The kinematics and stability of single‐radius versus multi‐radius femoral components related to Mid‐range instability after TKA

There continues to be some dissatisfaction with the function of total knee arthroplasties (TKA). “Mid‐range instability” has been linked to multi‐radius femoral components allowing transient ligament slackness and instability during knee flexion. Single‐radius designs have been introduced to avoid this. We compared the kinematics and stability of eight natural knees versus multi‐radius and single‐radius TKAs in vitro. The loading conditions imposed across the range of active knee extension were anterior–posterior drawer forces, internal–external rotation torques, and varus–valgus moments. Significant differences were not found between the biomechanical behavior of the two TKAs. Both were significantly different from the natural knee in allowing greater anterior drawer laxity near extension, probably caused by excision of the anterior cruciate ligament, but no difference occurred beyond 30° flexion. No differences were found for any of the other degrees‐of‐freedom of movement. A geometric analysis suggested that the multi‐radius design may tense the MCL more than the single‐radius in mid‐flexion, contrary to expectation. These kinematic and stability tests did not find mid‐range instability of the knees, and so they could not demonstrate enhanced mid‐range stability of the single‐radius TKA over the older multi‐radius implant. This suggests that mid‐range instability may relate to unrecognized ligament laxity during surgery, rather than being inherent to a specific feature of implant design. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:53–58, 2012     

Effects of Being a Peer-Leader in an Eating Disorder Prevention Program: Can We Further Reduce Eating Disorder Risk Factors?

Studies regarding the effect of peer-leadership on peer-leaders in prevention programs remain extremely limited. In this study, 83 undergraduate sorority members, who previously participated in the program, served as peer-leaders for an eating disorder prevention program. Peer-leaders attended 9 hours of training and then led two 2-hour sessions. Leaders showed decreases (beyond participation in earlier studies) in dietary restraint, bulimic pathology, body dissatisfaction, and thin-ideal internalization from pre-training through 7-week follow up. Results from this exploratory study suggest that peer-leaders who participate in a program and subsequently lead it may experience additional benefits compared to participation in the program alone.     

白花蛇舌草-半枝莲药对组分对结肠腺癌Lovo细胞生物学行为的影响

摘要:目的　探讨白花蛇舌草-半枝莲药对组分对结肠腺癌Lovo细胞增殖、侵袭、迁移和凋亡的影响及作用机制。方法　将白花蛇舌草、半枝莲按质量1∶1进行3次煎煮,获得水提物,后取适量浸膏用石油醚回流脱脂,再以乙酸乙酯进行多次萃取,获得白花蛇舌草-半枝莲药对组分,并计算得率。实验分为对照组（正常培养Lovo细胞）、白花蛇舌草-半枝莲药对组分低剂量组（10 mg/L）、中剂量组（30 mg/L）及高剂量组（50 mg/L）。通过噻唑蓝比色法（MTT）检测各组细胞培养24、48、72 h后的增殖抑制率。各组细胞培养48 h后,流式细胞仪检测细胞周期分布;Transwell实验检测细胞侵袭能力;划痕实验检测细胞迁移能力;TUNEL法检测细胞凋亡情况;Western blot法检测Grb2相关结合蛋白1（Gab1）、血管内皮生长因子受体2（VEGFR-2）、磷脂酰肌醇3-激酶（PI3K）、苏氨酸激酶（Akt）、基质金属蛋白酶-9（MMP-9）、B淋巴细胞瘤-2基因（Bcl-2）、Bcl-2相关X蛋白（Bax）蛋白表达情况。结果　化学萃取后的白花蛇舌草-半枝莲药对中主要含有对羟基苯乙酮、野黄芩苷、木犀草素和芹菜素4种化合物,组分得率为0.61%。与对照组相比,低、中、高剂量组细胞增殖抑制率升高,G1期肿瘤细胞比例增加,细胞凋亡指数增高,侵袭细胞数和划痕闭合率明显减小（均P＜0.05）,细胞中Gab1、VEGFR-2、PI3K、Akt、MMP-9、Bcl-2蛋白表达降低,Bax表达升高（均P＜0.05）,且存在剂量依赖性。结论　白花蛇舌草-半枝莲药对组分可抑制结肠腺癌Lovo细胞的增殖,降低其迁移和侵袭能力,诱导细胞凋亡,其机制可能与抑制Gab1/VEGFR-2/PI3K/Akt信号通路活化有关。     

Mycobacterial interspersed repetitive units (MIRU) differentiate Mycobacterium avium subspecies paratuberculosis from other species of the Mycobacterium avium complex

Mycobacterial interspersed repetitive units (MIRU) comprise short tandem repeat structures found at multiple loci throughout the Mycobacterium tuberculosis genome and have been used for typing these pathogens. We have identified MIRU at 18 conserved loci throughout the common portions of the Mycobacterium avium subspecies paratuberculosis (MAP) and M. avium subspecies avium (MAA) genomes. Six of these loci were found to differ between MAA and MAP in the number of tandem repeat motifs occurring at each MIRU locus. Locus specific PCR at 4 of these loci segregated MAP into two major groups, which could be differentiated from ovine-pigmented strains of MAP and the MAP vaccine strain 316F. The same PCR differentiated MAA into five MIRU profiles. PCR at either MIRU locus 1 or MIRU locus 4 distinguished between MAP and all other M. avium complex (MAC) tested. PCR at both loci 1 and 4 also distinguished MAP from Mycobacterium intracellulare. MIRU typing may provide an additional simple and rapid procedure for the differentiation between MAP and other MAC.     

Laparoscopic Roux en-Y Gastric Bypass Using a Modified Retrocolic–Supracolic Approach: Outcomes from 300 Patients

Background

Laparoscopic Roux en-Y gastric bypass (LRYGB) achieves sustained long-term weight loss and reduced mortality in morbidly obese patients. It is routinely performed using an ante- or retrocolic approach with the jejuno-jejunostomy constructed in the infracolic compartment. We have modified the standard technique of performing LRYGB by constructing both anastomoses in the supracolic compartment. This study describes the outcomes of consecutive primary LRYGB performed using this novel retrocolic–supracolic approach.

Methods

Data were prospectively collected on consecutive primary LRYGB performed in a tertiary-referral Bariatric Centre in the United Kingdom from September 2009 to March 2013. Data included demographics, operative outcomes (duration of surgery, postoperative anastomotic leak/bleeding/reoperations), development of strictures, length of stay, excess weight loss (EWL) and resolution of diabetes mellitus.

Results

Hand-sewn LRYGB was successfully performed using the retrocolic–supracolic approach in 300 of 307 (98 %) consecutive patients (72 % female). Median (IQR) age, weight and baseline body mass index were 49 (41–56) years, 146 (134–163) kg and 52.9 (48.8–57.2) kg/m², respectively. There were 4 (1.3 %) anastomotic leaks and 8 (2.6 %) postoperative bleeds. The 30-day reoperation rate was 1.6 %. Median (IQR) hospital stay was 2 (2–2) days. Postoperative dysphagia requiring endoscopic balloon dilatation occurred in 19 (6.3 %) patients. Mean ± SD 12-month EWL was 69.9 ± 19.0 %. Within the follow-up period, 81 % of patients with type II diabetes mellitus achieved remission and 19 % reduced dosage of diabetes medication.

Conclusions

LRYGB performed using the retrocolic–supracolic approach was safe, feasible, technically advantageous and resulted in clinical outcomes akin to the standard infracolic approach.

     

The floating cardiac fat pad—sign of occult pneumothorax

Pneumothoraces are a possible sequela of chest trauma with potential morbidity and mortality if not recognized and treated promptly. A portable supine chest radiograph is frequently the first radiologic study performed in the setting of trauma. While large pneumothoraces can be readily recognized on these radiographs, smaller pneumothoraces are missed in up to 15 % of trauma patients. There are many radiographic signs of occult pneumothoraces, and we are presenting a new radiographic sign of occult pneumothorax. The floating cardiac fat pad sign occurs when pleural air collects anteriorly and superiorly in the most non-dependent portion of the chest lifting the pericardial fat pad off the diaphragm. Lung markings are still seen surrounding the pericardial fat pad due to the inflated lower lobe of the lung resting dependently. Rapid and accurate identification of pneumothoraces is critical but often difficult on chest radiographs. Although there are many existing radiographic signs for identification of pneumothorax, prospective identification of small pneumothoraces is still relatively poor. Here, we describe an additional sign which aides in the detection of pneumothoraces, the floating cardiac fat pad. When present, this should prompt further evaluation with chest CT or upright chest radiograph.     

Deletion and recombination events between the DNA-A and DNA-B components of Indian cassava-infecting geminiviruses generate defective molecules in Nicotiana benthamiana

Cloned DNA-B components, belonging to the bipartite begomoviruses Indian cassava mosaic virus (ICMV) and Sri Lankan cassava mosaic virus (SLCMV), family Geminiviridae, when co-inoculated along with previously cloned DNA-A components of the respective viruses onto the experimental host Nicotiana benthamiana, generated defective DNAs (def-DNA) ranging in size from 549 to 1555 nucleotides. All the cloned def-DNAs contained the common region (CR) as well as portions of either DNA-A or DNA-B and, in a few cases, both DNA-A and DNA-B, representing recombinant products, the junction points of which correspond to repeats of 2-11 bases found in the parental molecules. The DNA-B-derived def-DNAs were, in some cases, associated with a decrease in levels of DNA-B, with a concomitant change in the symptoms from downward leaf curling in the older leaves to upward leaf-rolling in newly emerging leaves, more typical of monopartite begomoviruses.     

Mycobacterium avium subspecies paratuberculosis infection in cases of irritable bowel syndrome and comparison with Crohn's disease and Johne's disease: common neural and immune pathogenicities

Mycobacterium avium subsp. paratuberculosis causes Johne's disease, a systemic infection and chronic inflammation of the intestine that affects many species, including primates. Infection is widespread in livestock, and human populations are exposed. Johne's disease is associated with immune dysregulation, with involvement of the enteric nervous system overlapping with features of irritable bowel syndrome in humans. The present study was designed to look for an association between Mycobacterium avium subsp. paratuberculosis infection and irritable bowel syndrome. Mucosal biopsy specimens from the ileum and the ascending and descending colon were obtained from patients with irritable bowel syndrome attending the University of Sassari, Sassari, Sardinia, Italy. Crohn's disease and healthy control groups were also included. Mycobacterium avium subsp. paratuberculosis was detected by IS900 PCR with amplicon sequencing. Data on the potential risk factors for human exposure to these pathogens and on isolates from Sardinian dairy sheep were also obtained. Mycobacterium avium subsp. paratuberculosis was detected in 15 of 20 (75%) patients with irritable bowel syndrome, 3 of 20 (15%) healthy controls, and 20 of 23 (87%) people with Crohn's disease (P = 0.0003 for irritable bowel syndrome patients versus healthy controls and P = 0.0000 for Crohn's disease patients versus healthy controls). One subject in each group had a conserved single-nucleotide polymorphism at position 247 of IS900 that was also found in isolates from seven of eight dairy sheep. There was a significant association (P = 0.0018) between Mycobacterium avium subsp. paratuberculosis infection and the consumption of hand-made cheese. Mycobacterium avium subsp. paratuberculosis is a candidate pathogen in the causation of a proportion of cases of irritable bowel syndrome as well as in Crohn's disease.     

五禽戏联合推拿对原发性痛经患者中医证候及血清TNF-α、CD4+、OT、β-EP 表达的影响

目的:观察五禽戏联合推拿治疗原发性痛经(PD)的临床疗效及对患者血清肿瘤坏死因子-α(TNF-α)、CD4⁺、催产素(OT)及β-内啡肽(β-EP)水平的影响。方法:选取80例PD女大学生,按随机数字表法分为对照组、五禽戏组、推拿组及五禽戏⁺推拿组,对照组给予田七痛经胶囊治疗,其余3组分别给予五禽戏、推拿及五禽戏+推拿治疗,治疗时间均为3个月经周期。采用中医证候积分评价临床疗效,通过血清TNF-α、CD4⁺、OT、β-EP表达的变化探讨五禽戏联合推拿治疗PD的作用机制。结果:与治疗前比较,4组中医证候积分治疗1个疗程、2个疗程、3个疗程后均降低(P<0.05),且随着疗程增加逐渐降低。停止治疗3个月后,4组中医证候积分均较治疗3个疗程时上升(P<0.05);五禽戏+推拿组中医证候积分低于五禽戏组和推拿组,差异均有统计学意义(P<0.05)。治疗后,4组血清TNF-α、OT水平均较治疗前降低(P<0.05),血清CD4⁺、β-EP水平均较治疗前升高(P<0.05)。4组治疗后CD4⁺、OT水平比较,差异均有统计学意义(P<0.05),而TNF-α、β-EP水平比较,差异均无统计学意义(P>0.05)。治疗后,五禽戏+推拿组OT水平均低于对照组、五禽戏组及推拿组(P<0.05),CD4⁺水平高于对照组(P<0.05)。经秩和检验,4组临床疗效比较,差异无统计学意义(P>0.05)。结论:五禽戏联合推拿治疗PD有较好的近期及远期疗效,其作用机制可能与调节患者的血清TNF-α、CD4⁺、OT、β-EP水平有关。