From the mouths of babes: dental caries in infants and children and the intensification of agriculture in mainland Southeast Asia.

Many bioarchaeological studies have established a link between increased dental caries prevalence and the intensification of agriculture. However, research in Southeast Asia challenges the global application of this theory. Although often overlooked, dental health of infants and children can provide a sensitive source of information concerning health and subsistence change. This article investigates the prevalence and location of caries in the dentition of infants and children (less than 15 years of age) from eight prehistoric mainland Southeast Asian sites collectively spanning the Neolithic to late Iron Age, during which time rice agriculture became an increasingly important subsistence mode. Caries prevalence varied among the sites but there was no correlation with chronological change. The absence of evidence of a decline in dental health over time can be attributed to the relative noncariogenicity of rice and retention of broad-spectrum subsistence strategies. No differences in caries type indicating differences in dental health were found between the sites, apart from the Iron Age site of Muang Sema. There was a higher prevalence of caries in the deciduous dentition than the permanent dentition, likely due to a cariogenic weaning diet and the higher sensitivity of deciduous teeth to decay. The level of caries in the permanent dentition suggests an increased reliance on less cariogenic foods during childhood, including rice. The absence of a temporal decline in dental health of infants and children strengthens the argument that the relationship between caries and agricultural intensification in Southeast Asia was more complex than the general model suggests.

Is there a role for total ankle replacement in polio patients?: A case report and review of the literature.

Although poliomyelitis is almost eradicated, as orthopaedic surgeons we occasionally encounter residual deformities in patients who suffered the disease in the past. An equino-varus deformity of the foot is the commonest deformity seen. In this report we present a 53 years old lady who had poliomyelitis as a child and presented with a painful, degenerate ankle and 12 degrees of varus deformity. CT confirmed advanced degenerative changes. The management options included realignment and fusion, supramalleolar ostoetomy or total ankle replacement. In view of the satisfactory active range of motion and advanced OA confirmed by CT scan we considered the option of total ankle replacement. To our knowledge this has never been reported before. At two and half years follow up the patient showed satisfactory functional results (AOFAS score 88/100) and high satisfaction. Plain radiographs revealed a well aligned joint with no evidence of loosening or osteolysis.

Revision of STAR total ankle replacement to hybrid AES-STAR total ankle replacement-a report of two cases.

Revision of a failed total ankle replacement is a surgical challenge due to paucity of the revision ankle implants. We report early results of two cases in which Scandinavian Total Ankle Replacements (STAR) were revised to hybrid AES (Ankle Evolution System)-STAR replacements for aseptic loosening of the tibial components. We are not aware of any similar case report in the literature reporting hybrid total ankle replacements.

Revision of failed total ankle arthroplasty to a hindfoot fusion: 23 consecutive cases using the Phoenix nail.

Aims: The aim of this study was to present a series of patients with aseptic failure of a total ankle arthroplasty (TAA) who were treated with fusion of the hindfoot using a nail. Patients and Methods: A total of 23 TAAs, in 22 patients, were revised for aseptic loosening and balloon osteolysis to a hindfoot fusion by a single surgeon (NH) between January 2012 and August 2014. The procedure was carried out without bone graft using the Phoenix, Biomet Hindfoot Arthrodesis Nail. Preoperative investigations included full blood count, CRP and ESR, and radiological investigations including plain radiographs and CT scans. Postoperative plain radiographs were assessed for fusion. When there was any doubt, CT scans were performed. Results: The mean follow-up was 13.9 months (4.3 to 37.2). Union occurred at the tibiotalar joint in 22 ankles (95.6%) with one partial union. Union occurred at the subtalar joint in 20 ankles (87%) of cases with two nonunions. The nail broke in one patient with a subtalar nonunion and revision was undertaken. The only other noted complication was one patient who suffered a stress fracture at the proximal aspect of the nail, which was satisfactorily treated conservatively. Conclusion: This study represents the largest group of patients reported to have undergone revision TAA to fusion of the hindfoot with good results Cite this article: Bone Joint J 2018;100-B:475-9.

Pharmacokinetics of the in vivo and in vitro conversion of 9-nitro-20(S)-camptothecin to 9-amino-20(S)-camptothecin in humans, dogs, and mice.

We have determined that 9-nitro-20(S)-camptothecin (9NC) converts to 9-amino-20(S)-camptothecin (9AC) in humans, dogs, and mice. Following a single oral dose of 0.1 mg/kg of 9NC, the human plasma concentration reached a maximum concentration of 483 ng/ml at 3.4 h with an area under the curve (AUC) of 2.6 micrograms.h/ml and a half-life of 2.5 h. As conversion of 9NC to 9AC occurred, the maximum calculated concentration of 9AC was 14.0 ng/ml at 10.3 h with an AUC of 311 ng.h/ml and a half-life of 7.1 h. Following a single oral dose of 1.0 mg/kg of 9NC, the maximum concentration of 9NC in the human volunteer was 1247 ng/ml at 5.3 h with an AUC of 17194 ng.h/ml and a half-life of 4.9 h. In this human, the Cmax of 9AC was 208 ng/ml at 17.2 h; the AUC was determined to be 9121 ng.h/ml, and the half-life was 13.1 h. In a dog after a single oral dose of 1.0 mg/kg 9NC, the maximum concentration for 9NC was 19.1 ng/ml at 0.7 h with a half-life of 6.4 h and an AUC of 186 ng.h/ml. The maximum concentration of 9AC in this dog was 9.2 ng/ml at 2.9 h with an AUC of 310 ng.h/ml and a half-life of 21.1 h. The maximum concentration of 9NC in the mouse after a single oral dose of 4.1 mg/kg of 9NC was 732 ng/ml at time 0.1 h with an AUC of 441 ng.h/ml and a half-life of 10.0 h. The maximum concentration of 9AC in the mouse was 26 ng/ml at 0.6 h. The AUC was 63 ng.h/ml, and the half-life was 1.2 h. Incubation of mouse liver, spleen, kidney, brain, and muscle tissue with 9NC all indicated conversion to 9AC, yet no conversion was observable in cell-free plasma from human or mouse blood. Structural identification of 9AC was confirmed by mass spectrometry.

Pharmacology of camptothecin esters.

An intact lactone ring of camptothecins is a structural requirement for their anticancer activity. Propionate esters of camptothecin (CPT) and 9-nitrocamptothecin (9NC), CZ48 and CZ112, respectively, have been synthesized as derivatives resistant to lactone hydrolysis and are chemotherapeutically active. In this study, we have examined the mechanism of action of CZ48 and CZ112 and their distribution, metabolism, and toxicity. CZ112 incubated in human plasma retained its lactone structure longer than 9NC (t1/2: 10.5 and < 1 hr for CZ112 and 9NC, respectively). This resistance to lactone hydrolysis was also observed in mouse plasma or albumin solutions. Neither CZ48 nor CZ112 inhibit topoisomerase I and thus are prodrugs dependent on hydrolysis to CPT or 9NC, respectively. Rates of hydrolysis of CZ48 to CPT are higher by homogenates of mouse liver, spleen, lung, and kidney than by plasma. Rates of hydrolysis by tumor cells in culture vary and were higher by breast cancer and melanoma cells than by colon cancer cells. On the basis of these and other data, it is proposed that CZ48 and CZ112 may act as anticancer agents by resisting hydrolysis to camptothecins while in circulation. Hydrolysis in tissues may release intact lactone in target tissues.

Skin and extremity loss in meningococcal septicaemia treated in a burn unit.

Meningococcal septicaemia is a severe systemic illness which has an overall mortality of 15 per cent. It differs from meningococcal meningitis in clinical presentation, treatment, complications and prognosis. Skin and extremity loss are particular problems seen in meningococcal septicaemia. As critical care improves more patients are being seen with these complications. We report two patients in which these complications are demonstrated. Both patients underwent multiple autogenic and allogenic skin grafting procedures for skin loss. Apparently necrotic extremities were initially treated conservatively, with good results. The total area of necrotic tissue reduced dramatically with this treatment. Despite this, however, one patient required a Syme amputation, in the other, two toes on the affected foot separated painlessly at the metatarsophalangeal joint. We also discuss some of the pathophysiology behind skin necrosis. A popular view at present is that endotoxin from the cell wall of Neisseria meningiditis initiates the release of vasoactive cytokines by the host. High levels of interleukin-1 and interleukin-6 have been associated with a greater likelihood of fatality.

Bilateral scaphoid exostoses.

We report a case of bilateral symptomatic scaphoid exostoses associated with osteoarthritis of the wrist. These were treated by surgical excision with good short-term results.

Orthopaedic management in four cases of mucolipidosis type III.

Four patients with mucolipidosis type III, three of them brothers, were seen initially in the first two decades of life. Their main symptoms were carpal tunnel syndrome, trigger fingers and generalized joint stiffness. Radiographs showed spinal deformities and hip dysplasia, but these were not causing pain. Carpal tunnel syndrome was treated surgically but joint stiffness and hip and knee contractures were managed by physiotherapy. Up to the age of 24 none of these patients has had pelvic osteotomy for hip dysplasia; this operation, not yet reported in mucolipidosis type III, may eventually be necessary.

First bioarchaeological evidence of probable scurvy in Southeast Asia: Multifactorial etiologies of vitamin C deficiency in a tropical environment.

This paper presents the first bioarchaeological evidence of probable scurvy in Southeast Asia from a six-year-old child at the historic-era site of Phnom Khnang Peung (15-17th centuries A.D.) in the Cardamom Mountains, Cambodia. Examination of skeletal material shows evidence consistent with scurvy - specifically, abnormal porosity on the greater wings of the sphenoid bone and hard palate, and vascular impressions on the ectocranial surface of the frontal bone and maxillary alveolar bone. In addition, this individual has evidence of cribra orbitalia indicative of anemia. Although a nutritionally linked etiology is the most common cause of scurvy, a number of other factors influencing ascorbic acid levels need to be considered in an environment with sufficient vitamin C potentially available in the diet. Assessing the environmental evidence, the possibility of a number of interrelated factors contributing to the development of scurvy in this individual seems the most plausible explanation. Factors affecting vitamin C levels may have included social aspects of food allocation or choice of food, genetic predisposition, anemia, pathogens, and nutrient malabsorption.

Total ankle replacement by the Ankle Evolution System: medium-term outcome.

We present the outcomes in 38 consecutive patients who had total ankle replacement using the Ankle Evolution System with a minimum follow-up of four years. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and regular standardised anteroposterior and lateral weight-bearing radiographs were obtained. Patient satisfaction and complications were recorded and the survival of the implants was demonstrated by the Kaplan-Meier method. The mean follow-up was for 57.8 months (48 to 80). The cumulative survival rate at six years was 94.7% (95% confidence interval 80.3 to 98.7). The mean total AOFAS score was 88.1 (53 to 100). The mean score for pain was 35.8 (20 to 40). Ten patients presented with edge-loading of whom nine had corrective surgery. Two ankles were revised, one to an arthrodesis and the other to replace the tibial component. Nine patients showed radiological evidence of osteolysis. They had minimal non-progressive symptoms and further surgery was not undertaken. Nevertheless, the concerns about osteolysis led to the implant being withdrawn by the manufacturer. The medium-term results of the ankle evolution system ankle replacement are satisfactory with high patient satisfaction, but the rate of osteolysis is of some concern. The long-term benefit of this procedure has yet to be determined.

The use of a polished dessert spoon during open anterior acromioplasty.

The technique of open anterior acromioplasty is well recognized for the treatment of patients with chronic impingement syndrome. We describe a modification to the technique with a polished dessert spoon.