Analysis 1.1. Comparison 1 Proximal femoral nail (PFN) versus Gamma nail, Outcome 1 Mortality.. .. .. . Analysis 1.2. Comparison 1 Proximal femoral nail (PFN) versus Gamma nail, Outcome 2 Final functional outcomes. Analysis 1.3. Comparison 1 Proximal femoral nail (PFN) versus Gamma nail, Outcome 3 Harris hip scores (0 to 100: high values = best function
Regenerating damaged tissue interfaces remains a significant clinical challenge, requiring recapitulation of the structure, composition, and function of the native enthesis. In the ligament-to-bone interface, this region transitions from ligament to fibrocartilage, to calcified cartilage and then to bone. This gradation in tissue types facilitates the transfer of load between soft and hard structures while minimizing stress concentrations at the interface. Previous attempts to engineer the ligament-bone interface have utilized various scaffold materials with an array of various cell types and/or biological cues. The primary goal of this study was to engineer a multiphased construct mimicking the ligament-bone interface by driving differentiation of a single population of mesenchymal stem cells (MSCs), seeded within blended fibrin-alginate hydrogels, down an endochondral, fibrocartilaginous, or ligamentous pathway through spatial presentation of growth factors along the length of the construct within a custom-developed, dual-chamber culture system. MSCs within these engineered constructs demonstrated spatially distinct regions of differentiation, adopting either a cartilaginous or ligamentous phenotype depending on their local environment. Furthermore, there was also evidence of spatially defined progression toward an endochondral phenotype when chondrogenically primed MSCs within this construct were additionally exposed to hypertrophic cues. The study demonstrates the feasibility of engineering spatially complex soft tissues within a single MSC laden hydrogel through the defined presentation of biochemical cues. This novel approach represents a new strategy for engineering the ligament-bone interface. Biotechnol. Bioeng. 2017;114: 2400-2411. © 2017 Wiley Periodicals, Inc.
The global age standardized prevalence of type 2 diabetes (T2DM) has doubled (4.7% to 8.5%) over the last three decades and is increasing more rapidly in low and middle-income countries (LMICs). The global economic burden of diabetes affects individuals and health care systems and is estimated to cost $825 billion USD a year. Within Mexico, T2DM is the second leading cause of mortality and the leading cause of morbidity using disability associated life years (DALYs). A retrospective chart review and cost analysis, analyzing those at risk of diabetes, was conducted at a rural community health clinic in Jalisco, Mexico. The goal was to project the cost of providing an appropriate scope of care and plan prevention-based population health programs. The results demonstrated that out of 264 charts reviewed, 218 (83%) had one or more diabetic risk factor. The estimated per patient per visit cost is $127.22 MP (Mexican Peso, 2018) and as the number of diabetes risk factors increases for an individual patient, the mean cost of their care to the system increases (p < .001). Those with at least one risk factor comprise the majority in both males and females with a median age of 36 and median BMI of 28, and this group also has the highest percentage of borderline hypertension (46%). This data demonstrates an opportunity to intervene in a group of young adults (ages 27-46) with a cluster of high-risk borderline risk factors and preventing them from developing obesity, hypertension and diabetes later in life.
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