Titanium three-dimensional (3D) printed triflange cups are an established treatment option for severe pelvic discontinuity, but are costly and, when produced offsite, involve weeks of surgical delay. Three-dimensional printing of polyetheretherketone (PEEK) at the point of care (POC) has recently been 510(k) cleared by the Food and Drug Administration for cranioplasty to reduce implant cost and time to treatment. We asked in this pilot study whether 3D-printed triflange cups from high-strength polyaryletherketone (PAEK) polymers like PEEK could be produced with sufficient strength for revision total hip arthroplasty and whether annealing could improve cup strength. For proof-of-concept, two representative triflange cup designs were developed based on a set of 49 full-body computed tomography scans from the public New Mexico Decedent Image Database repository. The triflange cups (n = 3 per design) were additively manufactured using an industrial 3D printer (F421) and AM 200 PAEK filament. A second set of cups (n = 3 per design) was annealed in an effort to improve strength. A customizable fixture was developed for mechanical testing of the personalized cups, which were loaded to failure in an MTS load frame. As-printed (nonannealed) polymer cups failed due to deformation followed by layer separation, whereas the annealed cups fractured. The ultimate load (mean ± SD) for the two nonannealed triflange cup designs was 10.2 ± 0.02 kN and 11.0 ± 1.9 kN, respectively. After annealing, the strength of the two designs was 2.60 ± 0.44 kN and 10.5 ± 2.7 kN. The nonannealed PAEK cups exceeded the strength published for a titanium 3D-printed design (5.4 kN). The promising results of this pilot study demonstrate proof-of-concept and suggest that PAEK polymers such as PEEK may be suitable biomaterials for future triflange cup applications. Additional research is needed to incorporate porosity into the printed designs and further refine the mechanical test model.
Menstrual cups are increasingly promoted in low-resource settings as long-lasting and cost-effective menstrual hygiene solutions. However, no studies have been done among cup users to characterize the bacterial communities found on cups with long-term use when stored. This study sought to comprehensively characterize the bacterial surface profile of the menstrual cup, identify factors associated with putative pathogens, and quantify the vaginal microbiome as potential source for menstrual cup bacterial communities. Over 30 months of follow-up, 369 menstrual cup samples were collected from 172 secondary schoolgirls participating in a randomized controlled trial in western Kenya. Samples were obtained from cups brought to school by girls during study visits. Menstrual cup and vaginal microbiomes were assessed using 16S rRNA gene amplicon sequencing. Mixed effects models were applied to identify factors associated with putative pathogens ( Escherichia coli, Staphylococcus aureus, coliform bacteria), and factors associated with vaginal microbiome as potential source environment to bacterial surface profile of the menstrual cup, estimated via fast expectation-maximization for microbial source tracking (FEAST). Menstrual cup bacterial surface profile composition was primarily comprised of soil and water bacteria. However, taxa specific to the vaginal microbiome (e.g., Lactobacillus crispatus, L. iners, and Gardnerella vaginalis) were also recovered from cups. The mean relative abundance (presence) of E. coli and S. aureus was 0.09% (36%) and 0.36% (24%), respectively, with higher relative abundance among participants with HSV-2 or non-optimal vaginal community state type 4. Damaged cups were also associated with higher relative abundance of putative pathogens, while antibiotic use was inversely associated with E. coli. On average, 25.1% of cup microbiota originated from the vagina, with lower contributions among older participants and those with damaged cups. No serious adverse events related to the menstrual cup were observed in the cohort. Interventions focused on improved cleaning and storage tools and methods, and access to clean water and sanitation infrastructure are required to maximize safety of menstrual cup use in low-resource settings.
The most common postoperative complication relating to reverse total shoulder arthroplasty (RTSA) is instability. The risk factors for luxation include a lack of the subscapularis tendon or inadequate soft tissue tension, the prosthetic design, the bone deficiency, the obesity, and mechanical factors such as bone impingement and implant position.. To prevent this luxation, we can insert a retentive polyethylene humeral cup, The purpose of this study was to evaluate the clinical outcomes, the incidence of luxation and scapular notching between standard versus retentive polyethylene humeral cups in Delta III RTSA. 51 patients with rotator cuff insufficiency and osteoarthritis who underwent primary Delta III PIH using a standard and retentive polyethylene humeral cup were retrospectively reviewed between September 2018 and December 2023. The main indication for placing the retentive polyethylene was the complete and irreparable chronic rupture of the subscapularis tendon with impossibility of reinsertion and with muscle atrophy. The average follow-up was 42,4 months (41,6 and 44,3 months respectively) Results. 51 patients were reviewed: 35 with standard humeral cups and 16 with retentive polyethylene humeral cups. We found no prosthesis luxation in either of the two study groups and there were no differences in forward flexion, abduction or internal rotation between the two groups at the end of the follow-up. There was a lower mean for external rotation in the retentive polyethylene humeral cup group (average,36.3 ± 11,6 vs 28,7 ±10,9) but it was not statistically significant. There was no statistical difference in the postoperative Constant score at the end of the follow-up. The incidence of scapular notching was 62.8 % and 62.5 % for the standard and retentive polyethylene humeral cups, respectively. The Delta III rTSA using either a standard or retentive polyethylene humeral cups provide functional improvement and pain relief. There were no differences between the two groups in clinical mobility, forward flexion, abduction, internal rotation, external rotation, incidence of luxation and scapular notching Level of evidence: Level III; Retrospective Cohort Comparison; Treatment Study.
An observational, ambispective study comparing the long-term clinical and radiological outcomes of two surface coatings (Porocoat® and Gription®) in Pinnacle® acetabular cups used for primary total hip arthroplasty. A total of 50 consecutively implanted cups between January 2012 and July 2013 were analyzed, categorized into Group A (n=25 Pinnacle®-Porocoat® cups) and Group B (n=25 Pinnacle®-Gription® cups). Clinical and radiological outcomes of both groups, including the need for surgical revision and time to revision, were compared over long-term follow-up, during the decade following the index procedure. The study population had a median age of 70 [61-73] years and was predominantly male (64%, n=32). Preoperative BMI and functional evaluation were similar for both coating types. Revision-free survival was 96% in Group A and 92% in Group B (p=.591). Both groups showed significant and comparable clinical improvement, with no cases of aseptic loosening. Only two Pinnacle®-Gription® cups presented with non-progressive radiolucent lines. Both Porocoat® and Gription® demonstrated stable fixation and favorable long-term clinical and radiological outcomes, with no significant differences observed during follow-up after primary total hip arthroplasty.
The menstrual cup is a device inserted into the vagina during menstruation to collect blood. Evidence of its effect on the vaginal microbiome and associations with laboratory-confirmed infections is limited. We compiled existing information to assess associations between menstrual cups and reproductive tract infections (RTIs), sexually transmitted infections (STIs), and the vaginal microbiome. We searched four databases (PubMed, CINAHL, Global Health, and Scopus, from inception to January 23, 2026) for trials or observational studies reporting on menstrual cup use and laboratory-confirmed RTIs, STIs and the vaginal microbiome. Study quality was assessed using the Cochrane Collaboration tool for trials and the Joanna Briggs Institute Critical Appraisal Checklist for Cohort Studies. Outcomes of interest between cup-users and users of alternative menstrual products (non-cup users) were compared using prevalence ratios (PR). Meta-analyses were conducted using fixed-effects models to generate pooled estimates. PROSPERO registration: CRD42024559595. Eleven studies involving 10,268 participants were included. Only three studies were considered of good quality. In two randomised controlled studies in Kenya, menstrual cups reduced the risk of STIs relative to non-cup users (adjusted PR [aPR] 0.74, 95% CI 0.60-0.91, p = 0.037, n = 695, I2 = 0.0%). The association with bacterial vaginosis was 0.81 (aPR, 0.63-1.04, p = 0.0963, n = 695, I2 = 0.0%). When combining observational and randomised studies, a protective effect on bacterial vaginosis persisted (PR 0.79, 95% CI 0.69-0.90, p = 0.0004, five studies, n = 2103, I2 = 0.0%, 3 continents). One trial showed an association between menstrual cups and HSV-2 of 0.71 (aPR, 95% CI 0.50-1.01, p = 0.057, n = 1451). Optimal vaginal community state type-1 (CST-I) was more likely among cup users compared to non-cup users (PR 1.18, 1.10-1.27, p < 0.0001, n = 2639, 5 studies in Kenya and Europe). No increased infection risks were noted among menstrual cup users across the infections evaluated. Main limitations included the low number and quality of existing studies. Menstrual cups reduced the risk of STIs in Kenya. For bacterial vaginosis, the association was consistent with a protective effect and supportive for a healthy vaginal microbiome composition in studies from different geographies. These data strengthen evidence on the value of menstrual cups as a global multipurpose menstrual product solution. UK-Medical Research Council, Medical Research Foundation, USA-National Institutes of Health; National Institute of Child Health and Human Development, and the Gates Foundation.
With the increased use of dual mobility primary hip arthroplasty with cementless and cemented cups, we found different clinical and radiographic responses. The goal of this systematic review is to compare the types of acetabular fixation according to clinical and radiographic changes. We conducted a pairwise analysis comparing cementless versus cemented cups in a dual mobility hip arthroplasty. The outcomes of interest were pain at rest, pain during activity, functional score, wear rate, and cup migration up to 7 years of follow-up. Of the 596 studies identified, only 3 were eligible for inclusion in the study. Our search strategy was broad and carefully designed to capture all relevant studies. We included two randomized controlled trials and one cohort study, amounting to 233 patients, of which 108 used cemented cups and 125 received cementless cups. There was no statistical significance (P > 0.05) in all outcomes analyzed between both types of acetabular fixation: pain at rest (SMD: 0.17; 95% CI: - 0.21 to 0.56), pain during activity (SMD: 0.36; 95% CI: - 0.03 to 0.74), functional score (MD: 1.72; 95% CI: - 0.51 to 3.95), cup migration (SMD: - 0.45; 95% CI:-0.96 to 0.05), and wear rate (MD: -0.13; 95% CI: -0.40 to 0.13). Dual mobility primary total hip arthroplasty, whether using a cemented or uncemented cup, represents an effective treatment option, yielding similar clinical and radiographic outcomes.
The use of large diameter metal-on-metal (LDMOM) heads and dual mobility (DM) articulations has reduced the risk of dislocation after primary total hip arthroplasty (THA). Furthermore, the monoblock cup versions eliminate the risks associated with modularity, such as corrosion. The purpose of this study was to determine the average 10-year outcomes and survivorship of modern uncemented monoblock cups (UMCs) in primary THA. Between 2005 and 2022, 2,292 primary THAs were performed using UMCs. There were 1,288 LDMOM articulations (56%), and 1,004 were DM (44%). The mean age at operation was 64 years (range, 29 to 92), and 57% of the patients were men. Patients were routinely followed with Harris Hip Scores and serial radiographs. Kaplan-Meier survival was determined for cup revision and aseptic loosening. All patients were followed for a minimum of two years. The mean follow-up was 10.8 years (range, two to 20). At the final follow-up, Harris Hip Scores and pain scores averaged 89 and 42, respectively. There were three dislocations (0.1%), all of which underwent successful closed reduction, and 10 deep postoperative infections (0.4%), all of which underwent staged revisions. There were 14 loose cups (0.6%) identified, nine associated with LDMOM metallosis and two with DM articulations, of which 13 were revised. All the other cups were deemed radiographically stable. There were five additional cups revised secondary to metallosis. The 10-year survivorship was 98.8% for any cup revision, 99.2% for aseptic cup loosening, and 99.3% for aseptic cup revision. Using UMCs in primary THA has provided excellent clinical results and survivorship at mid-term follow-up, with a very low dislocation rate. Although LDMOM use has fallen out of favor, UMCs still afford durable implant fixation, negating the concern over modular cup corrosion when coupled with DM articulations.
Styrene, a constituent of polystyrene food-contact materials, can migrate into hot beverages, but data on short-term consumer exposure and associated biological responses remain limited. In this single-arm longitudinal human biomonitoring pilot study, 40 healthy adults consumed tea or coffee daily in Styrofoam cups for approximately two weeks. Biomarkers were measured at baseline, day 6, and day 11, including urinary mandelic acid (MA) and phenylglyoxylic acid (PGA), salivary malondialdehyde (MDA), comet assay parameters in peripheral blood lymphocytes, and micronucleus (MN) frequency in buccal cells. Measured styrene migration into beverages ranged from 3.3 to 7.1 μg/L, below the World Health Organization guideline value. Urinary metabolites and salivary MDA showed substantial interindividual variability and no consistent temporal pattern. In contrast, generalized estimating equation models showed progressive increases in comet assay indicators over the exposure period. Tail intensity and tail moment increased over time, with stronger changes among participants consuming two cups daily. MN frequency did not change significantly. These findings suggest that repeated short-term consumption of hot beverages in polystyrene cups was associated with modest changes in selected early biomarkers of biological effect under consumer-use conditions. The results should be interpreted cautiously in light of the modest sample size, short follow-up, and absence of more specific mechanistic endpoints, but they support further study of repeated low-level exposure to food-contact materials.
Postoperative instability remains a significant concern following total hip arthroplasty (THA), particularly in patients with small acetabular dimensions or in situations requiring limited surgical exposure (e.g., elderly fracture cases). Dual mobility cups incorporating peripheral fins and apical fixation spikes may enhance primary stability; however, these fixation features may complicate insertion through limited posterior exposure. This technical note describes a custom guiding sleeve designed to facilitate acetabular reaming and insertion of dual mobility cups with peripheral fins and apical fixation spikes while preserving surrounding soft tissues. A cadaveric feasibility study was conducted using three fresh-frozen hips with small acetabular dimensions. A custom-designed cylindrical guiding sleeve was used during acetabular reaming and cup insertion through a limited posterior approach. The guiding sleeve created a protected cylindrical corridor that displaced surrounding soft tissues and facilitated acetabular preparation and cup insertion without soft-tissue impingement in this cadaveric feasibility study. The guiding sleeve demonstrated technical feasibility in this cadaveric feasibility study and may represent a useful adjunct for acetabular preparation and implantation of dual mobility cups with peripheral fins and apical spikes through limited posterior exposure. Further clinical studies are warranted to evaluate its effectiveness in vivo.
Total hip arthroplasty (THA) for hip developmental dysplasia (DDH) carries a high perioperative complication rate, with dislocation representing the most frequent adverse event. Monoblock dual-mobility (DMM) cups have demonstrated promising results in reducing prosthetic instability while ensuring long-term implant survival. However, data specifically addressing DMM THA in low-grade DDH remain scarce. The aim of this study was to evaluate clinical outcomes and complication rates at a minimum ten-year follow-up in patients undergoing DMM THA for low-grade DDH. A single-centre retrospective study was conducted, including all patients who underwent DMM THA for Crowe grade I or II DDH between 2008 and 2018. Clinical outcomes including the Harris Hip Score (HHS), Postel-Merle d'Aubigné (PMA) score, Devane score, visual analog scale (VAS), and range of motion (ROM) were assessed preoperatively, at one year, and at final follow-up. Implant survival was estimated using Kaplan-Meier analysis. Thirty-one THAs were performed in 25 patients (mean age 55.1 ± 13.4 years; mean follow-up 10.06 ± 1,98 years). All functional scores improved significantly at final follow-up (HHS 48 to 98, PMA 11 to 17, Devane 3 to 4, all p < 0.001). No dislocation, loosening, periprosthetic fracture, or septic complication was recorded. Implant survival was 100% at ten years. The DMM THA for low-grade DDH provides excellent long-term functional outcomes with a remarkably low complication profile, supporting the routine use of DMM cups in this indication.
Natural rubber harvesting remains highly dependent on manual labor, particularly during latex cup collection, which limits efficiency and increases operational costs. Intelligent robotic harvesting systems require accurate visual perception and reliable grasp point positioning under rubber plantation environments. However, latex cups are typically small, visually diverse, and often affected by adjacent latex drains, making detection and manipulation challenging for existing vision models. To address these challenges, this study proposed a lightweight vision-based framework for latex cup detection and grasp-point positioning in automated rubber harvesting. The proposed NRLC-YOLO is developed based on YOLO11n-seg by integrating a lightweight backbone, a local-global attention enhancement module, and a dynamic convolution strategy. In addition, a fast grasp-point positioning method is designed to determine the gripping center of latex cups, enabling stable robotic manipulation. As validated by experimental results, our model yields a mAP @50-95 of 78.5%, which surpasses the baseline approach with fewer parameters and lower computational costs. The average error of the proposed grasp-point positioning scheme is measured at 8.08 pixels. Field experiments further demonstrate a grasping success rate of up to 93.3% under real plantation conditions. The proposed framework provides an efficient AI-enabled perception solution for automated latex cup harvesting and offers practical support for the development of intelligent rubber plantation management systems.
Performing a total hip arthroplasty (THA) in obese patients is known to be associated with an elevated rate of complications. The use of dual mobility cups (DMC) has already been proven for decreasing dislocation episodes in high-risk populations. This is an observational cohort study evaluating the functional and radiological outcomes of DMC across BMI categories namely healthy, overweight and obese populations. This is a retrospective multi-centric study of 419 patients who underwent a primary THA with a DMC (THA-DMC) from 2006 to 2022. The patients were divided in three groups according to their BMI and were evaluated clinically with the modified Hip Harris Score (mHHS) and radiologically. Post-operative complications were recorded during the follow-up period. The mean age of the included patients was 70 ± 13.19 years (p = 0.006). The mean follow-up period was nine ± 6.2 years. At final follow-up, the mean modified HHS score was 85.56 ± 6.09 in the normal weight subgroup vs 92.39 ± 4.89 in the overweight subgroup and 89.24 ± 4.40 in the obese subgroup (p = 0.2). Three patients, one in the overweight and two in the obese subgroups, had a traumatic dislocation unrelated to the surgery. No cases of intraprosthetic dislocations were observed. Two patients in the obesity subgroup required additional surgeries for septic complication. The radiological assessment revealed no signs of migration or tilting of the components. Osteolysis was detected in 4 cases with non-progressive lines and no symptoms at last follow up. Heterotopic ossifications were observed in 15 asymptomatic patients. Three patients had a traumatic peri-prosthetic fracture. The use of a contemporary dual mobility cup in obese patients seems to yield excellent functional and radiological outcomes with a complication rate comparable to that of a non-obese population. Comparative studies with conventional cups are needed to confirm or infirm our results.
The presence of micro- and nanoplastics (MNPs) in daily life raises increasing concerns about their potential health and environmental impacts. However, how food components influence MNP release from packaging materials and the resulting exposure risks remain poorly understood. Here, we investigated the effect of the primary tea polyphenol, epigallocatechin gallate (EGCG), on MNP release from polystyrene cups during a simulated tea-drinking process involving thermal treatments. A surface-enhanced Raman scattering sensor was developed to quantify released plastic particles in situ using EGCG-based luminescent metal-phenolic network labeling. The released particles were identified primarily as nanoplastics, and the presence of EGCG significantly (P < 0.05) increased MNP release, particularly during microwave heating and most prominently upon repeated cup use. Interestingly, EGCG increased the MTT response of differentiated Caco-2 cells exposed to released NPs in a dose-dependent manner, suggesting a potential mitigation of NP-associated cytotoxicity under the tested in vitro conditions. This study provides new insight into the dynamic interactions between food components and plastic packaging during realistic consumption scenarios, revealing an overlooked pathway influencing human exposure to nanoplastics. The findings expand the current understanding of contaminant release mechanisms at the food-environment interface and inform future strategies for exposure mitigation and sustainable material design to ensure food safety and protect environmental and public health.
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The use of highly-porous acetabular components in total hip arthroplasty (THA) has gained popularity. To elucidate the clinical and radiological outcomes of three-dimensional (3D)-printing highly porous cups, we compared highly-porous cups and hydroxyapatite (HA)-coated non-highly-porous cups in computed tomography (CT)-based navigated THA. We retrospectively investigated 196 hips of 175 patients (the highly-porous group, 112 hips of 97 patients; the HA-porous group, 84 hips of 78 patients) who underwent THA using a CT-based navigation system. After propensity score matching for age, sex, diagnosis, and surgical approach, each group comprised 66 hips. Clinical outcomes were evaluated using the Japanese Orthopaedic Association hip (JOA) score and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) score preoperatively and at six, 12, and 24 months postoperatively. Radiological outcomes for cup orientation, positioning, initial gap, migration, loosening, and radiolucent line (RLLs) were assessed. Cup placement was measured using 3D templating software. Clinical outcomes did not differ significantly between groups after two years. The mean absolute error of cup orientation did not differ significantly between the two groups (inclination: 2.9 ± 2.3° versus 2.6 ± 2.2°, respectively; anteversion: 2.7 ± 2.0° versus 2.7 ± 2.0°, respectively). There was no migration or loosening in both groups during the study period. The incidence of initial gap was significantly higher in the highly- porous group than in the HA-porous group (18 of 66 cases, 27.3% versus eight of 66 cases, 12.1%, P = 0.027). The RLLs exhibited progressive decline during the two-year follow-up in both groups, and there were no significant differences at two years. The two-year clinical outcomes and radiological evaluations of the 3D-highly porous and non-highly-porous cups were comparable. Initial gaps in the 3D-printing highly porous cups diminished, and the highly porous cups showed excellent radiological outcomes.
Although coffee consumption is often reported as a trigger for atrial fibrillation (AF), prospective studies on the association between coffee consumption and AF risk have been inconsistent. Hence, we sought to assess the association between coffee consumption and risk of AF. We searched PubMed, Embase, and Cochrane Library up to November 30, 2025, without language restriction. We included cohort or nested case-control studies that enrolled participants with no AF history who did not drink coffee or had daily coffee consumption. The outcome was the risk of new-onset AF in participants with coffee consumption. Overall, 9 observational cohorts were selected for this meta-analysis, comprising 704,121 individuals and 35,253 new-onset AF cases. The subgroup analysis showed a reduced new-onset AF risk among participants who drank coffee for less than or equal to 1 cup daily (RR: 0.96; 95%CI: 0.93-0.99), but no significant association with new-onset AF risk among those who drank 1-3 cups/d (RR: 0.95; 95%CI: 0.85-1.06), 3-5 cups/d (RR: 0.96; 95%CI: 0.91-1.02), ≥4 cups/d (RR: 0.89; 95%CI: 0.78-1.02), or ≥5 cups/d (RR: 0.93; 95%CI: 0.86-1.02). Compared with the lowest level of coffee intake, the overall estimate of the highest coffee consumption in the included studies also showed that ≥4 cups/d were not significantly associated with reduced risk of new-onset AF (RR: 0.95; 95% CI: 0.89-1.02). In addition, this result was consistent across men (RR: 1.05; 95% CI: 0.97-1.14) and women (RR: 0.91; 95% CI: 0.80-1.04). Daily coffee consumption of 1 cup or less can reduce the risk of new-onset AF. However, higher coffee consumption is not associated with the risk of new-onset AF.
The lack of dedicated classification infrastructure and clear guidance on sustainable consumption results in potentially recyclable paper cups being diverted to incineration or landfill disposal. To address this, this study develops a life cycle assessment framework to compare the environmental performance of a circular system with that of the linear disposal system and traditional single-use and reusable cups. In detail, by integrating energy structure transitions with material flow simulations, this research quantifies environmental mitigation potentials across multi-dimensional midpoint impact categories. The results indicate that the circular system yields environmental benefits exceeding 60%, which increase to 78% under optimized scenarios characterized by extended fiber lifespans and cleaner energy substitution. It also reduces environmental cost by 82.9% relative to the linear system. Through sensitivity analysis, it was found that the circular mode of paper cups has relatively low sensitivity to parameters, and also demonstrates significant environmental impact advantages among all alternatives. Dynamic projections reveal that by 2030, driven by China's low-carbon power transition, the comparative advantage of circularity will expand, potentially recovering 0.91 Mt of paper resources and mitigating 0.94 Mt of CO2 eq. emissions annually. These findings highlight the need for integrated interventions, including regulatory adjustments, advancements in aqueous coating technologies, and sustainable consumption measures, to address environmental burden shifting and support the low-carbon circular transition of single-use paper cups.
Accurate acetabular cup placement is crucial for the long-term success of total hip arthroplasty (THA). This cadaveric study investigated the reliability of intrapelvic landmarks for cup positioning in conventional THA, examining the influence of surgeon experience, surgical approach (direct anterior and posterolateral), and pelvic positioning. 108 conventional THA procedures were performed on 24 hips of 12 lower extremity cadavers by nine surgeons with different surgical experiences (Group I: high volume, group II: intermediate volume and group III: low volume) through a posterolateral (PL) or direct anterior approach (DAA). The anteversion and inclination of the acetabular cups were measured using an image-based robotic arm system. Outliers were defined according to Lewinnek's and Callanan's safe zones and the groups were compared. In groups I, II and III, the percentages of cups within the safe zone of Lewinnek for the combined versions were 38.9, 33.3, and 27.8 for DAA (p = 0.12); and 16.7, 27.8, and 16.7 for PL (p = 0.633) approaches, respectively, while the percentage of cups within the safe zone of Callanan for the combined versions was 27.8, 27.8, and 16.7 for DAA (p = 0.667); and 11.1, 16.7, and 11.1 for PL (p = 0.849) approaches, respectively. This study demonstrates the unreliability of intrapelvic landmarks for accurate acetabular cup placement in conventional THA, irrespective of surgeon experience. The absence of the trunk in the cadaveric model may have affected pelvic tilt, underscoring the importance of intraoperative pelvic positioning in achieving optimal cup placement. These findings suggest that reliance on intrapelvic landmarks alone may not be sufficient for accurate cup positioning and highlight the potential benefits of alternative techniques, such as robotic-assisted THA.
Pharmaceuticals and personal care products (PPCPs) as well as current-use pesticides (CUPs) are considered to be contaminants of emerging concern (CECs), but there is limited information that exists about their occurrence and impact in the marine environment. A database of these CECs has been created as an overview of their occurrence and distribution in European marine waters by the ICES Marine Chemistry Working Group (MCWG) and collaborators from various European countries. The majority of the compiled data corresponded to pharmaceuticals in seawaters, but much less data were available for other matrices (biota and sediment) and CEC groups. Generally, concentrations were characterized for a limited spatial area and/or a small number of species/organisms. A Total Occurrence Index (TOI) was developed, taking into account the number of data available, the maximum concentrations and the frequency of detection together as indicators. The TOI provided estimates for the CECs in the database and has been used to identify the most relevant PPCPs and CUPs. The highest TOIs were found for the pharmaceuticals salicylic acid, hydrochlorothiazide, gemfibrozil, mefenamic acid, paracetamol and diclofenac; the PCPs 2-ethylhexyl-4-methoxycinnamate, 4-methylbenzylidene camphor, octocrylene, galaxolide, benzophenone-3 and tonalide; and the CUPs chlorpyrifos, chlorthal-dimethyl, simazine and irgarol. It is noted that additional data are required, particularly in the sediment and the biota matrices, to more fully understand the distribution and impact of these CECs in the marine environment, when considering the wide geographical distribution areas covered in this review. Further assessment is also required, to prioritise those CECs, based on which of them are expected to cause the most adverse toxic effects to marine ecosystems.
Accurate acetabular cup positioning is crucial in primary total hip arthroplasty (THA), as malposition is associated with instability and early failure. We hypothesized that acetabular cup orientation may differ according to the surgical approach used. The aim of this study was to assess whether acetabular anteversion and inclination vary according to surgical approach and whether these differences affect the proportion of acetabular cups positioned outside reference orientation zones. A retrospective single-centre comparative study was conducted including 300 primary THAs performed between 2018 and 2022. A stratified random sample of 100 hips per approach was selected: posterolateral (PLA), direct lateral (DLA), and direct anterior (DAA). Cup inclination and anteversion were measured on standardized postoperative radiographs using calibrated digital software. Positioning was analyzed according to the safe zones described by Lewinnek and Reina, as well as the zone corresponding to the lowest observed dislocation ratio reported by Esposito et al. Continuous and categorical variables were compared using appropriate statistical tests (p < 0.05). Mean inclination and anteversion for the overall cohort were 41.5° and 17.6°, respectively. Significant differences were observed between approaches for both inclination (p < 0.001) and anteversion (p = 0.011), with the DLA demonstrating lower mean anteversion compared with the PLA and DAA. No significant differences were observed in the proportion of cups positioned within the Lewinnek safe zone (p = 0.276). However, significant differences were observed in the proportion of cups within the Reina target zone (p = 0.0015) and within the zone centred on 48° inclination and 24° anteversion (± 10°) derived from Esposito et al. (p = 0.0004). Acetabular cup positioning appears to vary according to surgical approach in primary THA, particularly regarding anteversion, with the PLA demonstrating higher mean anteversion and the DLA lower values. However, these differences did not translate into clinically relevant differences in positioning within established reference orientation zones according to widely used criteria.