The Oxford unicompartmental knee arthroplasty (OUKA) is a successful treatment for endstage, symptomatic anteromedial osteoarthritis. This study reports the results of a cohort of consecutive cemented and cementless medial OUKAs from an independent center and aims to answer the following questions: what is the survival of OUKA in the hands of a nondesigner surgeon? Are there any differences in the survival of cementless and cemented OUKA? Are the failure modes any different with the cementless and cemented OUKA?
Methods
One thousand one hundred twenty consecutive OUKAs were implanted in a single center for the recommended indications. Patients were prospectively identified and followed up. Survival was calculated with revision as the end point.
Results
There were 522 cemented and 598 cementless implants. The mean follow-up was 8.3 years for cemented implants (range 0.5-17, standard deviation [SD] 2.9) and 2.7 years (range 0.5-7, SD 1.8) for cementless implants. The Oxford knee score improved from a preoperative mean of 22 (SD 8.1) to 40 (SD 7.9) at the last follow-up (P < .001). There were 59 failures requiring revision surgery, with a 5.3% cumulative revision rate. The most common reason for failure was progression of osteoarthritis in the lateral compartment, occurred in 26 cases (2.3%). The cumulative 10-year survival was 91% (95% confidence interval 87.3-95.2).
Conclusion
The results of this prospective, consecutive case series from the African continent demonstrated that excellent results are achievable with the OUKA in independent centers if the correct indications and surgical technique are used. 相似文献
Introduction: While prescribing biosimilars to patients naive to a biologic treatment is a well-accepted practice, switching clinically stable patients from an originator to a biosimilar is an issue for clinicians. Well-designed clinical trials and real-world data which study the consequences of switching from an originator biologic treatment to its biosimilar alternative are limited, especially for monoclonal antibodies.
Areas covered: A systematic literature review was conducted on PubMed to identify evidence of the consequences of switching from original biologics to biosimilars. References of included papers were also scrutinized. After a title-, abstract- and full text screening, out of the 153 original hits and 77 additional ones from screening the references, 58 papers (12 empirical papers, 5 systematic reviews and 41 non-empirical papers) were included.
Expert opinion: Preventing patients on biologic medicines from switching to biosimilars due to anticipated risks seems to be disproportional compared to the expected cost savings and/or improved patient access. Indeed, it is the opinion of the authors that the concern of switching to biosimilars is overhyped. 相似文献
Patients with muscular dystrophy and concomitant cardiomyopathy are only reluctantly accepted for heart transplantation because of the perioperative risk secondary to respiratory muscle weakness. We describe a man with Steinert's disease (myotonic dystrophy) who received a cardiac allograft because of end-stage dilated cardiomyopathy. This case shows the importance of uninterrupted physiotherapeutic training and assistance to minimize respiratory infections and ventilatory insufficiency in patients with muscle diseases under high-dose immunosuppression. To our knowledge, this is the first heart transplantation reported in a patient with Steinert's disease who has clinically overt muscular impairment. 相似文献
Alterations in circulating angiogenic cells (CAC) and endothelial progenitor cells (EPC), known to contribute to endothelial
repair, could explain the reversal of endothelial function in response to exercise training. Moreover, training-induced vascular
remodeling might affect the acute response of EPC and CAC following a single exercise bout. We studied the impact of exercise
training on CAC function and numbers of CD34+/KDR+ EPC in patients with chronic heart failure (CHF) and we assessed the effect of acute exercise on CAC and EPC in sedentary
and trained patients. Twenty-one sedentary CHF patients underwent 6-month exercise training and were compared to a non-trained
control group (n = 17) and 10 healthy age-matched subjects. At baseline and follow-up, flow-mediated dilation was assessed and graded exercise
testing (GXT) was performed. Before and immediately after GXT, CAC migratory capacity was assessed in vitro and circulating
CD34+/KDR+ EPC were quantified using flow cytometry. At baseline, CAC migration was significantly impaired in sedentary CHF patients
but normalized acutely after GXT. Training corrected endothelial dysfunction, which coincided with a 77% increase in CAC migration
(P = 0.0001). Moreover, the GXT-induced improvement detected at baseline was no longer observed after training. Numbers of CD34+/KDR+ EPC increased following 6-month exercise training (P = 0.021), but were not affected by GXT, either prior or post-training. In conclusion, the present findings demonstrate for
the first time that exercise training in CHF reverses CAC dysfunction and increases numbers of CD34+/KDR+ EPC, which is accompanied by improvement of peripheral endothelial function. The acute exercise-induced changes in CAC function
wane with exercise training, suggesting that repetitive exercise bouts progressively lead to functional endothelial repair. 相似文献
Ventricular remodeling following myocardial infarction (MI) includes myocardial hypertrophy, a process requiring increased protein synthesis and sarcomere assembly. The anti-hypertrophic effect of MuRF1/MafBx, both muscle-specific E3-ubiquitin ligases, has been demonstrated in animal experiments and in cultured cardiomyocytes. We assessed MuRF1/MAFbx expression in myocardium remote of recently (<2 weeks) infarcted regions (MI), compared with patients undergoing coronary artery bypass surgery, with normal systolic function and without previous infarction (control or Con). Left ventricular myocardial biopsies were obtained from the contralateral normal zone in MI (n = 14) patients and from the Con (n = 12) group. MuRF-1/MAFbx expression was assessed using RT-PCR and Western blot (WB). In addition, the myocardial expression of TNF-α was measured (RT-PCR) and troponin I, β-myosin and phosphorylated Akt/Akt (pAkt/Akt) were quantified (WB). MuRF1 and MAFbx expression (mRNA and protein level) were significantly reduced in biopsies from MI patients. TNF-α was significantly higher in MI and exhibited a negative correlation with MuRF1 and MAFbx. The expression of troponin I and cardiomyocyte size were increased in MI in comparison to Con, whereas β-myosin expression was not altered. When compared with Con, pAkt/Akt was elevated. The results of the present study suggest that the atrogenes MuRF1/MAFbx are involved in regulating the hypertrophic response, characteristic of the early post-infarction remodeling phase. Reduced expression of MuRF1 and MAFbx in the myocardium might permit hypertrophy, which is supported by the elevation of troponin I. A regulatory role of TNF-α needs to be confirmed in further experiments. 相似文献
Hodgkin’s lymphoma is characterized by the presence of mono-nucleated Hodgkin cells and bi- to multi-nucleated Reed-Sternberg cells. We have recently shown telomere dysfunction and aberrant synchronous/asynchronous cell divisions during the transition of Hodgkin cells to Reed-Sternberg cells.1
Design and Methods
To determine whether overall changes in nuclear architecture affect genomic instability during the transition of Hodgkin cells to Reed-Sternberg cells, we investigated the nuclear organization of chromosomes in these cells.
Results
Three-dimensional fluorescent in situ hybridization revealed irregular nuclear positioning of individual chromosomes in Hodgkin cells and, more so, in Reed-Sternberg cells. We characterized an increasingly unequal distribution of chromosomes as mono-nucleated cells became multi-nucleated cells, some of which also contained chromosome-poor ‘ghost’ cell nuclei. Measurements of nuclear chromosome positions suggested chromosome overlaps in both types of cells. Spectral karyotyping then revealed both aneuploidy and complex chromosomal rearrangements: multiple breakage-bridge-fusion cycles were at the origin of the multiple rearranged chromosomes. This conclusion was challenged by super resolution three-dimensional structured illumination imaging of Hodgkin and Reed-Sternberg nuclei. Three-dimensional super resolution microscopy data documented inter-nuclear DNA bridges in multi-nucleated cells but not in mono-nucleated cells. These bridges consisted of chromatids and chromosomes shared by two Reed-Sternberg nuclei. The complexity of chromosomal rearrangements increased as Hodgkin cells developed into multi-nucleated cells, thus indicating tumor progression and evolution in Hodgkin’s lymphoma, with Reed-Sternberg cells representing the highest complexity in chromosomal rearrangements in this disease.
Conclusions
This is the first study to demonstrate nuclear remodeling and associated genomic instability leading to the generation of Reed-Sternberg cells of Hodgkin’s lymphoma. We defined nuclear remodeling as a key feature of Hodgkin’s lymphoma, highlighting the relevance of nuclear architecture in cancer. 相似文献
The purpose of this study was to develop a rapid and fully automatic method for the assessment of microvascular density and
perfusion in sidestream dark field (SDF) images. We modified algorithms previously developed by our group for microvascular
density assessment and introduced a new method for microvascular perfusion assessment. To validate the new algorithm for microvascular
density assessment, we reanalyzed a selection of SDF video clips (n = 325) from a study in intensive care patients and compared the results to (semi-)manually found microvascular densities.
The method for microvascular perfusion assessment (temporal SDF image contrast analysis, tSICA) was tested in several video
simulations and in one high quality SDF video clip where the microcirculation was imaged before and during circulatory arrest
in a cardiac surgery patient. We found that the new method for microvascular density assessment was very rapid (<30 s/clip)
and correlated excellently with (semi-)manually measured microvascular density. The new method for microvascular perfusion
assessment (tSICA) was shown to be limited by high cell densities and velocities, which severely impedes the applicability
of this method in real SDF images. Hence, here we present a validated method for rapid and fully automatic assessment of microvascular
density in SDF images. The new method was shown to be much faster than the conventional (semi-)manual method. Due to current
SDF imaging hardware limitations, we were not able to automatically detect microvascular perfusion. 相似文献
Based on attribution theory, this study hypthesized that past spousal supportiveness may act as a moderator of the link between
one partner’s current support behavior and the other partner’s relationship satisfaction. A sample of 88 patients with colorectal
cancer and their partners completed questionnaires approximately 3 and 9 months after diagnosis. The data were analyzed employing
dyadic data analytic approaches. In the short-term, spousal active engagement—which involved discussing feelings and engaging
in joint problem solving—was positively associated with relationship satisfaction in patients as well as in partners, but
only when past spousal support was relatively low. Spousal protective buffering—which involved hiding worries and fears and
avoiding talking about the disease—was negatively associated with relationship satisfaction in patients, again only when past
spousal support was relatively low. If past spousal support was high, participants rated the quality of their relationship
relatively high, regardless of their partner’s current support behavior. Over time, past spousal supportiveness was not found
to mitigate the negative association between spousal protective buffering and relationship satisfaction. Overall, our results
indicate that relationship satisfaction can be maintained if past spousal supportiveness is high even if the partner is currently
not very responsive to the individual’s needs, at least in the short-term. 相似文献