The prognostic value of polycomb group protein B‐cell‐specific moloney murine leukemia virus insertion site 1 in stage II colon cancer patients

The aim of this study was to investigate the prognostic value of B‐cell‐specific moloney murine leukemia virus insertion site 1 (BMI1) protein expression in primary tumors of stage II colon cancer patients. BMI1 protein expression was assessed by immunohistochemistry in a retrospective patient cohort consisting of 144 stage II colon cancer patients. BMI1 expression at the invasive front of the primary tumors correlated with mismatch repair status of the tumors. Furthermore, BMI1 expression at the luminal surface correlated with T‐stage, tumor location, and the histological subtypes of the tumors. In a univariate Cox proportional hazard analysis, no statistical significant association between risk of relapse and BMI1 protein expression at the invasive front (HR: 1.12; 95% CI 0.78–1.60; p = 0.53) or at the luminal surface of the tumor (HR: 1.06; 95% CI 0.75–1.48; p = 0.70) was found. Likewise, there was no association between 5‐year overall survival and BMI1 expression at the invasive front (HR: 1.12; 95% CI 0.80–1.56; p = 0.46) or at the luminal surface of the tumor (HR: 1.16; 95% CI 0.86–1.60; p = 0.33). In conclusion, BMI1 expression in primary tumors of stage II colon cancer patients could not predict relapse or overall survival of the patients, thus having a limited prognostic value in stage II colon cancer patients.     

Superior fixation and less periprosthetic stress-shielding of tibial components with a finned stem versus an I-beam block stem: a randomized RSA and DXA study with minimum 5 years’ follow-up

Background and purpose — The stem on the tibial component of total knee arthroplasty provides mechanical resistance to lift-off, shear forces, and torque. We compared tibial components with finned stems (FS) and I-beam block stems (IS) to assess differences in implant migration.

Patients and methods — In a patient-blinded RCT, 54 patients/knees (15 men) with knee osteoarthritis at a mean age of 77 years (70–90) were randomly allocated to receive tibial components with either a FS (n = 27) or an IS (n = 27). Through 5 to 7 years’ follow-up, implant migration was measured with RSA, periprosthetic bone mineral density (BMD) was measured with DXA, and surgeons reported American Knee Society Score (AKSS).

Results — At minimum 5 years’ follow-up, maximum total point motion (MTPM) was higher (p = 0.04) for IS (1.48?mm, 95% CI 0.81–2.16) than for FS (0.85?mm, CI 0.38–1.32) tibial components. Likewise, total rotation (TR) was higher (p = 0.03) for IS (1.51?, CI 0.78–2.24) than for FS (0.81?, CI 0.36–1.27). Tibial components with IS externally rotated 0.50° (CI –0.06 to 1.06) while FS internally rotated 0.09° (CI –0.20 to 0.38) (p = 0.03). Periprosthetic bone stress-shielding was higher (p < 0.01) up to 2 years’ follow-up for IS compared with FS in the regions medial to the stem (–13% vs. –2%) and posterior to the stem (–13% vs. –2%). Below the stem bone loss was also higher (p = 0.01) for IS compared with FS (–6% vs. +1%) up to 1-year follow-up. Knee score improved similarly in both groups up to 5 years’ follow-up.

Interpretation — Periprosthetic bone stress-shielding medial and posterior to the stem until 2 years, and tibial component migration at 5 years, was less for a finned compared with an I-shaped block stem design.

Trial registration: ClinicalTrials.gov identifier: NCT00175136.     

Reliability of computer-assisted periacetabular osteotomy using a minimally invasive approach

Background

Periacetabular osteotomy (PAO) is the treatment of choice for younger patients with developmental hip dysplasia. The procedure aims to normalize the joint configuration, reduce the peak-pressure, and delay the development of osteoarthritis. The procedure is technically demanding and no previous study has validated the use of computer navigation with a minimally invasive transsartorial approach.

Methods

Computer-assisted PAO was performed on ten patients. Patients underwent pre- and postoperative computed tomography (CT) scanning with a standardized protocol. Preoperative preparation consisted of outlining the lunate surface and segmenting the pelvis and femur from CT data. The Biomechanical Guidance System was used intra-operatively to automatically calculate diagnostic angles and peak-pressure measurements. Manual diagnostic angle measurements were performed based on pre- and postoperative CT. Differences in angle measurements were investigated with summary statistics, intraclass correlation coefficient, and Bland–Altman plots. The percentage postoperative change in peak-pressure was calculated.

Results

Intra-operative reported angle measurements show a good agreement with manual angle measurements with intraclass correlation coefficient between 0.94 and 0.98. Computer navigation reported angle measurements were significantly higher for the posterior sector angle (\(1.65^{\circ }\), \(p=0.001\)) and the acetabular anteversion angle (\(1.24^{\circ }\), \(p=0.004\)). No significant difference was found for the center-edge (\(p=0.056\)), acetabular index (\(p=0.212\)), and anterior sector angle (\(p=0.452\)). Peak-pressure after PAO decreased by a mean of 13% and was significantly different (\(p=0.008\)).

Conclusions

We found that computer navigation can reliably be used with a minimally invasive transsartorial approach PAO. Angle measurements generally agree with manual measurements and peak-pressure was shown to decrease postoperatively. With further development, the system will become a valuable tool in the operating room for both experienced and less experienced surgeons performing PAO. Further studies with a larger cohort and follow-up will allow us to investigate the association with peak-pressure and postoperative outcome and pave the way to clinical introduction.

     

Ear measurement of temperature is only useful for screening for fever in an adult emergency department

Background

A new generation of ear thermometers with preheated tips and several measurements points should allow a more precise temperature measurement. The aim of the study was to evaluate if the ear temperature measured by this ear thermometer can be used to screen for fever and whether the thermometer is in agreement with the rectal temperature and if age, use of hearing devices or time after admission influences the temperature measurements.

Methods

Open cross-sectional clinical single site study patients, >?18?years old, who were acutely admitted to the short stay unit at the ED. A sample size of 99 patient per subgroup was recruited as random convenience series. As ear thermometer Braun Thermoscan Pro 4000® and as rectal thermometer Omron Flex Temp Smart ® was used. For different cut off of temperature the AUC was calculated and Bland-Altman analysis for calculation of 95% limits of agreement with rectal temperature, with subgroup analysis concerning age, time span from admission time and use of hearing aid.

Results

Among 599 patients the sensitivity to detect fever with an ear thermometer varied between 68 and 70% with AUC from 0.88–0.97. If the ear temperature was ≥37.5 oC, the sensitivity to detect patients with ≥38.0 oC rectally was 95% which raised to 100% for a rectal temperature of ≥38.3 oC. For the ear thermometer’s ability to determine the exact temperature the 95% limits of agreement were +/??0.8 oC. with no influence from age, duration of hospital stay or hearing aids.

Conclusion

The examined ear thermometer is able to detect fever, defined as ≥38 oC rectally in an adult ED population by using an ear cut-point of 37.5 oC, but not to measure the exact temperature. Used in this way around a fifth of the patients will still be in need of a rectal temperature measurement, but less than 5% with fever ≥38.0 oC will remain undetected and none with fever ≥38.3 oC. Age, admission time and use of hearing aid did not influence the temperature measurements.

Trial registration

Clinical Trials: ID NCT02977481, date 11/18/2016.

     

Connexins regulate calcium signaling by controlling ATP release

Forced expression of gap junction proteins, connexins, enables gap junction-deficient cell lines to propagate intercellular calcium waves. Here, we show that ATP secretion from the poorly coupled cell lines, C6 glioma, HeLa, and U373 glioblastoma, is potentiated 5- to 15-fold by connexin expression. ATP release required purinergic receptor-activated intracellular Ca²⁺ mobilization and was inhibited by Cl⁻ channel blockers. Calcium wave propagation also was reduced by purinergic receptor antagonists and by Cl⁻ channel blockers but insensitive to gap junction inhibitors. These observations suggest that cell-to-cell signaling associated with connexin expression results from enhanced ATP release and not, as previously believed, from an increase in intercellular coupling.     

The Copeland resurfacing humeral head implant does not restore humeral head anatomy. A retrospective study

Purpose

Recently, there has been concern that the Copeland resurfacing humeral head implant (RHHI) leaves the shoulder joint overstuffed. The purpose of this study was in a selected cohort of patients operated with a Copeland RHHI (1) to evaluate the Length of the Gleno-Humeral Offset (LGHO), (2) to assess the patient-reported quality of life and functional outcome measured by Western Ontario Osteoarthritis of the Shoulder Index (WOOS) and (3) to determine the number of revisions in the cohort.

Methods

Pre- and postoperative radiographs were retrieved from 71 of 91 possible patients operated with a Copeland RHHI from 2005 to 2009. The cohort consisted of 30 males and 41 females at a mean age of 61 (38–89) years. One radiologist measured the LGHO and performed double measurements. The WOOS score 1 year after surgery and the number of revisions from all patients operated with a Copeland RHHI in Denmark was requested from the Danish Shoulder Arthroplasty Registry.

Results

The mean LGHO was 4.99 ± 0.53 cm before surgery and 5.39 ± 0.58 cm after surgery, (p < 0.001). 95 % limits of agreement for measurements of LGHO were ± 0.11 cm. One year after surgery, the WOOS score was 67 for the cohort and 64 for all patients operated with a Copeland RHHI in Denmark. 13 of 71 RHHI in the cohort were revised.

Conclusion

The Copeland RHHI causes significantly increased LGHO and leads to overstuffing in the shoulder joint. The WOOS score in the cohort was comparable to that for all other Danish patients operated with a Copeland RHHI.