Trochanteric Bursitis Following Primary Total Hip Arthroplasty: Incidence,Predictors, and Treatment

Background

Trochanteric bursitis (TB) remains a common complication after total hip arthroplasty (THA), with an incidence between 3% and 17%, depending on the surgical approach, with the posterior approach (PA) being relatively protective compared to the lateral approach. The purposes of this study were to determine the incidence of TB after primary THA, identify potential risk factors for TB, and examine the utility of different modes of treatment.

Smooth muscle cells improve endothelial cell retention on polytetrafluoroethylene grafts in vivo

OBJECTIVE: We investigated the influence of smooth muscle cells (SMC) on endothelial cell (EC) retention on polytetrafluoroethylene (PTFE) grafts and the effect of SMC seeding on intimal hyperplasia in vivo in a rabbit model. METHODS: Fibronectin-coated PTFE grafts (4 mm diameter) were seeded with either EC alone, SMC alone, or SMC followed 24 hours later by EC. The grafts were connected to an extracorporal aortic shunt for 1 hour or were individually implanted for 1, 30, and 100 days into the infrarenal aorta as an end-to-side bypass graft. The number of retained cells was compared at 1 hour and at 1 day after implantation. Neointimal thickness was measured 30 and 100 days after implantation. RESULTS: After 1-hour exposure to blood flow, EC retention rate was greater (P <.005) if seeded on top of SMC (98% +/- 2%; n = 8) versus being seeded alone (65 +/- 11%; n = 8). SMC retention rate was 95 +/- 5% (n = 8) when seeded alone. Similar cell retention was obtained 1 day after implantation. After 30-day implantation the neointima was thicker in grafts seeded with EC and SMC (282 +/- 136 microm; n = 3) than with EC only (52 +/- 45 microm; n = 3; P <.001). However, the neointimal thickness for dual-cell-seeded grafts (126 +/- 60 microm; n = 3) was not significantly different (P =.09) from EC-seeded grafts (79 +/- 48 microm; n = 3) after 100-day implantation. CONCLUSION: EC retention on PTFE grafts in vivo is improved if seeded over a layer of SMC. Further studies are needed to determine whether overlying EC modulate proliferation of underlying SMC.     

Strategies for the use of Ginkgo biloba extract,EGb 761®, in the treatment and management of mild cognitive impairment in Asia: Expert consensus

BackgroundMild cognitive impairment (MCI) is a neurocognitive state between normal cognitive aging and dementia, with evidence of neuropsychological changes but insufficient functional decline to warrant a diagnosis of dementia. Individuals with MCI are at increased risk for progression to dementia; and an appreciable proportion display neuropsychiatric symptoms (NPS), also a known risk factor for dementia. Cerebrovascular disease (CVD) is thought to be an underdiagnosed contributor to MCI/dementia. The Ginkgo biloba extract, EGb 761^®, is increasingly being used for the symptomatic treatment of cognitive disorders with/without CVD, due to its known neuroprotective effects and cerebrovascular benefits.AimsTo present consensus opinion from the ASian Clinical Expert group on Neurocognitive Disorders (ASCEND) regarding the role of EGb 761^® in MCI.Materials & MethodsThe ASCEND Group reconvened in September 2019 to present and critically assess the current evidence on the general management of MCI, including the efficacy and safety of EGb 761^® as a treatment option.ResultsEGb 761^® has demonstrated symptomatic improvement in at least four randomized trials, in terms of cognitive performance, memory, recall and recognition, attention and concentration, anxiety, and NPS. There is also evidence that EGb 761^® may help delay progression from MCI to dementia in some individuals.DiscussionEGb 761^® is currently recommended in multiple guidelines for the symptomatic treatment of MCI. Due to its beneficial effects on cerebrovascular blood flow, it is reasonable to expect that EGb 761^® may benefit MCI patients with underlying CVD.ConclusionAs an expert group, we suggest it is clinically appropriate to incorporate EGb 761^® as part of the multidomain intervention for MCI.     

Assessment of feature size abnormalities using receiver operating characteristic analysis

The ability of an observer to detect variations in size of a geometrical image feature have been investigated using receiver operating characteristic (ROC) analysis. Three types of image were constructed using computer graphics: disc-shaped targets of variable radius, model chest radiographs showing a variable heart diameter and model arterial angiograms with variable vessel width. Five factors were investigated: observer experience, variation of detectability with theoretical signal-to-noise ratio, the prior probability of the presence of an abnormality, viewing distance, and uncertainty in the location of an abnormality. In all but one experiment, excellent agreement was found between measured detectabilities and the predictions of signal detection theory, providing an initial practice session was included for each observer. No significant variation in detectability was found using six different prior probabilities and two different viewing distances, and the reduction in detectability for a four-alternative location task was in good agreement with theoretical predictions. The high statistical efficiencies found for the detection of geometrical signals suggest that the levels of observer "internal" noise arising from decision-making processes during an ROC experiment are very low.     

Circadian blood pressure variation after acute stroke.

We aimed to characterise the patterns of circadian blood pressure (BP) variation after acute stroke and determine whether any relationship exists between these patterns and stroke outcome. BP was recorded manually every 4 h for 48 h following acute stroke. Patients were classified according to the percentage fall in mean systolic BP (SBP) at night compared to during the day as: dippers (fall > or = 10-<20%); extreme dippers (> or = 20%); non-dippers (> or = 0-<10%); and reverse dippers (<0%, that is, a rise in mean nocturnal SBP compared to mean daytime SBP). One hundred and seventy-three stroke patients were included in the study (83 men, 90 women; mean age 74.3 years). Four patients (2.3%) were extreme dippers, 25 (14.5%) dippers, 80 (46.2%) non-dippers and 64 (36.9%) reverse dippers. There was a non-significant trend in the proportion of patients who were dead or dependent at 3 months in the extreme dipper (p=0.59) and reverse dipper (p=0.35) groups. Non-dipping and reverse-dipping were relatively common patterns of circadian BP variation seen in acute stroke patients. These patterns were not clearly associated with outcome.     

Early Hemoconcentration Predicts Increased Mortality Only among Transferred Patients with Acute Pancreatitis

Background/Aims: The prognostic utility of hemoconcentration in acute pancreatitis (AP) remains controversial. Methods: We examined the relationship between early hemoconcentration and in-hospital mortality in an observational cohort study. Data was collected from 177 US hospitals from January 2004 to September 2005. Early hemoconcentration was defined as hemoglobin ≥14.6 mg/dl (hematocrit ～44%)atany point during the first 24 h of initial hospitalization. For transferred cases, we linked clinical data from the first hospitalization to outcomes from the second hospitalization. We then examined the impact of hospital transfer status on the prognostic utility of hemoconcentration. Results: We identified 388 (2.2%) cases as interhospital transfers. Of these, we successfully linked 198 (51.0%) to their initial hospitalization. Early hemoconcentration was associated with increased mortality among transferred cases (OR 7.4, 95% CI 1.6, 35.4). However, no such relationship existed among non-transferred cases (OR 0.9,95% CI 0.7,1.2). Differences in outcome between transferred vs. nontransferred cases were not explained by extent of comorbid illness or initial disease severity (either APACHE II or organ failure). Conclusions: Early hemoconcentration predicted increased risk of mortality only among transferred cases despite similar levels of initial disease severity. These findings may help explain discordant results from prior studies of hemoconcentration in AP.     

Recent concepts in the management of extracranial carotid stenosis: carotid endarterectomy versus carotid artery stenting

Carotid stenosis is seen in 10% of patients with ischemic stroke, and carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the two invasive treatments options available. Pooled analysis of the three largest randomized trials of CEA involving more than 3000 symptomatic patients estimated 30-day stroke and death rate at 7.1% after CEA. Some subgroups among the symptomatic patients appeared to have more benefit from CEA. These include patients aged 75 years or more, patients with ulcerated plaques, and patients with recent transient ischemic attacks within 2 weeks of randomization. Selection of asymptomatic patients for carotid revascularization should be guided by an assessment of comorbid conditions, life expectancy, and other individual factors, and should include a thorough discussion of the risks and benefits of the procedure with an understanding of patient preferences. The recent trials comparing CEA with CAS has not established its superiority over CEA. The carotid revascularization endarterectomy versus stenting (CREST) study showed that CAS is still associated with a higher periprocedural risk of stroke or death than CEA. In patients over 70 years of age, CEA is clearly superior to CAS. The increased risk of nonfatal myocardial infarction in the CREST group subjected to CEA clearly suggests that patients being considered for CEA or CAS require a careful preliminary cardiac evaluation. CAS can be justified for patients whose medical comorbidities or cervical anatomy make them questionable candidates for CEA. The benefit of revascularization by either method versus modern aggressive medical therapy has not been established for patients with asymptomatic carotid stenosis.     

Adult stem cells from bone marrow (MSCs) isolated from different strains of inbred mice vary in surface epitopes, rates of proliferation, and differentiation potential

For reasons that are not apparent, it has been difficult to isolate and expand the adult stem cells referred to as mesenchymal stem cells or marrow stromal cells (MSCs) from murine bone marrow. We developed a protocol that provides rapidly expanding MSCs from 5 strains of inbred mice. The MSCs obtained from 5 different strains of mice were similar to human and rat MSCs in that they expanded more rapidly if plated at very low density, formed single-cell-derived colonies, and readily differentiated into either adipocytes, chondrocytes, or mineralizing cells. However, the cells from the 5 strains differed in their media requirements for optimal growth, rates of propagation, and presence of the surface epitopes CD34, stem cell antigen-1 (Sca-1), and vascular cell adhesion molecule 1 (VCAM-1). The protocol should make it possible to undertake a large number of experiments with MSCs in transgenic mice that have previously not been possible. The differences among MSCs from different strains may explain some of the conflicting data recently published on the engraftment of mouse MSCs or other bone marrow cells into nonhematopoietic tissues.