Is the Revision Rate Higher After Hip Arthroplasty in Teenage Patients? A Prospective Study with Long-Term Follow-Up of More Than 10 Years

BackgroundTotal hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) are already proven good for end-stage arthritis in the older populations but it is challenging in young teenage patients. The primary aim was to assess Hip Disability and Osteoarthritis Outcome Score (HOSS), Harris Hip Score (HHS) and secondary aim for implant survival rate.Materials and MethodsThe details of 33 teenage patients (forty hips) who underwent HRA (21) and THA (19) at our institution (January 2002 to December 2013) with a mean follow-up period of 11.00 years (range 7.00–18.40) were included. The study group had 25 males and eight females.ResultsThe overall median HOOSs with interquartile range were 89.00 (87.63–0.00). The median HOOSs at follow-up were as follows: 95.00 (90.00–95.00) for symptoms, 92.00 (90.00–95.00) pain, 87.00 (85.00–90.00) for functions, 81.00 (75.00–85.00) for sports and 94.00 (88.00–95.00) for QOL. HHS improved significantly from 36.88 ± 6.14 to 90.12 ± 6.56 (p < 0.001). The HHS of HRA group improved from 36.29 ± 5.83 to 89.38 ± 5.23 and THA group improved from 37.26 ± 6.22 to 90.94 ± 7.84. The 5-year radiological follow-up X-rays did not show any radiolucent line wider than 2 mm in all three zones of the acetabulum and no progressive subsidence or migration of > 1 mm and divergent radiopaque line in femur. The Implant survival rate for HRA was 100% at 5 years, 100% at 10 years, 92% at 15 years and THA group was 100% at 5 years and 90% at 10 years.ConclusionOur study showed a disability rate of zero with improved HOSS and HHS. The overall implant survival rate was good with 100% at 5 years, 97% at 10 years and 89.9% at 15 years in contrast to the previous studies with the use of modern implants and newer standard surgical techniques.Level of EvidenceA Level II study http://www.spine.org/Documents/LevelsofEvidenceFinal.pdf.     

Assessment of estrus cyclicity in the Asian elephant (Elephas maximus) by measurement of fecal progesterone metabolite 5α-P-3OH, using a non-invasive assay

Reproductive management of the Asian elephant (Elephas maximus) is important for its conservation. To monitor its estrous cyclicity, we earlier used an indirect ELISA to show that levels of fecal progesterone (P(4))-metabolite (allopregnanolone: 5α-P-3OH) in semi-captive females sampled randomly positively correlated with serum P(4) levels [12]. In this longitudinal study (51 weeks), we measured levels of fecal 5α-P-3OH and serum P(4) in seven semi-captive female elephants. Females exhibited three types of hormonal profiles. Four females showed cyclical patterns of fecal 5α-P-3OH and serum P(4) typical of normal estrous cycles, two showed acyclic pattern while one showed high values indicative of a pregnant animal. Values for anestrous or follicular phases were ≤ 0.3 μg g(-1) (5α-P-3OH) and ≤ 0.3 ng mL(-1) (P(4)); for luteal phase 0.32-11.09 μg g(-1) (5α-P-3OH) and 0.32-1.48 ng mL(-1) (P(4)); for pregnancy 1.41-7.38 μg g(-1) (5α-P-3OH) and 0.39-1.6 ng mL(-1) (P(4)). A positive correlation (t = 8.8, p < 0.01, n = 321) between levels of fecal 5α-P-3OH and serum P(4) was observed. A random sample of 30 free-ranging female elephants showed fecal 5α-P-3OH values of 0.06-23.4 μg g(-1), indicating them to be in different stages of estrous cyclicity. This study is the first to assess the reproductive phases of female Asian elephants based on the correlative-patterns of both the fecal 5α-P-3OH and serum P(4) values over multiple estrous cycles. This has a potential application in the reproductive management and conservation of Asian elephants.     

Montanide ISA™ 201 adjuvanted FMD vaccine induces improved immune responses and protection in cattle

Despite significant advancements in modern vaccinology, inactivated whole virus vaccines for foot-and-mouth disease (FMD) remain the mainstay for prophylactic and emergency uses. Many efforts are currently devoted to improve the immune responses and protective efficacy of these vaccines. Adjuvants, which are often used to potentiate immune responses, provide an excellent mean to improve the efficacy of FMD vaccines. This study aimed to evaluate three oil adjuvants namely: Montanide ISA-201, ISA-206 (SEPPIC, France) and GAHOL (an in-house developed oil-adjuvant) for adjuvant potential in inactivated FMD vaccine. Groups of cattle (n = 6) were immunized once intramuscularly with monovalent FMDV ‘O’ vaccine formulated in these adjuvants, and humoral (serum neutralizing antibody, IgG₁ and IgG₂) and cellular (lymphoproliferation) responses were measured. Montanide ISA-201 adjuvanted vaccine induced earlier and higher neutralizing antibody responses as compared to the two other adjuvants. All the adjuvants induced mainly serum IgG₁ isotype antibody responses against FMDV. However, Montanide ISA-201 induced relatively higher IgG₂ responses than the other two adjuvants. Lymphoproliferative responses to recall FMDV antigen were relatively higher with Montanide ISA-201, although not always statistically significant. On homologous FMDV challenge at 30 days post-vaccination, 100% (6/6) of the cattle immunized with Montanide-201 adjuvanted vaccine were protected, which was superior to those immunized with ISA-206 (66.6%, 4/6) or GAHOL adjuvanted vaccine (50%, 3/6). Virus replication following challenge infection, as determined by presence of the viral genome in oropharynx and non-structural protein serology, was lowest with Montanide ISA-201 adjuvant. Collectively, these results indicate that the Montanide ISA-201 adjuvanted FMD vaccine induces enhanced immune responses and protective efficacy in cattle.     

Antioxidative and hypolipidemic efficacy of alcoholic seed extract of Swietenia macrophylla in streptozotocin diabetic rats

The present study was designed to examine the antioxidative potential and antihyperlipidemic activity of Swietenia macrophylla in streptozotocin diabetic rats. The experimental groups were rendered diabetic by intraperitoneal injection of a single dose of streptozotocin (STZ; 40 mg/kg body weight, BW). Rats with glucose levels >200 mg/dL were considered diabetic and were divided into five groups. Three groups of diabetic animals were orally administered daily with seed extract (SME) at a dosage of 50, 100 and 200 mg/kg BW. One group of STZ rats was treated as diabetic control and another group orally administered 600 μg/kg BW glibenclamide daily. Repeated daily oral administration of S. macrophylla significantly reduced blood glucose levels after 45 days of treatment. The lipid peroxidation products such as thiobarbituric acid reactive substances and lipid hydroperoxides of SME treated rats decreased in the plasma, liver and kidney. Glutathione peroxidase, superoxide dismutase and catalase activity were significantly increased in SME treated rats. Antioxidants such as reduced glutathione level in the plasma, liver and kidney and vitamins C and E levels in the plasma increased in SME treated rats. Total cholesterol, triglycerides, phospholipids and free fatty acids and lipoproteins levels increased. Altered lipid profile of treated rats lead to normality with treatment of S. macrophylla. Thus, our results indicate that the administration of 100 mg/kg BW SME restores near normal blood glucose, redox status and lipid profile in STZ-diabetic rats.     

Effects of nanoparticle‐encapsulated curcumin on arsenic‐induced liver toxicity in rats

We investigated the therapeutic effectiveness of the nanoparticle‐encapsulated curcumin (CUR‐NP) against sodium arsenite‐induced hepatic oxidative damage in rats. The CUR‐NP prepared by emulsion technique was spherical in shape with an encapsulation efficiency of 86.5%. The particle size ranged between 120 and 140 nm with the mean particle size being 130.8 nm. Rats were divided into five groups of six each. Group 1 served as control. Group 2 rats were exposed to sodium arsenite (25 ppm) daily through drinking water for 42 days. Groups 3, 4, and 5 were treated with arsenic as in group 2, however, they were administered, empty nanoparticles, curcumin (100 mg/kg bw) and CUR‐NP (100 mg/kg bw), respectively, by oral gavage during the last 14 days of arsenic exposure. Arsenic increased the activities of serum alanine aminotransferase and aspartate aminotransferase and caused histological alterations in liver indicating hepatotoxicity. Arsenic increased lipid peroxidation, depleted reduced glutathione and decreased the activities of superoxide dismutase, catalase, glutathione peroxidase and glutathione reductase in liver. All these effects of arsenic were attenuated with both curcumin and CUR‐NP. However, the magnitude of amelioration was more pronounced with CUR‐NP. The results indicate that curcumin given in nano‐encapsulated form caused better amelioration than free curcumin. © 2013 Wiley Periodicals, Inc. Environ Toxicol 30: 628–637, 2015.     

Does Balancing a Total Hip Arthroplasty Require a New Paradigm? Functional 3-Dimensional Balancing in Total Hip Arthroplasty

BackgroundTraditional principles for successful outcomes in Total Hip Arthroplasty (THA) have relied largely on placing the socket in the native position and trying to restore static anatomical femoral parameters gauged on X-rays or intra-operative measurement. Stability is conventionally achieved by making appropriate changes during the time of trial reduction. Post-operative complications of dislocation and significant Limb Length Discrepancy (LLD) requiring foot wear modification represents opposite ends of the spectrum from a biomechanical perspective and these continue to be relatively high. A move towards giving more importance to functional dynamic parameters rather than static anatomical parameters and less reliance on stability testing at trial reduction is warranted.MethodsIntraoperative 3D functional balancing of THA without stability testing at trial reduction was practiced in all subjects undergoing THA in our unit from April 2014. To date 1019 patients have had their hips replaced with the same technique. They were followed up till April 2020 for post-operative complications of dislocation and significant LLD needing footwear modification. A secondary cohort of 114 patients from 1st January to December 31st 2017 within this primary group were analyzed clinically and radiologically to ascertain the implications of functional 3D balancing on X-ray parameters, clinical outcome scores (Harris Hip Score and Oxford Hip Score), ability to squat, and subtle subjective post-operative perception of limb lengthening (POPLL).ResultsIn the primary group of 1019 patients, there were only two dislocations and no patient needed footwear modification for LLD. In the detailed analysis of the secondary cohort of 114 patients, the correlation with restoration of static radiological parameters was inconsistent. 40 patients could not squat and 4 patients had subtle subjective post-operative perceived limb lengthening (POPLL). Measured outcomes such as HHS and OHS were improved in all patients with significant statistical significance (P < 0.001).ConclusionThis study underlines the fact that more importance must be given to functional dynamic parameters by 3D balancing of the THA and not on static anatomical X-rays parameters and stability testing during trial reduction. This represents a paradigm shift in the evolution of total hip arthroplasty.Level of EvidenceA Level II study. (Data collected from the ongoing prospective study) (http://www.spine.org/Documents/LevelsofEvidenceFinal.pdf).Supplementary InformationThe online version contains supplementary material available at 10.1007/s43465-021-00505-3.