Are there clinically relevant anatomical differences of the proximal femur in patients with mild dysplastic and primary hip osteoarthritis? A CT-based matched-pairs cohort study.

AIM: To investigate the three-dimensional anatomy and shape of the proximal femur, comparing patients with secondary osteoarthritis (OA) due to mild developmental dysplasia of the hip (DDH) and primary hip OA. MATERIALS AND METHODS: This retrospective radiographic computed tomography (CT)-based study investigated proximal femoral anatomy in a consecutive series of 84 patients with secondary hip OA due to mild DDH (Crowe type I&II/Hartofilakidis A) compared to 84 patients with primary hip OA, matched for gender, age at surgery, and body mass index. RESULTS: Men with DDH showed higher neck shaft angles (127±5° vs. 123±4°; p<0.001), whereas women with DDH had a larger femoral head diameter (46±4 vs. 44±3 mm; p=0.002), smaller femoral offset (36±5 vs. 40±4 mm; p<0.001), decreased leg torsion (25±13° vs. 31±16°; p=0.037), and a higher neck shaft angle (128±7° vs. 123±4°; p<0.001) compared to primary OA patients. Similar patterns of the three-dimensional endosteal canal shape of the proximal femur, but a high inter-individual variability for femoral canal torsion at the meta-diaphyseal level were found for DDH and primary OA patients. CONCLUSION: Standard cementless stem designs are suitable to treat patients with secondary hip OA due to mild DDH; however, high patient variability and subtle anatomical differences in the proximal femur should be respected.

Correction to: Solochrome cyanine: A histological stain for cobalt-chromium wear particles in metal-on-metal periprosthetic tissues.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Solochrome cyanine: A histological stain for cobalt-chromium wear particles in metal-on-metal periprosthetic tissues.

Metal-on-metal (MoM) hip arthroplasties produce abundant implant-derived wear debris composed mainly of cobalt (Co) and chromium (Cr). Cobalt-chromium (Co-Cr) wear particles are difficult to identify histologically and need to be distinguished from other wear particle types and endogenous components (e.g., haemosiderin, fibrin) which may be present in MoM periprosthetic tissues. In this study we sought to determine whether histological stains that have an affinity for metals are useful in identifying Co-Cr wear debris in MoM periprosthetic tissues. Histological sections of periprosthetic tissue from 30 failed MoM hip arthroplasties were stained with haematoxylin-eosin (HE), Solochrome Cyanine (SC), Solochrome Azurine (SA) and Perls' Prussian Blue (PB). Sections of periprosthetic tissue from 10 cases of non-MoM arthroplasties using other implant biomaterials, including titanium, ceramic, polymethylmethacrylate (PMMA) and ultra-high molecular weight polyethylene (UHMWP) were similarly analysed. Sections of 10 cases of haemosiderin-containing knee tenosynovial giant cell tumour (TSGCT) were also stained with HE, SC, SA and PB. In MoM periprosthetic tissues, SC stained metal debris in phagocytic macrophages and in the superficial necrotic zone which exhibited little or no trichrome staining for fibrin. In non-MoM periprosthetic tissues, UHMWP, PMMA, ceramic and titanium particles were not stained by SC. Prussian Blue, but not SC or SA, stained haemosiderin deposits in MoM periprosthetic tissues and TSGT. Our findings show that SC staining (most likely Cr-associated) is useful in distinguishing Co-Cr wear particles from other metal/non-metal wear particles types in histological preparations of periprosthetic tissue and that SC reliably distinguishes haemosiderin from Co-Cr wear debris.

Evaluation of a semi-automated software program for the identification of vertebral fractures in children.

AIM: To assess observer reliability and diagnostic accuracy in children, of a semi-automated six-point technique developed for vertebral fracture (VF) diagnosis in adults, which records percentage loss of vertebral body height. MATERIALS AND METHODS: Using a semi-automated software program, five observers independently assessed T4 to L4 from the lateral spine radiographs of 137 children and adolescents for VF. A previous consensus read by three paediatric radiologists using a simplified algorithm-based qualitative technique (i.e., no software involved) served as the reference standard. RESULTS: Of a total of 1,781 vertebrae, 1,187 (67%) were adequately visualised according to three or more observers. Interobserver agreement in vertebral readability for each vertebral level for five observers ranged from 0.05 to 0.47 (95% CI: -0.19, 0.76). Intra-observer agreement using the intraclass correlation coefficient (ICC) ranged from 0.25 to 0.61. The overall sensitivity and specificity were 18% (95% CI: 14-22) and 97% (95% CI: 97-98), respectively. CONCLUSION: In contrast to adults, the six-point technique assessing anterior, middle, and posterior vertebral height ratios is neither satisfactorily reliable nor sensitive for VF diagnosis in children. Training of the software on paediatric images is required in order to develop a paediatric standard that incorporates not only specific vertebral body height ratios but also the age-related physiological changes in vertebral shape that occur throughout childhood.

Erratum: Electron Localization in Dissociating H_{2}

This corrects the article DOI: 10.1103/PhysRevLett.116.043001.

Electron Localization in Dissociating H_{2}

We investigate the dissociation of H_{2}^{+} into a proton and a H^{0} after single ionization with photons of an energy close to the threshold. We find that the p^{+} and the H^{0} do not emerge symmetrically in the case of the H_{2}^{+} dissociating along the 1sσ_{g} ground state. Instead, a preference for the ejection of the p^{+} in the direction of the escaping photoelectron can be observed. This symmetry breaking is strongest for very small electron energies. Our experiment is consistent with a recent prediction by Serov and Kheifets [Phys. Rev. A 89, 031402 (2014)]. In their model, which treats the photoelectron classically, the symmetry breaking is induced by the retroaction of the long-range Coulomb potential onto the dissociating H_{2}^{+}.

Stent graft repair of subclavian and axillary vascular injuries: The Groote Schuur experience.

BACKGROUND: Trauma-related subclavian and axillary vascular injuries (SAVIs) are generally associated with high morbidity and mortality rates in the surgical literature. There is an emerging trend towards increasing use of stent grafts (covered stents) for repair, with evidence limited to small case series and case reports. OBJECTIVES: To report on the clinical and device-related outcomes of stent graft repair of trauma-related SAVIs at a single institution. METHODS: A retrospective chart review of all patients with trauma-related SAVIs requiring stent graft repair was performed. Outcome measures included technical success, mortality, amputation rate, device-related complications (early and late), and reintervention rates (early and late). RESULTS: A total of 31 patients was identified between June 2008 and October 2013 (30 males, 1 female). Mean age was 27.9 years (range 19-51). All 31 patients sustained a penetrating injury (93.5% stab, 6.5% gunshot injuries). There were 21 subclavian and 10 axillary artery injuries. Five patients (16%) were HIV-positive. Nine patients (29%) were shocked on presentation. Early results (30 days): There were no periprocedural deaths. Primary technical success was 83.9% (26/31). Five patients required adjunctive interventional or operative procedures. There were no early procedure-related complications, reinterventions or open conversions in this study. Overall, suboptimal results were seen in five patients (one type I endoleak and four type II endoleaks). Follow-up results (>30 days): Nineteen patients (61.3%) were available for follow-up. Mean duration of follow-up was 55.7 weeks (range 4 - 240). Overall stent graft patency was 89.5% (17/19). Four patients (21.1%) had an occluded stent graft. Stent graft salvage was possible in two patients. Three type II endoleaks were seen on follow-up. Late reinterventions were performed in five patients (26.3%). Conversion to an open procedure was not required in any patient. There was one late death and one major amputation of a stented limb in a patient who had sustained severe soft-tissue injuries during the follow-up period. CONCLUSION: Perioperative, early and intermediate results suggest that stent graft repair of select trauma-related SAVIs is relatively safe and effective. Axillary arteriovenous fistulas remain a particular challenge using this treatment modality. Larger prospective studies are required to define the utility of stent grafts for select trauma-related SAVIs better.

Oral arsenic trioxide-based regimen as salvage treatment for relapsed or refractory mantle cell lymphoma.

BACKGROUND: Mantle cell lymphoma (MCL) is aggressive, and relapsed/refractory disease has poor outcomes. PATIENTS AND METHODS: Thirty-nine patients (men = 34, women = 5) at 64 (41-82) years of age with relapsed/refractory MCL, ineligible for high-dose chemotherapy and had received 2 (1-5) prior regimens, were treated with a continuous oral regimen, comprising oral arsenic trioxide (oral-As2O3), chlorambucil and ascorbic acid. RESULTS: Overall response rate was 49% (complete response, CR = 28%; partial response, PR = 21%). Only grade 1/2 toxicities were observed (hematologic: 56%, hepatic: 8%). Response was maintained in 11 patients (CR = 8; PR = 3), after a median of 24 (2-108) months. Independent prognostic factors for response were increased lactate dehydrogenase (P = 0.04) and unfavorable MCL international prognostic index (P = 0.04). At a median follow-up of 21 (1-118) months, the median progression-free survival (PFS) was 16 months, and overall survival (OS) 38 months. Independent prognostic factors for PFS were female gender (P = 0.002), and Eastern Cooperative Oncology Group (ECOG) performance score of 2 (P = 0.009). Independent prognostic factors for OS were female gender (P < 0.001), ECOG performance score of 2 (P = 0.03), non-response (P < 0.001), and disease progression after initial response (P = 0.05). CONCLUSION: An oral regimen of oral-As2O3, chlorambucil and ascorbic acid was active with minimal toxicity in relapsed/refractory MCL, achieving durable responses in ∼30% of cases.

Horses and cows might teach us about human knees.

Our comparative study of the knees of horses and cows (paraphrased as highly evolved joggers and as domesticated couch-potatoes, respectively) demonstrates significant differences in the posterior sections of bovine and equine tibial cartilage, which are consistent with specialisation for gait. These insights were possible using a novel analytical measuring technique based on the shearing of small biopsy samples, called dynamic shear analysis. We assert that this technique could provide a powerful new tool to precisely quantify the pathology of osteoarthritis for the medical field.

Follow-up of Indigenous-specific health assessments - a socioecological analysis.

OBJECTIVES: To describe patterns of uptake of Indigenous-specific health assessments and associated follow-up items, and examine the barriers and enablers to delivery and billing of follow-up over the first 3 years of implementation of the Indigenous Chronic Disease Package (ICDP). DESIGN, SETTING AND PARTICIPANTS: We used a socioecological approach to analyse data derived from the Sentinel Sites Evaluation of the ICDP - with data from 24 sites across Australia. Administrative data (1 May 2009 to 30 May 2012) and program data (1 March 2010 to 30 May 2012) were provided by the Department of Health. Data on barriers and enablers to follow-up of health assessments were obtained from community focus groups, in-depth interviews and discussions with key informants (1 November 2010 to 30 December 2012). MAIN OUTCOME MEASURES: Monthly number of Medicare Benefits Schedule items claimed for Indigenous-specific health services and follow-up; qualitative data on enablers and barriers categorised according to patient, patient-health service relationship, health service or organisation, community and policy environment levels or influence. RESULTS: There was an increase in the uptake of health assessments, but relatively limited delivery of follow-up care and billing for Indigenous-specific follow-up items. Follow-up was constrained by factors that operated at various levels: patient, interpersonal, health service, community and policy. Constraints included practitioners' lack of awareness of item numbers, staffing, poor state of clinical information systems, billing against non-Indigenous-specific items or more general follow-up items, emphasis on health assessments with less attention to requirements for follow-up, limited capacity to arrange and facilitate follow-up, and communication and transport challenges for patients. CONCLUSIONS: Work is required across various levels of the system to address barriers to follow-up care. Enhancing follow-up care is vital to achieving health benefits from the large financial and human resource investment in health assessments.

A prospective study of prevalence and association of peripheral neuropathy in Indian patients with newly diagnosed type 2 diabetes mellitus.

BACKGROUND: Diabetic peripheral neuropathy (DPN) predisposes to foot ulceration and gangrene. It has been reported that DPN is lower in Indians relative to Caucasians. Studies among recent onset patients with type 2 diabetes mellitus (T2DM) are very few. We studied the prevalence and risk factors of DPN in patients with newly diagnosed T2DM. MATERIALS AND METHODS: We prospectively studied 195 consecutive patients over age 30 with a duration of diabetes ≤6 months. All underwent a clinical and biochemical evaluation and were screened for DPN using Neuropathy Symptom Score (NSS) and Neuropathy Disability Score (NDS) as well as the vibration perception threshold using a biothesiometer. We compared the prevalence of peripheral neuropathy (PN) in 75 age- and sex-matched healthy controls. RESULTS: The cases had a mean age of 47.6 ± 10.2 years (59% males) and duration of symptoms of 5.9 ± 8.2 months prior to presentation. The overall prevalence of DPN was 29.2% [95% CI 22.8-35.7]. PN among matched control was 10.7% (95% CI 3.5-17.8). The prevalence of DPN showed an increasing trend with age (trend chi-square 11.8, P = 0.001). Abnormal vibration perception threshold was present in 43.3% (95% CI 36.3-50.3) of cases and had a significant correlation with NDS (P = 0.000). Abnormal monofilament testing was present in 6.1% of cases (95% CI 2.7- 9.5). A logistic regression analysis showed that DPN was independently associated with age (P = 0.002) and duration of diabetes prior to presentation (P = 0.02) but not with body mass index, plasma glucose, or HbA1c. CONCLUSIONS: Our study showed high prevalence of PN in recently diagnosed patients with T2DM, which was independently associated with age and duration of symptoms of diabetes prior to the diagnosis. Screening for DPN at diagnosis of diabetes is warranted, especially among older subjects.

Overset meshing in combination with novel blended weak-strong fluid-structure interactions for simulations of a translating valve in series with a second valve.

Mechanical circulatory support (MCS) devices can bridge the gap to transplant whilst awaiting a viable donor heart. The Realheart Total Artificial Heart is a novel positive-displacement MCS that generates pulsatile flow via bileaflet mechanical valves. This study developed a combined computational fluid dynamics and fluid-structure interaction (FSI) methodology for simulating positive displacement bileaflet valves. Overset meshing discretised the fluid domain, and a blended weak-strong coupling FSI algorithm was combined with variable time-stepping. Four operating conditions of relevant stroke lengths and rates were assessed. The results demonstrated this modelling strategy is stable and efficient for modelling positive-displacement artificial hearts.

The hereditary predisposition to hip osteoarthritis and its association with abnormal joint morphology.

OBJECTIVE: Genetic factors and abnormalities of joint morphology are important in the aetiology of hip osteoarthritis (OA). The extent to which genetic influences are manifest through joint morphology has undergone limited investigation. Using a cohort with an hereditary predisposition to end-stage hip OA and a control group with no inherited risk, we aimed to identify associations with abnormal joint morphology and clinical features. DESIGN: One hundred and twenty-three individuals (mean age 52 years) with a family history of total hip arthroplasty (THA) (termed 'sibkids') were compared with 80 spouse controls. Morphology was assessed using standardised radiographs and cam, dysplasia, and pincer deformities defined. Regression modelling described the association of cohort with abnormal joint morphology, adjusting for confounders [age, gender, body mass index (BMI), OA, and osteophyte]. RESULTS: Sibkids had an odds ratio of 2.1 [95%confidence interval (CI) 1.3-3.5] for cam deformity. There were no differences in the prevalence of dysplasia or pincer deformities. In both groups, hips with cam deformities or dysplasia were more likely to have clinical features than normal hips [odds ratio (OR) 4.46 (1.8-11.3), and 4.40 (1.4-14.3) respectively]. Pincer deformity was associated with positive signs in the sibkids but not in the controls (OR 3.0; 1.1-8.2). DISCUSSION: After adjustment for confounders that cause secondary morphological change, individuals with an hereditary predisposition to end-stage hip OA had a higher prevalence of morphological abnormalities associated with hip OA. Sibkids were more likely to demonstrate clinical features in the presence of pincer deformity, suggesting that the genes are acting not only through abnormal morphology but also through other factors that influence the prevalence of pain.

Antifungal drug usage in haematologic patients during a 4-year period in an Asian university teaching hospital.

BACKGROUND: Invasive fungal disease (IFD) is an important problem complicating the therapy of haematologic patients. AIM: This study aimed to provide data on the epidemiology of IFD in an Asian teaching hospital, as well as the prescription practice of antifungal drugs. METHOD: We conducted a retrospective review of 275 haematologic patients who were prescribed antifungal drugs in a 4-year period (2007-2010), of whom 130 (47%) had undergone haematopoietic stem cell transplantation. RESULTS: Antifungal prophylaxis with either fluconazole or itraconazole was given in 214 patients (78%). There were 414 prescriptions of antifungal drugs (including liposomal amphotericin B, voriconazole, caspofungin, micafungin, anidulafungin), of which 361 prescriptions were empirical. There were 14 patients with proven IFD, 11 of whom had breakthrough infection while on itraconazole prophylaxis. Interestingly, seven of these cases were due to infection by itraconazole-sensitive candida. CONCLUSION: These results provide important epidemiologic data necessary for the formulation of strategies for prevention and treatment of IFD in Asian patients.

Preoperative pain location is a poor predictor of outcome after Oxford unicompartmental knee arthroplasty at 1 and 5 years.

PURPOSE: Indications for unicompartmental knee arthroplasty (UKA) vary between units. Some authors have suggested, and many surgeons believe, that medial UKA should only be performed in patients who localise their pain to the medial joint line. This is despite research showing a poor correlation between patient-reported location of pain and radiological or operative findings in osteoarthritis. The aim of this study is to determine the effect of patient-reported preoperative pain location and functional outcome of UKA at 1 and 5 years. METHODS: Preoperative pain location data were collected for 406 knees (380 patients) undergoing Oxford medial UKA. Oxford Knee Score, American Knee Society Scores and Tegner activity scale were recorded preoperatively and at follow-up; 272/406 (67 %) had pure medial pain, 25/406 (6 %) had pure anterior knee pain, and 109/406 (27 %) had mixed or generalised pain. None had pure lateral pain. The primary outcome interval is 1 year; 132/406 patients had attained 5 years by the time of analysis, and their 5-year data are presented. RESULTS: At 1 and 5 years, each group had improved significantly by each measure [mean ΔOKS 15.6 (SD 8.9) at year 1, 16.3 (9.3) at year 5]. There was no difference between the groups, nor between patients with and without anterior knee pain or isolated medial pain. CONCLUSIONS: No correlation is demonstrated between preoperative pain location and outcome. We conclude that localised medial pain should not be a prerequisite to UKA and that it may be performed in patients with generalised or anterior knee pain.

Medial femoral head border is a reliable and reproducible reference for axis determination for femoral component of unicompartmental knee arthroplasty.

PURPOSE: The femoral component should be implanted parallel to the mechanical axis in unicompartmental knee arthroplasty. It was hypothesised that a line between medial femoral condyle centres and medial border of femoral head will be parallel to the mechanical axis; this study set out to examine this hypothesis. METHODS: One hundred X-rays in fifty patients were included for this study. Long-leg standing X-rays including hip and ankle with patellae facing forwards were obtained. On these films, we measured the angle, α, between mechanical axis and the line between the femoral head centre and knee centre (medial mechanical axis), and the angle, ß, between the medial mechanical axis and a line between medial femoral condyle and femoral head centre. RESULTS: The average value of α was 0.1 ± 0.5° and the average value of ß 3.0° ± 0.3°. These data indicate that mechanical axis and medial mechanical axis are virtually parallel to each other. CONCLUSION: As medial femoral head border is easily identified fluoroscopically, it is a reliable landmark for orientating the femoral component of medial UKA.

Species compositions and ecology of the riverine ichthyofaunas in two Sulawesian islands in the biodiversity hotspot of Wallacea.

This account of the riverine ichthyofaunas from the islands of Buton and Kabaena, off south-eastern mainland Sulawesi, represents the first detailed quantitative checklist and ecological study of the riverine fish faunas in the biological hotspot of Wallacea. The results are based on analysis of samples collected by electrofishing at a wide range of sites from July to September in both 2001 and 2002. While the fauna was diverse, with the 2179 fishes caught comprising 64 species representing 43 genera and 22 families, the catches were dominated by the Gobiidae (26 species and 25% by numbers), Eleotridae (seven species and 27% by numbers), Zenarchopteridae (three species and 22% by numbers) and Anguillidae (two species and 12% by numbers). The most abundant species were the eleotrids Eleotris aff. fusca-melanosoma and Ophieleotris aff. aporos, the anguillid Anguilla celebesensis, the zenarchopterids Nomorhamphus sp. and Nomorhamphus ebrardtii and the gobiids Sicyopterus sp. and Glossogobius aff. celebius-kokius. The introduced catfish Clarias batrachus was moderately abundant at a few sites. Cluster analysis, allied with the similarity profiles routine SIMPROF, identified seven discrete groups, which represented samples from sites entirely or predominantly in either Buton (five clusters) or Kabaena (two clusters). Species composition was related to geographical location, distance from river mouth, per cent contribution of sand and silt, altitude and water temperature. The samples from the two islands contained only one species definitively endemic to Sulawesi, i.e. N. ebrardtii and another presumably so, i.e. Nomorhamphus sp., contrasting starkly with the 57 species that are endemic to Sulawesi and, most notably, its large central and deep lake systems on the mainland. This accounts for the ichthyofaunas of these two islands, as well as those of rivers in northern mainland Sulawesi and Flores, being more similar to each other than to those of the central mainland lake systems. This implies that the major adaptive radiation of freshwater fishes in Sulawesi occurred in those lacustrine environments rather than in rivers.

Temporary vascular shunting in vascular trauma: a 10-year review from a civilian trauma centre.

BACKGROUND: Temporary intravascular shunts (TIVSs) can replace immediate definitive repair as a damage control procedure in vascular trauma. We evaluated their use in an urban trauma centre with a high incidence of penetrating trauma. METHOD: A retrospective chart review of all patients treated with a TIVS in a single centre between January 2000 and December 2009. RESULTS: Thirty-five TIVSs were placed during the study period: 22 were part of a damage control procedure, 7 were inserted at a peripheral hospital without vascular surgical expertise prior to transfer, and 6 were used during fixation of a lower limb fracture with an associated vascular injury. There were 7 amputations and 5 deaths, 4 of the TIVSs thrombosed, and a further 3 dislodged or migrated. Twenty-five patients underwent definitive repair with an interposition graft, 1 primary anastomosis was achieved, and 1 extra-anatomical bypass was performed. Five patients with non-viable limbs had the vessel ligated. CONCLUSIONS: A TIVS in the damage control setting is both life- and limb-saving. These shunts can be inserted safely in a facility without access to a surgeon with vascular surgery experience if there is uncontrollable bleeding or the delay to definitive vascular surgery is likely to be more than 6 hours. A definitive procedure should be performed within 24 hours.

Clinical-Epidemiological Pattern of Primary Immunodeficiencies in Malaysia 1987-2006: A 20 year experience in Four Malaysian Hospitals.

AIM OF STUDY: To determine the clinical and epidemiological characteristics of patients seen with primary immunodeficiencies referred at four Malaysian Hospitals between 1987 to 2007. METHODS: Patient data were retrospectively obtained from patient records and supplemented by information from a standardized questionnaires taken at the time of diagnosis from 4 participating hospitals. The completed data were transferred to document records kept by the first author. The diagnoses made were based on criteria set by WHO Scientific Committee 1986. RESULTS: Fifty one (51) patients with completed records satisfied the criteria of primary immunodeficiencies based on WHO Scientific Committee 1986. Predominant Antibody deficiency (40.4%) is the commonest of the class of primary immunodeficiency (based on modified IUIS classification) followed by phagocytic defect (17.3%), combined immunodeficiencies (15.4%) and other cellular immunodeficiencies (11.5%). The commonest clinical presentation is pneumonia (54%) . A positive Family history with a close family relative afflicted was a strong pointer to diagnosis for PID (52.6%) Primary immnodeficiencies are seen in all the major ethnic groups of Malaysia, predominantly among Malays. As observed in other patient registries, diagnostic delay remains the major cause of morbidity and mortality. CONCLUSION: Primary immunodeficiencies is relative rare but is an emerging disease in Malaysia. Creating awareness of the disease, may reveal more cases within the community. It is sufficient to be a health issue in Malaysia as in other developing countries in the future.