The traditional Haber-Bosch method suffers from harsh conditions and high energy consumption, while electrocatalytic nitrate reduction to ammonia (ENRA) is a green route for ammonia synthesis and can serve as a cathode reaction for Zn-nitrate batteries. Its development is limited by sluggish intermediate hydrogenation and severe hydrogen evolution reaction (HER). Herein, we develop topology-engineered isomeric polyoxometalate (POM)-confined bimetallic metal-organic framework (MOF) electrocatalysts (NH2-MIL-53, -88, -101). Flexible NH2-MIL-88(FeNi) enables tight encapsulation of [PW12O40]3- (PW12) clusters via the "breathing effect", yielding PW12@NH2-MIL-88(FeNi) with synergistically modulated electronic distribution and proton transfer. Combined experimental and theoretical studies reveal that confined PW12 induces electronic redistribution over Fe/Ni centers, concurrently strengthening NO3 - adsorption on Fe and accelerating *NO2 hydrogenation on Ni. Beyond electronic effects, PW12 loosens the rigid hydration layer and forms conjugated acid-base pairs with MOF amino groups, promoting proton diffusion, boosting *NO2 hydrogenation, and suppressing HER. Thus, PW12@NH2-MIL-88(FeNi) achieves an NH3 yield rate of 20.1 mg h-1 mgcat. -1 with a Faradaic efficiency of 98.6% under neutral electrolytes. When used as a cathode in rechargeable Zn-nitrate batteries, it delivers a peak power density of 13.2 mW cm-2. This study establishes a generalizable paradigm for engineering interfacial proton transport and electronic properties via POM confinement in MOFs.
Persistent pain after total hip arthroplasty (THA) is a common complication requiring extensive diagnostic effort and is often associated with potentially invasive and morbid treatment options. With THA volume expected to steadily increase there is a similarly growing need for creative and effective diagnostic and therapeutic options for these clinically challenging patients. Hip arthroscopy has emerged as a promising tool in the setting of persistent pain after THA with expanding indications and promising outcomes. The purpose of this article was to provide a review of the current state of literature regarding arthroscopic and endoscopic solutions for common causes of persistent pain after THA with a focus on patient selection, indications, surgical considerations, outcomes, and complications. The most common indication for hip arthroscopy after THA is iliopsoas tendinopathy, showing excellent outcomes with symptom resolution in greater than 90% of patients after arthroscopic iliopsoas release or lengthening. The second most common indication is diagnostic arthroscopy in the setting of otherwise negative extensive work-up, which has shown diagnostic value for occult implant loosening, capsular fibrosis, and metal hypersensitivity. Endoscopic decompression for the treatment of ischiofemoral impingement and sciatic nerve decompression has also shown consistent improvements in pain and function. In addition to these well described indications, future utilization of hip arthroscopy for loose body removal, capsular plication for instability, and management of prosthetic joint infection are potentially emerging indications. Hip arthroscopy after THA is a safe and effective tool for the management of common causes of persistent pain after THA with robust support for iliopsoas pathology and emerging evidence and outcomes for less common indications. Future research will both expand and narrow these indications as diagnostic criteria, patient selection, and surgical techniques are refined.
Background: Unstable pelvic ring injuries often require surgical stabilization to restore pelvic ring integrity. The anterior subcutaneous internal fixator, or pelvic INFIX, has emerged as an alternative to external fixation and open anterior fixation. This study evaluated the functional, radiographic, and complication-related outcomes of INFIX fixation for unstable anterior pelvic ring injuries. Methods: We retrospectively reviewed 21 adult patients treated with anterior pelvic INFIX for unstable anterior pelvic ring fractures, with or without posterior fixation, at a Level 1 Trauma Center between 2017 and 2024. Fractures were classified according to the AO/OTA system. Functional outcomes were assessed using the Iowa Pelvic Score and Short Form-12 questionnaire. Radiographic outcomes were evaluated according to Tornetta and Matta criteria. Complications were recorded throughout follow-up. The INFIX device was routinely removed 6 months postoperatively. Results: The cohort included 15 males and six females, with a mean age of 42.5 ± 11.1 years. Mean Injury Severity Score was 25.3 ± 9.6, and mean follow-up after implant removal was 31 (IQR 28-34) months. The mean Iowa Pelvic Score was 80.2 ± 7.4, indicating an overall good functional outcome. Mean SF-12 physical and mental scores were 49.2 ± 3.5 and 48.3 ± 7.9, respectively. Radiographic outcomes were excellent in eight patients, good in 11, and fair in two. Complications included postoperative hemorrhage, implant loosening, heterotopic ossification, and three cases of lateral femoral cutaneous nerve (LFCN) injury. Conclusions: INFIX fixation appears to be a reliable minimally invasive option for unstable anterior pelvic ring injuries, providing satisfactory mid-term functional and radiographic outcomes with an acceptable complication profile.
Drug-induced liver injury (DILI) is a global health issue with limited treatment options. The nuclear factor erythroid 2-related factor 2 (Nrf2) signaling pathway plays a critical role in defending against DILI, making it a potential therapeutic target. This study aimed to investigate the hepatoprotective effect of salvianolic acid B (Sal B), a polyphenol derived from Salvia miltiorrhiza Bge., against DILI and to elucidate its underlying molecular mechanisms, particularly focusing on the Nrf2 pathway. Compounds screening was carried out to identify Sal B as a potent Nrf2 activator. Cellular thermal shift assay (CETSA), surface plasmon resonance (SPR), and microscale thermophoresis (MST) were employed to examine the direct interaction between Sal B and kelch-like ECH-associated protein-1 (Keap1), an Nrf2 inhibitor. Nrf2 knock-out (Nrf2-/-) mice and liver-specific Keap1 knockout (Hepcre-Keap1flox/flox) mice were used to assess the role of Nrf2 and Keap1 in Sal B-mediated hepatoprotection. Mass spectrometry-based chemoproteomic analysis and mutagenesis studies were performed to identify the specific cysteine residues modified by Sal B. Molecular dynamics simulations were used to analyze conformational changes in Keap1 following Sal B binding. Sal B strongly activated Nrf2, and its hepatoprotective effects were significantly diminished by Nrf2 knock-out. Sal B directly bound to Keap1. In Hepcre-Keap1flox/flox mice, DILI was attenuated, and Sal B's protective effects were weakened. Sal B covalently modified Cys395 and Cys434 within the Keap1 double-glycine repeat (DGR) domain. Mutagenesis of these residues impaired Sal B-Keap1 interaction and abolished Nrf2 activation. Sal B's modification altered the conformation of the Keap1 kelch domain, loosening the Nrf2 binding pocket and facilitating Nrf2 activation. Sal B exerts hepatoprotective effects against DILI by activating Nrf2 through covalent modification of Keap1 at Cys395 and Cys434. These findings provide mechanistic insights into the potential of Sal B as a novel therapeutic agent for DILI.
Unicompartmental knee arthroplasty (UKA) has become an effective treatment for medial compartment osteoarthritis of the knee. However, its use in patients who also have patellofemoral joint osteoarthritis (PFOA) before surgery remains controversial. Restoring postoperative lower limb alignment and achieving accurate implant positioning are also important factors for the success of UKA, but there is still a lack of studies that combine both patient-related factors and surgical technique-related factors in the Chinese population. This study retrospectively analyzed 69 Chinese patients (79 knees) with medial compartment osteoarthritis who underwent Oxford UKA between May 2017 and December 2020. The severity and location of PFOA were assessed by MRI. Postoperative coronal alignment was categorized by the femorotibial angle (FTA) into neutral, mild varus, moderate varus, and extreme/out-of-range groups. Implant positioning was classified as ideal or non-ideal according to established radiographic target ranges for aLDFA, aMPTA, PTS, and component alignment angles. Functional outcomes were evaluated using VAS, KSS, WOMAC, and Kujala scores, with multifactorial interactions analyzed via multivariate analysis of covariance (MANCOVA). At a mean follow-up of 66.5 ± 9.6 months, Oxford UKA markedly improved overall patient function. While no cases of prosthesis loosening or revision were observed, three patients reported persistent postoperative pain and two presented with valgus deformity. Postoperative functional scores did not differ by PFOA severity or lesion location. Regarding lower-limb alignment, neutral and mild varus (< 6°) knees had higher KSS function scores than moderate varus and extreme/out-of-range knees and lower WOMAC scores. KSS knee scores were higher in neutral and mild varus than in the extreme group. Implant positioning (ideal vs non-ideal) was not associated with postoperative scores. Mid-term follow-up showed that Oxford UKA achieved satisfactory clinical outcomes. The severity and location of PFOA before surgery did not significantly affect postoperative knee function. Maintaining postoperative alignment within the target range (neutral to slight varus; within 6° of varus) may be associated with better functional recovery.
Koji production is a critical process that determines the flavor and quality of the final soy sauce product. However, the complex mechanisms underlying microbial metabolism and the evolution of the physicochemical environment still require further analysis. This study focuses on three parallel koji rooms in an industrialized koji fermentation process. This work tracked the dynamics of physicochemical indices, volatile flavor compounds, and microbial communities over a full 40 h cycle. Data integration and correlation analysis elucidated the close linkage between the microbial community, the fermentation environment, and flavor formation. Koji moisture declined gradually, with faster losses at later fermentation stages. This physiological dehydration arose from microbial metabolic heat, forced aeration and structural loosening of koji, not simple physical evaporation. System pH displayed a typical U-shaped trend across fermentation. Values dropped early, most likely driven by accumulating organic acids, before rising from mid to late fermentation. This pH rebound was tentatively attributed to ammonia release from proteolytic breakdown, which may neutralize acidic compounds. These observations cast doubt on the conventional assumption that organic acid levels may be reliably estimated solely from pH measurements. Physicochemical analysis showed continuous accumulation of amino acid nitrogen (0.6-0.9 g/100 g) and total acidity throughout fermentation. By contrast, reducing sugar concentrations differed across individual koji rooms, presumably owing to divergent microbial adaptation in early fermentation. A total of 77 common compounds were identified, among which 13 key odor-active compounds with OAV ≥ 1, such as 4-vinylguaiacol and 3-methylbutyraldehyde, constitute the characteristic flavor profile of soy sauce starter culture. High-throughput sequencing uncovered a distinct ecological pattern: eukaryotic communities, dominated by Aspergillus oryzae, converged under controlled regulation. While prokaryotic communities differentiated dynamically, driven by spatial heterogeneity in the semi-open fermentation environment. Spearman correlation analysis further indicated potential functional partitioning: high-abundance taxa (e.g., Aspergillus oryzae, Weissella) were predominantly associated with macromolecular substrate degradation, whereas rare low-abundance taxa (e.g., Alternaria) displayed significant correlations with the biosynthesis of key characteristic flavor compounds. This study clarifies the synergistic regulatory mechanisms linking physicochemical conditions, microbial metabolism, and flavor precursor formation during industrial koji production. The findings establish a scientific foundation for optimizing process parameters and achieving standardized quality control in soy sauce manufacturing.
The proportion of revision surgeries among all arthroplasties performed annually suggests a higher revision burden for total knee arthroplasty (TKA) than for total hip arthroplasty (THA). This study analyzed temporal trends in the knee-to-hip (K/H) revision burden ratio (RBR) over the past decade; evaluated hip and knee RBRs separately; compared trends across four national arthroplasty registries; and assessed changes in revision causes for THA and TKA over time. A retrospective, registry-based observational study was conducted using publicly available annual reports from four national arthroplasty registries in the United Kingdom (UK), Australia, the United States, and Sweden. Annual numbers of primary and revision THA and TKA procedures were extracted. Hip and knee Revision Burden Ratios (RBR) and Knee to Hip Revision Burden Ratios (K/H RBR) were calculated annually. Temporal trends were assessed using linear regression, and revision causes common to all registries were analyzed for the 2018 to 2023 period. Across registries, primary arthroplasty volumes increased substantially, with knee procedures exceeding hip procedures. Globally, the K/H RBR increased significantly (β = 3.63 percentage points/year, R2 = 0.876, P < 0.001), driven by a decrease in hip RBR (β = -0.165, P = 0.006) and an increase in knee RBR (β = 0.207, P < 0.001). Similar trends were observed in the UK, Australia, and Sweden, whereas no significant temporal change was identified in the United States. The proportion of revisions due to aseptic loosening declined significantly, whereas infection and periprosthetic fractures increased over time, particularly after TKA. Revision burden is progressively shifting from hip to knee arthroplasty, driven by declining aseptic loosening and a concomitant rise in infection-related revisions, particularly after TKA, where infection is becoming the predominant failure mechanism. These findings have major implications for clinical practice and highlight the need for infection-focused prevention and treatment strategies.
Expansin-like A (EXLA) proteins belong to one of the four main families within the expansin superfamily, a group of plant proteins essential for cell wall loosening. Here, we report, for the first time, the purification of a novel EXLA, named cpEXLA, from canihua seeds. cpEXLA (yield ~0.16 mg per 100 g of seeds) is a 29 kDa glycoprotein with a high melting temperature (Tm of 86.75 ± 1.06 °C). Elucidation of its primary structure reveals that the mature protein consists of 246 amino acids, ten of which are cysteine residues forming five disulphide bridges. Structural studies based on 3D model prediction reveal the presence of N- and C-terminal domains, which are typical of EXLAs and rich in β-sheets, as confirmed by circular dichroism (CD) spectroscopy. Furthermore, comparative analysis of amino acid sequences between cpEXLA and 219 similar EXLAs, retrieved from dicotyledonous genomes and transcriptomes, identified eighteen invariant amino acid residues: eleven in the N-terminal domain and seven in the C-terminal domain. Finally, phylogenetic analysis of EXLAs in dicotyledonous species shows a close relationship with other EXLAs from the Amaranthaceae family, confirming that EXLA proteins are highly conserved among dicotyledonous plants. Overall, cpEXLA represents an intriguing native tool for studying cell wall evolution and the functional role of EXLAs.
Total hip arthroplasty (THA) is one of the most successful orthopaedic procedures and provides good functional outcomes in both rheumatoid arthritis (RA) and osteoarthritis (OA) patients. However, RA patients face higher risks of adverse post-operative outcomes. Despite recognising the unique risks of RA autoimmunity and drug therapy, there remains minimal RA-specific evidence to guide arthroplasty surgeons. This study analysed the rate of all cause revision, and revision for infection, dislocation, periprosthetic fracture, and aseptic loosening for 3657 RA and 446 428 OA patients who underwent primary THA recorded in the Australian Orthopaedic National Joint Replacement Registry (AOANJRR). Key findings of this study indicate that RA is associated with a younger age at THA, an increased risk of all-cause revision (HR 1.35; 95% CI 1.16-1.56; p = 0.001), and an increased risk of revision for infection (HR 1.48; 95% CI 1.12-1.98; p = 0.006), dislocation (HR 1.87; 95% CI 1.45-2.42; p < 0.001), and early aseptic loosening (0-3 month; HR 2.81; 95% CI 1.50-5.26; p = 0.001). There was no difference in all-cause revision for cemented, cementless, or hybrid THA fixation in RA patients. This study suggests that RA continues to be associated with worse post-THA outcomes compared to OA. Further research is needed to develop strategies that improve perioperative management of inflammation and immune suppression to reduce the risk of post-operative complications in RA patients undergoing THA.
Fast-acting botulinum neurotoxins (BoNTs) are highly desirable for both medical and aesthetic indications, but the underlying mechanism for the differing onset of BoNTs' action remains unknown. Here, we demonstrate that the "belt" of BoNTs, a largely unstructured loop wrapping around their catalytic light chain (LC), is key to onset of intoxication. The more flexible BoNT/E belt promotes quicker LC translocation into the neuronal cytosol, leading to faster onset of action compared to BoNT/A. Furthermore, we discover a "belt-buckle" checkpoint that regulates this process. By loosening the BoNT/A belt-buckle via protein engineering, we enhance its sensitivity to acidic pH, leading to an accelerated onset of action. Conversely, locking the belt-buckle with an antibody neutralizes BoNT/A. Our findings open avenues for developing fast-acting BoNTs and effective countermeasures.
High moisture content critically constrains the disposal efficiency of waste activated sludge (WAS). Conventional flocculation conditioning exhibits limited efficacy as it fails to release water encapsulated in extracellular polymeric substances (EPS) and cells. This study proposes a novel process using Fe(Ⅱ)-activated 1,3-dichloro-5,5-dimethylhydantoin (Fe(Ⅱ)/DCDMH) to enhance sludge dewaterability. Under acidic conditions (pH 5), the synergistic oxidation and flocculation effects from in-situ generated reactive species (•OH, •Cl and Fe(Ⅳ)) and Fe(Ⅲ) greatly enhanced sludge dewatering performance. The capillary suction time (CST) and specific resistance to filtration (SRF) decreased by 57.34% and 85.79%, respectively. Mechanistic investigations revealed that reactive species altered the functional group structure of EPS and decreased the content of water-retaining components like proteins and polysaccharides. Such effects induced a loosened EPS structure, sludge flocs fragmentation and the increases in internal porosity and pore size, thereby facilitating water release. Concurrently, in-situ formed Fe(Ⅲ) also suppressed surface negative and hydrophilic surface area, promoting the re-agglomeration of fragmented fine flocs, which enlarged overall sludge particle size, reconstructed drainage channels, and enhanced flocculation performance. Moreover, the radicals preferentially degraded EPS to disrupt the water-retaining structure, while the molecular HClO penetrated cell membranes and induced intracellular oxidative damage. These processes collectively altered cell permeability, regulated cell death processes, and effectively suppressed microbial viability. It provides theoretical support for potential control of hazardous microorganisms in sludge during disposal.
Sacroiliac (SI) joint dysfunction, an under-recognized cause of chronic low back pain, is predominantly prevalent in women. In selected patients it can be treated using minimally invasive fusion with stabilizing implants. While short-term outcomes of SI joint fusion (SIJF) are well documented, long-term effects and incidence of implant loosening remain relatively unknown. This study aims to determine both the incidence and potential risk factors of loosening after SIJF. A retrospective longitudinal single-center study was conducted including all patients who underwent SIJF between 2011 and 2021. A subset with postoperative radiographs was analyzed for radiographic signs of implant loosening, indicated by radiolucency around the implant. Survival analyses were conducted to assess occurrence of loosening rates, and a risk factor analysis was performed. Additionally, specific locations of radiographic loosening signs were evaluated. A total of 297 interventions (211 patients, 187 females, mean age 47 years) were included. In all cases triangular titanium implants were used. Signs of radiographic implant loosening were observed in 39 SI joints. The one-year incidence of radiographic implant loosening was 2.0%, and the five-year incidence was 15.0%. The only factor associated with a higher risk of radiographic implant loosening was moderately impaired mobility (P < 0.001). Loosening signs were predominantly observed at the sacral side of the implant (67.2%). A one- and five-year incidence of respectively 2% and 15% of implant loosening was observed in SIJF. Moderately impaired mobility was significantly associated with loosening, but causality remains uncertain.
Periprosthetic osteolysis (PPO) is the main cause of aseptic loosening after total joint arthroplasty, often resulting from wear particle-induced osteogenic impairment. Morroniside (Mor), a major bioactive iridoid glycoside from C. officinalis, has been shown to have protective effects in osteoporosis. However, its efficacy against wear particle-induced osteolysis remains elusive. Herein, we evaluated the anti-PPO efficacy of Mor using a CoCrMo particle (CoP)-induced murine calvarial osteolysis model, and investigated the protective effects and signalling pathways associated with osteogenesis in CoP-stimulated mice and MC3T3-E1 cells. The results demonstrated that Mor effectively attenuated CoP-induced osteolysis in mice. Additionally, it reversed osteogenic impairment in both CoP-stimulated mice and MC3T3-E1 cells. Mechanistically, this protection was mediated by activating the Wnt/β-catenin signalling pathway in both in vivo and in vitro models. Notably, inhibiting the Wnt signalling pathway with XAV939 abolished the protective effects of Mor in both models. These findings indicate that Mor alleviates CoP-induced osteolysis by restoring osteogenic function via the Wnt/β-catenin pathway, highlighting its potential as a therapeutic agent for PPO.
This is a retrospective, single-center cohort study comparing the long-term radiographic osseointegration and aseptic loosening between a 3D-printed EPORE® collar and a prior generation HA-coated collar in endoprosthetic reconstructions. Achieving stable bone integration in endoprosthetic reconstructions remains challenging, with hydroxyapatite (HA)-coated collars being the only option available in the past. Earlier studies from our center have shown reliable and accelerated osseointegration at the bone-collar interface using a novel highly porous 3D-printed EPORE® collar system compared to a previously used HA-coated collar. Methods: Twenty-eight patients who underwent an implantation of endoprostheses utilizing the novel 3D-printed EPORE® collar system were case-matched to 24 patients who had previously undergone surgeries using a HA-coated collar. The mean age at surgery was 65.2 years (range: 17-95 years). Patients in the HA-coated collar group had a mean age of 63.8 years (range: 17-86 years), while those in the 3D-printed collar group had a mean age of 66.7 years (range: 32-95 years), with no statistically significant difference between groups (p = 0.876). A minimum radiological and clinical follow-up of 2 years was available in all included cases. Osseointegration was evaluated using postoperative plain radiographs in two planes based on a previously validated semi-quantitative score. Results: When aseptic loosening was used as the primary endpoint, no failures occurred in the 3D-printed EPORE® group during the study period. The overall rate of stem loosening (including both aseptic and septic causes) was 7% (2/28) in the 3D-printed group and 16% (4/24) in the HA-coated group. All cases of loosening in the 3D-printed cohort were related to septic failure. This translates into a 2-year aseptic-loosening-free survival of 100% in the 3D-printed group. When the radiographic osseointegration was analyzed as the endpoint, the rate of successful osseointegration was significantly higher in the 3D-printed group (92.9%, 26/28; 95% CI 76.5-99.1%) compared with the HA-coated group (70.8%, 17/24; 95% CI 48.9-87.4%; p = 0.04). The distribution of ongrowth scores also differed significantly between groups. The highest ongrowth score (grade 4) was achieved in 82.14% of 3D-printed implants (23/28; 95% CI 63.1-93.9%), compared with 37.5% of HA-coated implants (9/24; p = 0.0002). The time to achieve grade 4 ongrowth was significantly shorter in the 3D-printed cohort, with a median of 470 days (IQR 360-610), compared with 1482 days (IQR 1020-1860) in the HA-coated group (p < 0.0001). In addition, patients in the 3D-printed implant group had a significantly higher mean body mass index compared with the HA-coated group (32.51 vs. 28.36, p = 0.01). Conclusions: These results show that the novel highly porous 3D-printed EPORE® collars reduce aseptic loosening and accelerate extracortical bridging in endoprosthetic replacements. This benefit persisted even in higher BMI or revision contexts when compared to the previously used HA-coated collars.
How Community Health Worker (CHWs) programs are governed shapes their performance. CHW governance can be challenged by CHWs' accountability to both governments and their communities, and the need to coordinate between multiple actors. Furthermore, little is known about how decentralization impacts CHW governance. We examined Nepal's Female community health volunteers (FCHV), where a 2015 constitutional change to federalism-a major governance reform representing one form of decentralization-shifted the responsibility for community health governance to local municipalities. We assessed FCHV governance in the federal landscape and provide preliminary insights into how federalization has impacted FCHV governance in its early years. We identified opportunities and challenges brought by federalization for six actors: federal, provincial and municipal governments, international donors, FCHVs and their representative organizations (unions), and non-governmental organizations. Our qualitative case study comprised 26 semi-structured interviews and five focus groups conducted with FCHVs, health workers, federal and municipal government representatives, researchers, and FCHV union, donor and NGO representatives, across four districts in Bagmati Province, combined with analysis of 259 documents. We analysed these data using a theoretical framework of CHW governance adapted from seven existing frameworks on health workforce and community health governance. We show that FCHV governance was characterized by improved accountability, transparency, participation, and responsiveness to local needs, to some extent. Decentralization remained incomplete, with governance challenged by limited budgetary and administrative decision-space at local levels, in part because of continued central-level control and limited revenue-raising capacity, coordination, and enforcement challenges, as well as lack of role clarity. While donors and NGOs participate in decision-making, FCHVs and their representative organizations are not consistently consulted. The results indicate that strengthening FCHV governance in federal Nepal will require capacity-building of municipalities while loosening the federal grip.
The aim of this retrospective study was to evaluate the long-term clinical outcomes of implant-supported prostheses and to analyze the type, frequency, and distribution of prosthetic complications in relation to prosthesis-related factors. Clinical records of patients who received implant-supported prosthetic treatment between 2017 and 2024 at the Department of Prosthodontics, Faculty of Dentistry, Gazi University, were retrospectively reviewed. A total of 269 patients with 778 implants were included. The follow-up period ranged from 14 to 228 months after functional loading, with a mean follow-up duration of 54.6 months. Fixed, hybrid, and implant-supported overdentures were evaluated. Prostheses were classified according to prosthesis type, restorative material, retention type, and impression level. Prosthetic complications were recorded. Statistical analyses included chi-square tests to evaluate complication distributions and Cox proportional hazards regression analysis to identify factors associated with time to first prosthetic complication. Statistical significance was set at P < 0.05. Implant-supported prostheses showed favorable long-term clinical outcomes; however, biological, mechanical, and technical complications were observed. The most common complications were screw loosening, prosthetic fractures and chipping of the veneering material. Complication rates differed significantly according to restorative material, prosthesis type, retention type, and impression level. Fixed partial dentures showed higher rates of chipping and screw-related complications compared with implant-supported single crowns. Hybrid prostheses, particularly acrylic-based prostheses, showed a higher incidence of acrylic tooth fractures. Cement-retained prostheses were more frequently associated with peri-implantitis, whereas screw-retained prostheses showed higher rates of mechanical complications. Cox regression analysis demonstrated that prosthesis type, restorative material, impression level, and retention type significantly influenced the risk of prosthetic complications (P < 0.05). Implant-supported prostheses exhibited high long-term survival in the present study; nevertheless, prosthetic complications were observed throughout the follow-up period. Prosthesis type, restorative material, retention type, and impression level were significantly associated with prosthetic complications. Appropriate treatment planning, material selection, regular follow-up, and patient compliance are essential to improve long-term clinical outcomes.
A choline-oxalic acid deep eutectic solvent (DES) was developed for the molecular-weight-controlled extraction of collagen peptides from sturgeon (Acipenser spp.) skin, a collagen-rich fish-processing by-product containing 78.28% protein and 63.47% collagen. Among three choline-based organic-acid DESs, choline-oxalic acid exhibited the best extraction performance and produced lower-molecular-weight peptide fractions than choline-lactic acid and choline-acetic acid systems. Under the optimized conditions of 70 °C, a solid-to-liquid ratio of 1:80, and 2 h, the extraction rate reached 98.45%. Time-dependent extraction enabled controllable peptide production: a 2 h treatment mainly generated collagen polypeptides in the 1-10 kDa range, whereas extending the reaction to 4 h produced oligopeptides predominantly in the 0.5-1 kDa range. For downstream recovery, isopropanol showed the highest precipitation efficiency, achieving approximately 92% peptide recovery at an extract-to-solvent ratio of 1:6. UV-Vis analysis showed a characteristic collagen peptide absorption band near 230 nm, while FT-IR spectra displayed typical amide bands, including amide I at approximately 1630 cm-1 and amide III at 1240-1300 cm-1, confirming the collagen-derived nature of the products. Molecular simulation further suggested that oxalic acid competed for backbone hydrogen bonding, while chloride ions interacted with hydroxyproline residues, as indicated by a Hyp-Cl- radial distribution peak at 0.328 nm, promoting collagen swelling, triple-helix loosening, and controlled depolymerization. Overall, this DES-based strategy provides a rapid, tunable, and potentially sustainable route for producing collagen peptides from aquatic by-products.
Accurate preoperative assessment of glenoid bone loss is critical in revision shoulder arthroplasty. The aim of this study was to evaluate the reliability of the Blueprint Revision 3D-CT planning software (Stryker, Kalamazoo, MI, USA) by comparing preoperative reconstructions with intraoperative findings. Agreement between preoperative and intraoperative assessments was analyzed for glenoid containment status, comparing 2D-CT and 3D reconstructed images derived from CT imaging (3D-CT) with intraoperative findings. Forty-seven patients undergoing revision of the same stemless anatomic total shoulder arthroplasty with a cemented polyethylene glenoid component were included in this analysis. Glenoid bone defects were classified using the established systems according to Antuña and Williams-Iannotti. Defect containment (contained vs. uncontained) was assessed preoperatively using 3D-CT and 2D-CT imaging and compared with intraoperative findings. Agreement between different imaging methods was evaluated using Cohen's kappa coefficient (κ). The most common indication for revision was glenoid loosening (79%), with a mean time to revision of 7 ± 3 years. Intraoperative evaluation classified 68.1% of glenoid defects as contained, which was correctly depicted in 80.9% of 3D-CT and 65.9% of 2D-CT. Agreement between 3D-CT and intraoperative findings was moderate (κ = 0.58, 80.9%) and outperformed 2D-CT (κ = 0.37, 65.9%). Agreement between 3D-CT and 2D-CT was also moderate (κ = 0.48, 72.3%). 3D-CT-based preoperative planning using Blueprint Revision demonstrates higher agreement with intraoperative findings compared to traditional 2D imaging. These findings support the value of advanced 3D planning tools in evaluating glenoid containment and guiding surgical decision-making in revision shoulder arthroplasty.
Background/Objectives: There is no consensus on whether it is possible to preserve implant retention during deep surgical site infections (SSIs), and there is no widely accepted treatment protocol to date for these patients. The aim of this study is to evaluate the efficacy of the debridement, antibiotics, and implant retention (DAIR) protocol in patients who were treated for degenerative thoracolumbar spinal disorder using spinal instrumentation. Methods: This retrospective study describes the 24-month outcomes of deep SSI that developed in 25 of 720 patients (3.5%) who underwent surgery for thoracolumbar degenerative spinal disorders (disc disease, spinal stenosis, and scoliosis) and were treated according to the DAIR protocol. Results: Of these 25 patients, 18 developed early infection (<1 month), 3 developed delayed infection (1-3 months), and 4 developed late-onset deep infection (>3 months). Staphylococcus aureus was isolated in 56% of the patients. The DAIR protocol was successful in 22 (88%) of the patients, while it failed in 3 (12%). Surgical implants were removed in 25% of patients with late-onset SSI, and only 11.1% with early onset and 0% with delayed SSI. All patients who failed DAIR were smokers. A significant association was found between the Charlson Comorbidity Index and the number of surgical interventions (p = 0.022). Conclusions: In this small retrospective cohort, the DAIR protocol appeared to be a feasible treatment option for deep SSI, particularly in early infections. Implant removal may be considered when infection persists after repeat DAIR or when implant loosening is observed.
The efficacy of patient-specific guides (PSGs) in improving accuracy and reducing the number of outliers in glenoid implant positioning in anatomic total shoulder arthroplasty has been clearly shown. However, long-term clinical benefit in terms of outcomes, revision rates and patient satisfaction remains unproven. Our purpose was to compare the long-term clinical and radiographic outcomes of two aTSA groups, with or without the use of a PSG for glenoid implant positioning. A retrospective comparative study based on a prospective cohort was conducted including all patients with aTSA Tornier Perform Anatomic Glenoid (Stryker, Kalamazoo, MI) performed between January 2013 and May 2015 at a minimum 10 years of follow-up (FU). Patients were divided into two groups based on the use of a 3D preoperative planning and PSG (PSG Vs no-PSG group) generated by Glenosys (Imascap, Plouzané, France). Forty-seven patients (27 in the no-PSG and 20 in the PSG group) were included. The last-FU radiographic and clinical outcomes were evaluated. One patient was revised to a reverse shoulder arthroplasty in each group (p>0.999) for glenoid loosening. There was no difference in terms of Visual Analogue Score (1±2 Vs 1±1 ;p=0.254), Subjective Shoulder Value (85±15 Vs. 87±14 ;p=0.592), the rate of satisfaction (4: 73%; 3: 23%; 2: 4% Vs 4: 79% ; 3: 16%; 2: 5% ;p= 0.856), active anterior elevation (153±21° Vs 163±11°; p=0.148), passive anterior elevation (155±20° Vs 167±9° ;p=0.1), active external rotation (54±18° Vs 56±8° ;p=0.809) active internal rotation (7±3 Vs 7±2 ;p= 0.706), and adjusted Constant Murley Score (118±21 Vs 123±14 ;p= 0.76). Furthermore, no significant difference in terms of Mole's mean score (5±7 ;p=0.686) and in the rate of component migration (19% Vs 20% ;p= 0.999) was observed. PSG systems for glenoid implants in aTSA show no improvement (revision and function) over 10 years of FU compared to the non-PSG method, indicating that PSG systems may not be necessary. The true benefits may lie in other areas that have not yet been sufficiently explored deserving specific evaluation.