Long-term analysis of revision reverse shoulder arthroplasty using cemented long stems.

BACKGROUND: Revision of failed shoulder arthroplasty is often associated with poor results and a high rate of complications. Significant humeral bone loss after removal of long stems poses a considerable surgical challenge. Therefore, the aim of our study was the evaluation of the clinical and radiologic outcome of cemented long-stem humeral components in revision reverse shoulder arthroplasty with a minimum 5 years' follow-up. METHODS: Between June 2001 and June 2009, revision reverse shoulder arthroplasty using long-stem cemented humeral components was performed in 124 patients. Mean age at time of surgery was 69.6 years (range, 42-87 years). Complete clinical and radiographic data were available in 50 patients at a mean of 7 years (range, 5-11.6 years). Postoperative radiographs were evaluated for radiolucent lines, implant migration, fracture, and glenoid notching. RESULTS: The mean Constant score improved from 11.1 points (range, 0-27 points) to 39.5 points (range, 14-73 points) at the latest follow-up. Progressive humeral radiolucency was present in 24 patients, including 6 patients demonstrating complete loosening or progressive distal migration of the humeral stem. We noted an overall of 12 additional complications in 8 patients, necessitating revision surgery in 16. CONCLUSION: The use of long-stem humeral components is a beneficial treatment in revision reverse shoulder arthroplasty. Nevertheless, the high percentage of patients with humeral loosening is concerning. Modular cementless revision stems that are adapted to the distal humeral medullary canal and additional distal screw and cable fixation might enhance durable distal fixation in case of advanced bone loss.

Revision to reverse shoulder arthroplasty with retention of the humeral component.

BACKGROUND: Revision in failed shoulder arthroplasty often requires removal of the humeral component with a significant risk of fracture and bone loss. Newer modular systems allow conversion from anatomic to reverse shoulder arthroplasty with retention of a well-fixed humeral stem. We report on a prospectively evaluated series of conversions from hemiarthroplasty to reverse shoulder arthroplasty. METHODS: In 14 cases of failed hemiarthroplasty due to rotator cuff deficiency and painful pseudoparalysis (in 13 women), revision to reverse shoulder arthroplasty was performed between October 2006 and 2010, with retention of the humeral component using modular systems. Mean age at the time of operation was 70 (56-80) years. Pre- and postoperative evaluation followed a standardized protocol including Constant score, range of motion, and radiographic analysis. Mean follow-up time was 2.5 (2-5.5) years. RESULTS: Mean Constant score improved from 9 (2-16) to 41 (17-74) points. Mean lengthening of the arm was 2.6 (0.9-4.7) cm without any neurological complications. One patient required revision due to infection. INTERPRETATION: Modular systems allow retainment of a well-fixed humeral stem with good outcome. There is a risk of excessive humeral lengthening.

Lipid peroxidation markers in Crohn's disease: the associations and diagnostic value.

BACKGROUND: Crohn's disease (CD) is an incurable and difficult to diagnose condition. While high sensitive C-reactive protein (CRP) remains the best biochemical marker, we evaluated the diagnostic usefulness of lipid peroxidation indices. METHODS: Malondialdehyde/thiobarbituric acid-reactive substances (MDA/TBARS), peroxidation potential (PP), lipid hydroperoxides (ROOH), oxidized-low density lipoprotein (oxLDL), and oxLDL antibodies (OLAB) were assessed in 52 CD patients and 99 volunteers and referred to clinical activity, inflammation, nutritional and antioxidant status. RESULTS: MDA/TBARS were higher in CD while oxLDL and PP decreased in active disease and ROOH and OLAB did not differ. oxLDL and PP negatively and OLAB positively correlated with CD activity. MDA/TBARS positively correlated with IL-6 and SOD-1 and negatively with catalase. IL-6 and SOD-1 explained 24% in MDA/TBARS variability. PP negatively correlated with CRP, platelets, and IL-6 and positively with glutathione peroxidase-1, paraoxonase-1, cholesterol, triglycerides, and albumins. Cholesterol and CRP explained 57% in PP variability. oxLDL negatively correlated with IL-1 and IL-6 and positively with glutathione peroxidase-1, paraoxonase-1, cholesterol, and albumins. Paraoxonase-1 explained 17% of oxLDL variability. OLAB positively correlated with IL-1 explaining 10% in its variability and negatively with cholesterol. MDA/TBARS were the best predictor of CD, comparable to CRP, with high specificity (MDA/TBARS sensitivity and specificity: 75% and 90%; CRP: 76% and 93%). Combined assessment of MDA/TBARS and CRP improved sensitivity (94%) corresponding with acceptable specificity (81%). CONCLUSIONS: MDA/TBARS are elevated in CD and may help to rule the disease out, while the combined evaluation with CRP may serve for CD confirmation. oxLDL and PP depended on substrate availability, decreased in CD.

Enhanced formation of advanced oxidation protein products in IBD.

BACKGROUND: Advanced oxidation protein products (AOPPs) are new protein markers of oxidative stress with pro-inflammatory properties, accumulated in many pathological conditions. The issue of their enhanced formation in IBD has not been addressed yet. METHODS: The concentration of relative AOPPs (rAOPP; concentration of AOPPs divided by albumin level) were measured in 68 subjects with ulcerative colitis (UC), 50 subjects with Crohn's disease (CD) and 45 healthy volunteers, and related to disease phenotype, clinical and biochemical activity, and therapeutic strategy. Diagnostic utility of rAOPP was evaluated by ROC analysis. RESULTS: In comparison with controls (1.367 micromol/g), rAOPP were increased in inactive (1.778 micromol/g, P = 0.053) and active (1.895 micromol/g, P = 0.013) UC and in active (1.847 micromol/g, P = 0.003) CD. In CD, but not UC, rAOPP correlated with disease activity (r = 0.42, P = 0.013). Significant correlations with the inflammatory/malnutrition indices-erythrocyte sedimentation rate (ESR) (r = 0.53), leukocytes (r = 0.33), platelets (r = 0.38), IL-6 (r = 0.36), and transferrin (r = -0.35) were demonstrated in CD. In UC, rAOPP correlated only with ESR (r = 0.35) and IL-6 (r = 0.30). Instead, associations with antioxidant dismutase (r = 0.29) and catalase (r = 0.22) were observed. The diagnostic power of rAOPP in discriminating diseased from non-diseased subjects was less than that of C-reactive protein (CRP). Simultaneous determination of rAOPP and CRP did not significantly improve the power of single CRP determination. CONCLUSIONS: IBD was associated with enhanced formation of AOPP, which differed between C and UC with respect to the relationship between rAOPP and disease activity, inflammatory and antioxidant response. These differences may reflect divergent ways that oxidative stress develops in CD and UC. The diagnostic power of rAOPP was insufficient for its clinical application.

Diagnostic potential of oxidative stress markers in children and adolescents with type 1 diabetes.

OBJECTIVES: To validate the diagnostic utility of oxidative stress markers in the evaluation of young type 1 diabetics, as suggested elsewhere. DESIGN: Advanced oxidation protein products (AOPP), thiobarbituric acid-reactive substances (TBARS) and total antioxidant status (TAS) were measured in sera from diabetics, their siblings and controls, with diagnostic potential evaluated by ROC analysis, and related to diabetes clinical parameters. RESULTS: In diabetics AOPP and TBARS were elevated, TAS decreased. Similar alterations were observed for AOPP and TAS in their siblings. AOPP and TAS were good indicators of diabetes. AOPP and TBARS correlated with HbA1C (independent predictor), but were poor markers of non-adequate glycemic control. The cardiovascular disease risk factors were independent predictors of TBARS concentrations. CONCLUSIONS: AOPP accumulation and TAS reduction seem to precede diabetes and might be considered as susceptibility indicators in relatives, but not as diabetes markers in general population (no diabetes specificity has been shown). Application in monitoring of metabolic control is not validated.

Paraoxonase-1 status in Crohn's disease and ulcerative colitis.

BACKGROUND: Paraoxonase 1 (PON1) is an extracellular enzyme, which in the gastrointestinal tract may act as a local detoxifier, antioxidant, immunomodulator, and/or quorum-quenching factor. There are no data on PON1 activity in Crohn's disease (CD). METHODS: PON1 phenotype and activity were determined spectrophotometrically in 52 subjects with CD, 67 with ulcerative colitis (UC), and 99 healthy individuals, and related to lipid peroxidation and disease phenotype, clinical and biochemical activity, and therapeutic strategy. Diagnostic utility of PON1 was evaluated by ROC analysis and compared with C-reactive protein (CRP). RESULTS: In comparison with controls (166 U), PON1 was reduced only in active CD (110 U, P < 0.0001) and UC (126 U, P < 0.0001), and correlated with disease activity (r = -0.47, P = 0.001 in CD and r = -0.50, P < 0.001 in UC). PON1 significantly correlated with erythrocyte sedimentation rate (ESR) (r = -0.36), platelets (r = -0.35), interleukin-6 (r = -0.45), hemoglobin (r = 0.29), transferrin (r = 0.46), albumin (r = 0.60) in CD, and CRP (r = -0.29), ESR (r = -0.37), platelets (r = -0.43), leukocytes (r = -0.50), interleukin-6 (r = -0.45), hemoglobin (r = 0.34), transferrin (r = 0.54), and albumin (r = 0.50) in UC. PON1 correlated positively with lipids but not with their peroxidation markers (thiobarbituric acid-reactive substances, lipid hydroperoxides, ox-LDL, and ox-LDL autoantibodies). PON1 phenotype B (protective against IBD) tended to be less frequent in IBD patients than controls, and associated with lower concentration of inflammatory indices. PON1 was a poorer indicator of CD or UC than CRP. CONCLUSIONS: PON1 was reduced in IBD, despite treatment with antioxidant 5'-aminosalicylate derivatives. PON1 reflected disease activity, inflammation severity, and anemia but not lipid peroxidation. The diagnostic power of PON1 was insufficient for its clinical application.

Advanced oxidation protein products (AOPPs) in juvenile overweight and obesity prior to and following weight reduction.

OBJECTIVES: To evaluate the formation of advanced oxidation protein products (AOPPs) in juvenile overweight/obesity and obesity-related disorders and to investigate the effect of weight reduction on AOPPs. DESIGN AND METHODS: AOPPs were determined in 114 overweight/obese children and adolescents without/with insulin resistance and metabolic syndrome and compared with 53 lean controls. Measurements were repeated following weight reduction program (diet/exercise, bran-enriched diet/exercise, and diet/exercise plus metformin). RESULTS: Overweight/obese subjects had higher AOPPs than lean controls, more elevated in patients with co-occurring metabolic syndrome. AOPPs positively correlated with central obesity, triglycerides, lipid peroxidation and insulin, and negatively with glucose to insulin ratio. AOPPs decreased following obesity intervention and DeltaAOPPs correlated with DeltaBMI%. AOPPs reduction was more pronounced in subjects on bran-enriched diet. Baseline AOPPs were a better predictor of clinically significant weight reduction than BMI%. CONCLUSIONS: Juvenile overweight/obesity was associated with AOPPs accumulation, more pronounced in metabolic syndrome. Body mass reduction decreased oxidative stress, with bran-enriched diet being more effective than diet/exercise alone.

Paraoxonase 1 (PON1) status in gastroesophageal malignancies and associated paraneoplastic syndromes - connection with inflammation.

OBJECTIVE: To evaluate the status and diagnostic utility of antioxidant paraoxonase 1 (PON1) in gastroesophageal cancers. DESIGN AND METHODS: PON1's arylesterase/paraoxonase activities and phenotype were determined in 82 cancers and 57 controls, and related to clinicopathological features, anemia and cachexia coexistence, cholesterol levels, liver function panel, and inflammatory and angiogenic indices. RESULTS: PON1's activities were decreased in cancer. Arylesterase activity correlated with cancer T and N stages, being an N1-independent predictor. Both activities correlated with transferrin, albumin, CRP and inflammation-based Glasgow Prognostic Score, and arylesterase activity also with interleukin-6 and midkine. Phenotype A (Q192 homozygotes) was associated with lower transferrin and higher TNF-alpha concentrations. PON1's arylesterase activity reflected anemia severity, being correlated with hemoglobin, hematocrit, and iron. PON1 arylesterase activity negatively correlated with alkaline phosphatase and gamma-glutamyl transferase, but not with bilirubin, aminotransferases, HDL or LDL cholesterol. PON1 moderately indicated cancer presence and regional metastasis. CONCLUSIONS: PON1 activity decreases in gastroesophageal cancers and corresponds to inflammation severity and cancer-related anemia. PON1 decrease indicates lymph node metastasis, but its moderate predictive power does not recommend PON1 determination alone for clinical application.