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  • Tyler Jacobs posted an update 23 days ago

    Objective Missed abortion occurs in ∼ 15% of all clinical pregnancies. The pathogenesis is not clearly known. However, defective placentation resulting in maternal systemic inflammatory response is considered responsible for missed abortion. Platelet lymphocyte ratio (PLR) and neutrophil lymphocyte ratio (NLR) are increasingly cited parameters of inflammation in the literature. However, no study evaluated the PLR and NLR rates in missed abortions so far. The aim of the present study is to investigate whether complete blood count (CBC) inflammatory parameters such as NLR and PLR are increased in patients with missed abortion. Methods Medical records of 40 pregnant women whose gestation ended in missed abortion at between 6 and14 weeks of gestation and of 40 healthy pregnant women were collected and compared retrospectively. The groups were compared regarding hemoglobin, hematocrit, platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), PLR and NLR. Results Platelet distribution width, NLR and PLR values were higher in the missed abortion group compared with the healthy pregnant women group (rates are p = 0.043; p = 0.038; and p = 0.010, respectively). Hematocrit, MPV, and lymphocyte values were found to be lower in the missed abortion group compared with the healthy pregnant women group (p = 0.027, p = 0.044 and p = 0.025, respectively). Conclusion The PDW, NLR and PLR values of the missed abortion group were reported high; and MPV values were reported low in the present study. These findings may help to speculate a defective placentation in the pathogenesis of missed abortion.Because of the early follow-up positive outcomes with cementless fixation, continued evaluations need to be performed to ensure longer-term efficacy. Additionally, although many studies report on the results of femoral and tibial component fixation, few studies report specifically on patellar outcomes. Therefore, the purpose of this study was to report on the (1) implant survivorship; (2) complications; and (3) radiographic outcomes in a large cohort of patients who received cementless total knee arthroplasties (TKAs), with particular attention to the patellar component. A total of 261 patients who underwent cementless TKA by a single, high-volume academic surgeon were studied. Patients had a mean age of 66 years and were distributed between 192 women (74%) and 69 men. All patients received the same cementless tibial, femoral, and patellar components. Mean follow-up period was 4.5 years (range, 4-5 years). Primary outcomes evaluated included all postoperative complications, with particular emphasis on the patatellar fixation in cementless TKA can be considered a safe technique.Unicondylar knee arthroplasty (UKA), as an alternative to total knee arthroplasty (TKA), has been shown to be an effective option for patients with single-compartment end-stage knee osteoarthritis. Implant survival is contingent upon proper alignment, which has been improved with the advent of robotic-assisted surgery (r-UKA), but whether this outweighs the increased cost of the robotic-assist device has not been analyzed in the literature. The purpose of this study was to investigate the mid-term cost-effectiveness of r-UKA compared with UKA with traditional instrumentation (t-UKA) in the United States. A cost-effectiveness analysis using a four-state Markov model was performed using data from the 2018 National Joint Registry of England and Wales and a retrospective multicenter, cohort study on a cohort of 65-year-old patients having undergone r-UKA. The main outcome was cost per revision avoided and sensitivity analyses were conducted to evaluate the impact of using different model assumptions on the results. The Markov model illustrated that the benefit derived from r-UKA versus t-UKA was beneficial from a payer’s perspective. The estimated incremental cost-effectiveness ratio (ICER) was $14,737 per revision avoided in a facility seeing 100 patients a year. Case volume was shown to be the primary variable affecting cost-effectiveness, with the value of r-UKA directly increasing with higher case volumes. Cost-effectiveness analyses demonstrated that the use of r-UKA is an effective alternative to t-UKA in patients with single-compartment knee osteoarthritis. While this study could benefit from longer follow-up clinical studies to illustrate the benefits of r-UKAs beyond the current 2 years time horizon, r-UKAs remained cost-effective, even after investigating several different assumptions.The evolution of anterior cruciate ligament (ACL) surgery, seemingly circular at times, informs and provides context for past and current controversies in ACL management. The purpose of this systematic review is to objectively summarize the historical course of ACL reconstruction and repair in the United States over the last 40 years. Femoral tunnel drilling and graft selection have evolved dramatically over the last few decades. An initial focus on restoring ACL anatomy was for a period sacrificed for decreased operative morbidity. However, recent developments in operative techniques aim to restore ACL anatomy while also achieving minimal operative morbidity. buy TJ-M2010-5 Despite this historically iterative process, there remains no perfect choice for the treatment of ACL tears. Continued research on ACL repair, anatomic graft placement, graft choice, and augmentation will help our patients over the next generation.Management of cartilage lesions of the knee can be complex, time consuming, and controversial, especially without a widely agreed upon “gold-standard” management. The PearlDiver database (www.pearldiverinc.com, Fort Wayne, IN) was queried for surgical management of cartilage lesions specified by Current Procedure Terminology (CPT) codes 29877, chondroplasty; 29879, microfracture/drilling; 29866, arthroscopic osteochondral autograft; 29867, arthroscopic osteochondral allograft; 27412, autologous chondrocyte implantation (ACI); 27415, open osteochondral allograft; or 27416, open osteochondral autograft. Procedures were categorized as palliative (chondroplasty), microfracture/drilling, or restorative (arthroscopic osteochondral autograft; arthroscopic osteochondral allograft; ACI; open osteochondral allograft; or open osteochondral autograft). Linear regression was performed to determine the significance of yearly trend across each procedure.From 2007 to 2016, a total of 35,506 surgical procedures were performed.

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