bluuebunny/crossref_metadata_2025 huggingface dataset:
Recent advances in pharmacological diversification of Src family kinase inhibitors
Authors: Negi Preeya , Cheke Rameshwar S. , Patil Vaishali M.
Published: May 2021

Background

Src kinase, a nonreceptor protein-tyrosine kinase is composed of 11 members (in human) and is involved in a wide variety of essential functions required to sustain cellular homeostasis and survival.

Main body of the abstract

Deregulated activity of Src family kinase is related to malignant transformation. In 2001, Food and Drug Administration approved imatinib for the treatment of chronic myeloid leukemia followed by approval of various other inhibitors from this category as effective therapeutics for cancer patients. In the past decade, Src family kinase has been investigated for the treatment of diverse pathologies in addition to cancer. In this regard, we provide a systematic evaluation of Src kinase regarding its mechanistic role in cancer and other diseases. Here we comment on preclinical and clinical success of Src kinase inhibitors in cancer followed by diabetes, hypertension, tuberculosis, and inflammation.

Short conclusion

Studies focusing on the diversified role of Src kinase as potential therapeutical target for the development of medicinally active agents might produce significant advances in the management of not only various types of cancer but also other diseases which are in demand for potent and safe therapeutics.
Assessment of new-onset depression and anxiety associated with COVID-19
Authors: Hurissi Eman , Abu-jabir Ethar , Mohammed Amnah , Mahnashi Mashael , Alharbi Sana , Alharbi Ahmad , Alnaami Ahmed , Alameer Essam , Alahmar Anwar , Alhazmi Abdulaziz
Published: May 2021

Background

Psychological disorders are common among individuals who experienced COVID-19. Previous studies have shown that females report higher depression and anxiety than males. The present study aims to test the differences in depression and anxiety between males and females who have experienced COVID-19. This a descriptive, observational, comparative study, among Saudi Arabian population. A total of 686 participants have been recruited. Participants completed an online questionnaire that contains questions about sociodemographic, COVID-19, Generalized Anxiety Disorder (GAD-7) questionnaire, and Patient Health Questionnaire (PHQ-9) to measure anxiety and depression, respectively.

Results

Twenty-six percent of the participants were excluded and our final sample consisted of 507 participants (median age 23; 65% females). Of the final sample, 23% (118) have been previously diagnosed with COVID-19. There is no significant difference in GAD-7 and PHQ-9 scores between COVID-19- positive and COVID-19-negative populations. However, females who have experienced COVID-19 reported significantly higher GAD-7 and PHQ-9 scores compared to males.

Conclusion

The results of our study show that females are significantly at a higher risk for depression and anxiety as a result of COVID-19 infection compared to males. Further epidemiological studies are required for a better understanding of this correlation.
Surgical challenges of excision of retroperitoneal germ cell tumors in children: a single institutional study with literature review
Authors: Bollemeijer Juliette F. , Mavinkurve-Groothuis Annelies M. C. , Kooij Cezanne D. , Zsiros József , Littooij Annemieke S. , van der Steeg Alida F. W. , Wijnen Marc H. W. A. , Hulsker Caroline C. C.
Published: May 2021

Background

Retroperitoneal germ cell tumors (GCTs) are rare, commonly large tumors, often diagnosed in infancy. Complete surgical resection may pose a serious challenge as encasement of major vessels and organ displacement can lead to perioperative complications. This study aims to illustrate the surgical challenges of excising retroperitoneal GCTs.

Results

Nine patients were included: six patients with a teratoma, two patients with a mixed GCT with a yolk sac tumor component, and one patient with a pure yolk sac tumor. Six were males and seven were younger than 1 year of age at time of presentation. In all cases, perioperative vascular or organ-related complications occurred in one patient; this resulted in short bowel syndrome. There was no recurrence or mortality during the follow-up period. Relevant literature is reviewed and described.

Conclusions

The anatomical relation of a retroperitoneal GCT to the major vessels and organs is unpredictable. Preoperative radiological evaluation can help to improve the understanding of the vascular anatomy and to plan accordingly. Anteriorly displaced veins may appear insignificant and arteries, such as the superior mesenteric artery may be encased. Preoperative imaging may prevent perioperative complications, leading to safer surgical procedures.

Level IV evidence

Therapeutic study
Birth Weight– or Gestational Age–adjusted Second-tier LCMSMS Cutoffs Improve Newborn Screening for CAH in New Zealand
Authors: de Hora Mark R , Heather Natasha L , Webster Dianne , Albert Benjamin B , Hofman Paul L
Published: May 2021

Context

The positive predictive value of newborn screening for congenital adrenal hyperplasia (CAH) in New Zealand is approximately 10%. The use of a second tier liquid chromatography-tandem mass spectrometry bloodspot steroid profile test with birth weight– or gestational age–adjusted screening cutoffs may result in further screening improvements.

Methods

Three years of newborn screening data with additional second-tier steroid metabolites was evaluated (n = 167 672 births). Data from babies with a negative screening test and confirmed CAH cases were compared. First- and second-tier steroid measurements were correlated with both birth weight and gestational age. Analysis of variance was used to determine birth weight and gestational age groups. Screening cutoffs were determined and applied retrospectively to model screening performance.

Results

First-tier immunoassay data correlated better with gestational age than with birth weight, but there was no difference with second-tier steroid measurements. Four distinct birth weight and gestational age groups were established for 17-hydroxyprogesterone and a steroid ratio measurement. Application of 97.5th percentile second-tier birth weight– or gestational age–adjusted cutoffs would result in 10 positive tests over the period of the study with 8 true-positive screens and 2 false-positive tests. The positive predictive value of screening would be increased from 10.8% to 80%.

Conclusions

The use of either birth weight– or gestational age–adjusted cutoffs for second-tier screening tests can significantly reduce the false positive rate of newborn screening for CAH in New Zealand without loss in screening sensitivity.
Value of the Sentinel Node Procedure in Pediatric Extremity Rhabdomyosarcoma: A Systematic Review and Retrospective Cohort Study
Authors: Jeremiasse Bernadette , van der Steeg Alida F. W. , Fiocco Marta , Hobbelink Monique G. G. , Merks Johannes H. M. , Godzinski Jan , Shulkin Barry L. , Wijnen Marc H. W. A. , Terwisscha van Scheltinga Cecilia E. J.
Published: May 2021

Background

Our aim is to show whether the sentinel node procedure (SNP) is recommendable for pediatric patients with extremity rhabdomyosarcoma (RMS). Lymph node metastases are an important prognostic factor in pediatric patients with extremity RMS. Accurate nodal staging is necessary to treat the patient accordingly. An alternative to the current recommended lymph node sampling is the sentinel node procedure (SNP).

Methods

A systematic review was performed summarizing all published cases of SNP in addition to 13 cases from our hospital and 8 cases from two other hospitals that have not been published before.

Results

For all patients (n = 55), at least one SLN was identified, but the SNP technique used was not uniform. The SNP changed the nodal classification of eight patients (17.0%) and had a false-negative rate of 10.5%.

Conclusions

The SNP is recommendable for pediatric patients with extremity RMS. It can change lymph node status and can be used to sample patients in a more targeted way than nodal sampling alone. Therefore, we recommend use of the SNP in addition to clinical and radiological nodal assessment for pediatric patients with extremity RMS.
Organization of credit work
Authors: Kazimagomedov Abdulla
Published: May 2021

The textbook presents theoretical and practical issues related to the organization of credit work of commercial banks with borrowers. The training material on the organization of lending to corporate and individual borrowers, interbank, international and state loans is presented in a short and accessible way, according to the modules. The risks inherent in various types of loans and credit bureaus are considered. In addition, to consolidate the knowledge of students, tasks, control and test questions are given.
Meets the requirements of the federal state educational standards of secondary vocational education of the latest generation.
For teachers and students studying in the general professional discipline "Organization of credit work" in the specialty 38.02.07 "Banking".
Modern information and communication technologies for successful business
Authors: Romanova Yuliya , Muzychkin Pavel , Zhenova Nataliya , D'yakonova Lyudmila , Eydlina Galina , Miloradov Konstantin , Vokina Svetlana , Antonenkova Al'bina
Published: May 2021

The textbook contains a verified set of materials about the opportunities and technologies of doing business on the global Internet.
Technologies and means of the electronic market, electronic cash flows and possibilities of their management are considered. Special attention is paid to the issues of site construction: tips and step-by-step instructions are given for the direct creation of a site, setting a task and implementing it to order, as well as numerous opportunities and tools for promoting a site on the web. The basics of the security of electronic business activity are presented. The material is presented in a clear and accessible form.
For students and undergraduates of various profiles, studying in the fields of "Economics" and "Management", graduate students, as well as entrepreneurs who want to promote their business via the Internet.
Operation of mining and transport vehicles in the quarries of the North
Authors: Ishkov Aleksandr , Vikulov Mihail , Bochkarev Yuriy
Published: May 2021

The textbook discusses the features of the operation of mining and transport machines in open-pit mining in a cold climate zone, highlights previously unexplored problems of operation of this type of equipment, and describes methods for determining the operational reliability of equipment.
The proposed methods of operation are based on the analysis of a significant amount of statistical material on failures of equipment operating at large mining enterprises of the Republic of Sakha (Yakutia). The influence of low temperatures on the reliability indicators and technical and economic results of the operation of mining and transport machines was determined quantitatively and qualitatively.
Meets the requirements of the federal state educational standards of higher education of the latest generation.
It is intended for students of higher educational institutions studying in the specialty 21.05.04 "Mining", it can also be useful for graduate students, researchers and practitioners specializing in the technical operation of mining and transport machines.
Fundamentals of public communication skills: practical recommendations
Authors: Obuhova Galina , Klimova Galina
Published: May 2021

The textbook discusses the methodological foundations of the preparation and presentation of public speeches in various fields of activity, including business. The factors influencing the skill of the speaker are considered. Recommendations are given on the technique of conducting various types of public speeches and practical techniques of audience ownership are shown. Special attention is paid to the methods of establishing contact between the speaker and the audience and the psychological influence of the speaker on the audience. Practical recommendations and exercises for improving the speaker's speech technique are presented. Special attention is paid to the ways of correcting speech defects.
Meets the requirements of the federal state educational standards of higher education of the latest generation.
It is intended for teachers, lecturers of the educational system, students and postgraduates, managers, lawyers, as well as for managers of various levels who are aware of the importance of verbal communication in their professional field. It can also be useful for a wide range of readers.
Machine repair technology
Authors: Strebkov Sergey , Sahnov Andrey
Published: May 2021

The tutorial discusses the technological processes of remontamashin, contains elements of the design of technological processes for the restoration of parts and assembly units, describes ways to restore the main defects of machine parts.
Meets the requirements of the federal state educational standards of higher education of the latest generation.
It is intended for students in the direction of training 35.03.06 "Agroengineering".
Strategic development of railway transport logistics
Authors: Cevelev Aleksandr
Published: May 2021

The monograph is devoted to the methodology of material and technical support of railway transport. According to the types of activities, the nature of the material and technical resources used, technologies, means and management systems, Russian railways belong to the category of high-tech industries that must have high quality and technical level, reliability and technological efficiency in operation. For this reason, the logistics system itself, both in structure and in the algorithm of the functions performed as a whole, needs a serious improvement in the quality of its work. The economic situation in Russia requires a revision of the principles and mechanisms of management based on the corporate model of supply chain management, focused on logistics knowledge. In the difficult economic conditions of the current decade, it is necessary to improve the quality of the supply organization of enterprises and structural divisions of railway transport, directly related to the implementation of the process approach, the advantage of which is a more detailed regulation of management actions and their mutual coordination. In order to increase the efficiency of its activities and develop the management system, Russian Railways is developing a lean production system aimed at further expanding the implementation of the principles of customer orientation, ideology and corporate culture.
At the present time, the solution of many issues is impossible without a cybernetic approach to the formulation of problems of material and technical support and logistics analysis of information technologies, to the implementation of the developed algorithms and models of development strategies and concepts for improving the business processes of the production system. The management strategy, or the general plan for the implementation of activities for the management of material resources, is based on a fundamental assessment of the alignment and correlation of forces and factors operating in the economic and political field, taking into account the impact on the specific form of the management strategy.
The materials will be useful to the heads and specialists of the directorates of the MTO, CDZs and can be used in the scientific research of bachelors, masters and postgraduates interested in the economics of railway transport and supply logistics.
Russophobia: the story of a chimera
Authors: Karabuschenko Pavel
Published: May 2021

This paper presents the history of the development of the Russophobic tradition of the collective West, which it used in its political and ideological interests. Russophobia is a chimera of Western propaganda, based on myths about the superiority of Western civilization and the chronic backwardness of Russians. The tradition indicated by the author is assessed as a kind of pseudo-ideological chimera, which permanently arises in the national enemies and geopolitical competitors of Russia as the main ideological means in the general mechanism of deterring the imaginary "Russian threat". It is known that Russia itself has improved the political space of Eastern Europe and Asia, in accordance with the understanding of its goals and objectives. And most often, it was this independence that caused discontent and indignation of her opponents.
It is intended for all those who are interested in the political history and modern politics of Russia.
Mineral oil: the development of ideas about the inorganic origin of oil and gas deposits
Authors: Pikovskiy Yuriy
Published: May 2021

The widely accepted theory of the organic origin of oil and gas accumulations is practically not used to select promising areas and places for exploratory drilling. This makes us pay close attention to the alternative mineral concept of the genesis of these minerals. The purpose of the book is to show how ideas about the deep inorganic origin of accumulations of oil and hydrocarbon gas developed from antiquity to modern times, before the creation of modern mineral theory. The importance of mineral theory for forecasting large oil and gas fields, as well as for optimizing oil and gas geoecology is shown.
For a wide range of readers interested in the origin of oil and gas fields, as well as the history of the development of this field of knowledge.
Pananthropea
Authors: Borzyh Stanislav
Published: May 2021

The monograph is dedicated to the supercontinent Pananthropea, which was created by the efforts of people, and therefore is named in his honor. It consists of all purely geographical continents, as well as all land areas, representing a single organism that functions exactly as a whole, but at the same time divided by nature itself. The relevance of this approach is shown as follows, as described in the three chapters of the text. First, it demonstrates the physical connectivity of all regions of our planet with each other, which is expressed in a change in the logic of the topology, today planted and controlled by man. Secondly, the presence of this huge and unbroken array is evidenced by the biological component of the world economy, which we have also transformed to suit our needs, thereby redrawing the natural course of affairs in this area and turning it into a global one. Third, the same is true of the cultural domain of our life, which at some point became universal, which again was achieved for the sake of our goals and interests, as a result of which we are all now members of a single interconnected association.
It is of interest to both specialists and a wide audience and will be useful for us to understand both ourselves and the reality that we have constructed.
Implementation of the Law on Responsible Treatment of Animals: from the quality of norms to effective law enforcement
Authors: Avhadeev V. , Bitkova L. , Bogolyubov C. , Bondarchuk I. , Vinokurov A. , Galinovskaya E. , Gorohov D. , Zlotnikova T. , Ivakin V. , Kichigin N. , Kupcova O. , Minina E. , Mukasheva A. , Olenina T. , Rudenko A. , Sivakov D. , Suyunchev M. , Hludeneva N. , Chertkov A. , Shuplecova Yu.
Published: May 2021

The collection contains articles on the quality of the conceptual apparatus and terminology of Federal Law No. 498-FZ of December 27, 2018 "On Responsible Treatment of Animals and on Amendments to Certain Legislative Acts of the Russian Federation", the subject of its legal regulation, the effectiveness of the mechanism for its implementation laid down in the law, state supervision and public control in the field of animal treatment. The problems of organizing the activities of animal shelters without owners, protecting animals from abuse and responsibility for such offenses, directions and ways to improve Federal Law No. 498-FZ and the practice of its application are also highlighted. Attention is paid not only to modern, but also to historical, international and foreign experience of legal regulation of the considered social relations, norms-requirements, restrictions and prohibitions in the field of keeping and using animals, moral and ethical aspects of interaction between people and animals, which emphasizes the complex and interdisciplinary nature of the presented research.
The publication is addressed to lawyers-scientists and practitioners, subjects of the law of legislative initiative, employees of state authorities and local self-government bodies directly involved in the application of the norms of Federal Law No. 498-FZ, employees of various organizations engaged in the maintenance, use and protection of animals, animal rights activists, students and postgraduates of law schools, as well as a wide range of readers interested in this issue.
The United States’ Policy towards the World Trade Organization during the Presidency of Donald Trump
Authors: Kleszczyńska Iga
Published: May 2021

The United States’ Policy towards the World Trade Organization during the Presidency of Donald Trump
The purpose of this article is to analyze the United States’ policy towards the World Trade Organization (WTO) during the presidency of Donald Trump. Given the stated aim, research questions allow to identify the significant priorities of American foreign policy within the Organization, trade policy challenges, and the current and future survival ofthe global exchange system. Hence, the article is focused on: the importance of the WTO for the global exchange system; the role and capabilities of the United States (US) in the Organization’s analysis; and identification of main priorities and challenges of the US foreign policy towards the WTO in the context of the current trade rivalry with China and itsimpact on the WTO’s future. The main hypothesis of the article indicates that the current US trade policy weakens the possibilities and further functioning of the WTO. The main theoretical perspective of the article is based on institutional liberalism and the theory of comparative advantage. The article has been developed by applying historical, institutional, and legal systemic and content analysis methods (in particular, government, WTO, and think tank reports and analyses).
Mid-term results of tibial cones
Authors: Hernandez Nicholas M. , Hinton Zoe W. , Wu Christine J. , Ryan Sean P. , Bolognesi Michael P.
Published: May 2021

Aims

Tibial cones are often utilized in revision total knee arthroplasty (TKA) with metaphyseal defects. Because there are few studies evaluating mid-term outcomes with a sufficient cohort, the purpose of this study was to evaluate tibial cone survival and complications in revision TKAs with tibial cones at minimum follow-up of five years.

Methods

A retrospective review was completed from September 2006 to March 2015, evaluating 67 revision TKAs (64 patients) that received one specific porous tibial cone during revision TKA. The final cohort was composed of 62 knees (59 patients) with five years of clinical follow-up or reoperation. The mean clinical follow-up of the TKAs with minimum five-year clinical follow-up was 7.6 years (5.0 to 13.3). Survivorship analysis was performed with the endpoints of tibial cone revision for aseptic loosening, tibial cone revision for any reason, and reoperation. We also evaluated periprosthetic joint infection (PJI), risk factors for failure, and performed a radiological review.

Results

The rate of cone revision for aseptic loosening was 6.5%, with an eight-year survival of 95%. Significant bone loss (Anderson Orthopaedic Research Institute grade 3) was associated with cone revision for aseptic loosening (p = 0.002). The rate of cone revision for any reason was 17.7%, with an eight-year survival of 84%. Sixteen percent of knees developed PJI following revision. A pre-revision diagnosis of reimplantation as part of a two-stage exchange protocol for infection was associated with both PJI (p < 0.001) and tibial cone revision (p = 0.001).

Conclusion

Mid-term results of tibial cones showed a survivorship free of cone revision for aseptic loosening of 95%. Patients with significant bone loss were more likely to have re-revision for tibial cone failure. Infection was common, and patients receiving cones at reimplantation were more likely to develop PJI and undergo cone revision. Cite this article: Bone Joint J 2021;103-B(6 Supple A):158–164.
Unexpected high rate of revision of a modern cemented fixed bearing modular posterior-stabilized knee arthroplasty
Authors: Lachiewicz Paul F. , Steele John R. , Wellman Samuel S.
Published: May 2021

Aims

To establish our early clinical results of a new total knee arthroplasty (TKA) tibial component introduced in 2013 and compare it to other designs in use at our hospital during the same period.

Methods

This is a retrospective study of 166 (154 patients) consecutive cemented, fixed bearing, posterior-stabilized (PS) TKAs (ATTUNE) at one hospital performed by five surgeons. These were compared with a reference cohort of 511 knees (470 patients) of other designs (seven manufacturers) performed at the same hospital by the same surgeons. There were no significant differences in age, sex, BMI, or follow-up times between the two cohorts. The primary outcome was revision performed or pending.

Results

In total, 19 (11.5%) ATTUNE study TKAs have been revised at a mean 30.3 months (SD 15), and loosening of the tibial component was seen in 17 of these (90%). Revision is pending in 12 (7%) knees. There was no difference between the 31 knees revised or with revision pending and the remaining 135 study knees in terms of patient characteristics, type of bone cement (p = 0.988), or individual surgeon (p = 0.550). In the reference cohort, there were significantly fewer knees revised (n = 13, 2.6%) and with revision pending (n = 8, 1.5%) (both p < 0.001), and only two had loosening of the tibial component as the reason for revision.

Conclusion

This new TKA design had an unexpectedly high early rate of revision compared with our reference cohort of TKAs. Debonding of the tibial component was the most common reason for failure. Additional longer-term follow-up studies of this specific component and techniques for implantation are warranted. The version of the ATTUNE tibial component implanted in this study has undergone modifications by the manufacturer. Cite this article: Bone Joint J 2021;103-B(6 Supple A):137–144.
Impact of perivascular lymphocytic infiltration in aseptic total knee revision
Authors: Crawford David A. , Passias Braden J. , Adams Joanne B. , Berend Keith R. , Lombardi Adolph V.
Published: May 2021

Aims

A limited number of investigations with conflicting results have described perivascular lymphocytic infiltration (PVLI) in the setting of total knee arthroplasty (TKA). The purpose of this study was to determine if PVLI found in TKAs at the time of aseptic revision surgery was associated with worse clinical outcomes and survivorship.

Methods

A retrospective review was conducted on 617 patients who underwent aseptic TKA revision who had histological analysis for PVLI at the time of surgery. Clinical and radiological data were obtained pre- and postoperatively, six weeks postoperatively, and then every year thereafter.

Results

Within this cohort, 118 patients (19.1%) were found to have PVLI on histological analysis. Re-revision was performed on 83 patients (13.4%) with no significant differences in all-cause or aseptic revisions between groups. A higher incidence of PVLI was noted in female patients (p = 0.037). There was no significant difference in improvement in the range of motion (p = 0.536), or improvement of KSC (p = 0.66), KSP (p = 0.61), or KSF (p = 0.3) clinical outcome scores between PVLI and no PVLI sub-groups. There was a higher incidence of a preoperative diagnosis of pain in the PVLI group compared with patients without PVLI (p = 0.002) present.

Conclusion

PVLI found on large-scale histological analysis in TKAs at aseptic revision surgery was not associated with worse clinical outcomes or rates of re-revision. Cite this article: Bone Joint J 2021;103-B(6 Supple A):145–149.
Excellent mid-term follow-up for a new 3D-printed cementless total knee arthroplasty
Authors: Restrepo Santiago , Smith Eric B. , Hozack William James
Published: May 2021

Aims

Cementless total knee arthroplasty (TKA) offers the potential for strong biological fixation compared with cemented TKA where fixation is achieved by the mechanical integration of the cement. Few mid-term results are available for newer cementless TKA designs, which have used additive manufacturing (3D printing). The aim of this study was to present mid-term clinical outcomes and implant survivorship of the cementless Stryker Triathlon Tritanium TKA.

Methods

This was a single institution registry review of prospectively gathered data from 341 cementless Triathlon Tritanium TKAs at four to 6.8 years follow-up. Outcomes were determined by comparing pre- and postoperative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) scores, and pre- and postoperative 12-item Veterans RAND/Short Form Health Survey (VR/SF-12) scores. Aseptic loosening and revision for any reason were the endpoints which were used to determine survivorship at five years.

Results

At mid-term follow-up, the mean KOOS JR score improved significantly from 33.14 (0 t0 85, standard deviation (SD) 21.88) preoperatively to 84.12 (15.94 to 100, SD 20.51) postoperatively (p < 0.001), the mean VR/SF-12 scores improved significantly from physical health (PH), 31.21 (SD 5.32; 23.99 to 56.77) preoperatively to 42.62 (SD 10.72; 19.38 to 56.82) postoperatively (p < 0.001) and the mental health (MH), 38.15 (SD 8.17; 19.06 to 60.75) preoperatively to 55.09 (SD 9.64; 19.06 to 66.98) postoperatively (p < 0.001). A total of 11 revisions were undertaken, with an overall revision rate of 2.94%, including five for periprosthetic joint infection (1.34%), three for loosening (0.80%), two for instability (0.53%), and one for pain (0.27%). The overall survivorship was 97.06% and survivorship for aseptic loosening as the endpoint was 98.40%, with a 99.5% survivorship of the 3D-printed tibial component.

Conclusion

This 3D-printed cementless total knee system shows excellent survivorship at mid-term follow-up. This design and the ability to obtain cementless fixation offers promise for excellent long-term durability. Cite this article: Bone Joint J 2021;103-B(6 Supple A):32–37.
Telemedicine during the COVID-19 pandemic
Authors: Chen Jeffrey Shi , Buchalter Daniel B. , Sicat Chelsea S. , Aggarwal Vinay K. , Hepinstall Matthew S. , Lajam Claudette M. , Schwarzkopf Ran S. , Slover James D.
Published: May 2021

Aims

The COVID-19 pandemic led to a swift adoption of telehealth in orthopaedic surgery. This study aimed to analyze the satisfaction of patients and surgeons with the rapid expansion of telehealth at this time within the division of adult reconstructive surgery at a major urban academic tertiary hospital.

Methods

A total of 334 patients underging arthroplasty of the hip or knee who completed a telemedicine visit between 30 March and 30 April 2020 were sent a 14-question survey, scored on a five-point Likert scale. Eight adult reconstructive surgeons who used telemedicine during this time were sent a separate 14-question survey at the end of the study period. Factors influencing patient satisfaction were determined using univariate and multivariate ordinal logistic regression modelling.

Results

A total of 68 patients (20.4%) and 100% of the surgeons completed the surveys. Patients were “Satisfied” with their telemedicine visits (4.10/5.00 (SD 0.98)) and 19 (27.9%) would prefer telemedicine to in-person visits in the absence of COVID-19. Multivariate ordinal logistic regression modelling revealed that patients were more likely to be satisfied if their surgeon effectively responded to their questions or concerns (odds ratio (OR) 3.977; 95% confidence interval (CI) 1.260 to 13.190; p = 0.019) and if their visit had a high audiovisual quality (OR 2.46; 95% CI 1.052 to 6.219; p = 0.042). Surgeons were “Satisfied” with their telemedicine experience (3.63/5.00 (SD 0.92)) and were “Fairly Confident” (4.00/5.00 (SD 0.53)) in their diagnostic accuracy despite finding the physical examinations to be only “Slightly Effective” (1.88/5.00 (SD 0.99)). Most adult reconstructive surgeons, seven of eight (87.5%) would continue to use telemedicine in the future.

Conclusion

Telemedicine emerged as a valuable tool during the COVID-19 pandemic. Patients undergoing arthroplasty and their surgeons were satisfied with telemedicine and see a role for its use after the pandemic. The audiovisual quality and the responsiveness of physicians to the concerns of patients determine their satisfaction. Future investigations should focus on improving the physical examination of patients through telemedicine and strategies for its widespread implementation. Cite this article: Bone Joint J 2021;103-B(6 Supple A):196–204.
Results of debridement, antibiotics, and implant retention for periprosthetic knee joint infection supplemented with the use of intraosseous antibiotics
Authors: Kildow Beau J. , Patel Shaun P. , Otero Jesse E. , Fehring Keith A. , Curtin Brian M. , Springer Bryan D. , Fehring Thomas K.
Published: May 2021

Aims

Debridement, antibiotics, and implant retention (DAIR) remains one option for the treatment of acute periprosthetic joint infection (PJI) despite imperfect success rates. Intraosseous (IO) administration of vancomycin results in significantly increased local bone and tissue concentrations compared to systemic antibiotics alone. The purpose of this study was to evaluate if the addition of a single dose of IO regional antibiotics to our protocol at the time of DAIR would improve outcomes.

Methods

A retrospective case series of 35 PJI TKA patients, with a median age of 67 years (interquartile range (IQR) 61 to 75), who underwent DAIR combined with IO vancomycin (500 mg), was performed with minimum 12 months' follow-up. A total of 26 patients with primary implants were treated for acute perioperative or acute haematogenous infections. Additionally, nine patients were treated for chronic infections with components that were considered unresectable. Primary outcome was defined by no reoperations for infection, nor clinical signs or symptoms of PJI.

Results

Mean follow-up for acute infection was 16.5 months (12.1 to 24.2) and 15.8 months (12 to 24.8) for chronic infections with unresectable components. Overall non-recurrence rates for acute infection was 92.3% (24/26) but only 44.4% (4/9) for chronic infections with unresectable components. The majority of patients remained on suppressive oral antibiotics. Musculoskeletal Infection Society (MSIS) host grade was a significant indicator of failure (p < 0.001).

Conclusion

The addition of IO vancomycin at the time of DAIR was shown to be safe with improved results compared to current literature using standard DAIR without IO antibiotic administration. Use of this technique in chronic infections should be applied with caution. While these results are encouraging, this technique requires longer follow-up before widespread adoption. Cite this article: Bone Joint J 2021;103-B(6 Supple A):185–190.
High-volume revision surgeons have better outcomes following revision total knee arthroplasty
Authors: Roof Mackenzie A. , Sharan Mohamad , Merkow David , Feng James E. , Long William J. , Schwarzkopf Ran S.
Published: May 2021

Aims

It has previously been shown that higher-volume hospitals have better outcomes following revision total knee arthroplasty (rTKA). We were unable to identify any studies which investigated the effect of surgeon volume on the outcome of rTKA. We sought to investigate whether patients of high-volume (HV) rTKA surgeons have better outcomes following this procedure compared with those of low-volume (LV) surgeons.

Methods

This retrospective study involved patients who underwent aseptic unilateral rTKA between January 2016 and March 2019, using the database of a large urban academic medical centre. Surgeons who performed ≥ 19 aseptic rTKAs per year during the study period were considered HV and those who performed < 19 per year were considered LV. Demographic characteristics, surgical factors, and postoperative outcomes were compared between the two groups.

Results

A total of 308 rTKAs were identified, 132 performed by HV surgeons and 176 by 22 LV surgeons. The LV group had a significantly greater proportion of non-smokers (59.8% vs 49.2%; p = 0.029). For all types of revision, HV surgeons had significantly shorter mean operating times by 17.75 minutes (p = 0.007). For the 169 full revisions (85 HV, 84 LV), HV surgeons had significantly shorter operating times (131.12 (SD 33.78) vs 171.65 (SD 49.88) minutes; p < 0.001), significantly lower re-revision rates (7.1% vs 19.0%; p = 0.023) and significantly fewer re-revisions (0.07 (SD 0.26) vs 0.29 (SD 0.74); p = 0.017).

Conclusion

Patients of HV rTKA surgeons have better outcomes following full rTKA. These findings support the development of revision teams within arthroplasty centres of excellence to offer patients the best possible outcomes following rTKA. Cite this article: Bone Joint J 2021;103-B(6 Supple A):131–136.
Patient satisfaction following total knee arthroplasty using restricted kinematic alignment
Authors: Abhari Sarag , Hsing Thomas M. , Malkani Max M. , Smith Austin F. , Smith Langan S. , Mont Michael A. , Malkani Arthur L.
Published: May 2021

Aims

Alternative alignment concepts, including kinematic and restricted kinematic, have been introduced to help improve clinical outcomes following total knee arthroplasty (TKA). The purpose of this study was to evaluate the clinical results, along with patient satisfaction, following TKA using the concept of restricted kinematic alignment.

Methods

A total of 121 consecutive TKAs performed between 11 February 2018 to 11 June 2019 with preoperative varus deformity were reviewed at minimum one-year follow-up. Three knees were excluded due to severe preoperative varus deformity greater than 15°, and a further three due to requiring revision surgery, leaving 109 patients and 115 knees to undergo primary TKA using the concept of restricted kinematic alignment with advanced technology. Patients were stratified into three groups based on the preoperative limb varus deformity: Group A with 1° to 5° varus (43 knees); Group B between 6° and 10° varus (56 knees); and Group C with varus greater than 10° (16 knees). This study group was compared with a matched cohort of 115 TKAs and 115 patients using a neutral mechanical alignment target with manual instruments performed from 24 October 2016 to 14 January 2019.

Results

Mean overall patient satisfaction for the entire cohort was 4.7 (SE 0.1) on a 5-point Likert scale, with 93% being either very satisfied or satisfied compared with a Likert of 4.3 and patient satisfaction of 81% in the mechanical alignment group (p < 0.001 and p < 0.006 respectively). At mean follow-up of 17 months (11 to 27), the mean overall Likert, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Western Ontario and McMaster Universities Osteoarthritis Index, Forgotten Joint Score, and Knee Society Knee and Function Scores were significantly better in the kinematic group than in the neutral mechanical alignment group. The most common complication in both groups was contracture requiring manipulation under anaesthesia, involving seven knees (6.1%) in the kinematic group and nine knees (7.8%) in the mechanical alignment group.

Conclusion

With the advent of advanced technology, and the ability to obtain accurate bone cuts, the target limb alignment, and soft-tissue balance within millimetres, using a restricted kinematic alignment concept demonstrated excellent patient satisfaction following primary TKA. Longer-term analysis is required as to the durability of this method. Cite this article: Bone Joint J 2021;103-B(6 Supple A):59–66.
The effectiveness of laboratory tests to predict early postoperative periprosthetic infection after total knee arthroplasty
Authors: Uvodich Mason E. , Dugdale Evan M. , Osmon Douglas R. , Pagnano Mark W. , Berry Daniel J. , Abdel Matthew P.
Published: May 2021

Aims

It remains difficult to diagnose early postoperative periprosthetic joint infection (PJI) following total knee arthroplasty (TKA). We aimed to validate the optimal cutoff values of ESR, CRP, and synovial fluid analysis for detecting early postoperative PJI in a large series of primary TKAs.

Methods

We retrospectively identified 27,066 primary TKAs performed between 2000 and 2019. Within 12 weeks, 169 patients (170 TKAs) had an aspiration. The patients were divided into two groups: those evaluated ≤ six weeks, or between six and 12 weeks postoperatively. The 2011 Musculoskeletal Infection Society (MSIS) criteria for PJI diagnosis in 22 TKAs. The mean follow-up was five years (two months to 17 years). The results were compared using medians and Mann-Whitney U tests and thresholds were analyzed using receiver operator characteristic curves.

Results

Within six weeks, the median CRP (101 mg/l vs 35 mg/l; p = 0.011), synovial WBCs (58,295 cells/μl vs 2,121 cells/μl; p ≤ 0.001), percentage of synovial neutrophils (91% vs 71% (p < 0.001), and absolute synovial neutrophil count (ANC) (50,748 cells/μl vs 1,386 cells/μl (p < 0.001) were significantly higher in infected TKAs. Between six and 12 weeks, the median CRP (85 mg/l vs 5 mg/l (p < 0.001)), ESR (33 mm/hr vs 14 mm/hr (p = 0.015)), synovial WBCs (62,247 cells/μl vs 620 cells/μl (p < 0.001)), percentage of synovial neutrophils (93% vs 54% (p < 0.001)), and ANC (55,911 cells/μl vs 326 cells/μl (p < 0.001)) were also significantly higher in infected TKAs. Optimal thresholds at ≤ six weeks were: CRP ≥ 82 mg/l (sensitivity 70%, specificity 77%), synovial WBCs ≥ 8,676 cells/μl (83%, 90%), percentage of synovial neutrophils ≥ 88% (67%, 78%), and ANC ≥ 8,346 cells/μl (83%, 91%). Between six and 12 weeks, thresholds were: CRP ≥ 34 mg/l (90%, 93%), synovial WBCs ≥ 1,983 cells/μl (80%, 85%), percentage of synovial neutrophils ≥ 76% (80%, 81%), and ANC ≥ 1,684 cells/μl (80%, 87%).

Conclusion

Early PJI after TKA should be suspected within six weeks if the CRP is ≥ 82 mg/l, synovial WBCs are ≥ 8,676 cells/μl, the percentage of synovial neutrophils is ≥ 88%, and/or the ANC is ≥ 8,346 cells/μl. Between six and 12 weeks, thresholds include a CRP of ≥ 34 mg/l, synovial WBC of ≥ 1,983 cells/μl, a percentage of synovial neutrophils of ≥ 76%, and/or an ANC of ≥ 1,684 cells/μl. Cite this article: Bone Joint J 2021;103-B(6 Supple A):177–184.
2021 Chitranjan S. Ranawat Award: Intraosseous vancomycin reduces periprosthetic joint infection in primary total knee arthroplasty at 90-day follow-up
Authors: Park Kwan J. , Chapleau Julien , Sullivan Thomas C. , Clyburn Terry A. , Incavo Stephen J.
Published: May 2021

Aims

Infection complicating primary total knee arthroplasty (TKA) is a common reason for revision surgery, hospital readmission, patient morbidity, and mortality. Increasing incidence of methicillin-resistant Staphylococcus aureus (MRSA) is a particular concern. The use of vancomycin as prophylactic agent alone or in combination with cephalosporin has not demonstrated lower periprosthetic joint infection (PJI) rates, partly due to timing and dosing of intravenous (IV) vancomycin administration, which have proven important factors in effectiveness. This is a retrospective review of a consecutive series of primary TKAs examining incidence of PJI, adverse reactions, and complications using IV versus intraosseous (IO) vancomycin at 30-day, 90-day, and one-year follow-up.

Methods

A retrospective review of 1,060 patients who underwent TKA between May 2016 to July 2020 was performed. There were 572 patients in the IV group and 488 in the IO group, with minimal 30 days of follow-up. Patients were followed up at regularly scheduled intervals (two, six, and 12 weeks). No differences between groups for age, sex, BMI, or baseline comorbidities existed. The IV group received an IV dose of 15 mg/kg vancomycin given over an hour preceding skin incision. The IO group received a 500 mg dose of vancomycin mixed in 150 ml of normal saline, injected into proximal tibia after tourniquet inflation, before skin incision. All patients received an additional dose of first generation cephalosporin. Evaluation included preoperative and postoperative serum creatinine values, tourniquet time, and adverse reactions attributable to vancomycin.

Results

Incidence of PJI with minimum 90-day follow-up was 1.4% (eight knees) in the IV group and 0.22% (one knee) in IO group (p = 0.047). This preliminary report demonstrated an reduction in the incidence of infection in TKA using IO vancomycin combined with a first-generation cephalosporin. While the study suffers from limitations of a retrospective, multi-surgeon investigation, early findings are encouraging.

Conclusion

IO delivery of vancomycin after tourniquet inflation is a safe and effective alternative to IV administration, eliminating the logistical challenges of timely dosing. Cite this article: Bone Joint J 2021;103-B(6 Supple A):13–17.
Preoperative risk stratification minimizes 90-day complications in morbidly obese patients undergoing primary total knee arthroplasty
Authors: Kerbel Yehuda E. , Johnson Mitchell A. , Barchick Stephen R. , Cohen Jordan S. , Stevenson Kimberly Lola , Israelite Craig L. , Nelson Charles L.
Published: May 2021

Aims

It has been shown that the preoperative modification of risk factors associated with obesity may reduce complications after total knee arthroplasty (TKA). However, the optimal method of doing so remains unclear. The aim of this study was to investigate whether a preoperative Risk Stratification Tool (RST) devised in our institution could reduce unexpected intensive care unit (ICU) transfers and 90-day emergency department (ED) visits, readmissions, and reoperations after TKA in obese patients.

Methods

We retrospectively reviewed 1,614 consecutive patients undergoing primary unilateral TKA. Their mean age was 65.1 years (17.9 to 87.7) and the mean BMI was 34.2 kg/m2 (SD 7.7). All patients underwent perioperative optimization and monitoring using the RST, which is a validated calculation tool that provides a recommendation for postoperative ICU care or increased nursing support. Patients were divided into three groups: non-obese (BMI < 30 kg/m2, n = 512); obese (BMI 30 kg/m2 to 39.9 kg/m2, n = 748); and morbidly obese (BMI > 40 kg/m2, n = 354). Logistic regression analysis was used to evaluate the outcomes among the groups adjusted for age, sex, smoking, and diabetes.

Results

Obese patients had a significantly increased rate of discharge to a rehabilitation facility compared with non-obese patients (38.7% (426/1,102) vs 26.0% (133/512), respectively; p < 0.001). When stratified by BMI, discharge to a rehabilitation facility remained significantly higher compared with non-obese (26.0% (133)) in both obese (34.2% (256), odds ratio (OR) 1.6) and morbidly obese (48.0% (170), OR 3.1) patients (p < 0.001). However, there was no significant difference in unexpected ICU transfer (0.4% (two) non-obese vs 0.9% (seven) obese (OR 2.5) vs 1.7% (six) morbidly obese (OR 5.4); p = 0.054), visits to the ED (8.6% (44) vs 10.3% (77) (OR 1.3) vs 10.5% (37) (OR 1.2); p = 0.379), readmissions (4.5% (23) vs 4.0% (30) (OR 1.0) vs 5.1% (18) (OR 1.4); p = 0.322), or reoperations (2.5% (13) vs 3.3% (25) (OR 1.2) vs 3.1% (11) (OR 0.9); p = 0.939).

Conclusion

With the use of a preoperative RST, morbidly obese patients had similar rates of short-term postoperative adverse outcomes after primary TKA as non-obese patients. This supports the assertion that morbidly obese patients can safely undergo TKA with appropriate perioperative optimization and monitoring. Cite this article: Bone Joint J 2021;103-B(6 Supple A):45–50.