Clinical Results of the Wear Performance of Cross-Linked Polyethylene in Total Hip Arthroplasty : Prospective Randomized Trial

To investigate the clinical results of cross-linked polyethylene (CLPE) and to compare the CLPE wear against zirconia and stainless steel heads, we studied the radiographic wear after a minimum 3-year follow-up in total hip arthroplasty (THA). Ninety-four hips were randomly implanted with a 22.225-mm head cemented THA—the group of non-CLPE against zirconia and CLPE against 2 different zirconias and stainless steel. The linear wear rate was significantly lower in the group of CLPE against zirconia (0.067, 0.059 mm/y) and against stainless steel (0.068 mm/y) compared with non-CLPE against zirconia (0.170 mm/y). In the short-term results, the wear performance of CLPE against zirconia was superior to that of non-CLPE; however, it did not show a better wear rate than CLPE against stainless steel. Furthermore, long-term investigations will be necessary for understanding CLPE wear in vivo.     

C5a Inhibitory Peptide Combined With Gabexate Mesilate Is a Clinically Available Candidate for Preventing the Instant Blood-Mediated Inflammatory Reaction

Background

The instant blood-mediated inflammatory reaction, characterized by activation of both the coagulation and complement cascades, is a serious obstacle to successful islet engraftment. No attractive protocol is clinically available as yet. The objective of the present study was to examine whether complementary peptide against an active region of C5a in combination with a clinically available anticoagulant could provide an effective protocol for suppression of the instant blood-mediated inflammatory reaction.

Methods

Three islet equivalents per gram of syngeneic rat grafts were transplanted intraportally into 6 pairs of rats with streptozotocin-induced diabetes. Islets from the same donor were transplanted into each pair. In each pair, one rat was treated with C5a inhibitory peptide in addition to continuous intravenous infusion of gabexate mesilate and the other rat, injected with equivalent amount of saline solution, served as the control. In addition, 6 rats that received transplants from irrelevant donors were treated with the same dose of gabexate mesilate. We evaluated the cure rate, time to normoglycemia, liver insulin concentration in recipients, and results of in vivo glucose tolerance tests.

Results

The cure rate was remarkably improved and the time to normoglycemia in cured animals was significantly shortened with C5a inhibitor plus gabexate treatment. In six rats that received only gabexate mesilate, normoglycemia was not restored during the study.

Conclusions

These data suggest that C5a inhibitory peptide combined with gabexate mesilate could be an attractive drug candidate without adverse effects to control the detrimental innate immune responses induced in clinical islet transplantation.     

Inverted Takotsubo cardiomyopathy masking acute myocardial infarction

We report a case of inverted Takotsubo cardiomyopathy masking acute myocardial infarction. In this case, echocardiography on admission showed left ventricular mid and basal akinesis and apical hyperkinesis compatible with an inverted Takotsubo contractile pattern. In the subacute phase, however, he was suspected of having acute myocardial infarction by serial changes of cardiac enzymes. After 8 days of admission, echocardiography showed normalization of the left ventricular contraction, except the inferior wall which was compatible with inferior myocardial infarction. Subsequent myocardial scintigraphy confirmed the diagnosis. It is important to recognize that inverted Takotsubo cardiomyopathy may mask acute myocardial infarction when they occur simultaneously.     

A case of acute rejection with adenovirus infection after ABO-incompatible kidney transplantation

Abstract:  We report clinical and histopathologic findings of a case of acute rejection with adenovirus infection after kidney transplantation. A 63-yr-old woman with end-stage renal disease caused by lupus nephritis received an ABO-incompatible living kidney transplantation from her husband. On the 7th post-operative day (POD), she had fever, hematuria, and bladder irritation. Although she was treated with an antibiotic, the symptoms were not improved. We diagnosed adenovirus infection as positive with the urine shell vial method and blood PCR analysis. Cyclophosphamide was interrupted and immunoglobulin therapy was performed. However, urine output decreased and serum creatinine levels increased. An episode biopsy was performed on POD 20. We diagnosed acute antibody-mediated rejection. She was treated with plasma exchange for acute rejection and antiviral drug (rivabirin) for active adenovirus infection. However, the renal graft dysfunction was deemed irreversible and the renal graft was removed on POD 34. The graftectomy specimen showed acute rejection and acute tubular necrosis with adenovirus infection.     

Effects of several virucidal agents on inactivation of influenza, Newcastle disease, and avian infectious bronchitis viruses in the allantoic fluid of chicken eggs

General theories on the inactivation of viruses in the presence of a concentrated protein, such as the allantoic fluid of chicken eggs, are not useful. That is, although sodium hypochlorite and sodium hydroxide are generally known as strong virucidal agents, they do not sufficiently inactivate viruses in allantoic fluid. We found that benzalkonium chloride (BC) is an effective virucidal agent against influenza, Newcastle disease, and avian infectious bronchitis viruses even in the presence of a concentrated protein. BC is easily biodegradable by activated sludge and is not very harmful to humans. We strongly recommend BC as a useful virucidal agent, especially in the manufacture of vaccines for these viruses.     

Sarcoid myositis with muscle weakness as a presenting symptom

A 54-year-old woman complaining of muscle weakness and weight loss was admitted to our hospital with suspected polymyositis. Muscle biopsy revealed Langhans-type giant cells and noncaseating granulomas. Therefore, sarcoid myositis was diagnosed. The patient was treated with prednisolone, and the symptoms improved gradually. Generally, sarcoidosis is identified clinically in patients with foggy vision or mediastinal lymphadenopathy, but muscular weakness may be an infrequently observed initial symptom. Sarcoidosis should be considered in the differential diagnosis of polymyositis.