The Dana total shoulder arthroplasty

Fifty-six Dana unconstrained total shoulder arthroplasties in forty-seven patients were followed for a minimum of two years. The preoperative diagnoses included osteoarthritis, rheumatoid arthritis, traumatic arthritis, avascular necrosis, failed hemiarthroplasty, and failed total shoulder arthroplasty of another design. For all of the patients, the average rating for pain improved from 3 points preoperatively to 8 points postoperatively, and the average rating for function improved from 3 to 7 points. The ranges of abduction and of external rotation improved substantially in the shoulders that were affected by osteoarthritis, rheumatoid arthritis, or osteonecrosis. Ten patients were treated with a hooded glenoid component, designed to improve stability in shoulders in which the rotator cuff is deficient. In these shoulders, both the rating for pain and the rating for function improved, although the range of motion did not. Complications that required revision of the arthroplasty developed in five shoulders in which a regular component had been implanted and in two that had a hooded glenoid component. A radiolucent line developed at the bone-cement interface of the glenoid component in fifty-three shoulders, but only two revisions were done for loosening of the glenoid component.     

Porous surface replacement of the hip with chamfered-cylinder component

One hundred porous surface replacements (PSR) were performed in 92 patients (63 men and 29 women) with a mean age of 53 (range 17-76). Follow-up times range from 1 to 4 years, with 48 patients having a follow-up of at least 2 years. Preoperative diagnoses were osteoarthritis (OA) 63, osteonecrosis (ON) 13, dysplasia 9, rheumatoid-ankylosing spondylitis 6, and other 9. Seventeen hips had metal-backed acrylic-fixed THARIES acetabular sockets, nine hips had a porous cobalt chrome hemispheric beaded acetabular component with adjuvant fixation screws and externally protruding screw hubs, and 74 hips had a porous chamfered cylinder-design acetabulum. Pain relief had been immediate and more complete than with acrylic-fixed or biologic-ingrowth stem-type replacement with comparable walking and function improvements. There have been no major systemic complications, sepsis, or loosening. There have been two transient peroneal nerve palsies and three trochanteric fibrous unions. There have been three reoperations, one for subluxation, one for "metalosis" due to mesh pad loosening, and one femoral neck fracture. Examination of one removed femoral surface component which has been histologically sectioned revealed excellent (90%) bone in-growth. Circumferential progressive radiolucencies developed at the bone-cement interface by 1 year in all of the 17 acrylic-fixed acetabular components. Reaming or seating defects were noted in 25% of the ingrowth components on postoperative radiographs. Radiographic analysis of immediate postoperative films of the chamfered cylinder design acetabular components frequently demonstrated bone-component interface radiolucencies which represented component seating defects. These initial interface radiolucencies became progressively more narrow over the first six months postoperatively suggesting "healing" of the reamed bone-component interface with trabecular bone around the chamfered cylinder acetabular components. Partial healing of initial interface voids with residual narrow radiolucencies were typical of the nine hemispheric-design acetabula with adjuvant screws and screw hubs. This new porous surface replacement (PSR) of the hip using porous ingrowth fixation avoids the major disadvantages of acrylic-fixed SR: excessive acetabular reaming and difficulty with acetabular revision. (When conversion to stem-type replacement is necessary the modular polyethylene socket liner can be exchanged.) The PSR has the prospect of enhanced fixation and improved longterm durability.     

The antioxidant and neuroprotective effects of the Psychotria camptopus Verd. Hook. (Rubiaceae) stem bark methanol extract contributes to its antiepileptogenic activity against pentylenetetrazol kindling in male Wistar rats

A substantial number of epileptic patients are resistant to the current medication thus necessitating the search for alternative therapies for intractable forms of the disease. Previous studies demonstrated the acute anticonvulsant properties of the methanol extract of the stem bark of Psychotria camptopus (MEPC) in rats. This study investigated the effects of MEPC on pentylenetetrazole-kindled Wistar rats. Kindling was induced by intraperitoneal injection of pentylenetetrazole (37.5 mg/kg) on every alternate day, 1 h after each daily oral pretreatment of rats (8?≤?n?≤?10) with MEPC (40, 80 and 120 mg/kg), vehicle or diazepam (3 mg/kg) for 43 days. The kindling development was monitored based on seizure episodes and severity. Rats’ brains were collected on day 43 for the determination of oxidative stress parameters. The histomorphological features and neuronal cell viability of the prefrontal cortex (PFC) and hippocampus were also assessed using H&E and Cresyl violet stains. Chronic administration of pentylenetetrazole time-dependently decreased the latency to myoclonic and generalized seizures, and increased seizure scores and the number of kindled rats. MEPC and diazepam significantly increased the latencies to myoclonic jerks and generalized tonic-clonic seizures. These substances also reduced seizure score and the number of rats with PTZ-kindling. MEPC improved glutathione status and decreased lipid peroxidation in the brains of kindled rats. MEPC also exhibited neuroprotection against pentylenetetrazole-induced hippocampal and PFC neuronal damages. These results suggest that P. camptopus has antiepileptogenic activity, which might be related to the augmentation of antioxidant and neuroprotective defense mechanisms, and further confirm its usefulness in the management of epilepsy.

     

Systems analysis of sex differences reveals an immunosuppressive role for testosterone in the response to influenza vaccination

Females have generally more robust immune responses than males for reasons that are not well-understood. Here we used a systems analysis to investigate these differences by analyzing the neutralizing antibody response to a trivalent inactivated seasonal influenza vaccine (TIV) and a large number of immune system components, including serum cytokines and chemokines, blood cell subset frequencies, genome-wide gene expression, and cellular responses to diverse in vitro stimuli, in 53 females and 34 males of different ages. We found elevated antibody responses to TIV and expression of inflammatory cytokines in the serum of females compared with males regardless of age. This inflammatory profile correlated with the levels of phosphorylated STAT3 proteins in monocytes but not with the serological response to the vaccine. In contrast, using a machine learning approach, we identified a cluster of genes involved in lipid biosynthesis and previously shown to be up-regulated by testosterone that correlated with poor virus-neutralizing activity in men. Moreover, men with elevated serum testosterone levels and associated gene signatures exhibited the lowest antibody responses to TIV. These results demonstrate a strong association between androgens and genes involved in lipid metabolism, suggesting that these could be important drivers of the differences in immune responses between males and females.The variability in the biology of human populations poses significant challenges in understanding different disease outcomes and developing successful therapeutics. The sources of this variation are likely the consequence of genetics, epigenetics, and the history of antigenic exposure (1, 2). As therapies targeting immune function are developed to improve clinical outcomes in cancer, viral and bacterial infections, autoimmune diseases, and transplantation, identifying the sources of immunological variation and finding biomarkers for immune health and dysfunction are crucial for their success (3).An important source of immunological variation is known to be the sex of the individual. Males experience a greater severity and prevalence of bacterial, viral, fungal, and parasitic infections than females, who also exhibit a more robust response to antigenic challenges such as infection and vaccination (4, 5). This stronger immune response in females could also explain why they more frequently develop immune-mediated pathologies during influenza infection, such as an overproduction of cytokines (cytokine storm) that contribute to an increase in capillary permeability and lung failure (6). Furthermore, females are at a higher risk for developing autoimmune diseases. In this later context, it is interesting to note that a recent study showed that females had, on average, 1.7 times the frequency of self-specific T cells as males (7). Despite the fact that initial observations relating the sex of the individual with the immune response were made many years ago (8), little is known about the mechanisms underlying these differences.Some sex-specific variations in the immune response can be directly attributed to sex hormones (9). In humans, sex steroids can bind to intracellular receptors located in immune cells such as monocytes, B cells, and T cells and activate hormone-responsive genes, suggesting that they can directly affect sex-related differences in both innate and adaptive immune responses (10). Whereas estrogens are associated with inflammation and can stimulate proliferation and differentiation of lymphocytes and monocytes, androgens suppress the activity of immune cells by increasing the synthesis of anti-inflammatory cytokines (11, 12).To date, no clear associations have been found between biological and clinical differences in the immune response between males and females in humans. In one study, results from public gene expression data (13) showed that many of the genes induced by a yellow fever vaccine were preferentially activated in females (14). However, whether these differences correlate with poor antibody outcomes remains to be determined.In this study, we sought to determine whether we could identify biomarkers from peripheral blood that could explain the sex-related differences in the serological response to the trivalent inactivated seasonal influenza vaccine (TIV) in both young and older cohorts.Young and older females had higher neutralizing antibodies than age-matched males, consistent with previous reports (15). Females also showed higher expression of inflammatory markers. However, none of these specific sex-related differences correlated with the observed disparities in the antibody response to TIV. Nevertheless, using a machine learning approach, we identified a set of genes previously shown to be regulated by testosterone and participating in lipid biosynthesis, whose expression was negatively associated with antibody responses to TIV in the male subjects in our study. Moreover, males with high levels of serum testosterone and expressing related gene signatures in blood cells showed the lowest neutralizing responses to TIV. These results suggest that testosterone might be immunosuppressive in vivo in humans, and indicate that its effect on an influenza vaccine and other immune responses could be due to the regulation of genes implicated in the metabolism of lipids.     

Incisional hernia repair after kidney transplantation in a tertiary high-volume center: outcomes from a 10-year retrospective cohort study

International Urology and Nephrology - Incisional hernia (IH) after Kidney Transplantation (KT) is a challenging complication due to both technical reasons and patients’ complexity. Data...