Immune Profiling of Human Gut-Associated Lymphoid Tissue Identifies a Role for Isolated Lymphoid Follicles in Priming of Region-Specific Immunity.

The intestine contains some of the most diverse and complex immune compartments in the body. Here we describe a method for isolating human gut-associated lymphoid tissues (GALTs) that allows unprecedented profiling of the adaptive immune system in submucosal and mucosal isolated lymphoid follicles (SM-ILFs and M-ILFs, respectively) as well as in GALT-free intestinal lamina propria (LP). SM-ILF and M-ILF showed distinct patterns of distribution along the length of the intestine, were linked to the systemic circulation through MAdCAM-1+ high endothelial venules and efferent lymphatics, and had immune profiles consistent with immune-inductive sites. IgA sequencing analysis indicated that human ILFs are sites where intestinal adaptive immune responses are initiated in an anatomically restricted manner. Our findings position ILFs as key inductive hubs for regional immunity in the human intestine, and the methods presented will allow future assessment of these compartments in health and disease.

Microbial life in preferential flow paths in subsurface clayey till revealed by metataxonomy and metagenomics.

BACKGROUND: Subsurface microorganisms contribute to important ecosystem services, yet little is known about how the composition of these communities is affected by small scale heterogeneity such as in preferential flow paths including biopores and fractures. This study aimed to provide a more complete characterization of microbial communities from preferential flow paths and matrix sediments of a clayey till to a depth of 400 cm by using 16S rRNA gene and fungal ITS2 amplicon sequencing of environmental DNA. Moreover, shotgun metagenomics was applied to samples from fractures located 150 cm below ground surface (bgs) to investigate the bacterial genomic adaptations resulting from fluctuating exposure to nutrients, oxygen and water. RESULTS: The microbial communities changed significantly with depth. In addition, the bacterial/archaeal communities in preferential flow paths were significantly different from those in the adjacent matrix sediments, which was not the case for fungal communities. Preferential flow paths contained higher abundances of 16S rRNA and ITS gene copies than the corresponding matrix sediments and more aerobic bacterial taxa than adjacent matrix sediments at 75 and 150 cm bgs. These findings were linked to higher organic carbon and the connectivity of the flow paths to the topsoil as demonstrated by previous dye tracer experiments. Moreover, bacteria, which were differentially more abundant in the fractures than in the matrix sediment at 150 cm bgs, had higher abundances of carbohydrate active enzymes, and a greater potential for mixotrophic growth. CONCLUSIONS: Our results demonstrate that the preferential flow paths in the subsurface are unique niches that are closely connected to water flow and the fluctuating ground water table. Although no difference in fungal communities were observed between these two niches, hydraulically active flow paths contained a significantly higher abundance in fungal, archaeal and bacterial taxa. Metagenomic analysis suggests that bacteria in tectonic fractures have the genetic potential to respond to fluctuating oxygen levels and can degrade organic carbon, which should result in their increased participation in subsurface carbon cycling. This increased microbial abundance and activity needs to be considered in future research and modelling efforts of the soil subsurface.

Artificial Intelligence Applied to Battery Research: Hype or Reality?

This is a critical review of artificial intelligence/machine learning (AI/ML) methods applied to battery research. It aims at providing a comprehensive, authoritative, and critical, yet easily understandable, review of general interest to the battery community. It addresses the concepts, approaches, tools, outcomes, and challenges of using AI/ML as an accelerator for the design and optimization of the next generation of batteries─a current hot topic. It intends to create both accessibility of these tools to the chemistry and electrochemical energy sciences communities and completeness in terms of the different battery R&D aspects covered.

Electrocardiographic markers in patients with type 2 diabetes and the role of diabetes duration.

BACKGROUND: The association between type 2 diabetes and electrocardiographic (ECG) markers are incompletely explored and the dependence on diabetes duration is largely unknown. We aimed to investigate the electrocardiographic (ECG) changes associated with type 2 diabetes over time. METHODS: In this cross-sectional study, we matched people with type 2 diabetes 1:1 on sex, age, and body mass index with people without diabetes from the general population. We regressed ECG markers with the presence of diabetes and the duration of clinical diabetes, respectively, adjusted for sex, age, body mass index, smoking, heart rate, diabetes medication, renal function, hypertension, and myocardial infarction. RESULTS: We matched 988 people with type 2 diabetes (332, 34% females) with as many controls. Heart rate was 8 bpm higher (p < 0.001) in people with vs. without type 2 diabetes, but the difference declined with increasing diabetes duration. For most depolarization markers, the difference between people with and without type 2 diabetes increased progressively with diabetes duration. On average, R-wave amplitude was 6 mm lower in lead V5 (p < 0.001), P-wave duration was 5 ms shorter (p < 0.001) and QRS duration was 3 ms (p = 0.03). Among repolarization markers, T-wave amplitude (measured in V5) was lower in patients with type 2 diabetes (1 mm lower, p < 0.001) and the QRS-T angle was 10 degrees wider (p = 0.002). We observed no association between diabetes duration and repolarization markers. CONCLUSIONS: Type 2 diabetes was independently associated with electrocardiographic depolarization and repolarization changes. Differences in depolarization markers, but not repolarization markers, increased with increasing diabetes duration.

Echocardiographic Measures of Left Atrial Structure and Function and the Association with Atrial Fibrillation following Acute Coronary Syndrome.

INTRODUCTION: Acute coronary syndrome (ACS) is associated with an increased risk of developing atrial fibrillation (AF). This arrhythmia is associated with adverse outcomes, making it important to identify high-risk patients. The aim was to evaluate the prognostic value of measures of left atrial (LA) structure and function in AF prediction following ACS. METHODS: Three hundred and eighty-one patients who had a percutaneous coronary intervention for ACS were included in the study. Our endpoint was new-onset AF. RESULTS: With a median follow-up time of 5.4 [3.9-6.8] years, 56 patients (14.7%) developed AF. Patients developing AF had significantly (p ≤ 0.05) increased maximal and minimal LA volumes (LAVmax and LAVmin, respectively). LAVmax and LAVmin remained significantly increased in AF patients when indexing to either body surface area (LAVmax/BSA and LAVmin/BSA, respectively), left ventricle length in end diastole (LAVmax/LVLd and LAVmin/LVLd, respectively), or late mitral annular diastolic velocity (LAVmax/a' and LAVmin/a', respectively), while LA expansion index (LAEi), LA emptying fraction (LAEF), and peak LA longitudinal strain (PALS) were decreased. In univariable Cox regressions, all LA measures were found to be predictors of AF. After multivariable adjustment for clinical and echocardiographic parameters, all measures reflecting atrial function (LAVmin, LAVmin/BSA, LAVmin/LVLd, LAVmin/a', LAVmax/a', LAEF, LAEi, and PALS) (p ≤ 0.05) but no structural measures (LAVmax, LAVmax/BSA, and LAVmax/LVLd) remained significant independent predictors of AF. CONCLUSION: Echocardiographic measures of LA function are independent predictors of AF following ACS. Evaluation of LA function might improve the prognostic workup, aid in risk stratification for AF, and improve selection for further examinations.

Graph neural network interatomic potential ensembles with calibrated aleatoric and epistemic uncertainty on energy and forces.

Inexpensive machine learning (ML) potentials are increasingly being used to speed up structural optimization and molecular dynamics simulations of materials by iteratively predicting and applying interatomic forces. In these settings, it is crucial to detect when predictions are unreliable to avoid wrong or misleading results. Here, we present a complete framework for training and recalibrating graph neural network ensemble models to produce accurate predictions of energy and forces with calibrated uncertainty estimates. The proposed method considers both epistemic and aleatoric uncertainty and the total uncertainties are recalibrated post hoc using a nonlinear scaling function to achieve good calibration on previously unseen data, without loss of predictive accuracy. The method is demonstrated and evaluated on two challenging, publicly available datasets, ANI-1x (Smith et al. J. Chem. Phys., 2018, 148, 241733.) and Transition1x (Schreiner et al. Sci. Data, 2022, 9, 779.), both containing diverse conformations far from equilibrium. A detailed analysis of the predictive performance and uncertainty calibration is provided. In all experiments, the proposed method achieved low prediction error and good uncertainty calibration, with predicted uncertainty correlating with expected error, on energy and forces. To the best of our knowledge, the method presented in this paper is the first to consider a complete framework for obtaining calibrated epistemic and aleatoric uncertainty predictions on both energy and forces in ML potentials.

Crop rotation mitigates impacts of corn rootworm resistance to transgenic Bt corn.

Transgenic crops that produce insecticidal proteins from Bacillus thuringiensis (Bt) can suppress pests and reduce insecticide sprays, but their efficacy is reduced when pests evolve resistance. Although farmers plant refuges of non-Bt host plants to delay pest resistance, this tactic has not been sufficient against the western corn rootworm, Diabrotica virgifera virgifera In the United States, some populations of this devastating pest have rapidly evolved practical resistance to Cry3 toxins and Cry34/35Ab, the only Bt toxins in commercially available corn that kill rootworms. Here, we analyzed data from 2011 to 2016 on Bt corn fields producing Cry3Bb alone that were severely damaged by this pest in 25 crop-reporting districts of Illinois, Iowa, and Minnesota. The annual mean frequency of these problem fields was 29 fields (range 7 to 70) per million acres of Cry3Bb corn in 2011 to 2013, with a cost of $163 to $227 per damaged acre. The frequency of problem fields declined by 92% in 2014 to 2016 relative to 2011 to 2013 and was negatively associated with rotation of corn with soybean. The effectiveness of corn rotation for mitigating Bt resistance problems did not differ significantly between crop-reporting districts with versus without prevalent rotation-resistant rootworm populations. In some analyses, the frequency of problem fields was positively associated with planting of Cry3 corn and negatively associated with planting of Bt corn producing both a Cry3 toxin and Cry34/35Ab. The results highlight the central role of crop rotation for mitigating impacts of D. v. virgifera resistance to Bt corn.

Social dimensions of fertility behavior and consumption patterns in the Anthropocene.

We consider two aspects of the human enterprise that profoundly affect the global environment: population and consumption. We show that fertility and consumption behavior harbor a class of externalities that have not been much noted in the literature. Both are driven in part by attitudes and preferences that are not egoistic but socially embedded; that is, each household's decisions are influenced by the decisions made by others. In a famous paper, Garrett Hardin [G. Hardin, Science 162, 1243-1248 (1968)] drew attention to overpopulation and concluded that the solution lay in people "abandoning the freedom to breed." That human attitudes and practices are socially embedded suggests that it is possible for people to reduce their fertility rates and consumption demands without experiencing a loss in wellbeing. We focus on fertility in sub-Saharan Africa and consumption in the rich world and argue that bottom-up social mechanisms rather than top-down government interventions are better placed to bring about those ecologically desirable changes.

Five-year polyethylene cup migration and PE wear of the Anatomic Dual Mobility acetabular construct.

INTRODUCTION: Dual mobility implants have been successful in reducing postoperative hip dislocation but mid-term results of cup migration and polyethylene wear are missing in the literature. Therefore, we measured migration and wear at 5-year follow-up using radiostereometric analysis (RSA). MATERIALS AND METHODS: A cohort of 44 patients (mean age 73, 36 female) with heterogeneous indications for hip arthroplasty but all with a high risk of hip dislocation received total hip replacement (THA) with The Anatomic Dual Mobility X3 monoblock acetabular construct and a highly crosslinked polyethylene liner. RSA images and Oxford Hip Scores were obtained perioperatively and 1, 2, and 5 years postoperatively. Cup migration and polyethylene wear were calculated using RSA. RESULTS: Mean 2-year proximal cup translation was 0.26 mm (95% CI 0.17; 0.36). Proximal cup translation was stable from 1- to 5-year follow-up. Mean 2-year cup inclination (z-rotation) was 0.23° (95% CI - 0.22; 0.68) and was greater in patients with osteoporosis compared to patients without osteoporosis (p = 0.04). Using 1-year follow-up as baseline, the 3D polyethylene wear rate was 0.07 mm/year (0.05; 0.10). Oxford hip scores improved 19 (95% CI 14; 24) points from mean 21 (range 4; 39) at baseline, to 40 (9; 48) 2 years postoperatively. There were no progressive radiolucent lines > 1 mm. There was 1 revision for offset correction. CONCLUSIONS: Anatomic Dual Mobility monoblock cups were well-fixed, the polyethylene wear rate was low, and the clinical outcomes were good until 5-year follow-up suggesting good implant survival in patients of different age groups and with heterogeneous indications for THA.

Radiostereometric analysis: comparison of radiation dose and precision in digital and computed radiography.

BACKGROUND: Radiostereometric Analysis (RSA) is used to measure fixation of joint prosthesis. This study compared radiation dose and image quality of a digital radiography (DR) RSA system and a computed radiography (CR) RSA system in a clinical setting. METHODS: RSA recordings of 24 hips and shoulders were analyzed. We compared two systems: (1) Arcoma T0 with ST-VI image plates and Profect CR-IR 363 reader to (2) AdoraRSA with CXDI-70C wireless DR detectors in a clinical uniplanar RSA set-up with a ± 20 degrees tube angulation and 35 cm × 43 cm detectors. Effective dose was calculated using dedicated software. Image quality was evaluated using calibration errors as calculated by the RSA software. RESULTS: The mean dose for hips was 0.14 (SD 0.04) mSv in the CR system and 0.05 (SD 0.02) mSv in the DR system. The mean dose for shoulders was 0.16 (SD 0.07) mSv in the CR system and 0.09 (SD 0.03) mSv in the DR system. Radiation dose was 64% (p < 0.001) and 43% (p = 0.03) lower in the DR system compared with the CR system for hip and shoulder RSA, respectively. Image quality was better for the DR system with 60-80% less calibration errors compared to the CR system. CONCLUSION: Owing to highly efficient detectors and added filtration at the x-ray tubes, the DR system considerably reduced radiation dose compared with the CR system without compromising image quality. Based on the findings in this study, we recommend replacing CR RSA systems with DR RSA systems. REGISTRATION: Patients were selected from clinical studies performed on the two systems and approved by the local ethics committee [20060165, M-20100112, M-20070082, M-20110224, and 20070258] and registered with ClinicalTrials.gov [NCT00408096, NCT01289834, NCT00913679, NCT02311179, and NCT00679120].

Migration pattern of cemented Exeter short stem in Dorr type A femurs. A prospective radiostereometry study with 2-year follow-up.

INTRODUCTION: The Exeter short stem (ESS) is 25 mm shorter than the standard length v40 Exeter stem (Stryker) and intended for a narrow femoral diaphysis. The purpose of the study was to evaluate the migration pattern of the cemented ESS. MATERIAL AND METHOD: In a prospective single-center cohort study, 23 patients (21 female) mean age 78 (range 70-89) with hip osteoarthritis and Dorr Type A femurs were included. Preoperative DXA was used to group patients into normal (> - 1) and low (< - 1) T-score. Components were the collarless polished double-tapered Exeter short stem type N°1 L125. Patients were followed for 2 years with model-based RSA (stem migration), regular hip radiographs (stem position and cementation quality), Oxford Hip Score (OHS) and VAS pain. RESULTS: At 2-year follow-up, the stems subsided 1.48 mm (CI 95% 1.69; 1.26) and retroverted 0.45° (CI 95% 0.01; 0.88). From 12 to 24 months, stem subsidence was 0.18 mm (CI 95% 0.1; 0.25) (p = 0.001) and retroversion was - 0.04° (CI 95% - 0.27; 0.18) (p = 0.70). T-score and stem subsidence correlated (rho = 0.48; p = 0.025) and patients with normal T-score (n = 7) had 0.42 mm (CI 95% - 0.01; 0.85) less subsidence as compared to patients with low T-score (n = 15) (p = 0.054). Stems in varus position (n = 9) subsided 1.7 mm (CI 95% 1.35; 2.05) compared to 1.33 mm (CI 95% 1.05; 1.60) for stems in neutral position (n = 13) (p = 0.07). Postoperative cementation quality did not influence 2-year stem migration. OHS improved to 40.7 (CI 95% 36.8; 44.7) and VAS pain at rest and activity decreased to 5 mm and 10 mm, respectively (p < 0.001). CONCLUSION: The 2-year migration pattern of the cemented ESS was similar to reports for the cemented standard length Exeter stem. Low preoperative T-score and varus stem-position showed a tendency for higher stem migration and should be studied as risk factors for failure in larger studies of cemented polished stems.

Multi-modal characterization of kesterite thin-film solar cells: experimental results and numerical interpretation.

We report a multi-modal study of the electrical, chemical and structural properties of a kesterite thin-film solar cell by combining the spatially-resolved X-ray beam induced current and fluorescence imaging techniques for the evaluation of a fully functional device on a cross-section. The data allowed the correlation of the chemical composition, defects at interfaces and inhomogeneous deposition of the layers with the local charge-collection efficiency of the device. We support our observations with Monte Carlo simulations of high-energy X-ray interactions with the semiconductor device, and finite-volume modeling of the charge-collection efficiency.

Acute changes in plasma glucose increases left ventricular systolic function in insulin-treated patients with type 2 diabetes and controls.

AIMS: We aimed to evaluate the effect of acute hyperglycaemia and hypoglycaemia on cardiac function in patients with type 2 diabetes (T2D) and a control group. MATERIALS AND METHODS: In a nonrandomized interventional study, insulin-treated patients with T2D (N = 21, mean ± SD age 62.8 ± 6.5 years, body mass index [BMI] 29.0 ± 4.2 kg/m2 , glycated haemoglobin [HbA1c] 51.0 ± 5.4 mmol/mol [6.8 ± 0.5%]) and matched controls (N = 21, mean ± SD age 62.2 ± 8.3 years, BMI 29.2 ± 3.5 kg/m2 , HbA1c 34.3 ± 3.3 mmol/L [5.3 ± 0.3%]) underwent one experimental day with plasma glucose (PG) clamped at three different 30-minute steady-state levels: (1) fasting plasma glucose (FPG); (2) hyperglycaemia (FPG + 10 mmol/L); and (3) hyperinsulinaemic hypoglycaemia (PG <3.0 mmol/L). Cardiac function was evaluated during each steady state by echocardiography. RESULTS: Acute hyperglycaemia increased left ventricular (LV) ejection fraction from baseline in patients with T2D (mean [95% confidence interval] 4.5 percentage points [1.1; 7.9]) but not in controls (2.0 percentage points [-1.4; 5.4]). Mitral annular peak systolic velocity (s') increased during hyperglycaemia in both patients and controls (0.4 m/s [0.2;0.6] and 0.6 m/s [0.4; 0.8], respectively), whereas global longitudinal strain rate only increased in the controls (-0.05 s-1 [-0.12; 0.02] and -0.11 s-1 [-0.18; -0.03], respectively). All measures of LV systolic function increased markedly during hypoglycaemia (P <0.01 for all). No interaction between group and PG level on cardiac function was observed. CONCLUSIONS: Acute hyperglycaemia and hypoglycaemia increase LV systolic function, with no difference between patients with T2D and controls. Standardization of PG may improve reproducibility when evaluating LV systolic function in patients with T2D.

Hypoglycaemia and rebound hyperglycaemia increase left ventricular systolic function in patients with type 1 diabetes.

AIM: To investigate echocardiographic changes during acute hypoglycaemia followed by recovery to hyperglycaemia or euglycaemia in patients with type 1 diabetes. MATERIALS AND METHODS: In a randomized crossover study, 24 patients with type 1 diabetes took part in two experimental study days, consisting of a hyperinsulinaemic-euglycaemic phase (5.0-8.0 mmol/L) for 45 minutes followed by a hyperinsulinemic-hypoglycaemic phase (2.5 mmol/L) for 60 minutes, and a recovery phase in either hyperglycaemia (20 mmol/L) or euglycaemia (5.0-8.0 mmol/L) for 60 minutes. Cardiac function was evaluated with echocardiography during each phase. RESULTS: Acute hypoglycaemia increased all markers of left ventricular (LV) systolic function, including LV ejection fraction (LVEF), global longitudinal strain (GLS), GLS rate and peak systolic velocity of mitral annular longitudinal movement (s'; P < 0.001 for all). During the recovery phases, all markers of LV systolic function were increased during hyperglycaemia (P < 0.01 for all), and LVEF and GLS remained increased during euglycaemia (P = 0.0116 and P = 0.0092, respectively). The increment in LVEF during the recovery phase was greater during hyperglycaemia than euglycaemia (P = 0.0046). CONCLUSIONS: Hypoglycaemia, recent hypoglycaemia, and overcorrection of hypoglycaemia to rebound hyperglycaemia increased LV systolic function in type 1 diabetes and may imply consideration of plasma glucose when evaluating LV function in patients with type 1 diabetes. An increase in LV systolic function may cause increased strain on the heart and partly explain the link between hypoglycaemia, high glycaemic variability and cardiovascular disease.

Cheap Turns Superior: A Linear Regression-Based Correction Method to Reaction Energy from the DFT.

Workflows to predict chemical reaction networks based on density functional theory (DFT) are prone to systematic errors in reaction energy due to the extensive use of cheap DFT exchange-correlation functionals to limit computational cost. Recently, machine learning-based models are increasingly applied to mitigate this problem. However, machine learning models require systems similar to trained data, and the models often perform poorly for out-of-distribution systems. Here, we present a simple bond-based correction method that improves the accuracy of DFT-derived reaction energies. It is based on linear regression, and the correction terms for each bond are derived from reactions among the QM9 data set. We demonstrate the effectiveness of this method with three DFT functionals in three different rungs of Jacob's ladder. The simple correction method is effective for all rungs but especially so for the cheapest PBE functional. Finally, we applied the correction method to a few reactions with molecules significantly different from those in the QM9 data set that was used to fit the linear regression model. Once corrected by this method, we found that the DFT reaction energies for such out-of-distribution reactions are within 0.05 eV of the G4MP2 method.

Outside the Safe Operating Space of the Planetary Boundary for Novel Entities.

We submit that the safe operating space of the planetary boundary of novel entities is exceeded since annual production and releases are increasing at a pace that outstrips the global capacity for assessment and monitoring. The novel entities boundary in the planetary boundaries framework refers to entities that are novel in a geological sense and that could have large-scale impacts that threaten the integrity of Earth system processes. We review the scientific literature relevant to quantifying the boundary for novel entities and highlight plastic pollution as a particular aspect of high concern. An impact pathway from production of novel entities to impacts on Earth system processes is presented. We define and apply three criteria for assessment of the suitability of control variables for the boundary: feasibility, relevance, and comprehensiveness. We propose several complementary control variables to capture the complexity of this boundary, while acknowledging major data limitations. We conclude that humanity is currently operating outside the planetary boundary based on the weight-of-evidence for several of these control variables. The increasing rate of production and releases of larger volumes and higher numbers of novel entities with diverse risk potentials exceed societies' ability to conduct safety related assessments and monitoring. We recommend taking urgent action to reduce the harm associated with exceeding the boundary by reducing the production and releases of novel entities, noting that even so, the persistence of many novel entities and/or their associated effects will continue to pose a threat.

Diagnostic and prognostic value of the electrocardiogram in stable outpatients with type 2 diabetes.

Aims. The European Society of Cardiology guidelines on diabetes and cardiovascular disease (CVD) recommend an electrocardiogram (ECG) in patients with diabetes and hypertension or with suspected CVD. We investigated whether ECG abnormalities can be used as a diagnostic and prognostic marker of heart failure (HF) in patients with type-2 diabetes (T2D) in secondary care diabetes-clinics. Methods. We included 722 patients with T2D in sinus rhythm. HF with preserved ejection fraction (HFpEF) was defined according to the European Society of Cardiology guidelines. Heart failure with mid-range ejection fraction (HFmrEF) was patients with dyspnoea and an LVEF 41-49%. Heart failure with reduced ejection fraction (HFrEF) or asymptomatic left ventricular systolic dysfunction (ALVSD) was defined as a LVEF ≤40%. Results. Overall, 24% patients had ECG abnormalities. A total of 15% had HF whereof 48% had ECG abnormalities. A normal ECG had a 99.3% negative predictive value (NPV) of ruling out HFrEF/ALVSD. In a sub-group with 0-1 simple clinical risk markers, the ECG ruled out both HFrEF/ALVSD, HFmrEF, and HFpEF with an NPV of 96.6%. The hazard-ratio (HR) of incident CVD or death in patients with HF and a normal ECG compared with patients without HF was 1.85 [95%CI 1.01-3.39], p = .05, while an abnormal ECG increased the HR to 3.84 [2.33-6.33], p < .001. Conclusion. HFrEF/ALVSD and HFmrEF were rare and HFpEF was frequent in this T2D population. A normal ECG ruled out HFrEF/ALVSD and in a sub-population with 0-1 simple clinical risk markers also both HFrEF/ALVSD, HFmrEF, and HFpEF.Key messagesWhat is already known about this subject?In early studies of unselected patients from primary care with suspected chronic heart failure, the presence of a normal ECG was found be useful to rule out heart failure with reduced ejection fraction.What does this study add?This study confirms that a standard electrocardiogram when normal in 722 stable outpatients with type 2 diabetes can be used to rule out HFrEF/ALVSD. Further, it adds knowledge about the risk of incident cardiovascular disease or death as a pathologic electrocardiogram increases the hazard ratio.How might this implicate clinical practice?With this study clinicians in secondary diabetes care clinics can use an electrocardiogram to select patients to undergo echocardiography when suspecting heart failure with reduced ejection fraction, as a normal electrocardiogram will rule out this diagnosis with a negative predictive value of >99%.

Polyethylene liner motion in dual-mobility hip prostheses: static and dynamic radiostereometry in 16 patients 1 year after operation.

BACKGROUND AND PURPOSE: Dual-mobility hip arthroplasty utilizes a freely rotating polyethylene acetabular liner to protect against dislocation. As liner motion has not been confirmed in vivo, we undertook this using dynamic radiostereometry (RSA). PATIENTS AND METHODS: 6 patients with Anatomical Dual Mobility acetabular components were included. Markers were implanted in the liners using a drill guide. Static RSA recordings and patient-reported outcome measures were obtained postoperatively and at 1-year follow-up. Dynamic RSA recordings were obtained at 1-year follow-up during passive hip movement: abduction/external rotation, adduction/internal rotation (modified FABER-FADIR), to end-range and at 45° hip flexion. Liner and neck movements were described as anteversion, inclination, and rotation. RESULTS: Liner movement during modified FABER-FADIR was detected in 12 of 16 patients. Median (range) absolute liner movements were: anteversion 10° (5-20), inclination 6° (2-12), and rotation 11° (5-48) relative to the cup. Median absolute change in the resulting liner/neck angle (small articulation) was 28° (12-46) and in liner/cup angle (larger articulation) was 6° (4-21). Static RSA showed changes in median liner anteversion from 7° (-12 to 23) postoperatively to 10° (-3 to 16) at 1-year follow-up and inclination from 42° (35-66) postoperatively to 59° (46-80) at 1-year follow-up. Liner/neck contact was associated with high initial liner anteversion (p = 0.01). INTERPRETATION: The polyethylene liner moves over time. 1 year after surgery the liner can move with or without liner/neck contact. The majority of movement is in the smaller articulation between head and liner.

Cemented and cementless dual mobility cups show similar fixation, low polyethylene wear, and low serum cobalt-chromium in elderly patients: a randomized radiostereometry study with 6 years' follow-up.

BACKGROUND AND PURPOSE: Dual mobility (DM) articulation total hip arthroplasty (THA) is used increasingly to reduce dislocation risk. We investigated cup fixation, polyethylene (PE) wear, serum chromium and cobalt ions, and their correlation to physical activity in patients with DM cups at 6-year follow-up. PATIENTS AND METHODS: In a patient-blinded RCT, 60 patients with hip osteoarthritis at a median age of 74 years (70-82) were randomly allocated to cemented (n = 30) or cementless hydroxyapatite-coated (n = 30) fixation of Avantage DM THA with a highly-crosslinked vitamin-E PE liner. Cup migration and PE wear were measured with radiostereometric analysis (RSA), chromium and cobalt ions were measured in serum, and physical activity was measured with accelerometers. RESULTS: At 6-year follow-up, proximal cup migration was similar: 0.14 mm (95% CI 0.01-0.28) for cemented cups and 0.21 mm (0.02-0.39) for cementless cups. The PE wear rate from 1- to 6-year follow-up was also similar: 0.06 mm/year (0.04-0.09) for cemented cups and 0.07 mm/year (0.04-0.11) for cementless cups. Serum metal ion levels were undetectable or very low. Physical activity was mainly low intensity and did not correlate to PE wear rate or cup migration. CONCLUSION: Cemented and cementless DM cups with highly crosslinked vitamin-E infused liners have similar cup migration and PE wear when used for primary THA surgery.

Larger 5-year migration but similar polyethylene wear of cementless hemispherical cups with electrochemically applied hydroxyapatite (BoneMaster) coating compared with porous plasma-spray titanium: a randomized 5-year RSA study.

BACKGROUND AND PURPOSE: BoneMaster (BM) is a thin electrochemically applied hydroxyapatite (HA) implant coating marketed with expectations of improved osseointegration properties but less polyethylene (PE) wear. We compared the midterm cup migration and PE wear of cementless porous-coated hemispherical cups with and without BM. PATIENTS AND METHODS: In this patient-blinded, randomized controlled trial, 53 patients with a mean age of 64 years (55-75) received total hip arthroplasty with a porous-coated (P) or porous and BoneMaster (PBM) coated Exceed cup and ArCom E1 infused PE. Patients were followed with RSA, Hip Osteoarthritis Outcome Score (HOOS), and Euro-Qol-5-3L (EQ-5D) at 3 and 6 months, and 1-, 2-, and 5-year follow-up. RESULTS: At 5-year follow-up, total translation and maximum total point motion was 0.28 mm (95% CI 0.08; 0.47) and 0.52 mm (CI 0.12; 0.93) higher in the PBM group than in the P group. PE wear was comparable between PBM and P cups, and 2D wear rate from 1-year follow-up to last follow-up was 0.03 mm (CI 0.02-0.03). The 5-year anterior translation was 0.05 mm (CI -0.10 to 0.21) in the normal BMD group and 0.40 mm (CI 0.22-0.57) in the osteopenia group. INTERPRETATION: At 5-year follow-up, Exceed cups in the PBM group migrated more than in the P group but the PE wear rate was low and similar. This study does not indicate any advantage of additional BoneMaster coating compared with porous coating alone on cementless hemispherical cups with regards to migration, polyethylene wear, and clinical outcomes.