Sagittal laxity after posterior cruciate ligament-retaining mobile-bearing total knee arthroplasty

Posterior cruciate ligament stretching after posterior cruciate ligament-retaining (CR) total knee arthroplasty (TKA) can lead to an increase in sagittal laxity, knee dysfunction, or accelerated damage to the tibial bearing surface. We conducted a prospective study on 74 consecutive mobile-bearing CR TKA to determine if knee laxity changed with time or if knees with large initial laxity experienced greater increases in laxity. Patients were studied with radiographic posterior and anterior drawer examinations at 3 and 23 months. Model-based shape-matching techniques were used to measure TKA kinematics. We found a 1-mm increase in posterior drawer. Knees with large postoperative drawers did not exhibit increased laxity at last follow-up. The use of a mobile-bearing CR TKA did not significantly modify the midterm knee sagittal laxity.     

Surgical outcome of Dupuytren’s disease—no higher self-reported recurrence after segmental fasciectomy

A single-center survey on the patients’ perception of recurrence after Dupuytren’s surgery was conducted. To evaluate the impact of surgical techniques on self-reported recurrence rates, a retrospective analysis of 216 surgically treated patients with a minimum 2-year follow-up was conducted using a postal questionnaire. Reported recurrence rates were somewhat lower in segmental fasciectomy (43%), which was performed in 39% of the patients compared to an overall reported recurrence rate of 54% in all surgical procedures. In total fasciectomy with skin resection and grafting, patients reported a surprisingly high recurrence rate of 63%. By taking the prognostic value of diathesis into account, the difference in recurrence rates between surgical techniques was not statistically significant. Nevertheless, no higher recurrence risk in segmental fasciectomy was noticed and total fasciectomy with or without skin resection did not appear to guarantee indefinite results. At this point, surgical treatment in Dupuytren’s disease is confined to correcting contractures, without curing the patients. Therefore, unless segmental fasciectomy is not feasible due to the severity of the contractures, we suggest to always consider minimal invasive surgery as a surgical option in the treatment of Dupuytren’s disease.     

Validation of DSM-IV Model of Psychiatric Syndromes in Children with Autism Spectrum Disorders

The objective of this study was to assess the internal construct validity of the DSM-IV as a conceptual model for characterizing behavioral syndromes in children with ASD. Parent and teachers completed the Child Symptom Inventory-4, a DSM-IV-referenced rating scale, for 6-to-12 year old clinic referrals with an ASD (N = 498). Ratings were submitted to confirmatory factor analysis and models were assessed for fit. Results were also compared to those obtained for a sample of non-ASD psychiatric outpatient school-age children. Fit indices ranged from acceptable to good for the ASD samples and compared well to those obtained in typically developing children. Findings lend support to the notion that DSM-IV syndromes may be an appropriate conceptual model for characterizing psychopathology in ASD.     

Periodic leg movements and REM sleep without atonia in Parkinson's disease with camptocormia

Camptocormia (a flexion of the trunk that only appears when standing or walking) affects a minority of patients with Parkinson's disease (PD). As it responds poorly to levodopa and is associated with reduced midbrain and pons volume, it may result from non‐dopaminergic, brainstem lesions. As several sleep abnormalities in PD also result from non‐dopaminergic brainstem lesions, we monitored sleep in 24 non‐demented PD patients with (n = 12) and without (n = 12) camptocormia and in 12 controls. Nearly half (42%) patients with camptocormia had abnormal periodic leg movement indices (>15/h), versus 17% patients without camptocormia and 8% of controls (p = 0.02). In addition, the percentage of enhanced muscle activity during REM sleep (measured on the chin and on the limb muscles) tended to be higher in patients with than without camptocormia (51 ± 39% vs. 20 ± 25%, p = 0.06). The other sleep and REM sleep characteristics (sleep and REM sleep onset latencies, sleep time and sleep stage percentages, REMs density, arousal, and apnea‐hypopnea indices) were not different between these two PD groups. Lesions causing this axial dystonia may spare the sleep systems but affect the control of movements during sleep. © 2009 Movement Disorder Society     

Role of the chemokine receptor CXCR2 in bleomycin-induced pulmonary inflammation and fibrosis

Pulmonary fibrosis is characterized by chronic inflammation and excessive collagen deposition. Neutrophils are thought to be involved in the pathogenesis of lung fibrosis. We hypothesized that CXCR2-mediated neutrophil recruitment is essential for the cascade of events leading to bleomycin-induced pulmonary fibrosis. CXCL1/KC was detected as early as 6 hours after bleomycin instillation and returned to basal levels after Day 8. Neutrophils were detected in bronchoalveolar lavage and interstitium from 12 hours and peaked at Day 8 after instillation. Treatment with the CXCR2 receptor antagonist, DF2162, reduced airway neutrophil transmigration but led to an increase of neutrophils in lung parenchyma. There was a significant reduction in IL-13, IL-10, CCL5/RANTES, and active transforming growth factor (TGF)-beta(1) levels, but not on IFN-gamma and total TGF-beta(1,) and enhanced granulocyte macrophage-colony-stimulating factor production in DF2162-treated animals. Notably, treatment with the CXCR2 antagonist led to an improvement of the lung pathology and reduced collagen deposition. Using a therapeutic schedule, DF2162 administered from Days 8 to 16 after bleomycin reduced pulmonary fibrosis and levels of active TGF-beta(1) and IL-13. DF2162 treatment reduced bleomycin-induced expression of von Willebrand Factor, a marker of angiogenesis, in the lung. In vitro, DF2162 reduced the angiogenic activity of IL-8 on human umbilical vein endothelial cells. In conclusion, we show that CXCR2 plays an important role in mediating fibrosis after bleomycin instillation. The compound blocks angiogenesis and the production of pro-angiogenic cytokines, and decreases IL-8-induced endothelial cell activation. An effect on neutrophils does not appear to account for the major effects of the blockade of CXCR2 in the system.     

Efficacy and safety of Hylan G-F 20 in shoulder osteoarthritis with an intact rotator cuff. Open-label prospective multicenter study

ObjectiveTo evaluate the feasibility, safety, and symptomatic efficacy of intra-articular Hylan G-F 20 in patients with shoulder osteoarthritis and an intact rotator cuff.MethodsOpen-label, prospective, multicenter study in patients with pain scores on a visual analog scale (VAS) between 40/100 and 90/100. An intra-articular injection of 2 ml of Hylan G-F 20 was given under fluoroscopic guidance. A second injection was given after 1, 2, or 3 months in the event of inadequate pain relief. The primary evaluation criterion was the VAS pain score 3 months after the first injection. Follow-up was 6 months.ResultsOf 39 included patients, 33 received a first injection and, among these, 16 received a second injection; 29 patients completed the study. No serious or severe treatment-related adverse events were recorded. There were 10 mild or moderate adverse events in eight patients. The mean VAS pain score decreased from 61.2 mm at baseline to 37.1 mm after 3 months (P < 0.001), and the decrease was larger in the subgroup that required a single injection.ConclusionThis prospective study shows that treatment with one or two intra-articular injections of Hylan GF 20 in patients who have shoulder osteoarthritis and an intact cuff is feasible, safe, and probably effective. Viscosupplementation using Hylan G-F 20 may constitute a helpful treatment option in patients who have shoulder osteoarthritis with an intact rotator cuff.     

Regulation of the IGFBP-5 and MMP-13 genes by the microRNAs miR-140 and miR-27a in human osteoarthritic chondrocytes

Background  

MMP-13 and IGFBP-5 are important factors involved in osteoarthritis (OA). We investigated whether two highly predicted microRNAs (miRNAs), miR-140 and miR-27a, regulate these two genes in human OA chondrocytes.