Gait and functional status analysis before and after total knee arthroplasty

Background

Among the procedures for severe gonarthrosis, total knee arthroplasty (TKA) is considered a successful method patient satisfaction and functional improvement; however, TKA is commonly associated with incompletely recovered gait function. The aim of this study was to evaluate the influence of TKA and physiotherapy programmes on gait features and patient-reported functional status and the relationship between them, leading to broader knowledge of the origins of long-term gait disturbances.

Brainstem system of hippocampal theta induction: The role of the ventral tegmental area

This article summarizes the results of studies concerning the influence of the ventral tegmental area (VTA) on the hippocampal theta rhythm. Temporary VTA inactivation resulted in transient loss of the hippocampal theta. Permanent destruction of the VTA caused a long‐lasting depression of the power of the theta and it also had some influence on the frequency of the rhythm. Activation of glutamate (GLU) receptors or decrease of GABAergic tonus in the VTA led to enhancement of dopamine release and increased hippocampal theta power. High time and frequency cross‐correlation was detected for the theta band between the VTA and hippocampus during paradoxical sleep and active waking. Thus, the VTA may belong to the broad network involved in theta rhythm regulation. This article also presents a model of brainstem–VTA–hippocampal interactions in the induction of the hippocampal theta rhythm. The projections from the VTA which enhance theta rhythm are incorporated into the main theta generation pathway, in which the septum acts as the central node. The neuronal activity that may be responsible for the ability of the VTA to regulate theta probably derives from the structures associated with rapid eye movement (sleep) (REM) sleep or with sensorimotor activity (i.e., mainly from the pedunculopontine and laterodorsal tegmental nuclei and also from the raphe). Synapse 69:553–575, 2015 . © 2015 Wiley Periodicals, Inc.     

High grade endometrial stromal sarcoma on thinprep

High grade endometrial stromal sarcoma (HGESS) is an uncommon malignancy recently re‐defined in the new WHO classification of endometrial stromal tumors. In this article, we discuss the differential diagnoses of metastatic HGESS in a fine needle aspiration (FNA) of a lymph node and compare the cytomorphology of HGESS in ThinPrep [(TP), Hologic Inc., Boxborough, MA] to conventional smears (CS). The patient had a history of stage I HGESS, status‐post supracervical hysterectomy without regional lymph node metastases. Her post‐operative course was complicated by pelvic fluid collections and enlarging para‐aortic lymph nodes. Diff‐Quik (DQ)‐stained and Papanicolaou (Pap)‐stained smears from a para‐aortic lymph node FNA demonstrated a cellular specimen with monomorphic population of plump to oval cells with scant, wispy cytoplasm in aggregates and as single cells. The nuclei showed fine chromatin and small inconspicuous nucleoli. Compared to the CS, HGESS cells in the TP showed similar cytological features, with the exception that the nuclei were slightly smaller, hyperchromatic, and the chromatin pattern was attenuated. In the absence of prior clinical history, the cytomorphology of metastatic HGESS in a lymph node can be difficult to differentiate from a lymphoma, a variety of metastatic spindle cell tumors or metastatic carcinoma. Immunohistochemical analysis and comparison with the primary tumor can be useful in proving the nature of the malignant cells. The cytomorphology of HGESS on TP correlated well in both single cells and aggregates when compared to CS. The differences noted were decreased nuclear size, nuclear hyperchromasia, and slightly attenuated nuclear detail on TP. Diagn. Cytopathol. 2015;43:756–762. © 2015 Wiley Periodicals, Inc.     

Preterm Labor: CD55 in Maternal Blood Leukocytes

Problem Intrauterine inflammation is a frequent and significant factor associated with the pathogenesis of preterm labor/birth (PTL/PTB). However, it remains unclear whether the intrauterine inflammatory responses activate the maternal peripheral circulation. We explored the association between PTL/PTB and the ‘activation’ of the peripheral circulatory system by determining whether CD55 mRNA expression within peripheral WBCs differed between PTL and control patients not in labor. Method of Study RNA was purified from white blood cells collected from pregnant women with preterm labor (n = 45), and from pregnant (n = 30) control women. CD55 gene expression was evaluated by quantitative PCR. Results The mean CD55 mRNA level within the PTL group (0.77 ± 0.03) was 1.48‐fold higher than that observed (0.52 ± 0.02) within the control group (P < 0.0001); 71% of PTL patients and only 6.7% of control subjects expressed elevated CD55 mRNA. The receiver operating characteristics (with 95% CI) of CD55 as a marker for PTL were as follows: Sensitivity, 69% (53–82%); Specificity, 93% (78–99%); Positive Predictive Value, 94% (80–99%); and Negative Predictive Value, 67% (51–80%). In the patient population that delivered prematurely (before 37 weeks), 81% expressed elevated CD55 mRNA levels with a mean of 0.78 ± 0.03 and 95% CI of 0.71–0.84. The receiver operating characteristics were as follows: Sensitivity, 73% (54–88%); Specificity, 86% (71–95%); Positive Predictive Value, 81.5% (62–94%); and Negative Predictive Value, 80% (64–91%). Conclusion Here we report for the first time that CD55 mRNA expression was elevated in the peripheral WBCs of subjects with preterm labor compared with control gestationally‐matched pregnant woman and that elevated leukocyte CD55 may be a useful predictor of subsequent PTB.     

The role of MR imaging in detection of hepatic iron overload in patients with cirrhosis of different origins

Background  

There are many pathological conditions with hepatic iron overload. Classical definite diagnostic methods of these disorders are invasive and based on a direct tissue biopsy material. For the last years the role of MR imaging in liver diagnostics has been increasing. MRI shows changes of liver intensity in patients with hepatic iron overload. Changes in MR signal are an indirect consequence of change of relaxation times T2 and T2*, that can be directly measured.     

Enzymatic synthesis of isotopomers of tyramine labeled with deuterium and tritium

The combined chemical and enzymatic methods of synthesis of five isotopomers of L ‐tyrosine, L ‐Tyr, and their derivatives, i.e. corresponding isotopomers of tyramine (TA), labeled with deuterium and tritium have been reported. Two‐step synthesis consists with introduction of deuterium or tritium label into intermediate L ‐Tyr using isotope exchange followed by enzymatic decarboxylation using enzyme tyrosine decarboxylase (EC 4.1.1.25). This way five isotopomers of L ‐tyrosine, i.e. [2‐²H]‐L‐, [2‐³H]‐L‐,[2‐²H/³H]‐L‐, [3′,5′‐²H₂]‐L‐,[3′,5′‐³H₂]‐L ‐Tyr, and six isotopomers of tyramine i.e. [1S‐²H]‐, [1S‐³H]‐, [1S‐²H/³H]‐, [3′,5′‐²H₂]‐, [3′,5′‐²H₂]‐, [2′,6′‐²H₂]‐TA were obtained. Copyright © 2007 John Wiley & Sons, Ltd.     

Seroprevalence of Bartonella henselae and Bartonella quintana infections in Poland in 1998-2001

Bartonella henselae and Bartonella quintana infections result in illnesses with symptoms of severity ranging from mild lymphadenopathy (CSD) to systemic disease. The aim of the study was to estimate a prevalence of B. henselae and B. quintana infections in human in Poland. Serum samples collected from 265 patients in 1998-2001 were tested for the presence of antibodies specific to B. henselae and B. quintana. Levels of serum IgM and IgG antibodies to Bartonella henselae and Bartonella quintana were measured with indirect microimmunofluorescence test (MRL Diagnostic, USA). Cats' sera were assessed with indirect microimmunofluorescence test (MRL Diagnostic, USA) and goat immune serum anti-cat IgG FITC conjugate (Sigma, USA). Bartonella henselae specific antibodies were detected in 146 (57.0%) patients with lymphadenopathy. From that number 11.3% have shown specific Bartonella henselae IgM serum antibodies. Bartonella quintana infection was detected with serological methods in 4 patients. It has been found that CSD is a seasonal infection, with most cases occurring in autumn. Most cases of the disease have been recognized in children 8-16 years old. Most of CSD cases (30.1%) were detected in Mazowieckie voivodeship. There were no cases of CSD in Pomorskie, Podkarpackie, Lubuskie and Opolskie voivodeship. The seroprevalence of Bartonella sp. infections in cats was estimated on 86% (31/36). The highest titer of specific Bartonella henselae antibodies detected in cats was 1024. The number of detected Bartonella henselae infections in Poland is very low. It is very probable that the number of cases is underestimated in our country. Cat scratch disease is the most frequently clinically and serologically identified bartonellosis.     

On robust model selection within the Cox model

Summary Model selection methods have shown to be useful in the process of econometric modelling. The paper studies robust Akaike–Schwarz type information criteria of model choice within the Cox model. The criteria are based on a smooth modification of the partial likelihood function. Apart from asymptotic results, a Monte Carlo study is presented, which shows the finite sample behaviour of the procedure under discrepancies from the Cox model. Analysis of a real unemployment data case is also included.     

Impaired synthesis is not the reason for decreased activity of extracellular superoxide dismutase in patients with diabetes

BACKGROUND: The aim of the study was to find the cause of decreased activity of extracellular superoxide dismutase (EC SOD) in patients with diabetes-is it the decreased synthesis or increased glycation? METHODS: Total EC SOD activity, the activity of its fractions (A, B, and C) and its glycated form were determined in basal state and 30 min after intravenous (i.v.) administration of 50 mg of heparin. Patients were given i.v. heparin at a dose of 10,000 IU (100 mg) each 6 h for at least 3 days, and the activity of EC SOD was determined before the first heparin administration, just before each subsequent administration, and 30 min after heparin administration. RESULTS: Pre- and postheparinic activities of EC SOD and its fraction C in the group of patients with diabetes were significantly lower (p <0.001) than in control group. Preheparinic activities of EC SOD did not differ between the examined groups of patients. The postheparinic activities were different during the first 18 h of treatment. They were significantly lower in the group of patients with diabetes. During the following hours, after subsequently administered doses, there were no differences in the activity of EC SOD between the examined groups. Decline of EC SOD activity was observed after administration of repeated doses of heparin both in the examined and in the control groups. CONCLUSIONS: The decrease of extracellular superoxide dismutase activity in diabetes develops due to excessive glycation but not due to impaired synthesis. Therefore, appropriate glycemic control can lead to normalization of EC SOD activity.     

Renal handling of uric acid in patients with type 1 diabetes in relation to glycemic control

BACKGROUND: The aim of the study was to compare the renal handling of uric acid (UA) in 16 patients with type 1 diabetes without renal failure (age 34.8 +/- 13.3 years) and in 15 healthy subjects (age 34.9 +/- 12.6 years). METHODS: Creatinine clearance (Cr-Cl), clearance of uric acid (UA-Cl), fractional excretion of uric acid (UA-FE), and 24-h urinary UA excretion (UA-U) were determined. Glycemic control was assessed using fasting glucose, glycated hemoglobin and fructosamine tests. RESULTS: Patients with diabetes had significantly (p < 0.0001) lower serum UA concentrations compared to control group (2.8 +/- 0.7 vs. 5.7 +/- 0.8 mg/dl), and higher urinary UA excretion (813 +/- 107 vs. 423 +/- 40 mg/day), UA clearance (21.9 +/- 7.1 vs. 5.2 +/- 0.9 mL/min) and fractional UA excretion (17.1 +/- 5.5 vs. 4.8 +/- 1.3%), with higher creatinine clearance (129 +/- 16 vs. 111 +/- 12 mL/min, p < 0.005). In patients with diabetes there was a strong negative correlation between serum UA concentration and UA 24-h excretion (R = -0.79; p < 0.001). Fractional UA excretion correlated with fasting glycemia and HbA1c (R = +0.51 and +0.53; p < 0.05). CONCLUSIONS: In type 1 diabetes there is significant UA renal clearance increase, which is higher with poor glycemic control. It leads to hypouricemia despite an approximately twofold UA excretion increase and therefore despite increased UA synthesis.