplantati su dobiveni od davatelja koji su umrli nakon kratke bolesti. Svi pacijenti operirani su otvorenim kirurškim zahvatom (medijalna ili lateralna artrotomija), uz fiksaciju mekih tkiva i fiksaciju prednjeg i stražnjeg roga. Svi pacijenti su evaluirani preoperativno, te 6 tjedana, 3 mjeseca, 6 mjeseci, jednu i dvije godine nakon operacije. Za kliničku evaluaciju bolesnika korištena su tri upitnika (KOOS, adaptirani HSS i SF-36 upitnik). Svakom pacijentu je učinjena rendgenska slika preoperativno, nakon 6 mjeseci i nakon jedne godine. Rezultati: Klinički, nije bilo razlika između rezultata koje su bolesnici samostalno naveli u upitnicima i onih dobivenih temeljem kliničkog pregleda. Rendgenska slika po Rosenbergu nije pokazala značajni pomak u suženju zglobne pukotine pod opterećenjem. Zaključak: Naši rezultati ukazuju na to da nakon dvije godine ne postoje klinički značajne razlike između transplantacije vijabilnog i duboko smrznutog transplantata

Skin marker-based versus bone morphology-based coordinate systems of the hindfoot and forefoot

Segment coordinate systems (CSs) of marker-based multi-segment foot models are used to measure foot kinematics, however their relationship to the underlying bony anatomy is barely studied. The aim of this study was to compare marker-based CSs (MCSs) with bone morphology-based CSs (BCSs) for the hindfoot and forefoot. Markers were placed on the right foot of fifteen healthy adults according to the Oxford, Rizzoli and Amsterdam Foot Model (OFM, RFM and AFM, respectively). A CT scan was made while the foot was loaded in a simulated weight-bearing device. BCSs were based on axes of inertia. The orientation difference between BCSs and MCSs was quantified in helical and 3D Euler angles. To determine whether the marker models were able to capture inter-subject variability in bone poses, linear regressions were performed. Compared to the hindfoot BCS, all MCSs were more toward plantar flexion and internal rotation, and RFM was also oriented toward more inversion. Compared to the forefoot BCS, OFM and RFM were oriented more toward dorsal and plantar flexion, respectively, and internal rotation, while AFM was not statistically different in the sagittal and transverse plane. In the frontal plane, OFM was more toward eversion and RFM and AFM more toward inversion compared to BCS. Inter-subject bone pose variability was captured with RFM and AFM in most planes of the hindfoot and forefoot, while this variability was not captured by OFM. When interpreting multi-segment foot model data it is important to realize that MCSs and BCSs do not always align.</p

Traditional invasive vs. minimally invasive esophagectomy: a multi-center, randomized trial (TIME-trial)

<p>Abstract</p> <p>Background</p> <p>There is a rise in incidence of esophageal carcinoma due to increasing incidence of adenocarcinoma. Probably the only curative option to date is the use of neoadjuvant therapy followed by surgical resection. Traditional open esophageal resection is associated with a high morbidity and mortality rate. Furthermore, this approach involves long intensive care unit stay, in-hospital stay and long recovery period. Minimally invasive esophagectomy could reduce the morbidity and accelerate the post-operative recovery.</p> <p>Methods/Design</p> <p>Comparison between traditional open and minimally invasive esophagectomy in a multi-center, randomized trial. Patients with a resectable intrathoracic esophageal carcinoma, including the gastro-esophageal junction tumors (Siewert I) are eligible for inclusion. Prior thoracic surgery and cervical esophageal carcinoma are indications for exclusion. The surgical technique involves a right thoracotomy with lung blockade and laparotomy either with a cervical or thoracic anastomosis for the traditional group. The minimally invasive procedure involves a right thoracoscopy in prone position with a single lumen tube and laparoscopy either with a cervical or thoracic anastomosis. All patients in both groups will undergo identical pre-operative and post-operative protocol. Primary endpoint of this study are post-operative respiratory complications within the first two post-operative weeks confirmed by clinical, radiological and sputum culture data. Secondary endpoints are the operative data, the post-operative data and oncological data such as quality of the specimen and survival. Operative data include duration of the operation, blood loss and conversion to open procedure. Post-operative data include morbidity (major and minor), quality of life tests and hospital stay.</p> <p>Based on current literature and the experience of all participating centers, an incidence of pulmonary complications for 57% in the traditional arm and 29% in the minimally invasive arm, it is estimated that per arm 48 patients are needed. This is based on a two-sided significance level (alpha) of 0.05 and a power of 0.80. Knowing that approximately 20% of the patients will be excluded, we will randomize 60 patients per arm.</p> <p>Discussion</p> <p>The TIME-trial is a prospective, multi-center, randomized study to define the role of minimally invasive esophageal resection in patients with resectable intrathoracic and junction esophageal cancer.</p> <p>Trial registration (Netherlands Trial Register)</p> <p><a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2040">NTR2452</a></p

Prospective individual patient data meta-analysis of two randomized trials on convalescent plasma for COVID-19 outpatients

Data on convalescent plasma (CP) treatment in COVID-19 outpatients are scarce. We aimed to assess whether CP administered during the first week of symptoms reduced the disease progression or risk of hospitalization of outpatients. Two multicenter, double-blind randomized trials (NCT04621123, NCT04589949) were merged with data pooling starting when = 50 years and symptomatic for <= 7days were included. The intervention consisted of 200-300mL of CP with a predefined minimum level of antibodies. Primary endpoints were a 5-point disease severity scale and a composite of hospitalization or death by 28 days. Amongst the 797 patients included, 390 received CP and 392 placebo; they had a median age of 58 years, 1 comorbidity, 5 days symptoms and 93% had negative IgG antibody-test. Seventy-four patients were hospitalized, 6 required mechanical ventilation and 3 died. The odds ratio (OR) of CP for improved disease severity scale was 0.936 (credible interval (CI) 0.667-1.311); OR for hospitalization or death was 0.919 (CI 0.592-1.416). CP effect on hospital admission or death was largest in patients with <= 5 days of symptoms (OR 0.658, 95%CI 0.394-1.085). CP did not decrease the time to full symptom resolution

Papio cynocephalus Endogenous Retrovirus among Old World Monkeys: Evidence for Coevolution and Ancient Cross-Species Transmissions

To study the evolutionary history of Papio cynocephalus endogenous retrovirus (PcEV), we analyzed the distribution and genetic characteristics of PcEV among 17 different species of primates. The viral pol-env and long terminal repeat and untranslated region (LTR-UTR) sequences could be recovered from all Old World species of the papionin tribe, which includes baboons, macaques, geladas, and mangabeys, but not from the New World monkeys and hominoids we tested. The Old World genera Cercopithecus and Miopithecus hosted either a PcEV variant with an incomplete genome or a virus with substantial mismatches in the LTR-UTR. A complete PcEV was found in the genome of Colobus guereza—but not in Colobus badius—with a copy number of 44 to 61 per diploid genome, comparable to that seen in papionins, and with a sequence most closely related to a virus of the papionin tribe. Analysis of evolutionary distances among PcEV sequences for synonymous and nonsynonymous sites indicated that purifying selection was operational during PcEV evolution. Phylogenetic analysis suggested that possibly two subtypes of PcEV entered the germ line of a common ancestor of the papionins and subsequently coevolved with their hosts. One strain of PcEV was apparently transmitted from a papionin ancestor to an ancestor of the central African lowland C. guereza

Treatment of patellofemoral cartilage defects in the knee by autologous matrix-induced chondrogenesis (AMIC)

This study presents the prospective two-year clinical and MRI outcome of autologous matrix-induced chondrogenesis (AMIC) for the treatment of patellofemoral cartilage defects in the knee. Ten patients were clinically prospectively evaluated during 2 years. MRI data were analysed based on the original and modified MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) scoring system. A satisfying clinical improvement became apparent during the 24 months of follow-up. The MOCART scoring system revealed a slight tendency to deterioration on MIRE between one and 2 years of follow-up. However, the difference was not statistical significant. All cases showed subchondral lamina changes. The formation of intralesional osteophytes was observed in 3 of the 10 patients (30%). In conclusion, AMIC is safe and feasible for the treatment of symptomatic patellofemoral cartilage defects and resulted in a clinical improvement. However, the favourable clinical outcome of the AMIC technique was not confirmed by the MIRE findings

Skin marker-based versus bone morphology-based coordinate systems of the hindfoot and forefoot

Segment coordinate systems (CSs) of marker-based multi-segment foot models are used to measure foot kinematics, however their relationship to the underlying bony anatomy is barely studied. The aim of this study was to compare marker-based CSs (MCSs) with bone morphology-based CSs (BCSs) for the hindfoot and forefoot. Markers were placed on the right foot of fifteen healthy adults according to the Oxford, Rizzoli and Amsterdam Foot Model (OFM, RFM and AFM, respectively). A CT scan was made while the foot was loaded in a simulated weight-bearing device. BCSs were based on axes of inertia. The orientation difference between BCSs and MCSs was quantified in helical and 3D Euler angles. To determine whether the marker models were able to capture inter-subject variability in bone poses, linear regressions were performed. Compared to the hindfoot BCS, all MCSs were more toward plantar flexion and internal rotation, and RFM was also oriented toward more inversion. Compared to the forefoot BCS, OFM and RFM were oriented more toward dorsal and plantar flexion, respectively, and internal rotation, while AFM was not statistically different in the sagittal and transverse plane. In the frontal plane, OFM was more toward eversion and RFM and AFM more toward inversion compared to BCS. Inter-subject bone pose variability was captured with RFM and AFM in most planes of the hindfoot and forefoot, while this variability was not captured by OFM. When interpreting multi-segment foot model data it is important to realize that MCSs and BCSs do not always align.</p