A biomechanical evaluation of one-stage vs two-stage bilateral knee arthroplasty patients

In this study the functional abilities of eight one-stage bilateral total knee replacement (TKR) patients were compared to five two-stage bilateral TKR and nine control subjects. The TKR individuals were an average of 62 months post-operative. Based on gait analysis, ground reaction force profiles during walking and isometric knee strength assessment, the one-stage individuals did not differ significantly from the control subjects. The two-stage individuals had significantly less knee range of motion during gait and smaller vertical ground reaction forces during the braking phase than the control and one-stage individuals. To compare left and right sides, a symmetry index was computed and there were no significant differences among the three groups. Based on the variables tested in this biomechanical evaluation it can be concluded that for individuals facing bilateral knee replacement a one-stage procedure can result in functional capabilities at least comparable to a two-stage procedure.     

Depression in attention deficit-disordered and normal children and their parents

Children's Depression Inventory (CDI) scores and correlates were examined in 116 ADD and normal children. Results indicated that ADD children and their parents reported higher levels of depression than did their normal counterparts. In normal children, a marginally significant relationship was found between mother's depression and CDI scores. In accord with previous research, no significant relationships were found among IQ, sex, age, or family status and CDI scores. The discussion section within the limitations of the present study, supports the idea of a demoralization syndrome in ADD children and their parents, as discussed by Cantwell and Carlson Although the CDI may be the best researched instrument for children's self-reported depression, more systematic research will be needed before adapting the CDI to the clinical setting.This research was supported in part by a grant (MH 37-628) awarded to the first author from the National Institute of Mental Health, Pharmacologic and Somatic Treatment Branch.     

Low-dose interferon-alpha in stage-I multiple myeloma and in IgM monoclonal gammopathy

Summary Interferon (IFN)-a can induce objective responses in advanced-stage multiple myeloma (MM) and can delay disease progression in patients responsive to chemotherapy. We studied the effects of low-dose (3 MU daily) human recombinant IFN- 2b for 6–12 months in 29 consecutive cases of previously untreated, stablephase, early stage, monoclonal gammopathy (MG) (23 cases of stage I MM and six cases of IgM MG). In 25/29 patients, the disease remained stable throughout the study period. A major objective response was observed in one of five cases of IgA MG. Normal Ig levels increased in all five cases of IgA MG. A significant disease progression occurred in 2/29 cases during the 1-year study period. These data showed that the objective response rate of early-stage MG to low-dose IFN was low and suggested that further investigation should focus on IgA MG. Writing committee: R. Fanin, D. Russo, F. Patriarca, C. Gallizia, and M. Baccarani.Pathology committee: S. Pileri, E. Sabattini (Bologna).Active members: G. Fasola, L. Virgolini, D. Damiani, M. Michieli, A. Geromin (Udine); P. Cristina, A. Polacco, E. Radin (Mestre); M. Buttò, E. Rorai, C. Mazzaro (Pordenone); M. N. De Savorgnani, D. Magris (Trieste); A. Guaran, F. Montanar (Palmanova); Q. Messina, A. Cellini (Sacile); F. Saladin, M. Ferrarese (Treviso); O. Fantin, R. Nimis (Latisana); M. A. Monco, G. Conte (Treviso); G. Pozzato (Trieste); E. Tomat, P. Naliato (Udine)Work supported by AIRC (Milano), bySezione Friulana della Lega Italiana per la Lotta contro i Tumori, and by the University of Udine, grants 60%. F. Patriarca is an AMS/FVG fellow     

MILITANCY TRAUMA : PENETRATING AND NONPENETRATING CARDIAC INJURY

Two hundred and eighty patients with serious chest injuries were treated at a service hospital during a period of 41 months. Out of 9 patients who suffered cardiac trauma S had penetrating cardiac injuries, 2 had penetrating pericardial injury and 2 patients had myocardial contusions. Myocardial contusions simulated myocardial infarction. All patients except one had polytrauma, associated injury to the lung or intra-abdominal organs. Early evacuation, resuscitation, high index of suspicion for cardiac injury and prompt surgical intervention were the keys to successful management in these patients. Thoracotomy was performed to repair the myocardial perforation and lacerated lung injuries. Associated infra-abdominal injuries were managed with laparotomy. Two patients died due to lack of cardiopulmonary bypass facilities and resistant cardiac arrhythmias. Seven patients had uneventful recovery.KEY WORDS: Heart injuries, Thoracic injuries, Traumatology, Wounds, gunshot, Wounds, nonpenetrating, Wounds, penetrating     

1139939111TLR6 protects first trimester trophoblast cells from TLR2/TLR1 mediated apoptosis

Introduction:  Increased trophoblast apoptosis has been observed in pregnancy complications such as preeclampsia. The factors promoting this cell death are unknown. Trophoblasts express Toll-like receptors (TLR), enabling them to recognize microorganisms. In response to the TLR2 ligand peptidoglycan (PDG), trophoblasts undergo apoptosis suggesting that gram-positive bacteria may promote trophoblast apoptosis. The objective of this study was to characterize the cellular mechanism by which TLR2 induces apoptosis. We report the role of TLR6 in the regulation of TLR2 mediated apoptosis following ligation by PDG.
Methods:  First trimester trophoblast cell lines express TLR1 and TLR2 but lack TLR6 and are sensitive to PDG-mediated apoptosis. Three stable transfectants were made to express either a TLR1 dominant negative (TLR1-DN), a TLR2 dominant negative (TLR2-DN) or full length TLR6. Cells were treated with PDG (40 μg/mL) after which cell viability, caspase-3 activity and cytokine production were evaluated.
Results:  Trophoblasts expressing the TLR2-DN showed a 57.4 ± 1.2% inhibition in PDG-induced caspase-3 activity compared with wildtype cells, while the TLR1-DN inhibited PDG-induced caspase-3 activity by 61.6 ± 1.1%. Expression of TLR6 by trophoblasts, reversed PDG-mediated apoptosis as shown by reduced caspase-3 activity (77.6 ± 1.2%) and increased cytokine production.
Conclusion:  These results suggest that a gram-positive bacterial infection during pregnancy may promote trophoblast apoptosis via TLR2/TLR1 heterodimers. Expression of TLR6, however, may protect the trophoblast from PDG-induced apoptosis and instead promote an inflammatory response. These findings shed new light on the mechanisms by which infection may affect placental function and pregnancy outcome.     

The specificities of polyclonal and monoclonal anti-idiotypes to anti-alpha(1----6)dextrans; possible correlations of idiotype with amino acid sequence

The specificities of polyclonal and monoclonal anti-idiotypes to three anti-alpha(1----6)dextrans-10.16.1, QUPC52, and W3129--were examined by competition ELISA. A major idiotype was defined by two polyclonal and two monoclonal anti-idiotypes to 10.16.1, and a polyclonal anti-idiotype to QUPC52. Another monoclonal anti-idiotype to 10.16.1 defines a non-overlapping determinant. One monoclonal anti-idiotype to 10.16.1 and one to W3129 were hapten inhibitable. By comparing amino acid sequences of Id+ and Id- anti-alpha(1----6)dextrans, the major idiotype was assigned to residues in VH CDR3, with a possible contribution from VH CDR2, a conclusion supported by the hapten inhibition results. Both a monoclonal and a previously described polyclonal anti-idiotype to W3129 define a determinant found on only W3129, among the anti-alpha(1----6)dextrans tested.     

Performance Characteristics of the PolyTiter Immunofluorescent Titration System for Determination of Antinuclear Antibody Endpoint Dilution

Conventional screening for circulating antinuclear antibodies (ANA) is generally performed by immunofluorescent (IF) microscopy with a 1:40 dilution of serum. Intensity of IF staining is then semiquantitated by using twofold serial dilutions, where the highest dilution in which staining intensity equals the endpoint control is expressed as an endpoint titer. The PolyTiter Immunofluorescent Titration system (Polymedco, Inc.) facilitates ANA-IF assay (IFA) testing by relating the intensity of IF staining to reference calibrators (defined in PolyTiter units), providing an endpoint titer directly from a 1:40 dilution. This study was conducted to assess the performance characteristics of the PolyTiter system. Two technologists each evaluated 10 replicates of three specimens and two controls on five sequential days. Endpoint dilution agreement (defined as ±2 dilutions) with the reference was 100% for all controls and for all specimens by one technologist. The second reader reported agreement of 98, 88, and 100% for the low, medium, and high specimens, respectively. Analysis of PolyTiter unit values yielded between-reader, between-run, and within-run precision coefficients of variation of less than 10%. The variance component in the lot-to-lot analysis was zero, indicating all of the variation was due to run-to-run differences. Overall endpoint dilution agreement between PolyTiter and serial dilution in the evaluation of 125 specimens at three sites was 90, 93, and 86%. Pattern identification with the PolyTiter was similar to that with serial dilution. The PolyTiter system demonstrates acceptable performance for routine ANA-IFA testing in the clinical laboratory.     

The sintered microsphere matrix for bone tissue engineering: in vitro osteoconductivity studies

A tissue engineering approach has been used to design three-dimensional synthetic matrices for bone repair. The osteoconductivity and degradation profile of a novel polymeric bone-graft substitute was evaluated in an in vitro setting. Using the copolymer poly(lactide-co-glycolide) [PLAGA], a sintering technique based on microsphere technology was used to fabricate three-dimensional porous scaffolds for bone regeneration. Osteoblasts and fibroblasts were seeded onto a 50:50 PLAGA scaffold. Morphologic evaluation through scanning electron microscopy demonstrated that both cell types attached and spread over the scaffold. Cells migrated through the matrix using cytoplasmic extensions to bridge the structure. Cross-sectional images indicated that cellular proliferation had penetrated into the matrix approximately 700 microm from the surface. Examination of the surfaces of cell/matrix constructs demonstrated that cellular proliferation had encompassed the pores of the matrix by 14 days of cell culture. With the aim of optimizing polymer composition and polymer molecular weight, a degradation study was conducted utilizing the matrix. The results demonstrate that degradation of the sintered matrix is dependent on molecular weight, copolymer ratio, and pore volume. From this data, it was determined that 75:25 PLAGA with an initial molecular weight of 100,000 has an optimal degradation profile. These studies show that the sintered microsphere matrix has an osteoconductive structure capable of functioning as a cellular scaffold with a degradation profile suitable for bone regeneration.     

Variable region cDNA sequences of three mouse monoclonal anti-idiotypic antibodies specific for anti-alpha(1----6)dextrans with groove- or cavity-type combining sites.

The variables regions of three syngeneic anti-idiotypic antibodies (Ab2s) were cloned and sequenced. They are encoded by different VL genes, two are from different members of V kappa-Ox1 superfamily. The H chains are encoded by VH genes belonging to three different VH families, J558, Q52 and 7183. Together with a previous report from this laboratory, the nucleotide sequences of four Ab2s to anti-alpha(1----6)dextrans have been presented. They are derived from a number of unrelated germline genes, and differ from similar studies in anti-NP, anti-GAT and anti-Ars systems. Three of four Ab2s in the anti-alpha(1----6)dextran system appear to have D-D fusions, which has also been reported in several other Ab2s.