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BACKGROUND: Irrigation is commonly used as an adjuvant treatment during the intralesional curettage of bone tumors. The goal of the present study was to analyze the in vitro cytotoxicity of commonly used irrigation solutions on chondrosarcoma and giant cell tumor (GCT) cells as there is no consensus on which solution leads to the greatest amount of cell death. METHODS: An in vitro evaluation was performed by exposing human GCT and human chondrosarcoma cell lines to 0.9% saline solution, sterile water, 70% ethanol, 3% hydrogen peroxide, 0.05% chlorhexidine gluconate (CHG), and 0.3% povidone iodine solutions independently for 2 and 5 minutes. A low-cytotoxicity control (LCC) and a high-cytotoxicity control (HCC) were established to determine the mean cytotoxicity of each solution and each solution’s superiority to LCC and non-inferiority to HCC. RESULTS: The present study demonstrated that 0.05% CHG was non-inferior to the HCC when chondrosarcoma was exposed for 5 minutes and when GCT was exposed for 2 and 5 minutes (mean cytotoxicity, 99% to 102%) (p < 0.003 for all). Sterile water was superior to the LCC when chondrosarcoma was exposed for 5 minutes and when GCT was exposed for 2 minutes (mean, 28% to 37%) (p < 0.05). Sterile water (mean, 18% to 38%) (p < 0.012) and 3% hydrogen peroxide (mean, 7% to 16%) (p < 0.001) were both inferior to the HCC. The 3 other solutions were non-superior to the LCC (mean, −24% to −5%) (p < 0.023). CONCLUSIONS: In vitro irrigation in 0.05% CHG provided high cytotoxicity, comparable with the HCC. Therefore, the use of a 0.05% CHG solution clinically could serve as a potential chemical adjuvant during intralesional curettage of chondrosarcoma and GCT. CLINICAL RELEVANCE: In an effort to reduce the burden of residual tumor cells, irrigation solutions are often utilized as adjuvant local therapy. Use of a 0.05% CHG solution clinically could serve as a potential chemical adjuvant to intralesional curettage of chondrosarcoma and GCT. Further in vivo studies may be indicated to assess clinical outcomes and safety associated with the use of 0.05% CHG in the treatment of chondrosarcoma and GCT.

The variation of plasma d-dimer, an inflammatory marker, from pre-explantation to pre-reimplantation in two-stage revision remains unclear. Our objective was to evaluate delta-changes (Δ) in d-dimer, erythrocyte sedimentation rate (ESR), and C-reactive-protein (CRP), to ascertain whether these delta-changes are associated with the outcome of reimplantation. We hypothesized a decrease in d-dimer before reimplantation.A retrospective review was performed on a consecutive series of 95 two-stage revisions indicated for periprosthetic joint infection. Surgeries were performed by 3 surgeons at a single institution (2018-2020). The minimum follow-up was 1 year. The inclusion criteria comprised availability of d-dimer results at pre-explantation and pre-reimplantation. As a result, only 30 reimplantations were included. Success of reimplantation was defined by Musculoskeletal Infection Society outcome reporting tool: Tier 1/Tier 2 vs Tier 3/Tier 4. Nonparametric tests and Mann-Whitney U-tests were conducted to compare Δd-dimer% (pre-explantation value - pre-reimplantation value/pre-explantation value × 100). The bootstrapped receiver operating characteristic curve analyses with 2,000 replicates of 30 cases were conducted.The median time between explantation and reimplantation was 86 days (interquartile range [IQR] = 77.7-138.5 days). Overall, a paradoxical median percent increase (Δd-Dimer% [INCREMENT] = 12.6%) in d-dimer was found from pre-explantation to pre-reimplantation (IQR = -28.06% to 77.3%). However, there was a percentage decrease in ESR (ΔESR% [DECREMENT] = -40%; IQR = -70.52% to 3.85%) and CRP (ΔCRP% [DECREMENT] = -75%; IQR = -87.43% to -61.34%). The changes in all these markers were not different between Musculoskeletal Infection Society Tier 1/2 and 3/4 outcomes (Δd-Dimer%, P = .146; ΔESR%, P = .946; ΔCRP%, P = .463). With area under curve of 0.676, Δd-dimer% (INCREMENT) appeared to be performing best in diagnosing infection control, which was nonexplanatory.Plasma d-dimer paradoxically increases before reimplantation while other inflammatory markers (ESR/CRP) decrease, emphasizing that surgeons shall adopt caution using d-dimer to make clinical decisions.

In recent years biomedical scientific community has been working towards the development of high-throughput devices that allow a reliable, rapid and parallel detection of several strains of virus or microparticles simultaneously. One of the complexities of this problem lies on the rapid prototyping of new devices and wireless rapid detection of small particles and virus alike. By reducing the complexity of microfluidics microfabrication and using economic materials along with makerspace tools (Avra Kundu, Ausaf, and Rajaraman 2018) it is possible to provide an affordable solution to both the problems of high-throughput devices and detection technologies. We present the development of a wireless, standalone device and disposable microfluidics chips that rapidly generate parallel readouts for selected, possible virus variants from a nasal or saliva sample, based on motorized and non-motorized microbeads detection, and imaging processing of the motion tracks of these beads in micrometers. Microbeads and SARS-CoV-2 COVID-19 Delta variant were tested as proof-of-concept for testing the microfluidic cartridges and wireless imaging module. The Microbead Assay (MA) system kit consists of a WiFi readout module, a microfluidic chip, and a sample collection/processing sub-system. Here, we focus on the fabrication and characterization of the microfluidic chip to multiplex various micrometer-sized beads for economic, disposable, and simultaneous detection of up to six different viruses, microparticles or variants in a single test, and data collection using a commercially available, WiFi-capable, and camera integrated device (Fig. 1).

Benchtop tissue cultures have become increasingly complex in recent years, as more “on-a-chip” biological technologies such as Microphysiological Systems (MPSs) work to incorporate cellular constructs that more accurately represent their respective biological systems. Such MPSs have begun providing major breakthroughs in biological research and are poised to shape the field in the coming decades. These biological systems necessitate integrated sensing modalities to procure complex, multiplexed datasets, with unprecedented combinatorial biological detail. In this work we expand on our polymer-metal biosensor approach by demonstrating a facile technology towards compound biosensing which are characterized through custom modeling approaches. Herein we develop a compound chip with 3D microelectrodes, 3D microfluidics, Interdigitated Electrodes (IDEs) and a micro-heater. The chip is subsequently tested using electrical/electrochemical characterization of 3D microelectrodes with 1kHz impedance and phase recordings, and IDE-based high frequency (~ 1MHz frequencies) impedimetric analysis of differential localized temperature recordings, both of which are modelled through equivalent electrical circuits for process parameter extraction. Additionally, a simplified antibody-conjugation strategy was employed for a similar IDE-based analysis of the implications for a key analyte (L-Glutamine) binding on the equivalent electrical circuit. Lastly, acute microfluidic perfusion modelling was performed to demonstrate ease of microfluidics integration into such a polymer-metal biosensor platform for potential complimentary localized chemical stimulation. Combined, our work demonstrates the design, development, and characterization of an accessibly designed, polymer-metal compound biosensor for electrogenic cellular constructs, geared towards comprehensive MPS data collection.

Esta traducción de 1Ts está efectuada como si se estuviese ante un escrito recién descubierto, lo cual no supone una fatua actitud adanista, sino los estribos de distancia y asombro necesarios para el propósito hermenéutico: reparar los deterioros que tintas superpuestas, corrosivos barnices y el paso del tiempo han causado en el relevante papel del primer documento cristiano llegado hasta hoy. Para este traslado de 1Ts, hecho desde el firme criterio filológico de llegar al fondo de las ideas del autor, se ha excavado en cada una de las voces que emplea. A través del texto obtenido, se analiza el titánico esfuerzo del que procede no ya el desarrollo del cristianismo, sino mucho de una nueva razón axiológica universal. Así, verso a verso, 1Ts va enlazándose, fuera de con la escritura bíblica, con múltiples textos clásicos grecorromanos, entre los que se cuenta, y con la conflictiva política imperial de la segunda mitad del siglo I. Cabe mencionar en el estudio aportes relativos a la autoría y a los destinatarios epistolares, así como a que, una vez restaurada la carta, resulta ser –al trasluz de su alegría– el eslabón perdido de la sátira menipea.

Resumen Introduccion Las fracturas de cadera reportan una incidencia en aumento; representan un reto para la salud publica por el alto costo socioeconomico y elevada morbimortalidad. Es importante documentar las complicaciones en la poblacion de Colombia, asi como los motivos de reingreso para poder plantear estrategias que contribuyan a disminuirlas. Materiales & Metodos Se realizo un estudio descriptivo, de cohorte transversal, entre enero 2015 y diciembre 2017. Se incluyeron todos los pacientes con fractura de cadera mayores de 65 anos. Se excluyeron aquellos con fracturas patologicas y pacientes con antecedente de fractura en esa cadera. Se recolectaron las variables de edad, sexo, antecedentes patologicos, uso de anticoagulantes, manejo farmacologico para osteoporosis, tipo de fractura, complicaciones intraquirurgicas y postoperatorias, asi como el tiempo total desde la fractura hasta el manejo quirurgico. Resultados Se incluyeron 155 fracturas de cadera con edad promedio de 81.6 anos. 74.8% mujeres. El subtipo de fractura mas frecuente fue la intertrocanterea (46.5%). El 93.6% de los casos recibio manejo quirurgico, siendo la artroplastia el procedimiento mas realizado. Se realizo manejo quirurgico en el 85.16% de los pacientes antes de 48 horas y al 40% antes de las 24 horas desde el momento de la fractura. El reingreso fue 20% y la principal causa fueron nuevas fracturas (5.8%). Discusion Se considera el abordaje de los pacientes desde un punto multidisciplinario que maneje sus comorbilidades, fragilidad osea, debilidad muscular y alteraciones en la esfera mental de forma integral, ya que esto puede afectar positivamente el estado de salud de estos pacientes. Nivel de Evidencia: III

En la presente investigación se pretende dar a conocer el trabajo a distancia y/o teletrabajo no sólo como una forma de llevar a cabo la prestación laboral, sino también como un instrumento que indirectamente puede ser aplicado para luchar contra la pandemia por la COVID-19, favorecer el medio ambiente y alcanzar el desarrollo pleno del derecho a conciliar la vida laboral, personal y familiar, entre otros beneficios. Así mismo, también se dan a conocer los efectos adversos de las citadas formas de trabajo no presencial como por ejemplo la aparición de riesgos psicosociales, si bien es cierto como se va a exponer en el cuerpo de esta investigación, que el uso efectivo del derecho al registro horario y del derecho a la desconexión digital mitigan la aparición de los citados riesgos. Igualmente, resulta necesario hacer alusión al papel que juega la negociación colectiva en la regulación de las formas de trabajo no presencial. 2021-22

This paper investigates the performance, of multi-fractured horizontal wells completed in naturally fractured reservoirs (NFR). The performance of these wells was modeled using a reservoir simulator that incorporates microseismics data to infer the area of production influence of the hydraulically induced fractures. A unique and novel set of microseismics diagnostics are introduced and used to identify fracture initiation, infer hydraulic fractures lengths, and determine propagation of the induced fractures. These results are input into an analytical Rate Transient solutions derived to account for variable fracture lengths, different orientations of the multiple hydraulic fractures along the wellbore, and to implement a well performance model that links the well architecture with the reservoir dynamics. Inflow performance and productivity relationships constructed using these solutions, provide a way to forecast deliverability performance of the reservoir-well-completion system and was used in conjunction of Artificial intelligence and Machine learning algorithms to create an optimization road map for completion optimization of multifractured horizontals The approach was used to benchmark and assess the performance of horizontals in fractured reservoirs, and when coupled with surveillance workflows, it was used as a production management tool. Field production results show the practical application of the performance solutions when applied to design and optimization of horizontal wells. Results for horizontal well types (new drills and refracturing) of several multi-staged propped fractured horizontals intersecting fracture "swarms" in the unconventional Haynesville and Bossier are presented. The approach is equally applicable to unconventional reservoirs, LTO and waxy crude in NFR. The methodology suggests a practical alternative to analyze and forecast the performance of horizontal well completions, estimate the efficiency of a horizontal completed with "N" frac stages in the form of a decline curve, determine the number of stages effectively contributing to production, estimate the degree of stimulation (SD) of the combined well system, and to provide an indication of the unrealized potential as an indicator for opportunity improvement.

Background Acetabular fractures often require surgical intervention for fracture fixation and can result in premature osteoarthritis of the hip joint. This study hypothesized that total hip arthroplasty (THA) in patients with a prior acetabular fracture who had undergone open reduction and internal fixation (ORIF) is associated with a higher rate of subsequent periprosthetic joint infection (PJI). Methods About 72 patients with a history of acetabular fracture that required ORIF, undergoing conversion THA between 2000 and 2017 at our institution, were matched based on age, gender, body mass index, Charlson comorbidity index, and date of surgery in a 1:3 ratio with 215 patients receiving primary THA. The mean follow-up for the conversion THA cohort was 2.9 years (range, 1-12.15) and 3.06 years (range, 1-12.96) for the primary THA. Results Patients with a previous acetabular fracture, compared with the primary THA patients, had longer operative times, greater operative blood loss, and an increased need for allogeneic blood transfusion (26.4% vs 4.7%). Most notably, PJI rate was significantly higher in acetabular fracture group at 6.9% compared with 0.5% in the control group. Complications, such as aseptic revision, venous thromboembolism, and mortality, were similar between both groups. Conclusion The present study demonstrates that conversion THA in patients with prior ORIF of acetabular fractures is associated with higher complication rate, in particular PJI, and less optimal outcome compared with patients undergoing primary THA. The latter findings compel us to seek and implement specific strategies that aim to reduce the risk of subsequent PJI in these patients.

El objetivo de la investigación fue analizar la relación entre los niveles de recaudación tributaria y la inversión pública a nivel departamental en el Perú durante el periodo 2008 – 2017. Se realizó un análisis cuantitativo de tipo correlacional y explicativo; en primer lugar, se desarrolló un estudio descriptivo y, posteriormente, se estimó una serie de modelos de datos de panel considerando los distintos tipos de impuestos recaudados por el gobierno central. Con base a los resultados encontrados se demostró que, existe una relación causal directa entre los niveles de recaudación tributaria y la inversión pública a nivel departamental, siendo más significativos el impuesto general a las ventas y el impuesto a la renta. Además, se encontró que existe una gran heterogeneidad y concentración de las capacidades e ingresos tributarios entre los departamentos del país.

Introduction: Periprosthetic joint infection (PJI) remains one of the most dreaded and challenging complications in adult reconstruction. While primary total joint arthroplasty is one of the most s...

As the number of primary total joint arthroplasty (TJA) procedures continues to rise, megaprostheses have found an emerging role in more complex revision arthroplasty cases that require additional reconstruction, stability, and restoration of function.Megaprosthesis options have evolved: in addition to cemented prostheses, cementless and even hybrid fixation designs optimize longevity. Proximal femoral replacement (PFR), distal femoral replacement (DFR), proximal tibial replacement (PTR), and total femoral replacement (TFR) are all limb salvage options in the setting of substantial bone loss, poor bone quality, and soft-tissue compromise.Dislocation is one of the most common complications after PFR, likely due to the loss of soft-tissue integrity, most notably the hip abductor musculature from the greater trochanter. The utilization of dual-mobility constructs, larger femoral heads, elevated acetabular liners, and constrained acetabular liners may reduce the risk of instability and improve overall hip function.Patients with megaprostheses may be more prone to periprosthetic joint infection and surgical site infection given multiple variables, such as the lengthy nature of the surgical procedure, prolonged wound exposure, extensive soft-tissue dissection and resection, poor soft-tissue coverage, and poorer host status.Despite advances in technology, complication and revision rates remain high after megaprosthesis reconstruction. Therefore, thorough attention to patient-specific factors must be considered for appropriate use of these constructs.

BACKGROUND An overall assessment of how patient demographic characteristics and comorbidities are improving or worsening can allow better understanding of the value of revision total joint arthroplasty (TJA). Therefore, the purpose of this study was to identify patient demographic characteristics and comorbidities trends and episode-of-care outcome trends from 2008 to 2018 in patients undergoing revision TJA. METHODS The National Surgical Quality Improvement Program database was queried to identify patient demographic characteristics, comorbidities, and episode-of-care outcomes in patients undergoing revision TJA from 2008 to 2018 (n = 45,706). Pairwise t tests and pairwise chi-square tests were performed on consecutive years with Bonferroni correction. Trends were assessed using the 2-tailed Mann-Kendall test of the temporal trend. RESULTS Among patients undergoing revision TJA, there was no clinically important difference, from 2008 to 2018, in age, body mass index (BMI), percentages with >40 kg/m2 BMI, diabetes (18.8% to 19%), chronic obstructive pulmonary disease (4.1% to 5.4%), congestive heart failure within 30 days (0% to 1%), or acute renal failure (0% to 0.2%). However, modifiable comorbidities including smoking status (14.7% to 12.0%; p = 0.01), hypertension (66% to 26.0%; p = 0.02), anemia (34.5% to 26.3%; p < 0.001), malnutrition (10.4% to 9.3%; p = 0.004), and overall morbidity or mortality probability have improved, with a decrease in the hospital length of stay and 30-day readmission and a significant increase in home discharge (p < 0.001 for all). CONCLUSIONS Time-difference analysis demonstrated that the overall health status of patients undergoing revision TJA improved from 2008 to 2018. However, formal time-trend analysis demonstrated improvements to a lesser degree. The multidisciplinary effort to improve value-based metrics including patient comorbidity optimization and episode-of-care outcomes for primary TJA has been shown to potentially have an impact on revision TJA. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Background Direct anterior approach (DAA) total hip arthroplasty can be performed through a traditional vertical incision or a horizontal (bikini) incision. The purpose of this study is to compare the 2 approaches, performed by a single surgeon past the learning curve, in terms of (1) overall wound complications and (2) patient-reported esthetics at the 6-month follow-up. Methods A case-control retrospective study was conducted. Eighty-six bikini DAA patients were matched 3:1 to 230 conventional DAA patients for gender, age, body mass index (BMI), and American Society of Anesthesiologists score. Outcomes evaluated included wound complications, acute periprosthetic joint infection, transfusion, length of surgery, and dysesthesia. A subgroup analysis was also performed on obese patients, BMI greater than 30 kg/m2. Furthermore, the patients rated cosmesis of the incision at 6 months using a Patient Scar Assessment Scale and the Vancouver Scar Assessment Scale. Results Bikini patients had lower rates of delayed wound healing compared to conventional incision (2.3% vs 6.1%, P = .087). This difference was statistically significant (0% vs 16.6%, P Conclusion Our study demonstrates that the DAA total hip arthroplasty can be performed safely through an alternative horizontal bikini incision with complication rates equivalent to conventional incision DAA and to those in other approaches when performed by surgeons in a high volume, efficient hip replacement institution. In patients whose BMI is >30, a potential benefit of the horizontal incision may be lower wound complications. This study design should be performed at other institutions and ideally at a multi-institution level to evaluate if results can be corroborated. Our opinion is that the horizontal bikini incision should be utilized but only after mastery of the DAA approach using the conventional vertical incision.