Contemporary femoral designs in total knee arthroplasty: effects on the patello-femoral congruence

Purpose

The objective of this study was to evaluate the radiological and clinical correlations between implant design and patellar positioning in patients who underwent TKA utilizing femoral implants with modern designs.

Methods

Thirty consecutive PFC PS Sigma TKAs, characterized by a new prolonged anterior flange and a “smoother” trochlea, were prospectively reviewed. All patellae were replaced. All patients were evaluated pre-operatively and prospectively at two years follow-up both clinically according to the Knee Society score as well as radiographically. This included computed tomography (CT); patellar tilt, patellar conformity angle, patellar lateralization, and femoral component external-rotation in relation to the clinical trans-epicondylar axis.

Results

Average patellar tilt at follow-up was 3° (±7.5°) with respect to a pre-operative 18.5° (±8.5°). Average patellar congruence angle at follow-up was −3° (range, −11° to +9°) with respect to a pre-operative 10.3° (range, + 1.5° to 25.5°). Average lateralization index at follow-up was 2.7 mm (range, −3.4 mm to +7.1 mm) with respect to a pre-operative 12.2 mm (± 4.8 mm). Femoral component positioning related to the trans-epicondylar axis showed an external rotation of 2.80° (± 2.10°) at follow-up with respect to 5.7° (± 1.80°). Clinically, two (6.6%) patients reported patello-femoral complications related to imperfections in the surgical technique more than the implant''s design.

Conclusions

This study highlighted that modern femoral designs in TKA allow for a correct reproducibility of a normal patello-femoral conformity. Strict surgical principles are paramount to avoid patello-femoral complications even when modern implants are used.     

Prognostic and predictive value of intratumoral microvessels density in operable non-small-cell lung cancer.

Experimental evidence suggests that tumor growth and progression depend on angiogenesis. In a retrospective study we evaluated the relationship between tumor angiogenesis and survival in patients with NSCLC treated with potentially curative surgery between 1992 and 1997. The study population consisted of 76 patients. An anti-CD34 monoclonal antibody was used to measure angiogenesis in tumor samples. Angiogenesis was quantified in terms of microvessel count (MVC): in each sample the three most intense regions of neovascularization were identified under low microscopic power. A x250 field in each of the three areas was then counted and the highest count of the three fields was recorded. Disease free (DFS) and overall survival (OS) during follow up were evaluated. Gender, age, stage, histologic type and KI-67 were the other factors considered for analysis. The median MVC in our series was 41.5. Among the clinicopathologic parameters examined the microvessel count was the only one to show a significant association with disease free survival in univariate analysis (P = 0.04). MVC value is a new indicator of tumor aggressiveness in patients with NSCLC who underwent potentially curative surgery and should be taken into consideration in selecting patients for adjuvant treatment.     

Performance of six severity-of-illness scores in cancer patients requiring admission to the intensive care unit: a prospective observational study

Introduction  

The aim of this study was to evaluate the performance of five general severity-of-illness scores (Acute Physiology and Chronic Health Evaluation II and III-J, the Simplified Acute Physiology Score II, and the Mortality Probability Models at admission and at 24 hours of intensive care unit [ICU] stay), and to validate a specific score – the ICU Cancer Mortality Model (CMM) – in cancer patients requiring admission to the ICU.     

Prevention and therapy of neutropenia in elderly patients

Standard chemotherapy in elderly patients is still nowadays a difficult issue, due to the fact that marrow reserve decrease with age and the results might lead to higher toxicity of otherwise well tolerated regimen and schedule. In the literature, very few data exist of myelosuppression in patients with solid tumors, while more data have been published on non-Hodgkin's lymphoma. The burden of toxicity increase with age, leading to the fact that some patients with curable or sensitive disease do not receive appropriate treatment. One of the ways to try to circumvent neutropenia is the prophylactic use of haematopoietic growth factors with the double aim of maintaining dose-intensity and reducing toxicity. This paper will describe the patterns of marrow toxicity in treating elderly patients with cancer and the role of haematopoietic growth factors.     

传统及改良冻存法对人胎肝细胞保护效果的比较

目的:比较传统及改良冻存法对人胎肝细胞保护效果,建立一种适合于人胎肝细胞冷冻保存的方法。方法:实验于2006-07/11在广州医学院进行。①人胎肝组织取自中期终止妊娠胎儿(20周,经胎儿亲属知情同意及医院伦理委员会批准)。冷冻保护液包括A液(DMEM培养液含1.5mol/L乙二醇 体积分数为0.2胎牛血清);B液(A液 0.1mol/L蔗糖)两部分。②传统冻存法:用0.025%Ⅰ型胶原酶消化胎肝组织,分离、收集消化后的胎肝细胞。胎肝细胞在A液、B液中分别渗透平衡20min后,在冷冻保护B液中经液氮蒸汽冷平衡5min后迅速入液氮冻存,1周后复苏培养观察。③改良冻存法:胎肝组织在A液、B液中分别渗透平衡20min后,在冷冻保护液B液中经液氮蒸汽冷平衡5min后迅速入液氮冻存,1周后复苏,入DMEM培养液37℃孵育1h,胶原酶消化胎肝组织,分离、收集消化后的胎肝细胞培养观察。④新鲜分离的胎肝细胞做为对照组。⑤复苏后分离所得胎肝细胞用锥虫兰染色评估细胞活率,并记录贴壁时间,观察集落生长情况。结果:①锥虫兰染色结果显示传统冻存法复温后的胎肝细胞活率为(73.8±2.2)%,明显低于新鲜分离的胎肝细胞活率(89.2±3.6)%及改良冻存法所得胎肝细胞活率(82.5±4.2)%(P<0.01)。②贴壁情况观察发现新鲜胎肝细胞与改良冻存法胎肝细胞于培养24h开始贴壁,而传统冻存法胎肝细胞贴壁时间滞后48h。③新鲜胎肝细胞及改良冻存法胎肝细胞于第3天出现生长集落(细胞数>10为一个集落),传统冻存法胎肝细胞在第5天出现生长集落,集落的数量低于改良冻存法及对照组(P<0.01)。结论:改良冻存法可避免冻存前损伤,提高细胞对冷冻的耐受性和冻存复温后细胞的活率。     

An alpha-globin gene initiation codon mutation in a black family with HbH disease

The molecular basis of hemoglobin H disease in a Black family of Canadian origin was investigated. Affected individuals had a combination of deletion and nondeletion alpha-thalassemia mutations on different chromosomes. Cloning and sequencing of the DNA of one member with the nondeletion form revealed a new thalassemia mutation, an A---- G substitution, in the initiation codon of the remaining alpha-globin gene of a rightward (-alpha 3.7) deletion chromosome. This mutation abolished an Ncol restriction site and therefore is detectable in genomic DNA by Southern blot analysis.