Total joint arthroplasty in a predominantly African-American population. Part two: Hip arthroplasty.

This second part of a two-part series examines total hip arthroplasty in an African-American population. Total hip arthroplasty has revolutionized orthopedic surgery since it began more than two decades ago. The quality and durability of results have enabled patients to pursue a more normal lifestyle, greatly relieved of their pain. Although many studies have reviewed the long-term results of total hip arthroplasty, none have addressed the results in a predominantly African-American population. This study retrospectively reviews the results of total hip arthroplasty in 62 African-American patients. Patients'' attitudes toward this surgery, their co-morbid conditions, complications, and results were examined with regard to activity level and acceptance of the procedure.     

Blood nickel concentrations in patients with stainless-steel hip prostheses

Nickel concentrations were analyzed by electrothermal atomic absorption spectrophotometry in serum and whole blood specimens from patients 9 to 15 years after unilateral (N = 11) or bilateral (N = 2) hip arthroplasty. The hip prostheses were of the "Charnley" or "TR-28" (metal-to-plastic) types, fabricated of stainless-steel (14 to 16 percent Ni) with polyethylene acetabular cups. In 12 of the 13 patients, nickel concentrations (+/- SD) averaged 0.30 +/- 0.25 microgram per L (range 0.05 to 0.85) in serum and 0.36 +/- 0.20 microgram per L (range 0.11 to 0.67) in whole blood; these values did not differ significantly from the corresponding nickel concentrations in specimens from 30 healthy controls (0.28 +/- 0.24 microgram per L, range less than 0.05 to 1.08, in serum; 0.34 +/- 0.28 microgram per L, range less than 0.05 to 1.05, in whole blood). The remaining patient, a 78-year-old man with bilateral hip arthroplasty, had nickel concentrations of 3.1 micrograms per L in serum and 2.3 micrograms per L in whole blood; renal insufficiency apparently contributed to hypernickelemia in this patient. The arthroplasty patients were asymptomatic with respect to their joint replacements; X-rays at the last follow-up examinations did not reveal bone resorption around the implants. This study shows that patients with stainless-steel hip prostheses of the metal-to-plastic types do not develop hypernickelemia in the apparent absence of corrosion, local complications, or systemic conditions, such as renal insufficiency.     

Use of hair cortisol analysis to detect hypercortisolism during active drinking phases in alcohol-dependent individuals

The assessment of cortisol levels in human hair has recently been suggested to provide a retrospective index of cumulative cortisol exposure over periods of up to 6 months. The current study examined the utility of hair cortisol analysis to retrospectively detect hypercortisolism during active drinking phases in alcoholics in acute withdrawal (n = 23), the normalisation of cortisol output in abstinent alcoholics (n = 25) and cortisol levels in age- and gender-matched controls (n = 20). Scalp-near 3-cm hair segments were sampled and analysed for cortisol content. Results showed three to fourfold higher cortisol levels in hair samples of alcoholics in acute withdrawal than in those of abstinent alcoholics (p < .001) or controls (p < .001), with no differences between the latter two groups. The current hair cortisol findings closely mirror results of previous research using well-established measures of systemic cortisol secretion and thus provide further validation of this novel method.     

Washing the dog reduces dog allergen levels, but the dog needs to be washed twice a week

BACKGROUND: Many asthmatic patients allergic to dogs refuse to part with their dog, and it is essential to develop techniques for lowering exposure with a dog in the home. OBJECTIVE: This study investigated the effect of dog washing on the subsequent recovery of Can f 1 from dog hair clippings and on the airborne allergen over a 7-day period. METHODS: Dogs, which had not been washed for at least the previous 3 weeks, were washed with a hand-held shower and proprietary shampoo. Hair clippings and dander samples from 25 dogs were collected before and immediately after washing. After these initial studies, 16 dogs had a small tuft of hair clipped from the collar or spinal area before washing and then daily for the next 7 days. Air sampling was performed in 5 homes, and the air samples were collected (airflow rate, 9 L/min) over an 8-hour period per day on 10 consecutive days (3 days of baseline sampling before washing and then 7 consecutive days after washing). Can f 1 level was measured by using 2-site ELISA. RESULTS: Washing significantly reduced recoverable Can f 1 from clippings (84% reduction: from 73 microg/g to 12 microg/g [geometric mean]; P <.0001) and from dander samples (86% reduction: from 347 microg/g to 50 microg/g [geometric mean]; P <.0001). There was a significant reduction in Can f 1 levels in dog hair over the observed 8-day period (F = 18.4, P <. 0001). By using a multiple comparison test, this observed significance was found to be due to the difference between the baseline levels and those on days 1 and 2 after washing, with no difference in the baseline Can f 1 compared with days 3 to 7. Airborne Can f 1 levels showed a downward trend, which reached statistical significance when the data were grouped into 3 sampling periods as follows: baseline (ie, mean of 3 days before sampling) was compared with days 1 to 4 after washing (41% reduction, 95% CI 13%-60%) and days 5 to 7 after washing (61% reduction, 95% CI 2%-84%; P =.014). CONCLUSIONS: Washing the dog reduces recoverable allergen from dog hair and dander. The dog needs to be washed at least twice a week to maintain the reduction in recoverable Can f 1 from its hair. Washing the dog achieves a modest reduction in the level of airborne Can f 1 in homes with a dog.     

髋关节置换术是否是妊娠的禁忌证

目的：探讨髋关节置换术是否适用于育龄期妇女。方法：查阅近年来国外的相关文献,并做进一步综合分析。结果：从生物力学角度看,妊娠或分娩不会增加髋关节置换术后关节脱位、假体松动、假体周围骨折或翻修手术的风险,对临床、功能和放射学结果没有不良影响。金属关节假体可释放出金属离子钴和铬。金属离子有潜在的全身毒性反应,尤其是在金属对金属关节假体植入后几个月内。在分娩时,胎盘可减少钴和铬通过胎盘进入胎儿体内。结论：从生物力学角度看,髋关节置换术不应该认为是妊娠或分娩的禁忌证。对于接触钴铬颗粒和离子的长期生物学效应仍知之甚少。     

Prolonged bleeding time during nitric oxide inhalation in the rabbit

During a study on the modulatory effect of inhaled nitric oxide (NO) on the airway, we observed an increased bleeding tendency. Therefore, we studied bleeding time and blood rheology in rabbits during inhalation of 3, 30 and 300 parts per million (ppm) NO. The rabbits were intubated during neurolept anaesthesia and were ventilated mechanically. The bleeding time was significantly increased after 15 min of inhalation of 30 ppm NO, from 51 + 5 to 72 + 7 s (mean + SEM, P < 0.001, n= 7). However, there were no changes in haematocrit, whole blood or plasma viscosity, erythrocyte aggregation tendency, or erythrocyte deformability. Inhalation of 3 ppm NO increased bleeding time from 46+11 to 59 + 8 s (n.s., n= 4) and 300 ppm NO from 48 + 12 to 78 + 17s(P<0.05, n= 4). In another group of rabbits mean arterial pressure (MAP) was monitored using NO inhalation. A non-significant decrease was seen with 3 ppm and 30 ppm NO, from 63 + 2 to 59 + 3 mmHg (n= 6) and from 65 + 2 to 61 + 1 mmHg (n= 6) respectively. Inhalation with 300 ppm NO decreased MAP from 62 + 3 to 55 + 2 mmHg (P < 0.05, n= 6). We conclude from these data that inhalation of NO, 30 ppm or more exerts systemic effects.     

Antineutrophil cytoplasm antibodies (ANCA) of IgA isotype in adult Henoch-Schönlein purpura

ANCA are associated with certain forms of systemic vasculitis, and have been reported previously to be of the IgG and IgM isotype. We examined ihc possible association between IgA ANCA and the IgA-related diseases Henoch-Schönlein purpura (HSP) and IgA nephropathy (IgAN). IgA and IgG ANCA were detected by isotype-specific solid-phase assays with a crude neutrophil extract, and their presence was confirmed by antigen-specific fluid-phase competitive inhibition tests and by indirect immunofluorescence. The possible interference by IgA rheumatoid factor was excluded. IgA ANCA were detected in sera from 11/I4 HSP patients (79%). from 1/30 IgAN patients (3%), from 1/40 patients with vasculitides classically associated with IgG ANCA (2-5%), and in none or 60 sera from healthy blood donors. IgG ANCA were present with IgA ANCA in three patients with HSP. Only one HSP serum had anti-myeloperoxidase (MPO) activity by both IgA and IgG isotype-specific ELISA, and none was positive for proteinase 3 (PR3). Western blot analysis performed with neutrophil extract showed that the four strongest IgA ANCA-positive HSP sera reacted with a 51 -kD protein; Western blot performed on cellular fractions showed that this protein is primarily membrane-associated, and different from fibronectin. Our study suggests that adult HSP is closely associated with circulating IgA ANCA. which may be directed against a different autoantigen than that recognized by IgG ANCA.     

指甲游离缘及毛发中核DNA抽提方法的探讨

目的探讨指甲游离缘及毛发中抽提核DNA的方法,并对抽提结果进行评估。方法采集5名健康成人志愿者指甲游离缘、发根及发干样本各30份。分别用无水乙醇和蒸馏水浸泡样本,去除外源性DNA。每份指甲游离缘样本为3mg指甲游离缘碎片;每份发根或发干样本各为3段0．3～0．5cm发根或发干。分别采用酚氯仿法、Chelex-100法和QIAamp@DNA Investigator试剂盒法抽提3种样本的核DNA,并运用PCR扩增对抽提DNA进行评估。扩增片段位于不同染色体上,长度分别为188、248、300和741bp。PCR扩增产物用1．8％琼脂糖凝胶电泳检测。为探讨样本量对抽提结果的影响,任意取指甲游离缘1、3和5mg,发根及发干各1、3和5根重复实验,并比较结果。初步探讨增加Taq酶量对黑色素抑制的消除作用。结果在3种抽提方法中长度为248bp的引物扩增成功率均为最高。指甲游离缘样本使用试剂盒法抽提核DNAPCR扩增成功率显著高于酚氯仿法及Chelex-100法（P〈0．05）。发干样本使用试剂盒法抽提核DNAPCR扩增成功率显著高于酚氯仿法（P〈0．05）。发根样本3种方法抽提核DNAPCR扩增成功率差异无统计学意义（P〉0．05）。指甲游离缘样本的PCR扩增成功率显著高于发根及发干样本（P〈0．05）,发根和发干样本的PCR扩增成功率差异无统计学意义。试剂盒法抽提指甲游离缘、发根和发干核DNAPCR扩增成功率随样本量增加而提高。酚氯仿法和Chelex-100法抽提发根或发干样本核DNAPCR扩增成功率随样本量增加呈下降趋势,提示可能存在黑色素抑制作用。增加Taq酶量对于消除黑色素抑制有一定作用。结论①3种抽提方法均能成功从指甲游离缘及毛发中抽提到核DNA,试剂盒法成功率最高。②指甲游离缘、发根和发干均可作为核DNA采样源,从指甲游离缘抽提DNA成功率最高。     

Screening for the fragile X syndrome among mentally retarded males by hair root analysis

A noninvasive antibody test was used to identify male fragile X patients in special education schools, on the basis of the lack of FMRP in hair roots. We studied 300 males with mental retardation of unknown cause attending special schools. Patients were divided into two groups, based on the scores according to a fragile X check list (Group 1 /= 10 points). Group 2 consists of 51 males and only 5 males in this group showed no FMRP expression in hair roots within the abnormal range (91%). Fragile X diagnosis in these cases was confirmed by DNA analysis. None of the males scoring more than 10 on the check list was diagnosed positive for the fragile X syndrome using DNA analysis. With our antibody test on hair roots we did not detect a fragile X patient in Group 1. The FMRP antibody test on hair roots is suitable in a screening program for the fragile X syndrome among mentally retarded males attending special education schools.     

中年患者128例生物型全髋置换和骨水泥全髋置换后的随访比较

背景：许多学者均认为骨水泥型全髋置换适合应用于年老且合并较严重的骨质疏松患者,生物型全髋置换适用于较为年轻的患者。 目的：对比中年患者生物型全髋置换和骨水泥型全髋置换的临床效果。 方法：对比分析58例骨水泥型全髋置换者与70例生物型全髋置换者置换后6个月、2年及5年的肢体功能恢复与影像学评估结果以及Harris评分,均为40~60岁中年患者。 结果与结论：生物型假体置换后6个月、2年、5年的Harris评分明显优于骨水泥型假体(P < 0.05),5年生存率也高于骨水泥型假体(P < 0.05)。骨水泥型假体置换后6个月,3例发生自发溶骨性疾病,3例2年后发生假体松动,3例5年后发生线性渗透溶;生物型假体置换2年后2例发生自发溶骨性疾病,置换后5年1例发生假体松动。说明生物型假体较骨水泥型假体更能促进中年患者置换后髋关节功能的恢复,减少并发症的发生,至少在5年的随访过程中获得了更令人满意的临床和影像学结果。关键词：生物型假体;骨水泥型假体;全髋关节置换;Harris评分;人工假体 doi:10.3969/j.issn.1673-8225.2012.17.008     

Local and systemic chemokine patterns in a human musculoskeletal trauma model

Objective and design  This prospective study aims to identify differences in local and systemic chemokines kinetics within 24 h of a standardised human surgical trauma (total hip arthroplasty) and their impact on systemic polymorphonuclear cells. Materials and methods  We examined seven patients with coxarthrosis, but without comorbidity, who had a total hip arthroplasty. Local drained blood and systemic blood samples were collected at wound closure and at 1, 4, and 24 h after surgery. Chemokines were measured using a multiplex antibody bead kit. Venous whole blood cell counts were taken at the same points in time. Results  There is a significant postoperative local burst of CCL2 and CXCL8 while systemic levels stay unchanged. The systemic levels of CCL3, CCL4, CCL5, CCL11, CXCL9, and CXCL10 were significantly reduced at 24 h post-surgery, but local levels remain unchanged or had only modest changes. There was a significant postoperative rise in monocytes and neutrophils. Conclusion  There is fundamental difference between local and systemic chemokine kinetics in the human trauma model studied. High postoperative concentrations of CCL2 and CXCL8 at the site of inflammation form a gradient that contributes to the recruitment of neutrophils and monocytes at the trauma site.     

Short Article The Use of Mercury against Pediculosis in the Renaissance: The Case of Ferdinand II of Aragon,King of Naples, 1467–96

The hair samples of Ferdinand II of Aragon (1467–1496), King of Naples, whose mummy is preserved in the Basilica of San Domenico Maggiore in Naples, showed a high content of mercury, with a value of 827ppm. Furthermore, examination using a stereomicroscope and a scanning electron microscope (SEM) of head and pubic hairs of Ferdinand II, revealed a lice infestation. The reasons for the massive presence of the mercury in the king''s hair are discussed and contemporary literature regarding the use of this metal in medical therapies and in cosmetic practices is analysed. As a result, the high value of mercury in the hair of Ferdinand II can be attributed to antipediculosis therapy, applied as a topic medicament. This case represents an important finding for the history of medicine, because demonstrates that in the Renaissance mercury was applied locally not only to treat syphilis, as well attested by direct and indirect sources, but also to prevent or eliminate lice infestation.     

Preliminary investigation of environmental prevalence of Clostridium difficile affecting inpatients in a north Indian hospital

A preliminary study was conducted to see the prevalence of Clostridium difficile in patients and their environment in a tertiary care hospital. Seventy-nine fecal specimens from hospitalized patients, 176 swab samples from beds and 48 from hands of hospital personnel were investigated. Sixty-three patients received antibiotics and 14 proton pump inhibitors. Abdominal pain was observed in 16 patients with fever in 15 of them. C. difficile culture was positive in 12.6% patients at initial sampling but none were toxin-positive. Eight patients developed diarrhea and five were both culture and toxin-positive. Fifty-one percent of bed swab samples and 62.5% of hand swab samples were culture positive. Similarly 8.5% of bed swab samples and 4.2% of hand swab samples were positive for toxins A and B. The environmental cross-infection between patients and carriage by hospital personnel are plausible sources of C. difficile infection and spread in our hospital.     

全膝关节置换假体松动时滑膜液中的诊断性标志物

背景：人工关节置换后的无菌性假体松动一直是全膝关节置换后常见的并发症,是否与骨性关节炎的发生时的腱糖蛋白c、白细胞介素6和肿瘤坏死因子等许多细胞因子的作用密切相关？ 目的：观察全膝关节置换后无菌性假体松动发生时假体滑膜液中白细胞介素6、肿瘤坏死因子α和腱糖蛋白c的表达。 方法：实验组选择45例全膝关节置换翻修患者,对照组为25例首次进行膝关节置换的患者。实验排除炎性关节炎、二次关节炎感染至全身或自身免疫病以及合并肝炎、恶性肿瘤、服用激素、免疫抑制剂等疾病史的患者。取各组患者假体滑膜液,Western blot检测腱糖蛋白c剪切变异体的表达,ELISA分析假体滑膜液中白细胞介素6,肿瘤坏死因子α和腱糖蛋白c水平的变化。 结果与结论：Western blot结果显示假体松动后假体滑膜液中存在大的腱糖蛋白c突变体。假体松动后滑膜液中白细胞介素6、腱糖蛋白c的水平大约是对照组的3倍,肿瘤坏死因子α水平大约是对照组的2.5倍。证实假体松动后假体滑膜液中腱糖蛋白c的含量升高,提示腱糖蛋白c可以作为诊断假体松动有效的标志物。     

Determination of virus-specific antigens in extracts from herpes simplex virus-infected cells by a Cr release inhibition test.

A 51cr release inhibition test (CRIT) was developed for determining herpes simplex virus type 1 antigens in infected cell extracts. Among the factors studied were the optimal concentrations of complement, antibody, and infected target cells. Under standardized conditions, the relationship between antigen content and inhibition of chromium release was linear in a semilogarithmic plot, indicating that the antigen content can be determined from testing two dilutions of a given preparation. Other tests showed that infected cells cryopreserved at -70 degrees C for periods exceeding 3 months can be used in CRIT. Five different batches of infected cell extracts were tested in both CRIT and blocking neutralization tests with comparable results being obtained, suggesting that both tests measure the same activity.     

Association between lupus psychosis and anti-ribosomal P protein antibodies

In 18 of 20 patients with psychosis secondary to systemic lupus erythematosus (SLE), autoantibodies to ribosomal P proteins were detected by immunoblotting and measured with a new radioimmunoassay using a synthetic peptide as antigen. The frequency of anti-P was not increased in patients with other central nervous system manifestations of SLE (3 of 20, by radioimmunoassay), in patients with transient behavioral abnormalities due to SLE (none of 8), in patients with psychosis who did not have SLE (none of 13), or in normal controls (none of 20). In four of five paired serum samples, anti-P-peptide antibody levels increased 5-fold to 30-fold during the active phase of lupus psychosis. Longitudinal studies of anti-P activity in two patients with psychosis revealed that anti-P levels increased before and during the active phases of psychosis but not during sepsis or other exacerbations of SLE, and that the elevations were selective for anti-P antibodies, as opposed to anti-DNA antibodies. Longitudinal studies of anti-P activity in two patients with anti-P but without psychosis showed less than threefold changes in anti-P levels despite exacerbations of disease. We conclude that anti-P is associated with lupus psychosis and that synthetic peptide antigens may be useful for the detection and measurement of autoantibodies to intracellular proteins.     

Systemic changes in haemostatic balance are not associated with increased levels of circulating microparticles in women with recurrent spontaneous abortion

PROBLEM: Placental fibrin deposits in patients wih recurrent spontaneous abortion (RSA) indicate an exaggerated haemostatic response. This 'hypercoagulability' may involve pro-coagulant factors such as circulating microparticles (MPs). We investigated the relationship between circulating pro-coagulant MPs and systemic coagulation in RSA patients. METHOD OF STUDY: Platelet- and endothelial cell-derived microparticles (PMPs, EMPs) were evaluated by flow cytometry in RSA patients (n = 51) and compared to controls (n = 24) using annexin V (total numbers of MP), and antibodies against CD61, CD63 and CD62P (PMP), as well as CD144 and CD62E (EMP). Prothrombin fragment 1 + 2 (F(1+2)) and thrombin generation were determined to assess the pro-coagulant potential of MP. RESULTS: Numbers of annexin V-binding MP were nearly similar in RSA patients and controls. However, a subgroup of ten RSA patients (10/51; 20%) presented with MP concentrations >10,000 x 10(6)/L, compared to only one women out of the control group (1/24; 4%; P = 0.038). Neither PMP and EMP nor F(1+2) and thrombin generation differed significantly within the study population. CONCLUSION: The present study shows that circulating MPs are not directly associated with the extent of systemic coagulation activation in RSA patients. We hypothesize that increased numbers of circulating MPs either are only indirectly associated with coagulation during pregnancy of RSA patients, or affect abortion via mechanisms independently from hypercoagulation.     

Augmentation of Natural Cell-Mediated Cytotoxic Activity by Supernatant from In Vitro Mitogen-Stimulated, In Vivo Hormone-Treated Lymphocytes in Immature Male (K Strain) Chickens

Newly hatched White Leghorn male chicks were used in this study. Triiodothyronine (T₃; 0.1 or 1 ppm) and Thyrotropin Releasing Hormone (TRH; 1 or 5 ppm) were added to the feed for an 8-week period starting at hatch. A fifth group received the unsupplemented diet and served as controls. Peripheral blood lymphocytes from each treatment group were cultured in vitro with or without different mitogens (PHA, Con-A, or LPS), and the culture supernatants were tested for the presence of lymphokines (LK). The natural cell-mediated cytotoxicity (NCMC) assay was carried out with or without supernatant using the standard chromium (Cr⁵¹) release assay. Control untreated chicks were used as donors for effector cells and the P815 mouse mastocytoma was used as a target. Supernatant from in vivo 1 ppm T₃- or 5 ppm TRH-treated lymphocytes significantly suppressed NCMC (or cells mediating NCMC, e.g., NK cells). However, supernatant from 1 ppm T₃-treated, PHA-stimulated lymphocytes significantly enhanced NK cells cytotoxicity, while supernatant from 5 ppm TRH-treated lymphocytes with PHA stimulation tended to suppress cytotoxicity. These results provide evidence supporting a regulatory role of the hypothalamo-pituitary thyroid axis on lymphokine (LK) production.

The results also suggest that these hormones act on different subpopulation of lymphocytes, and therefore, the mediators released by them.     

Hepatitis B antigen-associated deoxyribonucleic acid polymerase activity and e antigen/anti-e system.

Serum samples of 403 asymptomatic blood donors carrying hepatitis B surface antigen (HB5Ag) were concentrated threefold and tested for e antigen and antibody to e antigen (anti-e) by immunodiffusion. Hepatitis B antigen (HBAg)-associated deoxyribonucleic acid (DNA) polymerase activity was specifically determined by the difference in incorporation of [methyl-3H]thymidine 5' -triphosphate into DNA by an aliquot of centrifuged serum samples after it had been treated either with normal rabbit serum or with rabbit antibody to HBSAg. All of 58 serum samples containing e antigen revealed HBAg-associated DNA polymerase activity, whereas none of 96 samples containing anti-e did. In the remaining 249 samples in which neither e antigen nor anti-e was found, 62 showed specific DNA polymerase activity, although at lower levels than the samples containing e antigen.     

Real-time quantitation of hepatitis B virus (HBV) DNA in tumorous and surrounding tissue from patients with hepatocellular carcinoma

Few data are available on the levels of HBV DNA in liver tissue of patients with hepatocellular carcinoma. In this study, HBV DNA was quantitated by a TaqMan real-time PCR method and results were normalised to an endogenous reference gene. The assay could detect reproducibly viral sequences from over 10(7) to less than 50 copies/microg of liver DNA. The HBV DNA content in liver samples from 11 HBsAg-positive patients (median: 10(5) copies/microg of DNA) was significantly higher (P < 0.001) compared to the viral DNA concentration detected in liver samples from 15 of 25 HBsAg-negative patients (median: 2.6 x 10(2) copies/microg). A liver DNA amount > or =1 HBV DNA copy per cell was detected in half of tissue samples from HBsAg-positive patients, and in none from HBsAg-negative ones. Liver tissue HBV DNA content was significantly higher in anti-HCV-negative than in anti-HCV-positive cases (P < 0.001). These results show that the quantitation of liver HBV DNA by real-time PCR can be useful to understand HBV state in hepatocellular carcinoma and viral interplay in patients with multiple viral infections.