Perthes disease: a survey of management amongst members of the British Society for Children’s Orthopaedic Surgery (BSCOS)

The treatment of Legg-Calvé-Perthes disease remains controversial. The aim of this survey was to ascertain the current management strategies of this condition amongst UK paediatric orthopaedic surgeons, with particular regard to containment procedures in the fragmentation phase. Questionnaires were distributed at the January 2006 meeting of the British Society for Children’s Orthopaedic Surgery (BSCOS) and was posted to all absent members. The results showed a great deal of variability not only in the treatment of Perthes disease, but also in the decision-making processes. Consideration must now be given to a carefully constructed national multi-centre prospective randomised controlled study into the optimum management of this disease     

Y chromosome deletions in azoospermic and severely oligozoospermic men undergoing intracytoplasmic sperm injection after testicular sperm extraction

Y chromosome deletions encompassing the AZFc region have been reported in 13% of azoospermic men and 7% of severely oligozoospermic men. We examined the impact of these Y deletions on the severity of testicular defects in 51 azoospermic men undergoing intracytoplasmic sperm injection (ICSI) after testicular sperm extraction (TESE) and 30 men with severe oligozoospermia undergoing ICSI after ejaculation of spermatozoa. In addition, five azoospermic patients shown previously to have Y chromosome deletions underwent histological evaluation of their previously obtained testis biopsy specimens. A further 27 azoospermic men underwent TESE-ICSI, but not Y chromosome DNA testing. Ten of 51 azoospermic men (20%) who underwent TESE-ICSI and Y-DNA testing were found to be deleted for portions of the Y chromosome AZFc region. Of these 10, five had spermatozoa retrievable from the testis, and in two cases the wives became pregnant. Of the 41 azoospermic men with no Y chromosome deletion, 22 (54%) had spermatozoa retrievable from the testis, and in 12 cases (29%) the wives became pregnant. Four of 30 (13%) severely oligozoospermic patients were found to be deleted for AZFc and in three (75%) of these pregnancy was achieved. The other 26 severely oligozoospermic couples who had no AZFc deletions underwent ICSI, and 12 (46%) have an ongoing or delivered pregnancy. The embryo implantation rate was not significantly different for azoospermic (22%), oligozoospermic (16%), Y-deleted (14%) or Y-intact (18%) men. Of the total of 19 infertile men who had Y chromosome deletions, 14 had deletions within Y chromosome intervals 6D-6F, in the AZFc region. Twelve of those 14 had some spermatozoa (however few in number) in the ejaculate or testis. Five of the Y-deleted men had deletions that extended more proximally on the Y chromosome, and in none of these could any spermatozoa be observed in either ejaculate or testis. These results support the concept that, in azoospermic or oligozoospermic men with Y chromosome deletions limited to intervals 6D-6F (AZFc), there are generally very small numbers of testicular or ejaculated spermatozoa. Larger Y deletions, including and extending beyond the AZFc region and encompassing more Y genes, tend to be associated with a total absence of testicular spermatozoa. In those cases where spermatozoa were retrieved, the presence of Y deletions had no obvious impact on fertilization or pregnancy rate.      

Replication-independent expression of genome components and capsid protein of brome mosaic virus in planta: a functional role for viral replicase in RNA packaging

To begin elucidation of the relationship between Brome mosaic virus (BMV) replication and encapsidation, we used a T-DNA-based Agrobacterium-mediated transient expression (agroinfiltration) system in Nicotiana benthamiana leaves to express either individual or desired pairs of the three genomic RNAs. The packaging competence of these RNAs into virions formed by the transiently expressed coat protein (CP) was analyzed. We found that in the absence of a functional replicase, assembled virions contained non-replicating viral RNAs (RNA1 or RNA2 or RNA3 or RNA1 + RNA3 or RNA2 + RNA3) as well as cellular RNAs. By contrast, virions assembled in the presence of a functional replicase contained only viral RNAs. To further elucidate the specificity exhibited by the functional viral replicase in RNA packaging, replication-defective RNA1 and RNA2 were constructed by deleting the 3' tRNA-like structure (3' TLS). Co-expression of TLS-less RNA1 and RNA2 with wt RNA3 resulted in efficient synthesis of subgenomic RNA4. Virions recovered from leaves co-expressing TLS-less RNA1 and RNA2 and either CP mRNA or wt RNA3 exclusively contained viral RNAs. These results demonstrated that packaging of BMV genomic RNAs is not replication dependent whereas expression of a functional viral replicase plays an active role in increasing specificity of RNA packaging.     

Spinal tuberculosis in HIV positive and negative patients: immunological response and clinical outcome

We measured cytokine secretion patterns in peripheral blood and granulation tissue by flow cytometry in 16 human immunodeficiency virus (HIV) positive and 26 HIV negative patients with spinal tuberculosis. Anti-retroviral therapy was not prescribed. There were no significant differences in the postoperative morbidity and neurological recovery between the two groups.

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Résumé  Nous avons mesuré, par cytométrie en flux, la sécrétion de cytokine dans le sang périphérique et le tissu de granulation chez des patients atteints de tuberculose rachidienne, 16 HIV positifs et 26 HIV négatifs. Il n’y avait pas de différence significative dans la morbidité post-opératoire et la récupération neurologique entre les deux groupes.

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Accepted: 21 February 2000     

Effect of Different Levels of Dietary Vitamin C on Growth Performance,Muscle Composition,Antioxidant and Enzyme Activity of <Emphasis Type="Italic">Macrobrachium rosenbergii</Emphasis>

A 12- week feeding trial was conducted to determine the effects of dietary vitamin C levels on the growth performance, antioxidant ability, muscle composition and enzyme activity in freshwater prawn, Macrobrachium rosenbergii. The experimental basal diets were supplemented with M. rosenbergii at the rates of 0 (control), 25, 50, 75, 150 and 300 mg/kg dry feed weight and the assays were in triplicate. Growth performance, body composition, antioxidant activity and serum biochemistry parameters were determined. However, the present investigation revealed that prawns fed with diet supplemented with 25–150 mg/kg of vitamins C shows enhanced (P < 0.05) growth performance, including final weight and weight gain. Additionally, prawns fed with 25–150 mg/kg of vitamins C supplemented diets achieved significant (P < 0.05) improvement in growth performance, digestive enzyme activities, and muscle biochemical composition, while, the prawns fed with 150 mg/kg of vitamin C showed enhanced performance respectively. However, the prawns fed with above 150–300 mg/kg showed poor performance. The antioxidant enzymatic activity (SOD, CAT) metabolic enzyme status in muscle showed no significant (P > 0.05) alterations in prawns fed with 25–150 mg/kg of vitamin C supplemented diets. Therefore, the present findings suggested that 150 mg/kg of vitamin C could be supplemented for flexible enhanced survival, growth, antioxidant defense system and production of M. rosenbergii.     

The Impella Microaxial Flow Catheter Is Safe and Effective for Treatment of Myocarditis Complicated by Cardiogenic Shock: An Analysis From the Global cVAD Registry

Background

Myocarditis complicated by cardiogenic shock remains a complex problem. The use of acute mechanical circulatory support devices for cardiogenic shock is growing. We explored the utility of Impella transvalvular microaxial flow catheters in the setting of myocarditis with cardiogenic shock.

Incidence and Risk Factors of Deep Vein Thrombosis After Liver Transplantation

BackgroundDeep venous thrombosis (DVT) occurs in 0.1% of persons per year, affecting 15%–40% of general surgical procedures without prophylaxis. Thromboembolic prophylaxis is not commonly used after orthotopic liver transplantation (LT) owing to the risks of bleeding and coagulopathy. Cirrhosis and the association with the coagulation cascade, before and after transplantation, are not well understood. The purpose of this study was to determine the incidence of DVT and its risk factors after LT.MethodsWe retrospectively reviewed LTs performed at our center from 2005 to 2012. We identified patients with Doppler examinations showing DVT after LT, platelet count, and international normalized ratio (INR) at time of DVT, associated symptoms, DVT prophylaxis, and perioperative risk factors. We determined the incidence of DVT, the odds ratio of each preoperative risk factor, the difference in platelet count and INR between those with and without a DVT, and the weighted risk of each factor in the development of DVT with the use of logistic regression modeling.ResultsOf 314 patients, the incidence of DVT was 8.6% (27/314). Between those with and without DVT there was no significant difference in age, sex, platelet count, INR, infection, hepatocellular cancer, use of venous bypass, and prior surgery. There was a significant difference in mobility, 67% vs 20% (P < .0001), and the use of factor VII, 11% vs 2% (P < .05). The estimated risk for of developing DVT for patients with neither of these factors was 4%; with factor VII the risk rose to 17%; with mobility difficulty the risk rose to 23%; and with both the risk was 62%. In our entire population, there were no cases of pulmonary embolism.ConclusionsThe risk of developing a DVT after LT is ≥9% even with mechanical DVT prophylaxis. Consideration should be given to using both mechanical and chemical prophylaxis after LT.