Thermal effusivity changes as a precursor to moist desquamation.

Skin toxicity is a ubiquitous side effect in radiotherapy and can be difficult to predict. Moist desquamation in cancer patients can decrease quality of life and occasionally demand unplanned treatment breaks thus worsening outcome. In breast cancer patients, moist desquamation occurs approximately one-third of the time, and while avenues such as intensity-modulated radiation therapy exist to decrease skin side effects, they may be prohibitively expensive to distribute widely. To selectively target patients who are at risk for high skin toxicity, toxicity prediction beyond heuristics is required. This study presents 3D thermal tomography, a translation technology that employs active thermal imaging to map the thermal effusivity of skin. Irradiated mice were imaged throughout reaction development to establish a correlation between effusivity changes and eventual toxicity severity. Female hairless mice (n = 11) were anesthetized and irradiated to 40 Gy in one fraction using a 1 cm Leipzig brachytherapy applicator with an Ir-192 source. After irradiation, thermal imaging was conducted daily with a flash lamp and infrared camera. Effusivity was calculated using custom software and tracked within irradiated and contralateral control regions. Mice were retrospectively grouped into high-grade (moist desquamation present, n = 6) and low-grade (n = 5). All mice showed an increase in the relative average effusivity difference among the treated and control regions between irradiation and peak reaction between 12 and 15 days after irradiation. The high-grade group showed an earlier increase in relative average effusivity difference (mean 1.7 days after irradiation versus 4.4 days after irradiation) than the low-grade group, and had a significantly greater relative average effusivity difference between 2-5 days after irradiation. We concluded that 3D thermal tomography is quick, non-invasive, non-ionizing and exhibited a correlative difference between mice that eventually developed moist desquamation and those that only presented dry desquamation. With further development, it may prove to be a useful tool in the clinic for differentiating patients who require preventative measures to reduce skin toxicity.

Surgical treatment of medial patellar luxation without femoral trochlear groove deepening procedures in dogs: 91 cases (1998-2009).

OBJECTIVE: To assess signalment, outcomes, and complications for dogs surgically treated for medial patellar luxation (MPL) with a combination of lateral retinacular imbrication and tibial crest transposition procedures without femoral trochlear groove deepening techniques, and to determine whether osteoarthritis progressed in these patients during the 8-week period following surgery. DESIGN: Retrospective case series. Animals-91 dogs. PROCEDURES: Medical records were reviewed for information on signalment, clinical history, unilateral versus bilateral disease, preoperative and postoperative MPL grades, duration of follow-up, and perioperative and postoperative complications. Radiographs obtained preoperatively and during 8-week follow-up examinations were reviewed and assigned degenerative joint disease (DJD) scores (range, 0 to 3). Data were analyzed to determine factors influencing outcomes. Kaplan-Meier curves were constructed for recurrence of MPL. RESULTS: Minor postoperative complications were reported for 31 of 91 (34.1%) dogs. Patellar reluxation occurred in 18 of 91 (19.8%) dogs. Reluxation or complications for which additional surgery was recommended developed in 6 of 91 (6.6%) dogs. At last clinical follow-up, 10 of 91 (11.0%) dogs had at least occasional lameness. No difference was revealed between preoperative and postoperative (8-week follow-up) radiographic DJD scores. CONCLUSIONS AND CLINICAL RELEVANCE: Results of surgical treatment of MPL without femoral trochlear groove deepening procedures were comparable to those in studies of surgical treatment that included groove deepening procedures. Radiographic indices of DJD did not increase during the 8 weeks following surgery. These results suggest that trochlear groove deepening procedures are not always necessary, and patients that undergo these techniques should be carefully selected.

Vaginal mesh for prolapse: a randomized controlled trial.

OBJECTIVE: To present 3-month outcomes of a double-blind, multicenter randomized controlled trial comparing traditional vaginal prolapse surgery without mesh with vaginal surgery with mesh. METHODS: Women with pelvic organ prolapse quantification prolapse stages 2-4 were randomized to vaginal colpopexy repair with mesh or traditional vaginal colpopexy without mesh. The primary outcome measure was objective treatment success (pelvic organ prolapse quantification stage 1 or lower) at 3 months. Secondary outcome measures included quality-of-life variables and complication rates. RESULTS: Sixty-five women were recruited from January 2007 to August 2009, when the study was halted due to predetermined stopping criteria for vaginal mesh erosion at a median follow-up of 9.7 months (range, 2.4-26.7 months). Thirty-two women underwent mesh colpopexy (24 anterior mesh, eight total mesh), and 33 women had vaginal colpopexies without mesh (primarily uterosacral ligament suspension) and concurrent colporrhaphy. There were no statistically significant baseline differences between the mesh and no-mesh groups with respect to demographics, menopausal status, and race. Analysis of the mesh and no-mesh women found no difference with respect to overall recurrence (mesh: 19 [59.4%] compared with no mesh: 24 [70.4%], P=.28). There were five (15.6%) vaginal mesh erosions. Two cystotomies and one blood transfusion occurred in the mesh group only. Subjective cure of bulge symptoms was noted in 93.3% of mesh patients and 100% of no-mesh patients. Furthermore, subjective quality-of-life measurements did not differ between the two groups at baseline or 3 months postoperatively. CONCLUSION: At 3 months, there is a high vaginal mesh erosion rate (15.6%) with no difference in overall objective and subjective cure rates. This study questions the value of additive synthetic polypropylene mesh for vaginal prolapse repairs. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, www.clinicaltrials.gov, NCT00475540. LEVEL OF EVIDENCE: I.

Thumb carpometacarpal suspension arthroplasty using interference screw fixation: surgical technique and clinical results.

PURPOSE: Arthritis of the thumb carpometacarpal (CMC) joint is a common condition, for which reconstruction using the flexor carpi radialis (FCR) is a standard treatment. We describe the technique and clinical results for thumb CMC arthroplasty using interference screw fixation of the FCR to the first metacarpal through a single incision. METHODS: Over 12 months, 29 consecutive CMC arthroplasties were performed in 29 patients using FCR transfer tenotomized at the level of the scaphoid with an absorbable biotenodesis screw for fixation. There were 24 women and 5 men, with a mean age of 58 years. Patients were evaluated at a minimum of one year with radiographs, standardized outcome instruments, and measurements of motion and strength. The scaphoid to first metacarpal distance was measured at 2 weeks, 3 months, and greater than 1 year to assess settling. RESULTS: A total of 28 patients were available at a mean of 19 months. No arthroplasties required revision. Postoperative scaphoid to first metacarpal distance was 5.9 mm, which had decreased by a mean of 1.4 mm at final follow-up. There were no side-to-side differences in range of motion or strength in the entire cohort except for lateral key pinch, which was lower on the reconstructed side. The mean postoperative Disabilities of the Arm, Shoulder, and Hand score was 15, and the mean visual analog scale score was 1. Correlations were found between age and lateral key pinch strength for the reconstructed and contralateral sides. There were no significant relationships among Disabilities of the Arm, Shoulder, and Hand score, visual analog scale, radiographic settling, side-to-side strength or range of motion versus gender, Eaton stage, or workers' compensation status. CONCLUSIONS: Our series demonstrates excellent clinical outcomes with no revisions at an average of 19 months for this technique. Strength, range of motion, and radiographic settling compare favorably with published results of alternative techniques. Except for lateral key pinch, there was no statistically significant difference in strength compared with the contralateral side. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Application of holographic display in radiotherapy treatment planning II: a multi-institutional study.

We hypothesized that use of a true 3D display providing easy visualization of patient anatomy and dose distribution would lead to the production of better quality radiation therapy treatment plans. We report on a randomized prospective multi-institutional study to evaluate a novel 3D display for treatment planning.The Perspecta Spatial 3D System produces 360 degrees holograms by projecting crosssectional images on a diffuser screen rotating at 900 rpm. Specially-developed software allows bi-directional transfer of image and dose data between Perspecta and the Pinnacle planning system.Thirty-three patients previously treated at three institutions were included in this IRB-approved study. Patient data were de-identified, randomized, and assigned to different planners. A physician at each institution reviewed the cases and established planning objectives. Two treatment plans were then produced for each patient, one based on the Pinnacle system alone and another in conjunction with Perspecta. Plan quality was then evaluated by the same physicians who established the planning objectives. All plans were viewable on both Perspecta and Pinnacle for review. Reviewing physicians were blinded to the planning device used. Data from a 13-patient pilot study were also included in the analysis.Perspecta plans were considered better in 28 patients (61%), Pinnacle in 14 patients (30%), and both were equivalent in 4 patients. The use of non-coplanar beams was more common with Perspecta plans (82% vs. 27%). The mean target dose differed by less than 2% between rival plans. Perspecta plans were somewhat more likely to have the hot spot located inside the target (43% vs. 33%). Conversely, 30% of the Pinnacle plans had the hot spot outside the target compared with 18% for Perspecta plans. About 57% of normal organs received less dose from Perspecta plans. No statistically significant association was found between plan preference and planning institution or planner.The study found that use of the holographic display leads to radiotherapy plans preferred in a majority of cases over those developed with 2D displays. These data indicate that continued development of this technology for clinical implementation is warranted.

Revision of the acetabulum with a contemporary cementless component.

We evaluated the performance of a contemporary cementless acetabular component at a minimum of 5 years postoperatively. One hundred eighty-seven consecutive acetabular component revisions were performed using a hemispherical porous-coated component. Patients were followed prospectively with radiographs and Harris hip scores. Twenty patients died, leaving 158 patients (166 hips) available for follow-up at a mean of 91 months. No patients were lost. Eleven acetabular components (7%) required repeated revision, including 4 (2%) for aseptic loosening. Seven of the 145 unrevised acetabular components with radiographic follow-up (5%) were loose. The results of acetabular revision with this contemporary acetabular component were good but inferior to those of earlier-generation implants. This difference is likely multifactorial.

Self-care strategies to cope with taste changes after chemotherapy.

PURPOSE/OBJECTIVES: To describe factors related to taste changes, to examine patients' use of a self-care suggestion sheet to manage taste changes associated with chemotherapy, and to identify potentially useful strategies for managing specific taste changes after chemotherapy. DESIGN: Quasi-experimental, pre/post design. SETTING: Four outpatient urban and suburban oncology centers in Illinois. SAMPLE: 42 patients who had received at least two cycles of chemotherapy previously identified to be associated with taste changes. METHODS: Pre- and postintervention survey of taste changes; patient education regarding self-care for taste changes. MAIN RESEARCH VARIABLES: Taste changes, taste change strategies, and self-care. FINDINGS: Most patients that reported taste changes had affected their ability to eat. Taste changes and strategies varied somewhat according to chemotherapy regimen. Avoiding strong-smelling or -tasting foods, eating blander foods, drinking more water with foods, oral care before eating, and eating smaller, more frequent meals were reported to help. CONCLUSIONS: Taste changes are common in patients receiving cisplatin, carboplatin, or cyclophosphamide. At-risk patients may benefit from prechemotherapy teaching regarding specific taste change management suggestions. Use of a taste change suggestion sheet encouraged self-care, and counseling patients regarding strategies to deal with taste changes may help them during chemotherapy. IMPLICATIONS FOR NURSING: Nurses should incorporate patient education tools that promote self-care regarding the management of taste changes in patients with known factors that could affect taste early in their chemotherapy.

Relationships between osteoprotegerin (OPG), receptor activator of nuclear factor kappaB ligand (RANKL), and growth hormone (GH) secretory status in short children.

GH deficiency places children at risk for decreased bone density and increased fracture rates. The RANKL/RANK/OPG system plays an important role in linking bone formation to bone resorption. Although OPG is thought to be secreted as a compensatory response to states of low bone density, its concentrations have not been found to differ significantly between GH-deficient, acromegalic, and healthy adults. AIM: To evaluate the associations between OPG and RANKL serum levels and GH secretory status in children. CHILDREN: 54 short children were recruited. METHODS: Serum OPG and RANKL, IGF-I, IGFBP-3, stimulated GH levels, bone DEXA results, and growth velocity were assessed. Regression modeling was used to evaluate significant predictors of OPG and RANKL levels. RESULTS: There were no significant differences in OPG and RANKL serum levels or bone DEXA results between GH-deficient and GH-sufficient children. A statistically significant quadratic relationship between OPG and IGFBP-3 concentrations was observed. CONCLUSIONS: IGFBP-3 was found to be the only significant predictor of OPG serum levels, allowing us to speculate that increased OPG levels may represent a compensatory response to the missing anabolic actions of IGF-I and/or GH in children with GH deficiency.

Assessment of axonal growth into collagen nerve guides containing VEGF-transfected stem cells in matrigel.

The early events associated with axonal growth into 10-mm nerve gaps were studied histologically in the rat sciatic nerve model to determine if the outgrowth of blood vessels, Schwann cells, and axons could be enhanced. In the first two experimental groups, collagen nerve guides were filled with either saline or Matrigel. Marrow-derived mesenchymal stem cells (MSCs) were added to Matrigel in two other groups, one of which contained cells transfected with VEGF (MSC/VEGF). After 21 days, the injury site was exposed, fixed, sectioned, and volume fractions of the conduit contents were determined by point counting. The bioresorbable collagen conduits appropriately guided the axons and vessels in a longitudinal direction. The volume fraction of axons was significantly greater in the group with saline when compared with all three groups with Matrigel. This measure had a significant positive correlation with actual counts of myelinated axons. The blood vessel volume fraction in the Matrigel group decreased compared with the saline group, but was restored in the MSC/VEGF group. All Matrigel groups had comparable cellularity and showed a distribution of residual Matrigel in acellular zones. The saline group, by contrast, sustained a network of delicate fibroblastic processes that compartmentalized the nerve and its natural matrix as it became infiltrated by axons as minifascicles. In conclusion, the reduction of axonal outgrowth in the Matrigel groups, when compared with the saline group, suggests that Matrigel may impede the early regenerative process even when enriched by the addition of MSCs or VEGF-transfected cells.

Short and long term failure of the modular oncology knee prosthesis.

This retrospective study investigated the modes of implant failure in 80 patients with modular oncology knee prostheses. Twenty patients (25%) required revision: 12 (60%) for stem loosening, 6 (30%) for bearing failure, and 2 (10%) for infection. Patients with bone sarcomas survived longer; however, long-term prosthetic survivorship was a problem. A higher failure rate was found in patients with tibial tumors and with adjuvant treatment of chemotherapy. This study demonstrates for improved long-term survivorship of modular oncology knee prostheses, there must be improvement in the methods of stem fixation, prosthetic materials, and bearing mechanics.

Risk factors for ventral luxation in canine total hip replacement.

OBJECTIVE: To identify risk factors associated with ventral luxation (VL) of canine total hip replacement (THR), and outcome. STUDY DESIGN: Retrospective study. ANIMALS: Dogs (n=602) that had THR (563 cemented, 35 cementless, 4 hybrid). METHODS: Dogs (1999-2004) with VL after THR were compared with dogs with uncomplicated THR. Data included signalment, body weight, diagnosis, implant size, acetabular cup orientation, and femoral displacement ratio (FDR). RESULTS: VL was diagnosed in 11 (1.8%) dogs after primary THR. Including 2 other dogs that had VL after the study period, 10 (77%) of 13 dogs had VL within 7 days of surgery. Risk factors for VL included Saint Bernard-type dogs (P=.0001), short neck extension (P=.0005), and high angle of lateral opening in other breeds (P=.018). There were trends toward higher risk of VL with lower FDR in Saint Bernard types (P=.060), and with cementless implants (P=.061). Twelve dogs had revision arthroplasty that was successful in all cementless and 2 cemented VL cases. Five dogs had recurrent VL and a poor outcome. CONCLUSION: VL is generally an early complication of THR, with no single common risk factor identified. CLINICAL RELEVANCE: Saint Bernard types and short neck extensions are associated with increased risk of VL. Poor cup orientation is a determining factor for VL in some dogs, but a protective orientation of the acetabular cup was not found. Revision is successful in most dogs, but recurrent VL merits a guarded prognosis.

Progression of radiographic evidence of osteoarthritis following tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 295 cases (2001-2005).

OBJECTIVE: To determine whether radiographic signs of osteoarthritis became progressively worse and tibial slope angle (TSA) changed substantially following tibial plateau leveling osteotomy for treatment of cranial cruciate ligament rupture in dogs. DESIGN: Retrospective case series. ANIMALS: 295 dogs (373 stifle joints). PROCEDURES: Medical records were reviewed. Radiographs obtained before and 8 weeks after surgery were used to determine the degenerative joint disease (DJD) score, calculated as the sum of individual scores (0 through 3) assigned to 30 radiographic factors. Radiographs obtained immediately and 8 weeks after surgery were used to measureTSA. For dogs that underwent bilateral surgery, data for the first joint treated were used in analyses. Data for the second joint treated in dogs that underwent bilateral surgery were analyzed separately. RESULTS: A small, but significant, increase was found in mean DJD score 8 weeks after surgery, compared with mean preoperative score. An inverse relationship was found between preoperative DJD score and the difference between postoperative and preoperative DJD scores. Mean TSA 8 weeks after surgery was significantly higher than mean TSA immediately after surgery. Analysis of data for the second stifle joints in the 78 dogs that underwent bilateral surgery yielded similar results. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that there was a small, but measurable, increase in the severity of radiographic changes attributed to osteoarthritis in the stifle joints of dogs that underwent tibial plateau leveling osteotomy because of cranial cruciate ligament rupture.

Evaluation of endothelial function in women with polycystic ovary syndrome.

OBJECTIVES: Previous studies have suggested that vascular reactivity may be altered in women with polycystic ovary syndrome (PCOS). We sought to evaluate the vascular reactivity specifically the endothelial function (EF) in women with PCOS and to study the effect of metformin on their EF. STUDY DESIGN: Thirty-one women diagnosed with PCOS and 33 healthy controls underwent evaluation of EF using a post-ischemia reactive hyperemia technique (Endo-PAT). EF was quantitatively determined as the ratio between the arterial pulse wave amplitude following a 5min arterial occlusion in the forearm to the pre-occlusion value. Oral metformin 850mg bid was administered to PCOS patients. After 3 months of treatment EF was reassessed using the same technique. RESULTS: The average endothelial function was 1.48+/-0.32 in the PCOS group versus 2.00+/-0.51 in the controls (P<0.001). There were no significant changes in the EF among the 18 patients who were treated with metformin, EF index pre- and post-treatment was 1.42 versus 1.43, respectively. CONCLUSIONS: Endothelial dysfunction is more likely to occur among PCOS patients than in healthy controls. These preliminary results suggest that metformin treatment for 3 months in PCOS patients does not improve endothelial function.

Long term disease-free survival resulting from combined modality management of patients presenting with oligometastatic, non-small cell lung carcinoma (NSCLC).

We report outcomes on 23 patients with oligometastastic (1 or 2 sites) NSCLC treated with aggressive local, regional, and systemic treatment. The results suggest that this is a favorable subset of patients who may benefit from such an approach, with a 22% rate of long-term survival. This treatment strategy is a departure from the usual practice of palliative-only therapy for all NSCLC patients presenting with metastatic disease.

Patient-centered surgical outcomes: the impact of goal achievement and urge incontinence on patient satisfaction one year after surgery.

OBJECTIVE: The purpose of this study was to assess factors that influence patient satisfaction 1 year after pelvic reconstructive surgery. STUDY DESIGN: We previously reported the objective success, goals, and expectations of a cohort of 78 patients 3 months after surgery. A second blinded independent physician investigator contacted the same patients by phone to reassess these items 1 year after surgery. Data were analyzed with the Spearman correlation, the Mann-Whitney test, the chi-squared test of association, and the Friedman test. RESULTS: Seventy patients (89%) of the original cohort completed the second assessment. Although group satisfaction and goal achievement were stable (P < .01), 70% of patients reported a change in their satisfaction ratings between 3 months and 1 year (rho = 0.3). Reduced satisfaction between 3 and 12 months after surgery was strongly associated with decreased goal achievement (rho = 0.47; P = .006). Fifty-six percent of patients reported urge incontinence symptoms after surgery (44% de novo and 12% persistent). Urge incontinence was the most common reason for patient dissatisfaction after surgery (P = .04). CONCLUSION: Symptoms of urge incontinence and reduced achievement of subjective surgical goals are associated with decreased long-term patient satisfaction after reconstructive pelvic surgery.

Relieving symptoms in cancer: innovative use of art therapy.

Art therapy has been used in a variety of clinical settings and populations, although few studies have explored its use in cancer symptom control. The specific aim of this study was to determine the effect of a 1-hour art therapy session on pain and other symptoms common to adult cancer inpatients. A quasi-experimental design was used (n=50). The Edmonton Symptom Assessment Scale (ESAS) and the Spielberger State-Trait Anxiety Index (STAI-S) were used prior to and after the art therapy to quantify symptoms, while open-ended questions evaluated the subjects' perceptions of the experience. There were statistically significant reductions in eight of nine symptoms measured by the ESAS, including the global distress score, as well as significant differences in most of the domains measured by the STAI-S. Subjects overwhelmingly expressed comfort with the process and desire to continue with therapy. This study provides beginning evidence for the efficacy of art therapy in reducing a broad spectrum of symptoms in cancer inpatients.

Spirituality and distress in palliative care consultation.

BACKGROUND: One's spirituality or religious beliefs and practices may have a profound impact on how the individual copes with the suffering that so often accompanies advanced disease. Several previous studies suggest that negative religious coping can significantly affect health outcomes. OBJECTIVE: The primary aim of this study was to explore the relationship between spirituality, religious coping, and symptoms of distress among a group of inpatients referred to the palliative care consult service. DESIGN: Pilot study. SETTING: The study was conducted in a large academic medical center with a comprehensive Palliative Care and Home Hospice Program. MEASUREMENT: (1) National Comprehensive Cancer Network Distress Management Assessment Tool; (2) Pargament Brief Religious Coping Scale (Brief RCOPE); (3) Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp); (4) Puchalski's FICA; and (5) Profile of Mood States-Short Form (POMS-SF). RESULTS: The 31 subjects surveyed experienced moderate distress (5.8 +/- 2.7), major physical and psychosocial symptom burden, along with reduced function and significant caregiving needs. The majority (87.2%) perceived themselves to be at least somewhat spiritual, with 77.4% admitting to being at least somewhat religious. Negative religious coping (i.e., statements regarding punishment or abandonment by God) was positively associated with distress, confusion, depression, and negatively associated with physical and emotional well-being, as well as quality of life. CONCLUSIONS: Palliative care clinicians should be alert to symptoms of spiritual distress and intervene accordingly. Future research is needed to identify optimal techniques to address negative religious coping.

Cosmetic outcome and incidence of infection with the MammoSite breast brachytherapy applicator.

We present our results regarding the cosmetic outcome achieved and the rate of infection using the MammoSite breast brachytherapy applicator to treat patients with partial breast irradiation. In addition, factors associated with cosmetic outcome and infection are analyzed. The study population consisted of 30 patients with early stage breast cancer treated using the MammoSite device from October 28, 2002, to February 13, 2004. Cosmetic outcome was analyzed for its association with the following parameters: volume of the balloon, balloon-to-skin distance, maximal skin point dose per fraction, V100 (percent of volume that received 100% of the prescription dose), V150 (percent of volume that received 150% of the prescription dose), and V200 (percent of volume that received 200% of the prescription dose). The occurrence of infection at the time of treatment and during follow-up was also recorded. At a median follow-up of 13 months (range 1-16 months), 53.3% of the patients (16/30) were reported to have an excellent cosmetic outcome and 40.0% (12/30) had a good cosmetic outcome. Excellent cosmetic outcome was associated with a greater mean balloon-to-skin distance compared to those who achieved a good cosmetic outcome (1.5 cm versus 1.2 cm) (p = 0.164). The mean V100, V150, and V200 of those in the excellent cosmetic outcome group were 92.1%, 34.5%, and 7.6% versus 93.0%, 34.7%, and 7.6% in the good cosmetic outcome group (p = 0.642, 0.926, and 0.853), The mean balloon volumes were 47.7 cm3 and 56.9 cm3, respectively (p = 0.063) in the excellent and good outcome groups. The mean maximal skin doses per fraction in the excellent and good outcome groups were 354.8 cGy and 422.3 cGy (p = 0.286), respectively. Infection occurred in 13.3% of the patients (4/30). An excellent or good cosmetic outcome was achieved in 93.3% of patients and infection occurred in 13.3% of patients treated with the MammoSite breast brachytherapy applicator. Excellent cosmetic outcome was associated with a greater balloon-to-skin distance, lower maximal skin dose per fraction, and smaller mean balloon volume; however, the results did not reach statistical significance.

Patterns and localization of gene expression during intramembranous bone regeneration in the rat femoral marrow ablation model.

Tissue formation and repair are dependent upon cascades of biological events, but the signals involved and the possible gene coexpression patterns during intramembranous bone repair are only poorly understood. We sought to place this mode of regeneration in context by profiling quantitative gene expression for a panel of 39 genes between days 1 and 14 following rat femoral marrow ablation. In situ hybridization was employed to localize a subset of genes. Additionally, principal components analysis was conducted to identify underlying factors suggestive of coexpression patterns. During inflammation (days 1-5), several genes, including cyclooxygenase-1 and -2, showed downregulation. Other proinflammatory cytokines, tumor necrosis factor-alpha and interleukin-1beta, exhibited increasing levels around day 5. During repair (days 3-10), growth factors, receptors, and inhibitor genes for transforming growth factor- beta; basic fibroblast growth factor; bone morphogenetic proteins 2, 4, and 7; vascular endothelial growth factor; and insulin-like growth factor-I were upregulated. In addition, the gene for core binding factor-alpha1 and markers of osteoblast function such as alkaline phosphatase, collagen type I, osteonectin, osteopontin, and osteocalcin had peak expression at day 5 or 7. The remodeling phase (days 10-14) was characterized by peaks for cytokines associated with osteoclastic activity including receptor activator of nuclear factor-kappaB, receptor activator of nuclear factor-kappaB ligand (RANKL), cathepsin K, tumor necrosis factor-alpha, interleukin-6, and cyclooxygenase-2. In situ hybridization showed that the most common sites of increased signal were within osteoblastic cells on trabecular and endosteal surfaces. Principal components analysis identified eight underlying factors that together explained over 80% of the variance in the data.

Revision of the acetabular component without cement after total hip arthroplasty. A concise follow-up, at fifteen to nineteen years, of a previous report.

We previously reported our results at a minimum of three and seven years after use of a porous-coated acetabular metal shell in a consecutive series of 138 revision total hip arthroplasties. The current report presents the longer-term outcomes of these procedures, at fifteen to nineteen years postoperatively. A total of twenty metal shells (14%) underwent repeat revision. Seven of the repeat revisions were performed because of recurrent dislocation, seven were done at the time of femoral revision surgery, and six were done because of infection. Nineteen of the revised shells were well fixed, and one was aseptically loose. Of the sixty-seven hips in which the acetabular component survived for more than fifteen years after the index operation, two (3%) required a change of the modular acetabular liner because of wear or osteolysis. Nine (16%) of the fifty-seven hips with at least fifteen years of radiographic follow-up had an osteolytic lesion of >1 cm in diameter. The fifteen-year survival rate of the metal shells, with failure defined as revision because of loosening or as radiographic evidence of loosening, was 97%. Revision total hip arthroplasty with this cementless acetabular component has been followed by excellent component survivorship at fifteen years; the most common reasons for repeat revision were recurrent dislocation and infection.