Cortical and cancellous morselized allograft in revision total hip replacement

Fifty patients who had revision femoral components with morselized impacted bone graft were studied in a retrospective, matched-pair analysis. In 25 patients the morselized graft was derived from cortical bone (Group A) and in 25 patients the morselized graft was derived from cancellous bone (Group B). The patients were matched for age, gender, weight, comorbid conditions, severity of bone loss, and allograft preparation. At a mean of 5.2 years followup (range, 3-7 years) after surgery, the mean Harris ?hip score and the mean thigh score in Group A was 88 and 1.2 points, respectively, and in Group B was 88 and 2.3 points, respectively. Subsidence greater than 5 mm and radiolucent lines on more than 20% of the stem interfaces were seen in fewer patients from Group A (three and two patients) than from Group B (eight and five patients). There was a correlation between radiolucent lines on more than 50% of the stem, stem subsidence, and thigh pain. The current study showed significantly better results using morselized cortical allograft when assessed by early clinical outcome, thigh pain, and stem subsidence greater than 5 mm.     

Anti-MAG neuropathy: Role of IgM antibodies,the paranodal junction and juxtaparanodal potassium channels

Objective

To improve understanding of disease pathophysiology in anti-myelin-associated glycoprotein (anti-MAG) neuropathy to guide further treatment approaches.

GABA‐modulating phytomedicines for anxiety: A systematic review of preclinical and clinical evidence

Anxiety disorders are chronic and functionally disabling conditions with high psychological stress, characterised by cognitive symptoms of excessive worry and focus difficulties and physiological symptoms such as muscle tension and insomnia. Gamma‐aminobutyric acid (GABA) is an inhibitory neurotransmitter within the central nervous system and is a key target of pharmacotherapies in the treatment of anxiety. Although current pharmaceutical treatments are often efficacious, they may cause undesirable side effects including cognitive decrements and withdrawal symptoms. Plant‐based “phytomedicines” may provide novel treatment options, to act as an adjunctive or alternative to existing anxiolytic medications. As such, we conducted a systematic review to assess the current body of literature on anxiolytic phytomedicines and/or phytoconstituents. An open‐ended search to 5 July 2017 was conducted using MEDLINE (PubMed), Scopus, and Cochrane library online databases and performed in a stepped format from preclinical to clinical investigations. Eligible studies must have had (a) in vitro evidence of GABA‐modulating activity, (b) animal studies using anxiety models to test an anxiolytic effect, and (c) human clinical trials. Ten phytomedicines were identified as having preclinical investigations showing interaction with the GABA system, in addition to human clinical trials: kava, valerian, pennywort, hops, chamomile, Ginkgo biloba, passionflower, ashwagandha, skullcap, and lemon balm. Collectively, the literature reveals preclinical and clinical evidence for various phytomedicines modulating GABA‐pathways, with comparative anxiolytic effect to the current array of pharmaceuticals, along with good safety and tolerability profiles.     

Anemia with impaired erythropoietin response in diabetic patients

BACKGROUND: Diabetes mellitus is associated with an increased prevalence of anemia, particularly in patients with nephropathy. We undertook this survey to determine the relationship between anemia and the renal production of erythropoietin in patients with diabetes mellitus. METHODS: The clinical data of 722 patients were obtained, including markers of diabetic complications. Erythropoietin levels were measured in the same samples. Patients with a full blood cell count, iron indexes, and renal function within the normal range (n = 151) were used to define the reference range for this population. Anemic patients who had erythropoietin levels within this range were defined as having an "inappropriate erythropoietin response to anemia." RESULTS: Of the 722 patients, 168 (23.3%) had anemia, of whom 130 (77.4%) had erythropoietin levels inappropriately within the normal range. Although 55.4% of anemic patients had moderate renal impairment, erythropoietin levels were also inappropriately low in 69.2% of anemic patients with normal renal function. However, most of these patients (17 of 26) had diabetic kidney disease, as denoted by albuminuria. CONCLUSIONS: The failure to produce erythropoietin in response to a declining hemoglobin level is a common contributor to anemia in patients with diabetes mellitus. This seems to be a manifestation of diabetic kidney disease, in the presence or absence of renal impairment.     

Synthetic grass cricket pitches and ball bounce characteristics

The use of synthetic grass cricket pitches is becoming more common at club and sub-elite levels which constitute the majority of cricket participants but there is sparse data on ball bounce characteristics on these surfaces.ObjectivesTo compare the speed, angle and consistency of ball bounce on two types of synthetic cricket surfaces, the Traditional and the All-Seasons, and compare these ball bounce characteristics with published data for natural turf pitches.DesignGroup-based comparison.MethodsHigh speed motion analysis was used to capture data from balls projected onto the cricket pitches from a bowling machine at three speeds: slow (47 km h^?1), medium (72 km h^?1) and fast (104 km h^?1). Both ends of the cricket pitches were assessed and two types of balls were used: 2-piece and 4-piece leather cricket balls. Digitisation was used to determine the ball speed and angle pre and post bounce and then to calculate the ratios of ball speed and angle. Consistency was determined by the coefficient of variation.ResultsThe All-Seasons synthetic surface generated a lower speed ratio and a higher angle ratio than the Traditional synthetic surface. The speed ratio for the Traditional surface fell within the range reported for natural turf, whilst the value for the All-Seasons surface was outside the range. Both synthetic surfaces produced angle ratios greater than those for natural turf surfaces.ConclusionsDifferences were detected between the different synthetic cricket surfaces and also when compared to natural turf. This variability may have implications for skill development as well as safety.     

Significant dermatological side effects of intravenous immunoglobulin

Intravenous immunoglobulin (IVIg) is an essential treatment for many neurological, immunological and haematological conditions. However, the severity of its rare adverse effects is often underrecognised. We report a series of 15 patients receiving IVIg for neurological and immunological disorders who developed severe skin reactions. Despite pre-medication, nearly all patients ceased IVIg due to the severity of the adverse response. Interestingly, the majority of patients were male and two-thirds were receiving treatment for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) or another inflammatory or demyelinating neuropathy. This marked propensity for male patients with CIDP to develop significant dermatological reactions following IVIg administration has not previously been described. Mechanisms involving the underlying autoimmunity inherent to this condition may play a role.