Despite rapid medical technology development, various challenges exist in three- and four-part proximal humeral fracture (PHF) management. This condition has led to a notably increased use of the reverse total shoulder arthroplasty (RTSA); however, open reduction and internal fixation (ORIF) is still the most widely performed procedure. Thus, these two modalities are crucial and require further discussion. We aim to compare the outcomes of three- or four-part PHF surgeries using ORIF and RTSA based on direct/head-to-head comparative studies. We conducted a systematic review and meta-analysis based on the Cochrane handbook and PRISMA guidelines. We searched MEDLINE (PubMed), Embase (Ovid), and CENTRAL (Cochrane Library) from inception to October 2020. Our protocol was registered at PROSPERO (registration number CRD42020214681). We assessed the individual study risk of bias using ROB 2 and ROBINS-I tools, then appraised our evidence using the GRADE approach. Six head-to-head comparative studies were included, comprising one RCT and five retrospective case-control studies. We found that RTSA significantly improved forward flexion but was comparable to ORIF in abduction (p = 0.03 and p = 0.47, respectively) and more inferior in external rotation (p < 0.0001). Moreover, RTSA improved the overall Constant-Murley score, but the difference was not significant (p = 0.22). Interestingly, RTSA increased complications (by 42%) but reduced the revision surgery rates (by 63%) compared to ORIF (p = 0.04 and p = 0.02, respectively). RTSA is recommended to treat patients aged 65 years or older with a three- or four-part PHF. Compared to ORIF, RTSA resulted in better forward flexion and Constant-Murley score, equal abduction, less external rotation, increased complications but fewer revision surgeries. Cite this article: EFORT Open Rev 2021;6:941-955. DOI: 10.1302/2058-5241.6.210049
Ubiquinon (Q10) is an endogenous antioxidant. It is lipophilic and practically insoluble in water. To improve its solubility and penetration, it was formulated into O/W nanoemulsion. The resulting Q10 nanoemulsion was then physically characterized for its droplet size, morphology, and viscosity. In addition, it was conducted a penetration test of Q10 in nanoemulsion delivery system compared to Q10 in emulsion using male Wistar rats. From the characterization results, it was found that the droplet size of Q10 nanoemulsion (70.07 ± 12.42 nm) less than Q10 emulsion (21.063 ± 3,57μm), the morphology of droplet Q10 nanoemulsion and Q10 emulsion that are spherical, and that the viscosity of Q10 nanoemulsion (10.5 CPa.s) less than Q10 emulsion (16 CPa.s). The penetration rate of Q10 in nanoemulsion and emulsion was observed at 2 hours, 4 hours, and 6 hours after treatment. The result was known that the penetration rate of Q10 in nanoemulsion (174.49 μm/h) > Q10 in emulsion (20.429 μm/h).
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