Normal radiological unossified hip joint space and femoral head size development during growth in 675 children and adolescents

Evaluation of hip joint space width during child growth is important to aid in the early diagnosis of hip pathology in children. We established reference values for hip joint space and femoral head size for each age. Hip joint space development during growth was retrospectively investigated medial and cranial in 1350 hip joints of children using standard anteroposterior supine plain pelvic radiographs. Maximum capital femoral epiphysis diameter and femoral radii were further more investigated. Hip joint space values show a slow decline during growth. Joint space was statistically significantly (p < 0.006) larger in boys than girls. Our hip joint space measurements on supine subjects seem slightly larger than those reported by Hughes on standing subjects. Evaluation of the femoral head diameter and the radii showed a size curve quite parallel to the known body growth charts. Radii medial and perpendicular to the physis are not statistically significantly different. We recommend to compare measurements of hip joint space at two locations to age dependent charts using the same imaging technique. During growth, a divergence in femoral head size from the expected values or loss of the spherical shape should raise the question of hip disorder. Clin. Anat. 30:267–275, 2017. © 2016 Wiley Periodicals, Inc.     

Inflammatory response against different carbon fiber-reinforced PEEK wear particles compared with UHMWPE in vivo

Poly(ether ether ketone) (PEEK) and its composites are recognized as alternative bearing materials for use in arthroplasty because of their mechanical properties. The objective of this project was to evaluate the biological response of two different kinds of carbon fiber-reinforced (CFR) PEEK compared with ultra-high molecular weight polyethylene (UHMWPE) in vivo as a standard bearing material. Wear particles of the particulate biomaterials were injected into the left knee joint of female BALB/c mice. Assessment of the synovial microcirculation using intravital fluorescence microscopy as well as histological evaluation of the synovial layer were performed 7 days after particle injection. Enhanced leukocyte–endothelial cell interactions and an increase in functional capillary density as well as histological investigations revealed that all tested biomaterials caused significantly (P < 0.05) increased inflammatory reactions compared with control animals (injected with sterile phosphate-buffered saline), without any difference between the tested biomaterials (P > 0.05). These data suggest that wear debris of CFR-PEEK is comparable with UHMWPE in its biological activity. Therefore, CFR-PEEK represents an alternative bearing material because of its superior mechanical and chemical behavior without any increased biological activity of the wear particles, compared with a standard bearing material.     

Head circumference and height in autism: a study by the Collaborative Program of Excellence in Autism

Data from 10 sites of the NICHD/NIDCD Collaborative Programs of Excellence in Autism were combined to study the distribution of head circumference and relationship to demographic and clinical variables. Three hundred thirty-eight probands with autism-spectrum disorder (ASD) including 208 probands with autism were studied along with 147 parents, 149 siblings, and typically developing controls. ASDs were diagnosed, and head circumference and clinical variables measured in a standardized manner across all sites. All subjects with autism met ADI-R, ADOS-G, DSM-IV, and ICD-10 criteria. The results show the distribution of standardized head circumference in autism is normal in shape, and the mean, variance, and rate of macrocephaly but not microcephaly are increased. Head circumference tends to be large relative to height in autism. No site, gender, age, SES, verbal, or non-verbal IQ effects were present in the autism sample. In addition to autism itself, standardized height and average parental head circumference were the most important factors predicting head circumference in individuals with autism. Mean standardized head circumference and rates of macrocephaly were similar in probands with autism and their parents. Increased head circumference was associated with a higher (more severe) ADI-R social algorithm score. Macrocephaly is associated with delayed onset of language. Although mean head circumference and rates of macrocephaly are increased in autism, a high degree of variability is present, underscoring the complex clinical heterogeneity of the disorder. The wide distribution of head circumference in autism has major implications for genetic, neuroimaging, and other neurobiological research.     

The risk of urinary incontinence after partial urethral resection in patients with anterior vulvar cancer

Objective

The number of women with vulvar carcinoma located in the anterior fourchette in immediate proximity to the urethral opening has increased. A retrospective analysis was performed in order to evaluate the risk of urinary incontinence after tumor-resection, standard inguinal lymphadenectomy and additional partial urethral resection.

Study design

Between 2002 and 2007, 19 women with vulvar carcinomas located close to the urethral opening and consequently treated by additional partial urethral resection of up to 1.5 cm, were evaluated for urinary loss postoperatively by standard incontinence questionnaire. All patients complaining about some kind of urinary loss underwent urodynamic measurement. Results were compared with 21 controls (women with anterior vulvar cancer treated without urethral resection).

Results

Five of 19 women (26%) of the study group complained about urinary disturbances and received urodynamic evaluation. Ninety-five percent of the patients (18/19 women) were continent by urodynamic criteria; in one woman the measurement was unreliable. One patient in the control group (1/21 women) complained of an increase of urge symptoms that had been present preoperatively.

Conclusions

Twenty-six percent of our patients after partial urethral resection reported incontinence symptoms, though this was not always confirmed by urodynamics. We conclude that the risk of urinary stress incontinence after partial urethral resection in anterior vulvar carcinoma is acceptable.     

The influence of surface micro-structure on endothelialization under supraphysiological wall shear stress

Interaction between platelets and artificial materials within cardiovascular devices triggers blood coagulation and represents a frequent adverse response to implant deployment. Avoidance of this interaction is obtained through the generation and sustenance under flow of a confluent and stable endothelial monolayer covering the luminal device surface, altogether defined as the process of endothelialization. Supraphysiological wall shear stress (WSS) levels generated within vascular assist devices (VADs) constitute a major challenge toward endothelialization. Here we report the experimental demonstration that stable endothelialization can be achieved at supraphysiological WSS levels by pure means of appropriate surface micro-structuring. Using a custom-designed flow bioreactor we exposed endothelial monolayers to physiological and supraphysiological WSS levels and investigated the resulting integrity of cell-to-cell junctions, the cell density and the cell polarization. At physiological WSS levels, optimal endothelialization was obtained independently from surface topography. However, at higher WSS levels, only monolayers grown on appropriately micro-structured surfaces preserved optimal integrity. Under these flow conditions, endothelial cells polarized by the contact with the micro-structure and, interestingly, oriented themselves in the direction perpendicular to flow. Such endothelial layers withstood WSS levels exceeding of 100% or more the thresholds detected on flat substrates.     

Gastrointestinal bleeding 30 years after a complicated cholecystectomy

Gastrointestinal bleeding from small-bowel varices is a rare and difficult to treat complication of portal hypertension. We describe the case of a 79-year-old female patient with recurrent severe hemorrhage from smallbowel varices 30 years after a complicated cholecystectomy. When double balloon enteroscopy was unsuccessful to reach the site of bleeding, a rendezvous approach was favored with intraoperative endoscopy. Active bleeding from varices within a biliodigestive anastomosis was found and controlled ...     

Prenatally engineered autologous amniotic fluid stem cell-based heart valves in the fetal circulation

Prenatal heart valve interventions aiming at the early and systematic correction of congenital cardiac malformations represent a promising treatment option in maternal-fetal care. However, definite fetal valve replacements require growing implants adaptive to fetal and postnatal development. The presented study investigates the fetal implantation of prenatally engineered living autologous cell-based heart valves. Autologous amniotic fluid cells (AFCs) were isolated from pregnant sheep between 122 and 128 days of gestation via transuterine sonographic sampling. Stented trileaflet heart valves were fabricated from biodegradable PGA-P4HB composite matrices (n = 9) and seeded with AFCs in vitro. Within the same intervention, tissue engineered heart valves (TEHVs) and unseeded controls were implanted orthotopically into the pulmonary position using an in-utero closed-heart hybrid approach. The transapical valve deployments were successful in all animals with acute survival of 77.8% of fetuses. TEHV in-vivo functionality was assessed using echocardiography as well as angiography. Fetuses were harvested up to 1 week after implantation representing a birth-relevant gestational age. TEHVs showed in vivo functionality with intact valvular integrity and absence of thrombus formation. The presented approach may serve as an experimental basis for future human prenatal cardiac interventions using fully biodegradable autologous cell-based living materials.     

Spinophilin is required for normal morphology, Ca2+ homeostasis and contraction but dispensable for ��-adrenergic stimulation of adult cardiomyocytes

Spinophilin (SPN) is a ubiquitously expressed scaffolding protein that interacts through several binding modules with a variety of target proteins. Thus, SPN bundles F-actin, targets protein phosphatase 1 to the ryanodine receptor, and targets regulators of G-protein signaling to G-protein coupled receptors in cardiomyocytes. In this work we studied the role of SPN on cardiomyocyte morphology, function, and β-adrenergic responsiveness using a homozygous SPN knock-out mouse model (SPN-/-). We show that spinophilin deficiency significantly (1) reduced cardiomyocyte length, (2) increases both Ca(2+) amplitude and maximal rate of Ca(2+) rise during systole, and (3) decreased shortening amplitude and maximal rate of shortening, while (4) β-adrenergic stimulation remained intact. Our data suggest that spinophilin is an upstream regulator required for normal growth and excitation-contraction coupling, but is dispensable for β-adrenergic stimulation of adult cardiomyocytes.     

Image quality and radiation exposure at pulmonary CT angiography with 100- or 120-kVp protocol: prospective randomized study

PURPOSE: To prospectively compare 16-section multidetector computed tomography (CT) at 100 and 120 kVp for image quality and radiation dose. MATERIALS AND METHODS: The study had institutional review board approval; written informed consent was obtained. Sixty patients were referred for evaluation of suspected pulmonary embolism with CT angiography. Patients were randomly assigned to a 100-kVp (n = 30; 17 men, 13 women; mean age, 66 years +/- 17 [standard deviation]; range, 19-89 years) or 120-kVp (n = 30; 15 men, 15 women; mean age, 62 years +/- 15; range, 28-86 years) protocol. Other scanning parameters were kept constant. Contrast medium was injected automatically with bolus tracking. Pulmonary vessel enhancement and image noise were quantified; signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Subjective vessel contrast was assessed by two radiologists in consensus. Effective dose was calculated on the basis of dose length product and volume CT dose index. Results of both protocols were compared by using the chi(2) test and Student t test. RESULTS: The 100-kVp protocol had a nonsignificantly higher mean vessel attenuation than the 120-kVp protocol (386.8 HU +/- 130.1 vs 317.9 HU +/- 112.5; P = .56) and a nonsignificantly higher image noise (16.9 HU +/- 5.8 vs 13.7 HU +/- 6.2; P = .84), which resulted in almost identical SNR (25.3 +/- 11.7 vs 27.0 +/- 14.5; P = .37) and CNR (22.0 +/- 11.2 vs 22.9 +/- 13.1; P = .51). There was no significant difference in subjective image quality between protocols. Mean effective dose for the 100-kVp protocol was significantly lower than that for the 120-kVp protocol (1.37 mSv +/- 0.39 vs 2.44 mSv +/- 0.97; -44%; P < .001). CONCLUSION: Reduction of kilovoltage from 120 to 100 kVp resulted in significant reduction of effective dose at pulmonary CT angiography, without significant loss of objective or subjective image quality.