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Purpose: Total knee arthroplasty (TKA) in patients who underwent previous knee surgeries can be a challenging procedure both technically and for the complication rate. Conversion TKA is affected by a higher risk of infection compared to primary TKA. The aims of this meta-analysis are i) to compare the infectious risk among patients undergoing TKA after a prior hardware implantation, evaluating removal vs maintenance of the hardware, and ii) within the removal group, to compare staged vs concurrent procedure. Methods: In accordance with the PRISMA guidelines, a systematic literature review was conducted up to January 2024. The review was registered in the PROSPERO database: CRD42024510444. The inclusion criteria comprised the following: i) patients aged 18 years or older, ii) individuals who had undergone total knee replacement and iii) those with a history of prior nonabsorbable hardware implantation. The pooled incidence of periprosthetic joint infections (PJI) was reported using odds ratios with corresponding 95% confidence intervals (CIs). Results: The investigation of database and references identified 284 studies. PJI risks differed significantly among groups, with a higher risk in the removal group (z = 3.5630, P = 0.0004). Furthermore, within the removal group, the risk of PJI was lower in cases of staged removal compared to concurrent removal (z = 2.0931, P = 0.0363). Conclusions: TKA following a previous knee hardware implantation indicates a higher PJI risk when the hardware is removed compared to leaving it in place. If hardware removal is necessary, staged removal is recommended. The presence of minor hardware is the only scenario where, if removal is necessary, one-stage approach is preferred.

From Egyptian mummies to the Chanel N° 5 perfume, aldehydes have been used for a long time and continue to impact our senses in a wide range of perfumes, foods, and beverages. Aldehydes represent one of the categories of volatile organic compounds (VOCs), which are categorized as chemicals with boiling points up to 260 °C and can be found in indoor environments in the gaseous phase. Because of their potential or known hazardous properties for humans, the World Health Organization (WHO)-Europe provided some guidelines that may prevent several health risks. Indeed, some aldehydes, reported to be risky for humans, have been retired from the market, such as butylphenyl methylpropional (BMHCA). The purpose of this review is to summarize the most important aldehydes found indoors and outdoors and analyse in depth the toxicological aspects of these compounds, whose presence in perfumes is often underestimated. In addition, the ingredients’ synonyms that are reported in the literature for the same compound were unified in order to simplify their identification.

Spine pain (SP) is the most common musculoskeletal disorder that causes transitional forms of motor disability. Considering its affordability and safety, manipulative therapy (MT) stands as one of the primary therapeutic approaches for SP and the related dysfunctional consequences. However, it is still difficult to assess and quantify the results of this treatment since there is a lack of objective evaluation tools in the available scientific literature. Thus, the purpose of this comprehensive review is to summarize the main outcomes used to evaluate the effectiveness of spine manipulations, focusing on their strengths and weaknesses. An extensive review of the PubMed, Cochrane, and Embase databases was performed to identify the literature of the last ten years regarding MT and the related assessment tools. A total of 12 studies met the inclusion criteria. The analyzed literature indicates that a wide range of outcome measures have been used to assess the effectiveness of spine MT. Pain is the main aspect to be investigated but it remains difficult to elucidate since it is strongly linked to various dimensions such as self-perception and psychological aspects. Therefore, it seems necessary to include new tools for evaluating the effects of spine MT, with the aim of exploiting new technologies and taking into consideration the SP biomechanical and biopsychosocial aspects.

Category: Hindfoot; Other Introduction/Purpose: Subtalar arthrodesis (SA) is a common procedure to treat end-stage subtalar osteoarthritis. We set out in order to determine whether a combined direct fixation of both anterior and posterior facets during SA might influence union and complications compared to isolated fixation of the posterior facet. Our hypothesis was that a combined fixation increases the union rate and reduces the complication rate. Methods: In this PRISMA-compliant PROSPERO-registered systematic review, we included studies reporting data after SA stabilized with screws in adults. The characteristics of the cohort, study design, surgical details, nonunion and complication rate at the longest follow-up were recorded. The modified Coleman Methodology Score (mCMS) was applied to appraise the quality of studies. Two groups were compared: an ANT/POST group (screws positioned both in the anterior and posterior facet) and an ONLY POST group (isolated posterior facet fixation). Results: Eighteen series (685 feet: ANT/POST=96, ONLY POST=589) were selected. The median follow-up was 28 months (IQR, 12-42). The pooled proportion showed a similar nonunion rate (6% vs 10%;p=0.46) and complication rate (14% vs 19%,p=0.47) in the ANT/POST group as compared to the ONLY POST group. The pooled proportion of reoperation was not different either (ANT/POST: 7% vs ONLY POST: 10%,p=0.37). Kernel regression suggested a correlation between the proportion of open/arthroscopic procedures and the nonunion rate (p=0.025) with a median nonunion rate at 10.9% and 5.9% for open and arthroscopic procedures, respectively. Mean CMS was 40.4 points (poor quality). Conclusion: This proportional meta-analysis suggested that a combined direct fixation of anterior and posterior facets during subtalar arthrodesis does not significantly influence the risk of nonunion nor affects the risk of complication and reoperation as compared to isolated posterior facet fixation.

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle replacement (TAR) is gaining momentum as surgical option in end-stage ankle osteoarthritis. Periprosthetic joint infection (PJI) is one of the most common complications and its management may be challenging. Our aim was to define the eradication rate and limits of the surgical procedures performed to treat PJI after TAR. Methods: This systematic review followed the PRISMA checklist and was registered in the Open Science Framework platform. Multiple databases were searched including clinical studies in which PJI after TAR was diagnosed and treated. Data were harvested regarding the cohort, the study design, the diagnostic criteria and the surgical treatment for PJI. The methodological index for nonrandomized studies (MINORS) was used to assess the methodological quality of studies. Three groups were built based on the surgical procedure performed by authors: Group 1 for debridement, antibiotics, and implant retention (DAIR), Group 2 for 1.5-stage revision (1.5-stage) and Group 3 for 2-stage revision procedures (2-stage). Results: Fourteen cohorts (eight studies,152 infected TARs, 152 patients; 44% females, mean age: 61.4 years) were included. All studies had a retrospective design. Ankle pain with swelling and increased local temperature usually led to a suspicion of PJI. In 100% of cases the diagnosis was confirmed through synovial fluid analysis with positive blood tests. Microorganisms were identified in 92% (range,64%-100%) of cases. The definition of eradication of the infection was heterogenous ( ‘no more surgery’ (4 studies)), normal clinical-serological markers (2 studies), negative intraoperative cultures (2 studies). The eradication rate in DAIR, 1.5-stage and 2-stage groups was 64% (39/58 patients) 91% (11/12) and 89% (47/54),respectively. The incidence of below-knee amputation was 6.5% at 38.6-month follow-up. MINORS score was 8/16 for noncomparative studies and 14.6/24 for comparative ones (moderate quality). Conclusion: Decision-making in PJI after TAR is based on small-sample retrospective studies of moderate quality. In this review, the estimated effectiveness of DAIR and exchange procedures to eradicate the infection was two-thirds and nine-tenths, respectively. In case of failure, below-knee amputation is not uncommon.

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle replacement (TAR) is an effective treatment for end-stage osteoarthritis. The aim of this systematic review was to assess the age of patients undergoing TAR in prospective comparative studies. Our hypothesis is that the age reported in most recent papers might be lower than those reported in older papers. Methods: This systematic review was performed using Pubmed, Scopus, EMBASE and Cochrane databases. Only Level I and II studies dealing with TAR were included. Data regarding demographics, study design, year of publication and year/years in which surgery was performed were extracted. A two-fold analysis was conducted building groups of patients based on the year of publication and creating 1) two groups (before and after the median year) and 2) three groups (using tertiles) in order to compare age of patients operated in different period of times. A comparison was also performed considering the median year of surgery for patients undergoing TAR. Results: Overall 59 cohorts (42 studies, published between 1999 and 2023; median year of publication: 2017) were included (6364 ankles, 6284 patients, median age 63 years). The difference between the median age for 27 cohorts published until 2016 (weighted median 63 years; IQR, 62.5-64) and the median age for 33 cohorts published after 2017 (weighted median 63.2 years; IQR, 63-67.8) was not statistically significant (p=0.09). The division in tertiles did not reveal any significant change in the weighted median age at surgery (T1 (1999-2014; 63.2 years; IQR, 62.8-64.1), T2 (2015-2018; 63 years; IQR,63-63.5) and T3 (2019-2023; 63.2 years; IQR, 62.6-67.8)) over time (p=0.65). The median age of patients operated between 1999 and 2008 vs 2009 and 2023 (data from 48 cohorts) was not different either (p=0.12). Conclusion: According to this review of prospective studies published between 1999 and 2023, the median age for patients undergoing TAR over the last two decades has been 63 years, remaining steady with no significant changes over time.

The scientific interest in the chemical modification of chitosan to increase its solubility and application has led to its conjugation with Schiff bases, which are interesting scaffolds endowed with diverse biological properties. The resultant chitosan-based Schiff bases (CSBs) are widely studied in scientific literature due to the myriad of activities exerted, both catalytic and biological, including anticancer, anti-inflammatory, antioxidant, and especially antimicrobial ones. Antimicrobial resistance (AMR) is one of the major public health challenges of the twenty-first century because it represents a threat to the prevention and treatment of a growing number of bacterial, parasitic, viral, and fungal infections that are no longer treatable with the available drugs. Thus, in this review, we present a brief outline of the biological activities of CSBs as well as their complexes with metals, with a particular focus on the recent literature regarding the antimicrobial effect of these captivating derivatives.

Recent evidence suggested the existence of a spatial associations for music tempo with faster left-hand responses to relatively slow tempos and faster right-hand responses to relatively fast tempos. We refer to a study that systematically explored these spatial associations across different tempo ranges, revealed a clear effect only in the fast tempo range (DOI 10.3758/s13414-019-01945-8). The present study further investigated whether a spatial association exists across different tempo ranges (i.e., “full”, “slow” or “fast” tempo range). In particular, the present study was conducted aiming (1) to test the spatial associations for tempo in the full tempo range (Experiment 1) and (2) to further investigate the occurrence of this spatial associations in the slow and fast tempo ranges (Experiment 2). Experiment 1 revealed a spatial association for tempo occurs in the full tempo range (40–200 bpm). Experiment 2 confirmed this association in the fast tempo range (133–201 bpm) but showed contradictory results in the slow tempo range (40–104 bpm). This suggests that a spatial association is plausible in the slow tempo range, although further research is needed to clarify this phenomenon.

The strict connections/interactions between microbial infections and cancer are nowadays widely accepted. Hence, the dual (or multiple) targeting of microbial infections and cancer is an essential issue to be addressed. In this context, metal complexes have gained considerable importance and effectiveness in medicinal chemistry. Particularly, N-heterocyclic carbene (NHC) complexes with transition metals have emerged as very promising compounds. Among the myriad of NHC–metal complexes, those bearing silver will be the subject of this review. Numerous Ag(I)-NHC complexes have revealed high antibacterial and/or anticancer properties, even higher than those of reference drugs. Herein, we summarize the most recent studies while also discussing the proposed mechanism of action and offering an interesting remark about the research in this field. Literature databases (PubMed/MEDLINE, Scopus, and Google Scholar) were used as sources to search the literature, referring to the last five years.

Background/Objectives: Infectious diseases represent a serious threat due to rising antimicrobial resistance, particularly among multidrug-resistant bacteria and influenza viruses. Metal-based complexes, such as N-heterocyclic carbene–gold (NHC–gold) complexes, show promising therapeutic potential due to their ability to inhibit various pathogens. Methods: Eight NHC–gold complexes were synthesized and tested for antibacterial activity against Escherichia coli, Enterococcus faecalis, Staphylococcus aureus, and for anti-influenza activity in lung and bronchial epithelial cells infected with influenza virus A/H1N1. Antibacterial activity was assessed through the determination of the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC), while the viral load was quantified using qRT-PCR. Results: Complexes 3, 4, and 6 showed significant antibacterial activity at concentrations of 10–20 µg/mL. Additionally, these complexes significantly reduced viral load, with complexes 3 and 4 markedly inhibiting replication. Conclusions: These findings support the potential use of NHC–gold complexes in combined antimicrobial and antiviral therapies, representing an attractive option for fighting resistant infections.

Coaxial electrospun membranes made of polycaprolactone (PCL) and polyvinylalcohol (PVA) were produced and filled with a promising synthetic gold complex (AuM1) for antitumoral applications. Coaxial nanofibers characterized by a PVA shell and PCL + AuM1 core were made to design a multi-step release in a physiological environment. The coaxial structure can sensitively limit the burst effect, allowing the release of 90% of the active substance AuM1 in about three days. By comparison, the PCL membrane loaded with AuM1 produced via uniaxial electrospinning releases 90% of the drug in about 1 h. The correlation of release kinetic data with the morphological evolution and the spectroscopic investigation highlighted how coaxial electrospinning is a promising process for designing drug delivery systems to control the release of active substances over time. The proper design of core–shell systems could be of great interest for prolonged therapies, such as antitumoral therapy.

N-heterocyclic carbene (NHC)–gold and –silver complexes have attracted the interest of the scientific community because of their multiple applications and their versatility in being chemically modified in order to improve their biological properties. However, most of these complexes contain one or more chiral centers, and have been obtained and studied as racemic mixture. In particular, concerning the interesting biological and medicinal properties, many questions about how the chirality may influence these properties still remain unanswered. Aiming at a better understanding, herein a series of enantiopure NHC–gold and –silver complexes was synthesized, characterized and biologically evaluated in different in vitro systems. The individuated complexes exerted different properties based on the complexed metal and the specific configuration, with the (R)-gold–NHC complexes being the most active, particularly as anti-inflammatory molecules. Docking simulations indicated a different binding mode for each enantiomer. Moreover, anticancer and antibacterial activities were also evaluated for the considered enantiomers. Overall, the reported data may contribute to a better understanding of the different biological properties exerted by the enantiopure gold and silver complexes.

A number of N-heterocyclic carbene–silver compounds (NHCs)AgX were tested in the direct carboxylation of terminal alkynes using carbon dioxide as the C1 carbon feedstock. The reactions proceed at a pressure of 1 atm of CO2 at room temperature, in the presence of Cs2CO3, and using silver–NHC complexes as catalysts. Thus, phenylacetylene and several alkynes are converted to the corresponding propiolic acids in good to high conversions. The activity of the catalysts is strongly influenced by the substituents on the NHC backbone and the nature of the counterion. Specifically, the most active compound exhibits iodide as the counterion and is stabilized by a benzimidazole derivative. After 24 h of reaction, a quantitative conversion is obtained utilizing DMF as the solvent and phenylacetylene as the substrate.

Abstract Ankle arthrodesis is commonly performed to treat end-stage ankle osteoarthritis. The aim of this study was to determine whether the use of fibular autograft might increase the fusion rate and decrease the complication rate in ankle arthrodesis (AA) fixed using cannulated screws. To perform this PRISMA-compliant proportional meta-analysis, multiple databases were searched for studies in which patients undergone AA (using exclusively cannulated screws and augmented with fibular bone graft) were followed. The characteristics of the cohort, the study design, surgical details, the nonunion and complication rate at the longest follow-up were extracted and recorded. The modified Coleman Methodology Score (mCMS) was applied to appraise the quality of studies. Two groups were built: arthrodeses fixed with screws combined with cancellous autograft (G1) and arthrodeses fixed with screws combined with cancellous autograft and augmented with a lateral fibular onlay (G2). A third group (arthrodeses fixed with screws and no graft, G3) was extracted from previous literature for a further comparison. Overall, we included 306 ankles (296 patients) from ten series (ten studies). In G1 and G2 there were 118 ankles (111 patients) and 188 ankles (185 patients), respectively. In patients where cancellous autograft was used, a further augmentation with a fibular lateral strut autograft did not change significantly the nonunion (4% [95% CI 1–9] in G1 vs. 2% [95% CI 0–5) in G2, p = 0.99) nor the complication rate (18% [95% CI 0–36] in G1 vs. 13% [95% CI 6–21) in G2, p = 0.71). Upon comparison with 667 ankles (659 patients, G3) in which arthrodeses had been performed without grafting, the nonunion and complication rates did not differ significantly either (pooled estimates: 3% [95% CI 1–3) in G1 + G2 vs. 3% [95% CI 2–4] in G3, p = 0.73 for nonunion; 15% [8–23] in G1 + G2 vs. 13% [95% CI 9–17] in G3, p = 0.93 for complications). In ankle arthrodesis fixed with cannulated screws combined with cancellous autograft at the fusion site, a construct augmentation with a distal fibular onlay strut graft positioned laterally at the ankle joint does not reduce the risk of nonunion or complication. In general, the use of bone graft does not influence significantly the nonunion nor the complication rate as compared to non-grafted screw-fixed ankle arthrodeses.Kindly check and confirm the corresponding author mail id is correctly identified.It's all correct

Background We reviewed the shoulder arthroplasty (SA) literature to correlate citations, methodological characteristics and quality of most-cited articles in this field. We hypothesized that a greater number of citations would be found for high-quality clinical studies. Methods We searched the Web of Knowledge database for the 50 most-cited articles about SA and collected author name, publication year, country of origin, journal, article type, level of evidence (LoE), subject of paper, type of arthroplasty and metrics (number of citations and citation rate). Coleman Methodology Score (CMS) was computed for clinical articles. Statistical analysis of variance and correlation coefficients were used to investigate the relationship between different variables. Results Out of the selected 50 studies on SA, 26% were nonclinical. There were 15,393 citations overall (mean 307.8), with a mean 19.5 citations per year (range 48.3-6.7). Thirty or 60% of all articles were LoE IV. All studies were published between 1984 and 2011 in 8 journals. Reverse SA (RSA) was the most common subject (36% of studies). The United States was the country responsible for most contributions (50% of studies). CMS ranged from 81 to 38 (mean 59.6). RSA received the highest number of citations ( P

Objective High tibial valgus osteotomy (HTO) is a widely accepted procedure indicated for varus knee with symptomatic osteoarthritis of the medial compartment. However, there is a lack of studies evaluating long term results of this procedure. The primary aim of this study was to evaluate the long‐term survival of opening wedge high tibial osteotomy (HTO) for isolated osteoarthritis in the medial compartment of the knee. The secondary objective was to identify independent predictors of conversion to total knee arthroplasty (TKA). Methods This is a long term retrospective study of 296 cases of open wedge HTOs performed at a single center (level of evidence IV) between January 2005 and August 2015. Opening wedge medial HTO was always performed after diagnostic arthroscopy. Eighty‐three percent of the population (233 patients, 247 procedures) was followed up at a mean 11.6 years (6–17) by telephone interview, to evaluate the possible conversion to TKA. Mean age at the index operation was 42.8 years (range 15–70) and most patients were male (70%). Associated procedures (e.g., platelet rich plasma supplementation, microfractures, meniscectomy, etc.) were carried out at the time of the HTO in 80 (32%) cases. Survival of HTO and its association with age, sex, body mass index, smoking habit, preoperative severity of varus deformity, cartilage status at surgery, and associated procedures were evaluated. Kaplan–Meier and Cox regression analyses were performed. Results Thirty‐three of the 247 HTOs (13.4%) were converted to knee replacement, with 86.6% of the original procedures surviving at a mean 12‐year follow‐up. Kaplan–Meier survival estimates at 17 years for HTO were 75.5% (95% confidence interval [CI] 66.7–84.3). There was significant difference (P

We consider the basic problem of the Calculus of variations of minimizing an integral functional among the absolutely continuous functions that satisfy prescribed boundary conditions. We resume the state of the art and our recent contributions concerning the validity of the Du Bois-Reymond condition, and the Lipschitz regularity of the minimizers and of minimizing sequences (e.g., Lavrentiev phenomenon).