Notes

Current view inside treatments for septic jolt as a result of Gram-negative microorganisms.
001. Intra-observer reliability was excellent for both methods raging from ICC 0.94 to 0.99 for the CM and ICC 0.89 to 0.95 for the MM. The mean MP was 19% for the CM and 28% for the MM (p < 0.001).

The CM is more reliable than the MM to measure hip migration in children with CP. If the CM is used and acetabular dysplasia with a GA are present on the hip radiograph, then a 9% hip migration underestimation should be considered on decisions for both referral and surgical management.

II.
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The study aimed to develop a scoring system based on clinical and radiological findings to predict the risk of a sequential slipped capital femoral epiphysis (SCFE).

Paediatric patients with unilateral SCFE and at least two years of radiographic follow-up were screened for inclusion. Medical records were reviewed for multiple variables including age, gender, body mass index (BMI), stability of SCFE, and time to sequential presentation. Radiographic analysis included triradiate physeal status, Risser staging, superior epiphyseal extension ratio (EER), posterior epiphyseal angle (PEA), posterior sloping angle (PSA) and slip severity.

In total, 163 patients (88 male, 54%, 75 female, 46%) met inclusion criteria. Of those, 65 (40%) with a mean age of 11.9 ± 1.3 years developed sequential SCFE at a mean of 9.8 ± 6.4 months after the initial slip. Eight independent variables were statistically different (p < 0.05) between unilateral and sequential groups. Following multivariate analysis, Risser stage and triradiate status were no longer significant and did not influence the strength of the final model (overall area under the curve (AUC) = 0.954) and were consequently excluded. We developed the PASS score using three radiographic parameters using chosen cut-off values that were close to their maximized value and weighted the point value assigned to each parameter based on the strength of predictor.

A PASS score of three or higher predicts a high probability of sequential SCFE with 95% confidence and may warrant prophylactic screw fixation. PASS score calculation can be used to predict a sequential SCFE and provide an objective method to determine the utility prophylactic screw fixation.

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Double and triple femoral neck lengthening osteotomies have been described to correct coxa brevis deformity. Only small studies reported the results. Our aim was to provide an overview of the outcomes of double and triple femoral neck lengthening.

After an extensive search of different online databases, we included studies reporting the results of double and triple femoral neck osteotomies. Clinical and radiological outcomes, and reported complications were extracted. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

After evaluating 456 articles, we included 11 articles reporting 149 osteotomies in 143 patients (31% male, 64% female, 5% unspecified). Mean age of the patients was 20 years (range 7 years to 52 years). Indications were developmental hip dysplasia (51%), Perthes disease (27%), infection (6%), post-trauma (4%), congenital disorders (2%), slipped capital femoral epiphysis (1%), idiopathic (3%) and unknown (6%). The mean limb length discrepancy reduced by 12 mm (0 mm to 40 mm). In total, 65% of 101 positive Trendelenburg sign hips experienced improvement of abductor muscle strength. An 18% (9% to 36%) increase could be found in functional hip scores. Mean increase in articulo-trochanteric distance was 24 mm (10 mm to 34 mm). Five patients older than 30 years at the time of osteotomy and two younger patients with prior hip incongruency had disappointing results and required arthroplasty. In all, 12 complications occurred in 128 osteotomies, in which complications were reported.

Double and triple femoral neck lengthening osteotomies in coxa brevis show good results with few complications in the literature, especially in young patients with non-arthritic hips.

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The objective of this study was to explore the predictors for failed reduction in children with developmental dysplasia of the hip (DDH) managed by arthrogram, closed reduction (CR) and spica cast immobilization.

We retrospectively reviewed the clinical data of patients with DDH treated by CR and cast immobilization (2015-2020), including age, sex, affected side, presence/absence of an ossific nucleus, International Hip Dysplasia Institute classification, the delineation of labrum and acetabular surface on arthrogram, inverted labrum, acetabular index (AI), hip abduction angle and medial dye pool (MDP) distance. Predictors that potentially predicted failure of CR were evaluated by logistic regression analysis, simple t-test, Fisher's Exact Test and chi-square test.

In total, 16 out of 187 hips failed to achieve initial CR (8.6%). Gender, age, preoperative AI and poor delineation of arthrogram were candidate predictors for failed CR in children aged six to 24 months with DDH; on the other hand, logistic regression analysis confirmed age and poor delineation of arthrogram significantly predicted failure of CR. Receive operating characteristic curve (ROC) showed MDP less than 6 mm and age higher than 14.5 months significantly increased the failure rate of CR in children aged six to 24 months with DDH.

Age and poor delineation of labrum and acetabular surface during arthrogram predicted failure of CR in children with DDH. In particular, age > 14.5 months and MDP distance ≥ 6 mm significantly increased the risk of CR failure.

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The aim of this study is to assess the pelvis's morphology and spatial orientation of the acetabulum, and their relation to the severity of Congenital Femoral Deficiency (CFD) using 3D imaging. Defining these pathologies is crucial for adequate surgical correction.

The shape and structure of the acetabulum and pelvis were evaluated in 14 children with unilateral CFD via 3D computed tomography (CT) scans, and then analysed with geometric morphometrics (Procrustes ANOVA). The association between pelvic directional asymmetry and CFD classifications (Aitken, Paley) was assessed. The affected acetabulum's orientation was compared to the non-affected side, and the variability of orientation in different CFD types was evaluated (bivariate correlation).

The hemipelvis with CFD is characterized by a smaller acetabulum, a laterally curved ischium and a less upright ilium (p < 0.001). Multivariate regressions revealed a greater level of pelvis asymmetry in more severe types of CFD (p < 0.001). The acetabulumrsion and steepness (superoposterior distortion). This should not be interpreted as a simple wall deficit, but as a complete acetabular misalignment (often misinterpreted in 2D imagery). Using transiliac osteotomies (e.g. Dega, Salter) is debatable due to abnormal acetabular orientation (superoposterior malalignment). Therefore, alternative options, e.g. San Diego or triple pelvic osteotomy, should be considered.
Stable slipped capital femoral epiphysis (SCFE) is often treated with
pinning, with the current gold standard being stabilization with a screw perpendicular to the physis. However, this can lead to impingement and a potentially unstable construct. In this study we model the biomechanical effect of two screw positions used for SCFE fixation. We hypothesize that single screw fixation into the centre of the femoral head from the anterior intertrochanteric line (the Universal Entry Point or UEP) provides a more stable construct than single screw fixation perpendicular to the physis with an anterior starting point.

Sawbone models of moderate SCFE were used to mechanically test the two screw constructs and an unfixed control group. Models were loaded to failure with a shear load applied through the physis in an Instron mechanical tester. The primary outcomes were maximum load, stiffness and energy to failure.

Screw fixation into the centre of the femoral head from the UEP resulted in a greater load to failure (+19%), stiffness (+13%) and energy to failure (+45%) than screw fixation perpendicular to the physis.

In this sawbone construct, screw fixation into the centre of the femoral head from the UEP provides greater biomechanical stability than screw fixation perpendicular to the physis. This approach may also benefit by avoiding an intracapsular entry point in soft metaphyseal bone and subsequent risk of impingement and loss of position.
In this sawbone construct, screw fixation into the centre of the femoral head from the UEP provides greater biomechanical stability than screw fixation perpendicular to the physis. This approach may also benefit by avoiding an intracapsular entry point in soft metaphyseal bone and subsequent risk of impingement and loss of position.Emerging evidence is revealing that microRNAs (miRNAs) play essential roles in mechanosensing for regulating osteogenesis. However, no mechanoresponsive miRNAs have been identified in human bone specimens. Methods Bedridden and aged patients, hindlimb unloaded and aged mice, and Random Positioning Machine and primary aged osteoblasts were adopted to simulate mechanical unloading conditions at the human, animal and cellular levels, respectively. Treadmill exercise and Flexcell cyclic mechanical stretching were used to simulate mechanical loading in vivo and in vitro, respectively. Results Here, we found increased miR-138-5p levels with a lower degree of bone formation in bone specimens from bedridden and aged patients. Loss- and gain-of-function studies showed that miR-138-5p directly targeted microtubule actin crosslinking factor 1 (MACF1) to inhibit osteoblast differentiation under different mechanical conditions. Regarding translational medicine, bone-targeted inhibition of miR-138-5p attenuated the decrease in the mechanical bone anabolic response in hindlimb unloaded mice. Moreover, bone-targeted inhibition of miR-138-5p sensitized the bone anabolic response to mechanical loading in both miR-138-5p transgenic mice and aged mice to promote bone formation. Conclusion These data suggest that miR-138-5p as a mechanoresponsive miRNA accounts for the mechanosensitivity of the bone anabolic response and that inhibition of miR-138-5p in osteoblasts may be a novel bone anabolic sensitization strategy for ameliorating disuse or senile osteoporosis.The development of nanomedicine is expected to provide an innovative direction for addressing challenges associated with multidrug-resistant (MDR) bacteria. In the past decades, although nanotechnology-based phototherapy has been developed for antimicrobial treatment since it rarely causes bacterial resistance, the clinical application of single-mode phototherapy has been limited due to poor tissue penetration of light sources. Syrosingopine Therefore, combinatorial strategies are being developed. In this review, we first summarized the current phototherapy agents, which were classified into two functional categories organic phototherapy agents (e.g., small molecule photosensitizers, small molecule photosensitizer-loaded nanoparticles and polymer-based photosensitizers) and inorganic phototherapy agents (e.g., carbo-based nanomaterials, metal-based nanomaterials, composite nanomaterials and quantum dots). Then the development of emerging phototherapy-based combinatorial strategies, including combination with chemotherapy, combination with chemodynamic therapy, combination with gas therapy, and multiple combination therapy, are presented and future directions are further discussed.
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