Birmingham hip resurfacing: a systematic review of outcomes at minimum 10-years follow-up.

Although controversy surrounding the use of metal-on-metal (MoM) arthroplasty implants continues to exist, satisfactory clinical and radiological outcomes have been reported following Birmingham Hip Resurfacing (BHR) at long-term follow-up, leading to an Orthopaedic Data Evaluation Panel (ODEP) rating of 13A. The purpose of this study was to systematically review the literature to evaluate the functional outcomes, radiological outcomes and revision rates following BHR at a minimum of 10 years follow-up. Using the PRISMA guidelines, two independent reviewers performed a literature search using Pubmed, Embase and Scopus databases. Only studies reporting on outcomes of BHR with a minimum of 10 years' follow-up were considered for inclusion. A total of 12 studies including 7132 hips (64.8% males), with mean follow-up of 11.5 years (10-15.3), met our inclusion criteria. Of included patients, 94.3% of patient underwent BHR for osteoarthritis at a mean age was 52.0 years (48-52). At final follow-up, 96% of patients reported being satisfied with their BHR, with mean Harris Hip Scores of 93.6 and Oxford Hip Scores of 16.5. Rates of radiological femoral neck narrowing of greater than 10% and non-progressive radiological loosening were reported as 2.0% and 3.8% respectively. At final follow-up, the overall revision rate was 4.9% (334/7132), deep infection rate was 0.4%, metal allergy/insensitivity rate was 1.6%, metal reaction rate was 0.3%, rate of peri-prosthetic fracture was 0.9% and aseptic loosening rates were 1.6%. This systematic review demonstrates that BHR results in satisfactory clinical outcomes, acceptable implant survivorship, low complication rates and modest surgical revision rates in the long-term at minimum 10-year follow-up.

Phase I evaluation of CDP791, a PEGylated di-Fab' conjugate that binds vascular endothelial growth factor receptor 2.

PURPOSE: Specific blocking of vascular endothelial growth factor receptor 2 (VEGFR-2) is a novel therapeutic approach. Here, we report the first phase I clinical trial evaluation of CDP791, a PEGylated di-Fab' conjugate that binds VEGFR-2. EXPERIMENTAL DESIGN: Cohorts of patients received CDP791 at doses between 0.3 and 30 mg/kg every 3 weeks for the initial two doses. RESULTS: The compound was well tolerated with no dose-limiting toxicity. Dose-related hypertension was observed in patients receiving CDP791 10 mg/kg or more and several patients on the higher doses developed infusion-related cutaneous hemangiomata arising 28 to 106 days after the first drug administration and resolving 3 weeks after cessation. Biopsy and histologic evaluation showed that CDP791-bound VEGFR-2 is non-phosphorylated, suggesting that the drug is biologically active. Concentrations of CDP791 considered biologically relevant were sustained for 3 weeks when doses of 10 mg/kg or more were administered. Although no reductions in vascular permeability were recorded using dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), there was a significant dose level-related reduction in tumor growth. While challenging the recent dogma that active VEGF inhibitors should modulate DCE-MRI measurements of vascular permeability, this highlights the potential of serial three-dimensional tumor measurements to detect tumor growth arrest. Twelve patients received drug for more than two treatments, although no partial or complete responses were seen. CONCLUSION: The data show that CDP791 is biologically active and well tolerated, achieving appropriate plasma concentrations when administered at 10 mg/kg or more every 3 weeks.

Simultaneous bilateral total hip arthroplasties in nonagenarians.

Total hip arthroplasty (THA) is an effective and durable treatment option for hip osteoarthritis (OA). As life expectancy continues to increase, so too will the demand for joint arthroplasty in the 10th decade of life, frequently in cases involving osteoarthritis of both hips. Simultaneous bilateral total hip arthroplasty (SBTHA) is a valuable therapeutic option in appropriately selected patients with bilateral degenerative hip disease, although its use in the very elderly is poorly reported on in the literature. A case of bilateral hip OA successfully treated with SBTHA in a nonagenarian is presented and the literature is reviewed.

Research in an antenatal clinic--the experience of the Nottingham Mothers' Stop Smoking Project.

The Nottingham Mothers' Stop Smoking Project was extremely successful in helping women to stop smoking during pregnancy and in reinforcing non-smoking behaviour. This paper describes the experience of undertaking the action research project in the antenatal clinic from the points of view of the researchers, women and midwifery staff. The article outlines the practical problems encountered in attempting to adhere to a research protocol. The implementation of the project involving friendly encouragement, a carbon monoxide monitor and the offer of self-help groups is described within the context of the busy antenatal clinic setting. Pregnant women's experience of the project and the views of midwifery staff are also presented. The feasibility of incorporating such projects into everyday activity is discussed.

Predictors of poor sportspersonship in youth sports: personal attitudes and social influences.

The present study examined personal and social correlates of poor sportspersonship among youth sport participants. Male and female athletes (n = 676) in the fifth through eighth grades from three geographic regions of the U.S. participated in the study. Young athletes involved in basketball, soccer, football, hockey, baseball/ softball, or lacrosse completed a questionnaire that tapped poor sportspersonship behaviors and attitudes, team sportspersonship norms, perceptions of the poor sportspersonship behaviors of coaches and spectators, and the sportspersonship norms of coaches and parents. Preliminary analyses revealed significant gender, grade, sport area, and location differences in self-reported unsportspersonlike behavior. The main analysis revealed that self-reported poor sport behaviors were best predicted by perceived coach and spectator behaviors, followed by team norms, sportspersonship attitudes, and the perceived norms of parents and coaches. Results are discussed in relation to the concept of moral atmosphere.

Biogenesis of a 35-kilodalton protein associated with outer mitochondrial membrane in rat liver.

Biochemical analyses following subcellular fractionation of rat liver indicated that the outer mitochondrial membrane contains a number of membrane-specific proteins of which a 35-kilodalton species (OMM-35) is a prominent component. These results were confirmed and extended by electron microscope immunocytochemical tests based on the protein A-gold technique. OMM-35 is tightly bound to the outer mitochondrial membrane, e.g. it was not released by sonication in the presence of 1.5 M KCl and 0.1% sodium deoxycholate. However, it did not react with the photoaffinity probe azidopyrene, which indicates that OM-35 is located peripherally on the membrane rather than buried deep in the lipid bilayer as an intrinsic protein. Since low levels of detergent were required for OMM-35 in intact mitochondria to react with exogenous antibodies, OMM-35 is probably located on the side of the outer membrane which faces the interior of the organelle. When rat liver mRNA was translated in a messenger-dependent cell-free system derived from rabbit reticulocytes, antiserum against OMM-35 precipitated a single polypeptide product which migrated on sodium dodecyl sulfate-polyacrylamide gels with molecular weight characteristics of a protein slightly larger (by Mr = 500) than OMM-35 obtained from isolated outer mitochondrial membrane. The mRNA coding for OMM-35 was recovered exclusively from membrane-free polysomes. Thus, the route followed for synthesis and subsequent insertion of OMM-35 into the outer membrane of mitochondria is the post-translational pathway which has been previously described for proteins destined for the interior compartments of this organelle.

Why do pregnant women smoke?

This study aimed to record the main reasons given by pregnant women for smoking and to observe how these varied by age, education, marital status, social class and level of tobacco consumption. The study involved 498 smoking mothers who were all new antenatal clinic attenders. Data were collected by self-completed questionnaire containing closed and open response items. The participation rate was 95%. Main reasons given for smoking in pregnancy included those related to mood control (i.e. to relax, calm down, enjoyment, out of boredom) and addiction. Pregnant women were more likely to smoke to control their mood if they were older and smoked less than ten cigarettes per day. They were more likely to give addiction as their reason for smoking if they were older. Pregnant women were also more likely to smoke due to boredom if they were single, especially divorced or separated, from unskilled or semi-skilled occupational groups and if their husband or partner was unemployed. The implications of the findings for health education are discussed.

Nottingham mothers stop smoking project -- baseline survey of smoking in pregnancy.

In the largest survey of smoking in pregnancy to date in the United Kingdom, 3882 women attending the two antenatal clinics in Nottingham during July and August 1986, were asked about their smoking habits. Thirty-seven per cent of pregnant women were smoking and only one in four of these was successful at stopping at some point during pregnancy. However, 55 per cent of the mothers who smoked at the start of pregnancy claimed to smoke less during pregnancy. No change was reported in the habits of one-quarter of the mothers who smoked during pregnancy and this proportion may represent an 'irreducible minimum'. Mothers were more likely to continue to smoke if younger (14-20 years), single, living with a partner who smoked, who left school at 16 years and were from manual working families. Those who succeeded in giving up smoking during pregnancy were more likely to be from professional and managerial families. Antenatal booklets about the dangers of smoking were the source of information cited most frequently. Half of the smoking mothers claimed not to have received advice from their family practitioners about the hazards of smoking nor information about how to give up the habit. Even fewer received such advice from hospital doctors, or midwives. This represents a major challenge to professional training in health education.