Aims: Metaphyseal cones and sleeves are components used in revision knee arthroplasty to ensure load transfer, encourage bone on-growth and prevent stress shielding. Additive manufacturing of titanium alloy implants is a novel technique with limited clinical outcome reports in the literature. The aim of this study was to determine radiographic evidence of osseointegration and early results of a single manufacturer porous titanium metaphyseal components in the proximal tibia. Methods: We retrospectively reviewed the prospectively collected database of two institutions. Patients who underwent revision knee arthroplasty using porous titanium components by a single manufacturer were identified. Immediate post-operative and latest follow-up radiographs were independently analysed by 2 reviewers to determine metaphyseal bone contact and level of osseointegration in relevant Knee Society Radiographic Evaluation and Scoring System zones. Results: 22 patients (15 males; 7 females) with a mean age of 71 (49e92) years were included. The mean follow-up period was 14 months (2e44 months). Cones were used in 16 patients and sleeves in 6. Interobserver reliability assessment showed substantial agreement (weighted Kappa 0.71, (95% CI: 0.60, 0.81). There was significant correlation between the bone contact in the immediate postop radiograph and osseointegration at final follow-up (kendall's tau-b: 0.698, p < 0.001). Infection free prosthetic joint survival was 20/22 at final follow-up. Conclusion: Porous titanium metaphyseal components produced with additive manufacturing provided excellent osseointegration and no early clinical failures. Partial or complete contact of the cone with native bone in the immediate postoperative radiograph resulted in osseointegration in all cases.
Background
The number of men undergoing prostate biopsy and subsequent cancer detection rates has changed significantly over the past 15 years. We aim to evaluate changes in the diagnostic pathway of prostate cancer between 2003 and 2018.
Methods
A total of 13 844 Western Australian biopsy‐naive men were assessed to determine trends in age, prostate‐specific antigen levels, number of core samples, positive cores and tumour grade (Gleason) between 2003 and 2018. Further, in 2018, the impact of pre‐biopsy multiparametric magnetic resonance imaging (mpMRI) was also assessed.
Results
Between 2003 and 2012, the number of men undergoing biopsy increased from 1445 to 3100. During this time, the prostate cancer detection rate (%) remained unchanged. However, in 2018, 2042 men underwent prostate biopsy (reduction of 34.1%) and the detection rate increased to 72.6%. The incidence of low‐grade cancer (Gleason score <7) increased from 28.1% in 2003 to 36.2% in 2012, but it decreased significantly to 15.1% by 2018. High‐grade cancer (Gleason score >7) declined from 21.3% in 2003 to 15.2% in 2012 but then increased to 35.7% in 2018. The use of mpMRI in 2018 improved the detection rate of high‐grade cancer. However, its specificity remains low (29.7%) and a considerable proportion of low Prostate Imaging Reporting and Data System score lesions was later diagnosed with cancer unsuitable for active surveillance.
Conclusion
In recent years, there has been a significant increase in the diagnosis high‐grade cancer and a reduction in cancer suitable for active surveillance. mpMRI identifies high‐grade tumours but is not a reliable alternative to prostate biopsy.
<p>Australia hosts at least two active continental basaltic volcanic fields with Holocene eruption ages yet little is understood about magma ascent and mantle to surface ascent pathways and timescales in these regions. In this study we use textural and chemical information stored within minerals from two of the youngest volcanic eruptions in northeast and southeast Australia to investigate magmatic plumbing systems and magma ascent in Australia&#8217;s intra-plate volcanic fields. Volcanic rock samples from the three main eruptive phases at Mt Schank volcano in the Newer Volcanics Province, South Australia, reveal textural and mineralogical differences throughout the evolution of the eruption that correspond to variations in eruption style and the availability of external water. Crustal xenoliths (e.g., quartz and limestone) are abundant in the middle, maar-forming phase of the eruption. The lack of mantle-derived xenoliths and xenocrysts throughout the eruption, olivine compositions and sector and oscillatory zoned, euhedral clinopyroxene suggest a more stalled ascent pathway of magma compared to the mantle xenolith-bearing volcanoes in parts of the Victorian sector of the province. Skeletal olivine crystals and dendritic clinopyroxene microlites indicate moderate degrees of undercooling at Mt Schank during magma ascent. In northeast Queensland, interaction of magma with mantle xenolith&#8217;s are used to determine magma ascent dynamics. Disequilibrium and quench textures and chemical zoning patterns in olivine, clinopyroxene, orthopyroxene and spinel on xenolith margins and within host glass reveal a detailed and complex history of magma ascent.</p>
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