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Introduction: In complex and deformed knees, soft tissue release (STR) is required to obtain symmetry in the femorotibial gap. The objective of this study was to attempt to predict the need for soft tissue release using surgical navigation in total knee replacement (TKR).Methods: Prospective and non-randomized study. One hundred thirty knees. At the start of navigation, an attempt was made to correct the femorotibial mechanical axis by applying force to the medial or lateral side of the knee (varus-valgus stress angle test). A gap balanced technique with computer-assisted surgery (CAS) was performed in all cases. The ligaments were tensioned, and using CAS visualization and control, progressive STR was performed in the medial or lateral side until a symmetry of the femorotibial gap was achieved.Results: Eighty-two patients had a varus axis ≥ 3° and 38 had a valgus axis (P < 0.001). STR was performed under navigation control in 38.5% of cases, lateral release (LR) in 12 cases, and medial release (MR) in 38 cases. After performing the varus-valgus stress angle test (VVSAT), the axis of 0° could be restored at some point during the manoeuvre in 28 cases. STR was required in 44.6% of varus cases and 27% of valgus cases (P = 0.05). A significant relationship was found between the previous deformity and the need for MR (P < 0.001) or LR (P = 0.001). STR was more common in male patients (P = 0.002) and as obesity increased.Conclusion: This study shows that pre-operative factors favouring the need to perform STR in a TKR implant can be defined. [ABSTRACT FROM AUTHOR]

Background: Matrix metalloproteinase-9 (MMP-9) is crucial in tissue remodeling after an adverse cardiac event. In experimental studies, melatonin has been found to attenuate MMP-9 activation. The present study assessed the effects of systemic melatonin administration on the prognosis of patients with acute myocardial infarction (AMI) successfully treated with primary percutaneous coronary intervention, and to examine the effects on MMP-9 levels. Methods: We conducted a randomized controlled trial, enrolling patients who underwent primary percutaneous coronary intervention due to AMI. They were assigned to two groups for melatonin or placebo. The primary endpoint was a combined event of mortality and heart failure readmission at 2 years. The secondary endpoint was the levels of MMP-9 after the percutaneous coronary intervention. Results: Ninety-four patients were enrolled, 45 in the melatonin group and 49 in the control group. At 2 years of follow-up, 13 (13.8%) patients suffered the primary endpoint (3 deaths and 10 readmissions due to heart failure), 3 patients in the melatonin group and 10 in the placebo group. The difference in the restricted mean survival time was 87.5 days (p = 0.02); HR = 0.3 (95% CI 0.08–1.08; p = 0.06); Log-rank test 0.04. After controlling for confounding variables, melatonin administration reduced MMP-9 levels to 90 ng/mL (95% CI 77.3–102.6). Conclusions: This pilot study demonstrated that compared to placebo, melatonin administration was associated with better outcomes in AMI patients undergoing primary percutaneous coronary intervention. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES Some researchers have observed an increased number of deaths during the follow-up of young patients who undergo aortic valve replacement due to severe aortic stenosis, suggesting that this procedure does not restore their life expectancy. Our goal was to confirm these findings and explore sex-based differences. METHODS All patients between 50 and 65 years of age who underwent isolated aortic valve replacement in 27 Spanish centres during an 18-year period were included. We compared observed and expected survival at 15 years of follow-up and estimated the cumulative incidence of death from a competing risks point of view. We stratified by sex and analysed if being a woman was an independent risk factor for death. RESULTS For men, the observed survival at 10 and 15 years of follow-up was 85% [95% confidence interval (CI) 83.6%–86.4%] and 72.3% (95% CI 69.7%–74.7%), respectively whereas the expected survival was 88.1% and 78.8%. For women, the observed survival at 10 and 15 years was 85% (95% CI 82.8%–86.9%) and 73% (95% CI 69.1%–76.4%), whereas the expected survival was 94.6% and 89.4%. At 15 years of follow-up, the cumulative incidence of death due to the disease in men and women was 8.2% and 16.7%, respectively. In addition, being a woman was an independent risk factor for death (hazard ratio = 1.23 (95% CI 1.02–1.48; P  = 0.03). CONCLUSIONS After the aortic valve replacement, men and women do not have their life expectancy restored, but this loss is much higher in women than in men. In addition, being a woman is a risk factor for long-term death. Reasons for these findings are unknown and must be investigated. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to analyse the efficacy of modular femoral stems for the treatment of certain post-operative periprosthetic fractures in patients with hip arthroplasty.Methods: Of a total series of 61 modular revision stems, 17 were used to address periprosthetic femoral fractures and 12 of these are the object of this study. The average follow-up was 3.7 years (range 1-14 years). The evaluations were performed at three and six months, and then annually using the HHS score and radiographic studies for the assessment of loosening, subsidence and bone integration of the stem.Results: Seven cases had type B2 fractures and five type B3 ones. All patients walked freely, eight of them using canes. HHS improved to a post-operative mean of 78 (range 72-83). Radiographically, fracture healing was observed at three months in nine cases. In six cases stem subsidence of a mean of 3.9 mm (range 2-12 mm) was observed, which stabilized a year following implantation and did not need revision surgery. In two cases a subsequent dislocation (at three and seven months after surgery) occurred, which were treated with constrained acetabular systems. In nine cases hypotrophy of the cortex in the diaphyseal area was noted, which did not alter the patients' clinical course.Conclusion: Modular femoral stems are an acceptable treatment in type B2 and B3 periprosthetic fractures. [ABSTRACT FROM AUTHOR]

Purpose: Computer-assisted surgery (CAS) may facilitate better positioning of total knee arthroplasty (TKA) along the coronal and lateral axes; however, there are doubts as to its usefulness in the rotational plane. Methods: This is a prospective study of 95 TKAs comparing two groups: the CAS group and the standard equipment group. The series comprises 95 cases. A radiography of the lower limb and computer tomographies (CTs) of the femoral condylar region, the proximal end of the tibia and the ankle were performed to measure rotational angulation. A month after TKA surgery, the radiography and the CTs were repeated to analyze the position of the prosthetic components in the rotational plane. Results: In the coronal axis, both CAS and mechanical technique improved femoro-tibial alignment, but when there are preexisting deformities ≥4°, CAS obtains better results. A strong correlation ( R = 0.94, p = 0.001) was observed between the mean rotational axis measured with CT in the tibial plateau and that measured from the axis of the ankle. The mean initial femoral rotation of the complete series was 6.7° and 2.7° at 1-month follow-up ( p < 0.001). In the standard instrumentation group, the femoral rotation went from 6.8° to 2.3°, whereas in the CAS group the femoral rotation went from 6.5° to 3.1° ( p = 0.039), which is very close to the ideal 3° angle of external rotation. Tibial rotation changed by 5.28° for the entire patient population, but no differences were found when comparing CAS and standard instrumentation. Conclusion: CAS improves frontal alignment in TKA, especially in the presence of preoperative deformities. In the femoral component, navigation most closely replicated the ideal 3° external rotation of the femoral component, but tibial rotation did not differ when comparing CAS to standard instrumentation. Level of evidence: II. [ABSTRACT FROM AUTHOR]

BACKGROUND AND AIM: The clinical impact of patient-prosthesis mismatch (PPM) on outcomes in young and middle-aged patients undergoing surgery for aortic valve replacement (AVR) remains unknown. Our objective was to examine the mid-term impact of PPM on overall mortality, quality of life, and cardiac events in this population. METHODS: All patients younger than 70 years of age undergoing isolated AVR from October 2005 to October 2011 were analyzed. PPM was defined as the indexed effective orifice area <=0.85 cm(2) /m(2) . We studied the impact of PPM on mid-term overall mortality, cardiac events, and New York Heart Association functional class using an analysis stratified for propensity score. Cardiac events were defined as cardiac death, sudden death, hospital readmission due to angina, syncope or heart failure or reoperation on aortic prosthesis. RESULTS: Two hundred and ninety-three patients were included in the study, of whom 81 (27.61%) had some degree of PPM. PPM had no impact on mid-term overall mortality (HR = 1.45; 95% CI = 0.65-3.22; p = 0.36), although it had a negative impact on cardiac events (HR = 11.52; 95% CI = 5.25-25.24; p < 0.001) and functional class (RR = 7.55; 95% CI = 2.59-22.03; p < 0.001). CONCLUSIONS: Moderate PPM appears to be a strong and independent predictor of cardiac events and advanced functional class in young and middle-aged patients undergoing AVR for severe stenosis. However, it is possible that it has no impact on overall mortality. doi: 10.1111/jocs.12265 (J Card Surg 2014;29:127-133). [ABSTRACT FROM AUTHOR]

Background and Aim The clinical impact of patient-prosthesis mismatch (PPM) on outcomes in young and middle-aged patients undergoing surgery for aortic valve replacement (AVR) remains unknown. Our objective was to examine the mid-term impact of PPM on overall mortality, quality of life, and cardiac events in this population. Methods All patients younger than 70 years of age undergoing isolated AVR from October 2005 to October 2011 were analyzed. PPM was defined as the indexed effective orifice area ≤0.85 cm2/m2. We studied the impact of PPM on mid-term overall mortality, cardiac events, and New York Heart Association functional class using an analysis stratified for propensity score. Cardiac events were defined as cardiac death, sudden death, hospital readmission due to angina, syncope or heart failure or reoperation on aortic prosthesis. Results Two hundred and ninety-three patients were included in the study, of whom 81 (27.61%) had some degree of PPM. PPM had no impact on mid-term overall mortality (HR = 1.45; 95% CI = 0.65-3.22; p = 0.36), although it had a negative impact on cardiac events (HR = 11.52; 95% CI = 5.25-25.24; p < 0.001) and functional class (RR = 7.55; 95% CI = 2.59-22.03; p < 0.001). Conclusions Moderate PPM appears to be a strong and independent predictor of cardiac events and advanced functional class in young and middle-aged patients undergoing AVR for severe stenosis. However, it is possible that it has no impact on overall mortality. doi: 10.1111/jocs.12265 (J Card Surg 2014;29:127-133) [ABSTRACT FROM AUTHOR]

ABSTRACT The elevation of metal levels in serum and urine during post-operative follow-up is a frequent find following the implantation of certain models of metal-on-metal hip prostheses. Among 45 patients with the same resurfacing prostheses, chromium (Cr) and cobalt (Co) levels in serum and urine were determined at 3, 4, 5, and 6 years after surgery. In the same period, levels of Cr, Co and molibdene (Mo) in scalp hair were also measured. Mean Cr and Co levels in serum were 8.29 µg/L (SD 17.97) and 8.38 µg/L (SD 21.97), respectively, whereas in urine levels were 16.20 µg/L (SD SD 32.55) and 75.40 µg/L (SD 190.86), respectively. In hair, mean Cr level were 163.27 µg/g (SD 300.62), mean Co level 61.98 µg/g (SD 126.48), and Mo 31.36 µg/g (SD 37.86). A high concordance was observed between chromium-urine and chromium-serum and between cobalt-urine and cobalt-hair. A moderate concordance was present between cobalt-urine and cobalt-serum, and between cobalt-hair and cobalt-serum. Eleven patients required revision surgery, five of them due to metallosis and periarticular cyst. At 1 year after reintervention, analytics were performed again and the following decrease rates were found: 42.8% in Cr levels, 51.1% in Mo levels, and 90.3% in Co levels. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:2025-2031, 2013 [ABSTRACT FROM AUTHOR]

Background: Porous tantalum is an option of cementless fixation for TKA, but there is no randomized comparison with a cemented implant in a mid-term followup. Questions/purposes: We asked whether a tibial component fixed by a porous tantalum system might achieve (1) better clinical outcome as reflected by the Knee Society Score (KSS) and WOMAC Osteoarthritis Index, (2) fewer complications and reoperations, and (3) improved radiographic results with respect to aseptic loosening compared with a conventional cemented implant. Methods: We randomized 145 patients into two groups, either a porous tantalum cementless tibial component group (Group 1) or cemented conventional tibial component in posterior cruciate retaining TKA group (Group 2). Patients were evaluated preoperatively and 15 days, 6 months, and 5 years after surgery, using the KSS and the WOMAC index. Complications, reoperations, and radiographic failures were tallied. Results: At 5-year followup the KSS mean was 90.4 (range, 68-100; 95% CI, ± 1.6) for Group 1, and 86.5 (range, 56-99; 95% CI, ± 2.4) for Group 2. The effect size, at 95% CI for the difference between means, was 3.88 ± 2.87. The WOMAC mean was 15.1 (range, 0-51; 95% CI, ± 2.6) for the Group 1, and 19.1 (range, 4-61; 95% CI, ± 2.9) for Group 2. The effect size for WOMAC was −4.0 ± 3.9. There were no differences in the frequency of complications or in aseptic loosening between the two groups. Conclusions: Our data suggest there are small differences between the uncemented porous tantalum tibial component and the conventional cemented tibial component. It currently is undetermined whether the differences outweigh the cost of the implant and the results of their long-term performance. Level of Evidence: Level I, therapeutic study. See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Two-dimensional transition metal dichalcogenides (2D-TMDs) are among the most promising materials for exploring and exploiting exciton transitions. Excitons in 2D-TMDs present remarkably long lifetimes, even at room temperature. The spectral response of exciton transitions in 2D-TMDs has been thoroughly characterized over the past decade by means of photoluminescence spectroscopy, transmittance spectroscopy, and related techniques; however, the spectral dependence of their electronic response is still not fully characterized. In this work, we investigate the electronic response of exciton transitions in monolayer MoSe2 via low-temperature photocurrent spectroscopy. We identify the spectral features associated with the main exciton and trion transitions, with spectral bandwidths down to 15 meV. We also investigate the effect of the Fermi level on the position and intensity of excitonic spectral features, observing a very strong modulation of the photocurrent, which even undergoes a change in sign when the Fermi level crosses the charge neutrality point. Our results demonstrate the unexploited potential of low-temperature photocurrent spectroscopy for studying excitons in low-dimensional materials, and provide new insight into excitonic transitions in 1L-MoSe2. [ABSTRACT FROM AUTHOR]

Background: Controversy exists regarding the relationship between radiographic findings and clinical status in knee osteoarthritis. Although the surgical indication for total knee arthroplasty (TKA) should be based on pain, clinical status, and the deterioration of quality of life, the radiographic study is the most commonly used criterion for preoperative evaluation. The objective of this study is to find out the relationship between the Ahlbäck classification and clinical status in patients undergoing TKA. Methods: 1329 protocols were collected from preoperative studies in four multi centric working groups (the Interax, Duracon, Scorpio, and Triathlon Spanish groups) in 30 Spanish hospitals. Mean age was 70.4 years (SD: 6.8; range: 35 to 98); 76.3% of patients were women. Patients entered the study whenever the surgeon found that medical treatment was insufficient to control pain and functional limitation. Data were collected using electronic Case Report Forms, and included Ahlbäck grading scores, Hospital for Special Surgery Knee Score (HSS), SF-12, and other clinical and epidemiologic variables. Results: According to the Ahlbäck grading system, patients were divided as follows: 243 grade I (18.3%), 358 grade II (26.9%), 416 grade III (31.3%), 241 grade IV (18.1%), and 71 grade V (5.3%). As for HSS, the following scores were obtained: <60 points in 925 patients (69.6%), 60 to 69 points in 286 patients (21.5%), 70 to 84 points in 112 patients (8.4%) and 85 to 100 points in 6 patients (0.5%). Scores showed a statistically significant difference depending on Ahlbäck grade, with a clear tendency towards decrease in HSS scores as the Ahlbäck grade increases (p<0.001).However, the HSS score difference between Ahlbäck grades I and V was of 9.56 points only. Comparing the statusof the patients at the start (1994) and at the end (2010) of the data collection process, we observed that patients who underwent surgery in the last years were older and showed a lower Ahlbäck grade. Conclusions: We found a relationship between Ahlbäck grading and the preoperative clinical score. The range of variability of the HSS score between the different Ahlbäck grades is small. [ABSTRACT FROM AUTHOR]

Background: Surgical navigation in TKA facilitates better alignment; however, it is unclear whether improved alignment alters clinical evolution and midterm and long-term complication rates. Questions/purposes: We determined the alignment differences between patients with standard, manual, jig-based TKAs and patients with navigation-based TKAs, and whether any differences would modify function, implant survival, and/or complications. Patients and Materials: We retrospectively reviewed 97 patients (100 TKAs) undergoing TKAs for minimal preoperative deformities. Fifty TKAs were performed with an image-free surgical navigation system and the other 50 with a standard technique. We compared femoral angle (FA), tibial angle (TA), and femorotibial angle (FTA) and determined whether any differences altered clinical or functional scores, as measured by the Knee Society Score (KSS), or complications. Seventy-three patients (75 TKAs) had a minimum followup of 8 years (mean, 8.3 years; range, 8-9.1 years). Results: All patients included in the surgical navigation group had a FTA between 177° and 182º. We found no differences in the KSS or implant survival between the two groups and no differences in complication rates, although more complications occurred in the standard technique group (seven compared with two in the surgical navigation group). Conclusions: In the midterm, we found no difference in functional and clinical scores or implant survival between TKAs performed with and without the assistance of a navigation system. Level of Evidence: Level II, therapeutic study. See the Guidelines online for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Minimal invasion surgery (MIS) is a recent technique recommended for Total knee arthroplasty (TKA) but demands an effort of the surgeons and the learning curve may be long. Methods: Twenty six MIS-TKA were matched to 36 standard TKA with respect to age, sex, body mass index or preoperative score. All patients suffered from knee osteoarthritis, which had not improved with medical treatment and which presented a less than 10° deformity in the coronal and sagittal radiographic projections. At six months after the surgery a specific questionnaire was completed as well as the KSS (Knee Society rating scale), the generic short-form health questionnaire (SF-12) and a visual analogue scale (VAS). Results: The MIS technique required more time of surgery (p < 0.001), hospital stay was noticeably shorter (p < 0.05) and drainage volume collected after surgery was significantly higher in the standard technique. We observe a higher frequency in small sizes implants for MIS surgery but no statistically significant differences were found between both groups regarding the radiological alignment of the implant. At six months no differences were found between the groups in range of motion, KSS scores, the physical or mental subscale SF-12, patient's pain perception, satisfaction or subjective improvement. Conclusions: Minimal invasion surgery in total knee arthroplasty showed no improvement over a standard approach. [ABSTRACT FROM AUTHOR]

Peridural fibrosis is one of the more frequent complications of lumbar surgery. Nonsteroidal anti-inflammatory drugs inhibit the inflammatory and fibroblastic response. We performed lumbar laminectomies in 24 rabbits, divided into two groups. The experimental group received 5 mg/kg/day of aceclofenac for 7 days and the control group received 1 cm3 of physiological saline. The samples were stained using immunohistochemical methods. The cellular populations in the inflammatory reaction and the thickness of the fibrous membrane were quantified. The mean of the fibrous area was always less in the rabbits of the experimental group compared to controls (47% less at 2 weeks and 41% less at 4 weeks). We observed an 8% decrease in the number of fibroblasts with antivimentin monoclonal antibodies in the experimental group. In this model, aceclofenac inhibits the presence of inflammatory cells in the fibrous scar in the early stages and reduces the extension of adhesions without adverse reactions. [ABSTRACT FROM AUTHOR]

Background: Some studies have raised the question about whether the good results obtained with the Charnley prosthesis could be replicated at general hospitals when it comes to the frequency of early complications and failure rates, both of which would be higher than those published by centres devoted to hip arthroplasties. Methods: We reviewed the results of 404 Low Friction Arthroplasties of the hip implanted between 1976 and 1993 in a general hospital by general orthopaedic surgeons. For the survival analysis, the end-point chosen would be the chirurgical revision of any of the prosthetic components for whatever reason. Results: The complications were 16 dislocations (4%), 14 deep infections (3.5%), 2 neurological injuries (0,5%) and 5 clinical deep venous thromboses (1.2%) (2 pulmonary embolisms). The survival rate at 25 years, both for stem and cup, was 83%. Survival was higher in those arthroplasties implanted in patients older than 60 years, with statistical significance. Conclusion: Low Friction Arthroplasty undertaken at general hospitals by general orthopaedic surgeons feature similar outcomes to those found in centres devoted to hip surgery. [ABSTRACT FROM AUTHOR]

Background: The first stage in the implant of a total knee arthroplasty with computer-assisted surgery is to fasten the emitters to the femur and the tibia. These trackers must be hard-fixed to the bone. The objectives of our study are to evaluate the technical problems and complications of these tracker-pins, the necessary time to fix them to the bone and the possible advantages of a new femoral-fixed tracker-pin. Methods: Three hundred and sixty seven tracker-pins were used in one hundred and fifty one computer-assisted total knee replacements. A bicortical screw was used to fix the tracker to the tibia in all cases; in the femur, however, a bicortical tracker was used in 112 cases, while a new device (OrthoLock) with percutaneous fixation pins was employed in the remaining 39. Results: Technical problems related to the fixing of the trackers appeared in nine cases (2.5%). The mean surgery time to fix the tracker pin to the tibia was 3 minutes (range 2-7), and 5 minutes in the case of the femoral pin (range: 4-11), although with the new tool it was only three minutes (range 2-4) (p < 0.001). No complications were observed with this new device. Conclusion: The incidence of problems and complications with the fixing systems used in knee navigation is very small. The use of a new device with percutaneous pins facilitates the fixing of femoral trackers and decreases the time needed to place them. [ABSTRACT FROM AUTHOR]

Background Measured bone density correlates well with the mechanical properties of the bone. Our objective was to evaluate optical densitometry as a method of measuring the periprosthetic bone density of the tibial platform in total knee replacement using serial dual-energy X-ray absorptiometry (DXA) as the reference test. Methods 30 patients who underwent a cemented total knee' replacement were followed up for over 2 years. Standard radiographs of the knee were obtained at 12 and 24 months. These were photo- graphed with a digital camera and enhanced with image processing software. A DXA scan was per- formed at the same time as the reference method. 3 regions of interest were defined under the tibial plateau (medial, lateral and stem positions). Results After 24 months of follow-up there was a significant decrease in density in the 3 regions, both with the optical and DXA methods. The concordance between methods was studied using Bland and Altman plots, Cronbach's alpha and intraclass correlation coefficients resulted in values from 0.72 to 0.87, depending on the region and the follow-up time. Interpretation Quantification of optical density values with a standardized measurement system on conventional radiographs is a reliable and efficient method of determining the bone mineral density. [ABSTRACT FROM AUTHOR]

Background/Objectives: Understanding sex-based differences in cardiovascular outcomes is paramount to improving clinical outcomes. Surgery is an aggressive but effective therapy for ascending aortic aneurysm. We sought to determine if being a woman is a risk factor for long-term mortality after this surgery. We compared their life expectancy with a general population of the same age, sex, year, and region. Methods: We compared men and women undergoing AAA surgery at our institution from 2000 to 2019. After balancing the population with propensity score (PS) matching, we compared long-term mortality control with a Cox regression. We determined the RS using the Ederer II method and compared it to a healthy reference population of the same age, sex, and region. Results: From 2000 to 2019, 232 women and 506 men underwent ascending aortic aneurysm surgery. After a mean follow-up of 51.5 ± 34.5 months, sex was not an independent risk factor for long-term mortality in the multivariable analysis [HR: 0.68 (95% CI 0.43–1.07, p = 0.23)]. Matching by baseline characteristics, 196 pairs were analyzed with no differences regarding mortality in the Cox regression [HR: 1.11 (95% CI 0.65–1.9, p = 0.23)]. Men and women who survived the postoperative period presented a relative survival of 100.3% (95% CI 97.4–101%) and 100.3% (95% CI 98.9–101.1%), respectively, similar to the reference population without the disease. Conclusions: For patients undergoing AAA surgery, sex was not an independent predictor of mortality. Men and women who survived the postoperative period presented a similar life expectancy to that of the reference population (people free from the disease of the same age, sex, year, and region). [ABSTRACT FROM AUTHOR]

Exciton physics in two-dimensional semiconductors are typically studied by photoluminescence spectroscopy. However, this technique does not allow for direct observation of non-radiating excitonic transitions. Here, we use low-temperature photocurrent spectroscopy as an alternative technique to investigate excitonic transitions in a high-quality monolayer MoS2 phototransistor. The resulting spectra presents excitonic peaks with linewidths as low as 8 meV. We identify spectral features corresponding to the ground states of neutral excitons ( X 1 s A and X 1 s B ) and charged trions (TA and TB) as well as up to eight additional spectral lines at energies above the X 1 s B transition, which we attribute to the Rydberg series of excited states of XA and XB. The intensities of the spectral features can be tuned by the gate and drain-source voltages. Using an effective-mass theory for excitons in two-dimensional systems we are able to accurately fit the measured spectral lines and unambiguously associate them with their corresponding Rydberg states. The unique optical and optoelectronic properties of transition metal dichalcogenides are dominated by excitonic effects, whose structure is not fully characterised. Here, exciton and trion transitions in a monolayer MoS2 phototransistor are investigated by low temperature photocurrent spectroscopy. [ABSTRACT FROM AUTHOR]

The Trifecta aortic valve has excellent hemodynamics characteristics. Moreover, the Perceval prosthesis may achieve better hemodynamics than the conventional valves; therefore, it has been proposed to reduce the incidence of patient–prosthesis mismatch. Our aim was to compare the prevalence of this complication between both prostheses. All patients who underwent valve replacement with a Perceval or a Trifecta from 2016 to 2020 at our institution were included. We calculated the prevalence of patient–prosthesis mismatch for each prosthesis and size and performed a multinomial logistic regression model to investigate the impact of choosing one prosthesis over the other. A total of 516 patients were analyzed. Moderate mismatch was present in 33 (8.6%) in the Trifecta group and 28 (21.4%) in the Perceval group, p < 0.001. Severe mismatch was present in 8 (2.1%) patients with Trifecta and 5 (3.8%) patients with Perceval, p = 0.33. Compared with the Perceval, the Trifecta prosthesis was shown to reduce moderate patient–prosthesis mismatch: OR = 0.5 (95% CI 0.3–0.9, p = 0.02). Both prostheses led to a similar risk of severe patient–prosthesis mismatch: OR = 0.9 (95% CI 0.3–2.8, p = 0.79). Both prostheses provide a very low risk of severe patient–prosthesis mismatch. Compared with the Perceval prothesis, the Trifecta prosthesis is able to reduce by 50% the risk of moderate mismatch. [ABSTRACT FROM AUTHOR]

Introduction: Mortality caused by ST elevation myocardial infarction (STEMI) has declined because of greater use of primary percutaneous coronary intervention (PCI). It is unknown if patients >75 have similar survival as peers. We aim to know it stratifying by sex and assessing how the sex may impact the survival. Methods: We retrospectively selected all patients >75 who suffered a STEMI treated with primary PCI at our institution. We compared their survival with that of the reference population (general population matched by age, sex, and geographical region). A Cox-regression analysis controlling for clinical factors was performed to know if sex was a risk factor. Results: Total of 450 patients were studied. Survival at 1, 3, and 5 years of follow-up for patients who survived the first 30 days was 91.22% (CI95% 87.80–93.72), 79.71% (CI95% 74.58–83.92), and 68.02% (CI95% 60.66–74.3), whereas in the reference population it was 93.11%, 79.10%, and 65.01%, respectively. Sex was not a risk factor, Hazard Ratio = 1.02 (CI95% 0.67-1.53; p = 0.92). Conclusions: Life expectancy of patients suffering a STEMI is nowadays intimately linked to survival in the first 30 days. After one year, the risk of death for both men and women seems similar to that of the general population. [ABSTRACT FROM AUTHOR]

Introduction: The life expectancy of patients who undergo ascending aortic replacement is unknown. The life expectancy of a population depends on a collection of environmental and socio-economic factors of the territory where they reside. Our aim was to compare the life expectancy of patients undergoing surgery for ascending aortic aneurysm with that of the general population matching by age, sex, and territory. In addition, we aimed to know the late complications, causes of death and risk factors. Methods: All patients who underwent elective replacement of an ascending aortic aneurysm at our institution between 2000 and 2019 were included. The long-term survival of the sample was compared with that of the general population using data of the National Institute of Statistics. Results: For patients who survived the postoperative period, observed cumulative survival at three, five and eight years was 94.07% (95% CI 91.87–95.70%), 89.96% (95% CI 86.92–92.33%) and 82.72% (95% CI 77.68–86.71%). Cumulative survival of the general population at three, five and eight years was 93.22%, 88.30%, and 80.27%. Cancer and cardiac failure were the main causes of death. Conclusions: Long-term survival of patients undergoing elective surgery for ascending aortic aneurysm who survive the postoperative period completely recover their life expectancy. [ABSTRACT FROM AUTHOR]

Objectives: Recently, desert dust in Europe has been recognized as a cardiovascular health problem. In Spain, desert dust inflows in recent years have been associated with worsening air quality. The present study examines whether desert dust events are related to the incidence of acute coronary syndrome (ACS) in patients under 55 years of age. Methods: Data from 2416 consecutive patients admitted to a tertiary hospital due to ACS were prospectively analyzed. A case-crossover time-stratified design using Poisson conditional regression models was applied to estimate the impact of desert dust events involving particulate matter concentrations of an aerodynamic diameter <10 μm (PM10) on the incidence of ACS in patients under 55 years of age. Results: Desert dust intrusion on days 0 to 5 before ACS onset showed no significant association with the incidence of ACS in patients under 55 years of age. The incidence rate ratios of PM10 concentrations 1, 2, 3, 3, 4, and 5 days before ACS onset (for changes of 10 µg/m3) were 1.02 (95% CI 0.97–1.1; p = 0.41), 1.01 (95% CI 0.96–1.07; p = 0.66), 0.99 (95% CI 0.94–1.05; p = 0.78), 0.96 (95% CI 0.9–1.02; p = 0.18), and 0.97 (95% CI 0.91–1.04; p = 0.41). Conclusions: Our findings suggest that desert dust is unlikely to be related to the incidence of ACS in patients under 55 years of age. [ABSTRACT FROM AUTHOR]

The author reflects on patient prosthesis mismatch (PPM) and its impact among patients with congenital heart disease. Topics include the description PPM as a situation in which the area of a functioning prosthetic valve is too small for the body surface area (BSA) of the patient, the author's assessment of studies investigating PPM, and risk factors affecting outcomes of patients who undergo aortic valve replacement (AVR). Recommendations regarding further research on PPM are also mentioned.

A letter to the editor is presented in response to the article "Predictive factors of early mortality after transcatheter aortic valve implantation: individual risk assessment using a simple score" by B. Iung and colleagues, published in a 2014 issue.

A letter to the editor is presented in response to the article "Performance analysis of EuroSCORE II compared to the original logistic EuroSCORE and STS scores for predicting 30-day mortality after transcatheter aortic valve replacement" by E. Durand in a 2013 issue.

The aim of this study was to assess the safety and effectiveness of valve in valve (VIV) TAVI with the autoexpandable valve, specifically in patients with failed Mitroflow (MF) bioprosthetic aortic valves. Pilot, single center, observational and prospective study that included 45 consecutive patients with symptomatic failed MF bioprosthetic aortic valve, referred for VIV TAVI. The safety primary endpoint was a composite of early events at 30 days, defined by VARC-2 criteria. The efficacy primary endpoint was the device success (no procedural mortality, correct positioning of a single prosthetic heart valve into the proper anatomical location and absence of moderate/severe prosthetic aortic valve regurgitation). We also analysed patient-prosthesis mismatch (PPM) parameters. Between March 2012 to December 2017, 45 symptomatic patients (age 79.9 ± 6.5 years) with degenerated MF valves (numbers 19: 33.3%; 21: 28.9%; 23: 24.4%; 25: 13.3%) underwent CoreValve (n = 11) or Evolut R (n = 34) implantation (23 and 26 mm sizes). The STS predicted risk of mortality was 6.3 ± 6.3%. The safety primary endpoint occurred in 4 patients (8.8%). The efficacy endpoint was present in all patients (100%). There were no coronary occlusions or procedural deaths. The number of patients with any degree of PPM raised from 51.1% (pre-TAVI) to 60% (post-TAVI). Self-expanding TAVI for degenerated MF bioprosthesis has favourable early outcomes. The VIV procedure has provided an important gateway to avoiding high-risk redo surgery and is now a potential option for MF failed surgically aortic implanted valves. Valve in valve with the autoexpandable valve in 45 patients with failed Mitroflow surgical aortic valves. Unlabelled Image • Self-expanding TAVI for degenerated MF bioprosthesis has favourable early outcomes. • The valve-in-valve procedure has provided an important gateway to avoid high-risk redo surgery. • The valve-in-valve procedure is now a potential option for degenerated MF degenerated surgically aortic implanted valves. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Minimally Invasive Total Knee Arthroplasty Using the Contralateral Knee As a Control Group: A Case-Control Study" in a 2010 issue.

Abstract: We describe a case of navigation-aided knee arthrodesis in a patient with a previous femoral deformity. Because of the complex deformity and the foreseeable difficulties in obtaining correct limb mechanical axis, a wireless navigation system was used to perform cuts of the distal femur and proximal tibia in both the coronal and sagittal planes. For a stable arthrodesis two monolateral external fixation devices were used. Twenty months after the procedure the patient did not have pain and walked without the aid of walking sticks. The final mechanical axis was 180°. [Copyright &y& Elsevier]

Aims: The main objective of this study is to determine whether exposure to Saharan dust causes airway inflammation and oxidative stress in patients with stable chronic heart failure (HF) and a left ventricular ejection fraction of less than 40%. Methods: A longitudinal study design is used, involving the inclusion of 40 patients with stable chronic HF and a left ventricular ejection fraction of less than 40%. Four sputum samplings will be taken from each patient, with one sampling taken each week over four consecutive weeks. The sputum samples will be used to analyze the degree of inflammation and oxidative stress. Air quality monitoring stations will be used to analyze the particulate matter (PM) exposure of each patient. The intrusion of desert dust will be identified using meteorological models. There will be 160 scheduled samplings in 40 patients with chronic HF. Mixed regression models will be used to assess the influence of the concentrations of PM (from the episodes of desert dust) upon the airway inflammation and oxidative stress markers. Conclusion: The results of this study will test the hypothesis that exposure to high concentrations of Saharan dust affects the normal function of the respiratory epithelium due to the imbalance between the production of free radicals and antioxidant enzymes, thus causing increased pulmonary inflammation and oxidative stress in patients with HF that in turn may facilitate decompensations of their background disease condition. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Saphenous Vein Graft Failure After Coronary Artery Bypass Surgery: Insights From PREVENT IV" by C. N. Hess and colleagues in the 2015 issue.

A letter to the editor is presented in response to the article "Performance of EuroSCORE II in a large US database: implications for transcatheter aortic valve implantation," by R. L. Osnabrugge and colleagues in the 2014 issue is presented.

Aim: To compare the safety and effect on tibial diaphyseal fracture bone union of two intramedullary nailing techniques: (1) dynamic locking with early, full weight bearing, and (2) static locking with delayed weight bearing until bone union. Patients and Methods: This is a retrospective case-control study of closed or type I open tibial diaphyseal fractures (types A and B according to the AO classification) treated with dynamic nailing (32 cases) or static nailing (35 cases). The type of intramedullary nail, the surgical technique and the postoperative protocol were similar for both groups, with the exception of the locking mode and the time of weight bearing. Time to union, mechanical and biological complications, and the number and type of re-operations needed until union were recorded and analysed. Results: Mean union time was 21 weeks in the dynamic group and 26 in the static group (p = 0.051). In both groups 3 cases of nonunion were noted. In the dynamic group there was 1 case of delayed union and 1 case of malunion. In the static group, 5 cases of delayed union and 5 cases of malunion were found. Four reoperations were required in the dynamic group, whereas 10 were needed in the static group (p >0.05). Initial degree of interfragmentary gaps had an impact on the mean time to union and the appearance of biological complications in both groups. Conclusion: Dynamic nailing assembly in intramedullary nailing in closed or type I open tibial diaphyseal fractures with limited comminution (types A and B according to the AO classification) is safe when used for these fracture types. A dynamic mode of nailing should be encouraged in these fracture patterns. [ABSTRACT FROM AUTHOR]

We present a novel approach for animating static images that contain objects that move in a subtle, stochastic fashion (e.g. rippling water, swaying trees, or flickering candles). To do this, our algorithm leverages example videos of similar objects, supplied by the user. Unlike previous approaches which estimate motion fields in the example video to transfer motion into the image, a process which is brittle and produces artefacts, we propose an Eulerian phase-based approach which uses the phase information from the sample video to animate the static image. As is well known, phase variations in a signal relate naturally to the displacement of the signal via the Fourier Shift Theorem. To enable local and spatially varying motion analysis, we analyse phase changes in a complex steerable pyramid of the example video. These phase changes are then transferred to the corresponding spatial sub-bands of the input image to animate it. We demonstrate that this simple, phase-based approach for transferring small motion is more effective at animating still images than methods which rely on optical flow. [ABSTRACT FROM AUTHOR]

Background: The use of mitral transcatheter edge-to-edge repair (TEER) is rapidly increasing. Anatomical changes have been described after TEER with the MitraClip system in patients with functional mitral regurgitation (MR), although no study has yet evaluated such anatomical impacts in patients treated with the G4 MitraClip generation. Methods: This research constituted a prospective, single-center, observational study including consecutive patients with functional MR. Mitral three-dimensional images were obtained transesophageally with echocardiography before and immediately after TEER. Patients receiving the late-generation (G4) system were compared to those receiving early-generation systems. Results: A total of 116 functional MR patients were evaluated, and 40 (34.5%) and 76 (65.5%) received a late-generation (G4) or early-generation device system, respectively. The baseline clinical and echocardiographic features were well-balanced between the groups. Overall, there was a significant reduction in mitral annular size after the intervention, and greater reductions in the anteroposterior diameter (4 mm vs. 3.54 mm, p = 0.03), annular perimeter (11.07 mm vs. 5.29 mm for 3D-perimeter, p = 0.001), and annular area (1.29 cm2 vs. 1.03 cm2, p = 0.002) were found for patients receiving the late G4 device generation compared to the early-generation systems. Conclusions: In patients with functional MR, we observed significant changes in mitral valve anatomy with a reduction in anteroposterior diameter, valve perimeter, and area. In our cohort, the extent of those changes was greater with the use of the new-generation G4 MitraClip system compared to prior device generations. [ABSTRACT FROM AUTHOR]

Objective. Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) has emerged as a useful alternative intervention to redo-surgical aortic valve replacement (Redo-SVAR) for the treatment of degenerated bioprosthesis valve. However, there is no robust evidence about the long-term outcome of both treatments. The aim of this meta-analysis was to analyze the long-term outcomes of Redo-SVAR versus ViV-TAVI by reconstructing the time-to-event data. Methods. The search strategy consisted of a comprehensive review of relevant studies published between 1 January 2000 and 30 September 2022 in three electronic databases, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE. Relevant studies were retrieved for the analysis. The primary endpoint was the long-term mortality for all death. The comparisons were made by the Cox regression model and by landmark analysis and a fully parametric model. A random-effect method was applied to perform the meta-analysis. Results. Twelve studies fulfilled the eligibility criteria and were included in the final analysis. A total of 3547 patients were included. Redo-SAVR group included 1783 patients, and ViV-TAVI included 1764 subjects. Redo-SAVR showed a higher incidence of all-cause mortality within 30-days [Hazard ratio (HR) 2.12; 95% CI = 1.49–3.03; p < 0.0001)], whereas no difference was observed between 30 days and 1 year (HR = 1.03; 95% CI = 0.78–1.33; p = 0.92). From one year, Redo-SAVR showed a longer benefit (HR = 0.52; 95% CI = 0.40–0.67; p < 0.0001). These results were confirmed for cardiovascular death (HR = 2.04; 95% CI = 1.29–3.22; p = 0.001 within one month from intervention; HR = 0.35; 95% CI = 0.18–0.71; p = 0.003 at 4-years follow-up). Conclusions. Although the long-term outcomes seem similar between Redo-SAVR and ViV-TAVI at a five-year follow-up, ViV-TAVI shows significative lower mortality within 30 days. This advantage disappeared between 30 days and 1 year and reversed in favor of redo-SAVR 1 year after the intervention. [ABSTRACT FROM AUTHOR]

In aged population, the early and long-term outcomes of coronary revascularization (CABG) added to surgical aortic valve replacement (SAVR) compared to isolated SAVR (i-SAVR) are conflicting. To address this limitation, a meta-analysis comparing the early and late outcomes of SAVR plus CABG with i-SAVR was performed. Electronic databases from January 2000 to November 2021 were screened. Studies reporting early-term and long-term comparison between the two treatments in patients over 75 years were analyzed. The primary endpoints were in-hospital/30-day mortality and overall long-term survival. The pooled odd ratio (OR) and hazard ratio (HR) with 95% confidence interval (CI) were calculated for in-early outcome and long-term survival, respectively. Random-effect model was used in all analyses. Forty-four retrospective observational studies reporting on 74,560 patients (i-SAVR = 36,062; SAVR + CABG = 38,498) were included for comparison. The pooled analysis revealed that i-SAVR was significantly associated with lower rate of early mortality compared to SAVR plus CABG (OR = 0.70, 95% CI 0.66–0.75; p < 0.0001) and with lower incidence of postoperative acute renal failure (OR = 0.65; 95% CI 0.50–0.91; p = 0.02), need for dialysis (OR = 0.65; 95% CI 0.50–0.86; p = 0.002) and prolonged mechanical ventilation (OR = 0.57; 95% CI 0.42–0.77; p < 0.0001). Twenty-two studies reported data of long-term follow-up. No differences were reported between the two groups in long-term survival (HR = 0.95; 95% CI 0.87–1.03; p = 0.23). CABG added to SAVR is associated with worse early outcomes in terms of early mortality, postoperative acute renal failure, and prolonged mechanical ventilation. Long-term survival was comparable between the two treatments. [ABSTRACT FROM AUTHOR]

Background: Rotating-hinge total knee prostheses may be used for the treatment of global instability about the knee. The designs of previous generations were associated with suboptimal outcomes.Questions/purposes: We evaluated the clinical and radiographic outcomes of salvage knee reconstructions using modern-generation, modular, kinematic rotating-hinge total knee prostheses.Methods: We retrospectively reviewed 26 rotating-hinge arthroplasty devices to examine whether acceptable results were obtainable using a single arthroplasty design. The average age of the patients was 77 years (SD, 9 years); the minimum followup was 24 months (mean, 46 months; range, 24-107 months). The indication was revision surgery in 21 patients and complex primary surgery in five. Patients were evaluated clinically (Knee Society score) and radiographically (positions of components, signs of loosening, bone loss).Results: Knee Society pain scores improved from 40 preoperatively to 77 postoperatively, and function scores improved from 36 to 51. ROM improved from -15 masculine to -10 masculine. None of the patients' knee pain or function worsened. No loosening of implants was observed. Nonprogressive radiolucent lines were identified around the femoral and tibial components in three knees. Three patients required reoperations: one showed a supracondylar periprosthetic fracture treated by open reduction and internal fixation, whereas the other two had periprosthetic infections.Conclusions: Reconstruction with rotating-hinge total knee prostheses can provide substantial improvement in function and a reduction in pain in extreme circumstances, such as gross instability. We believe this salvage procedure should be reserved for severe ligamentous deficiencies in elderly and sedentary patients or whenever revision surgery techniques fail.Level Of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

To establish a protocol for the treatment of fragility fractures in the hospital setting based on treatment of osteoporosis. An intervention protocol was implemented in patients with fragility fractures based on (1) indicating the diagnosis of osteoporotic fracture in the summary of discharge; (2) “lifestyle recommendations”; and (3) therapy for osteoporosis. Thirty-one hospitals were involved and they were informed of the importance of protocol compliance. In the first phase, a retrospective study was conducted to establish the number of low-energy fractures treated and the percentage of them that had complied with the protocol ( n = 887). Then, prospectively, the same data were collected for the patients managed for 1 year ( n = 6,826) in three sections of 4-month intervals. The percentage of compliance increased from 8.2 to 57.2% in the first point, from 12.6 to 42.4% in the second, and from 10.3 to 43.2% in the third. The implementation of programs to improve osteoporosis treatment is very useful for ensuring adherence in the management of osteoporosis following admission due to fragility fracture. [ABSTRACT FROM AUTHOR]

Background: There is no robust evidence regarding the types of valves implanted among patients undergoing surgical aortic valve replacement (SAVR) in Spain. Methods: All cases of patients undergoing SAVR ± coronary artery bypass grafting from January 2007 to December 2018 in the public Spanish National Health System were included. We analyzed the trends of SAVR volume, risk profile and type of implanted valve across time and place. Using multivariable logistic regression, we identified factors associated with biological SAVR. Results: In total, 62,870 episodes of SAVR in 15 Spanish territories were included. In 35,693 (56.8%), a tissue valve was implanted. The annual volume of procedures increased from 107.3/million (2007) to 128.6 (2017). In 2018, it fell to 108.5. Age increased and Charlson's comorbity index worsened throughout the study period. Tissue valve implantation increased in most regions. After adjusting for other covariates, we observed a high variability in aortic valve implantation across different regions, with differences of as much as 20-fold in the use of tissue valves. Conclusions: Between 2007 and 2018, we detected a significant increase in the use of bioprostheses in patients undergoing SAVR in Spain, and a great variability in the types of valve between the Spanish territories, which was not explained by the different risk profiles of patients. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Recent studies have found increased long-term cardiovascular morbidity after off-pump coronary artery bypass surgery (OPCAB). We evaluated the efficacy and safety of dual antiplatelet therapy (DAT) in the prevention of cardiovascular events at two years after OPCAB surgery. METHODS: Retrospective study that included all patients that underwent OPCAB surgery in our institution between 2009 and 2010. Single or dual antiplatelet therapy was initiated at hospital discharge, and its effect in patients' prognosis was analyzed. Follow-up was conducted by telephone and using the hospital databases. The primary end-point was the composite of acute coronary syndrome (ACS), revascularization, stroke, or cardiovascular death. RESULTS: The study included 237 patients divided into: (A) 128 patients who received single antiplatelet therapy and (B) 109 patients who received dual antiplatelet therapy. The mean follow-up was 23.85 months (standard deviation 0.5 months). 13.9% of patients had a primary end-point event. Patients in group A had a higher event rate compared with group B (18.8% vs. 8.3%, p = 0.02), with a significant reduction in hospital readmissions for ACS (10.9% vs. 3.7%, p = 0.035). In the multivariate analysis, dual antiplatelet therapy was an independent protective factor in the occurrence of events (hazard ratio = 0.395, 95% CI, 0.176 to 0.885, p = 0.024). There were no significant differences between the two groups with respect to bleeding events. CONCLUSION: Dual antiplatelet therapy after OPCAB surgery is associated with a decrease in the appearance of new cardiovascular events, due to a reduction in the number of hospital readmissions for ACS. doi: 10.1111/jocs.12144 (J Card Surg 2013;28:366-372). [ABSTRACT FROM AUTHOR]

Objectives Recent studies have found increased long-term cardiovascular morbidity after off-pump coronary artery bypass surgery (OPCAB). We evaluated the efficacy and safety of dual antiplatelet therapy (DAT) in the prevention of cardiovascular events at two years after OPCAB surgery. Methods Retrospective study that included all patients that underwent OPCAB surgery in our institution between 2009 and 2010. Single or dual antiplatelet therapy was initiated at hospital discharge, and its effect in patients' prognosis was analyzed. Follow-up was conducted by telephone and using the hospital databases. The primary end-point was the composite of acute coronary syndrome (ACS), revascularization, stroke, or cardiovascular death. Results The study included 237 patients divided into: (A) 128 patients who received single antiplatelet therapy and (B) 109 patients who received dual antiplatelet therapy. The mean follow-up was 23.85 months (standard deviation 0.5 months). 13.9% of patients had a primary end-point event. Patients in group A had a higher event rate compared with group B (18.8% vs. 8.3%, p = 0.02), with a significant reduction in hospital readmissions for ACS (10.9% vs. 3.7%, p = 0.035). In the multivariate analysis, dual antiplatelet therapy was an independent protective factor in the occurrence of events (hazard ratio = 0.395, 95% CI, 0.176 to 0.885, p = 0.024). There were no significant differences between the two groups with respect to bleeding events. Conclusion Dual antiplatelet therapy after OPCAB surgery is associated with a decrease in the appearance of new cardiovascular events, due to a reduction in the number of hospital readmissions for ACS. doi: 10.1111/jocs.12144 (J Card Surg 2013;28:366-372) [ABSTRACT FROM AUTHOR]