Midterm Assessment of Causes and Results of Revision Total Knee Arthroplasty

Background  

There is limited information regarding revision total knee arthroplasty (TKA) with respect to etiology, outcome, and long-term survival comparing different implant types.     

The association of the Friesinger score and pulse pressure in an urban South Asian patient population: pulse pressure,an independent predictor of coronary artery disease

Increase in pulse pressure has been shown to be predisposing factor for Coronary Artery Disease (CAD) in diverse patient populations but its relationship with the severity of CAD, particularly in the South Asians immigrant population of United States has not been demonstrated. We performed a single-center, cross-sectional study. Pulse pressure was calculated by the difference between the systolic and diastolic brachial blood pressures, and the Friesinger score (FS) was used to quantify the severity of CAD with the score of 5 used as a cutoff for extensive disease. We also sought to assess the correlation between the Friesinger score and the 10-year cardiovascular event (CVD) risk as calculated by the Framingham score. Odds ratios and 95% confidence intervals for the associations between explanatory variables and a high Friesinger score were estimated using multivariate logistic regression models. P values below .05 were considered to be statistically significant. Statistical analysis was performed using STATA version 10 software package (College Station, TX). The mean pulse pressure was significantly higher in participants with an FS of ≥5 compared with participants with an FS of <5 (63 vs. 46 mm Hg; P = .004). In univariate analysis, a pulse pressure ≥40 mm Hg was associated with a five-fold increased odds of a higher FS compared with a pulse pressure <40 mm Hg (P = .039), which was unchanged in multivariate analysis. In multivariate analysis, even after adjustment for presence of hypertension, a 10 mm Hg increase in pulse pressure was associated with a 1.97-fold increased odds of a higher FS (95% CI 1.22–3.71, P = .009). The mean Framingham score was higher in participants with a higher FS, but this difference was not significant (32.7 vs. 20.3; P = .1139). Our study demonstrates that pulse pressure, a well-established marker of vascular health, is a significant independent predictor of the severity of CAD as assessed by coronary angiography in South Asians.     

Antiproliferative potential of sarcophine and its semisynthetic sulfur-containing derivatives against human mammary carcinoma cell lines

The marine-derived cembranoid sarcophine (1) and its sulfur-containing semisynthetic derivatives (2–6) were evaluated for anticancer potential using cell cycle progression markers. No effect on MCF-7 cell viability or apoptosis was seen with these derivatives at concentrations of up to 100 μM after 72 h of incubation. At 100 μM, sarcophine and its derivatives 2–5 arrested the MCF-7 cells in G0/G1 phase, with concomitant decrease in the cell populations at S and G2+M phases. MDA-MB-231 cells were not responsive to any of the derivatives. Our preliminary results suggest that the sulfur-containing derivatives of sarcophine, especially 2 and 3, show potent and cell-specific antiproliferative activity.     

Osteopenia in survivors of Wilms tumor

Diminished bone mass (osteopenia) is recognized increasingly as a consequence of therapy in survivors of cancer in childhood. It has been reported in two small series of survivors of Wilms tumor. The objectives of this study were to explore, in a larger sample of such subjects, the prevalence of osteopenia and a possible relationship between osteopenia of the lumbar spine and abdominal irradiation. All survivors of Wilms tumor (n=49) in a single institution were considered eligible for study. Thirty-one agreed to participate; the non-participants were not notably different in their demographic characteristics and diseases/treatment experience. Information was obtained about prior treatment, and usual diet, sun exposure and physical activity. Bone mineral content was measured by dual energy X-ray absorptiometry, and biochemical markers of bone turnover, calciotropic hormones and minerals were assessed in a single blood sample. By Z-scores of whole body bone mineral content, 8 subjects were osteopenic. This was unrelated to milk intake or sun exposure and was not more common in the lumbar spine of those who had been irradiated (15/31 subjects). Physical activity correlated positively with bone mineral density Z-scores (p<0.005). Normal bone formation was reflected in normal blood levels of osteocalcin. C-telopeptide levels, reflecting bone resorption, were high but approximately correlated inversely with maturity. Low serum magnesium and parathyroid hormone levels were detected in a minority of subjects. Osteopenia is present in a large minority (27%) of survivors of Wilms tumor, and an imbalance of bone turnover (with excessive resorption) may be common. Irradiation does not appear to play a causal role. It is possible that a subtle renal tubular defect exists in these individuals; a prospect worthy of further exploration.     

The cerebellum at birth in therian mammals,with special reference to rodents

The stage of cerebellar development at birth was assessed in 23 species of placental mammals. Serial histological sections were examined and five stages in the differentiation of the cerebellar cortical layers were defined. A wide diversity of conditions at birth was found. The available evidence (after parsimony reconstruction) suggests that the last common ancestor of placentals was born with an altricial cerebellum in which the molecular layer was just present between the external granular layer and the prospective Purkinje cell layer. Some placental species have an even more altricial cerebellum at birth (e.g., Muscardinus avellanarius, Sorex araneus), with Mesocricetus auratus as the most altricial species among the taxa studied. In the newborn M. auratus a cerebellar anlage was present with only a loose accumulation of cells located at the dorsal cerebellar anlage above the ventricular neuroepithelial layer. The five species of caviomorph rodents examined here are relatively precocial as far as the cerebellum is concerned. The only other rodent species that has a similarly advanced state was the murid Acomys sp. Most of the life history variables examined were not strongly correlated with the cerebellar stage at birth if at all. However, a significant positive correlation (r(2) = 0.67) was observed between the cerebellar stage at birth and the gestation length and a significant negative correlation (r(2) = 0.31) was observed between cerebellar stage and the average litter size. The weak correlation may be due to sampling among different distantly related clades. The most mature cerebella at birth still had an external granular layer, indicating that the mossy fiber-granule cell connectivity is not yet fully developed and further indicating that this connectivity may depend on external experience to fully mature. All species that have their eyes open at birth also have the most mature cerebelli. The growth of the cortical layers was also studied in a postnatal ontogenetic series of the marsupial Monodelphis domestica. As is the case with placentals, the most advanced stage of cerebellar development coincides with the opening of the eyes.     

Bilateral lipoma arborescens associated with early osteoarthritis

Lipoma arborescens is a rare disease that has generally been considered to be unilateral. We report a case of bilateral disease in a patient with associated marked premature osteoarthritis of the knees. We postulate a possible association between these two conditions and explain a possible underlying mechanism. We suggest that lipoma arborescens be considered as a rare underlying cause of young patients with bilateral premature osteoarthritis, and recommend MRI as the definitive imaging modality. Electronic Publication     

Quantification of glutaric and 3-hydroxyglutaric acids in urine of glutaric acidemia type I patients by HPLC with intramolecular excimer-forming fluorescence derivatization

BACKGROUND: Glutaric aciduria type I (GA1) is an autosomal recessive disorder that usually causes neurological damage. Early diagnosis of the disease prior to the appearance of clinical symptoms can lead to better outcomes. METHODS: We describe a simple and selective HPLC method with intramolecular excimer-forming fluorescence derivatization to diagnose GA1. Glutaric acid (GA) and 3-hydroxyglutaric acid (3HGA) in urine and an internal standard were derivatized with 1-pyrenebutyric hydrazide (PBH). The derivatives were separated on a C18 column and fluorometrically detected at 475 nm (excitation of 345 nm) with a run time of 18 min. RESULTS: Excellent linearity over a wide range, reproducibility (coefficient of variation < or =14.5%), and sensitivity (limit of detection 0.4 micromol/l 3HGA and 0.2 micromol/l GA) were obtained. A retrospective study on previously diagnosed GA1 patients' urine from our laboratory archives between 1999 and 2004 was performed by analysts blinded to the study. CONCLUSIONS: The method enabled us to differentiate GA1 cases (n=36) from controls (n=99), regardless of the years of urine storage. The method is valuable for both retrospective and prospective diagnoses of GA1.