The effect of vitamin D supplementation on outcomes following total hip or knee arthroplasty surgery: a rapid systematic review of current evidence.

Purpose: Vitamin D deficiency has been linked to poorer outcomes following hip (THR) and knee (TKR) replacement. We review the effect of peri-operative supplementation on clinical and patient-reported outcomes following THR/TKR. Methods: This study was registered with PROSPERO (CRD42021238086). Searches of electronic databases were performed from inception to March 2021. All randomised, cohort, or case-controlled studies reported in English of adults undergoing THR/TKR where vitamin D supplementation was given peri-operatively and at least one outcome was reported were included. Studies reporting on vitamin D in relation to osteoporosis and hip fracture were excluded, as were conference abstracts and those involving preclinical models. Risks of bias were performed using the RoB-2 and ROBINS-I tools. Results: Three studies comprising 413 TKR patients were identified; two were randomised controlled trials and one was a prospective cohort study. No studies meeting the inclusion criteria reported on the outcomes following THR. Supplementation was associated with a statistically significant reduction in the IL6:IL10 ratio at 24- and 48h following surgery, but no effect was noted on Western Ontario and McMaster Universities Osteoarthritis Index scores or the rates of falls. All studies were judged to be limited by bias, with heterogeneity in the supplementation dose and timing of administration, as well as the reported outcome measures used. Discussion: Further adequately powered randomised-controlled trials using vitamin D supplementation and a specific clinically relevant or patient-reported outcome measure are required to assess if pre-operative vitamin D insufficiency is a modifiable risk factor to improve outcomes following THR/TKR.

Dose optimisation of intravenous tranexamic acid for elective hip and knee arthroplasty: The effectiveness of a single pre-operative dose.

OBJECTIVES: We have increased the dose of tranexamic acid (TXA) in our enhanced total joint recovery protocol at our institution from 15 mg/kg to 30 mg/kg (maximum 2.5 g) as a single, intravenous (IV) dose. We report the clinical effect of this dosage change. METHODS: We retrospectively compared two cohorts of consecutive patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) surgery in our unit between 2008 and 2013. One group received IV TXA 15 mg/kg, maximum 1.2 g, and the other 30 mg/kg, maximum 2.5 g as a single pre-operative dose. The primary outcome for this study was the requirement for blood transfusion within 30 days of surgery. Secondary measures included length of hospital stay, critical care requirements, re-admission rate, medical complications and mortality rates. RESULTS: A total of 1914 THA and 2537 TKA procedures were evaluated. In THA, the higher dose of TXA was associated with a significant reduction in transfusion (p = 0.02, risk ratio (RR) 0.74, 95% confidence interval (CI) 0.58 to 0.96) and rate of re-admission (p < 0.001, RR 0.50, 95% CI 0.35 to 0.71). There were reductions in the requirement for critical care (p = 0.06, RR 0.55, 95% CI 0.31 to 1.00), and in the length of stay from 4.7 to 4.3 days (p = 0.02). In TKA, transfusion requirements (p = 0.049, RR 0.64, 95% CI 0.41 to 0.99), re-admission rate (p = 0.001, RR 0.56, 95% CI 0.39 to 0.80) and critical care requirements (p < 0.003, RR 0.34, 95% CI 0.16 to 0.72) were reduced with the higher dose. Mean length of stay reduced from 4.6 days to 3.6 days (p < 0.01). There was no difference in the incidence of deep vein thrombosis, pulmonary embolism, gastrointestinal bleed, myocardial infarction, stroke or death in THA and TKA between cohorts. CONCLUSION: We suggest that a single pre-operative dose of TXA, 30 mg/kg, maximum 2.5g, results in a lower transfusion requirement compared with a lower dose in patients undergoing elective primary hip and knee arthroplasty. However, these findings should be interpreted in the context of the retrospective non-randomised study design.Cite this article: R. J. M. Morrison, B. Tsang, W. Fishley, I. Harper, J. C. Joseph, M. R. Reed. Dose optimisation of intravenous tranexamic acid for elective hip and knee arthroplasty: The effectiveness of a single pre-operative dose. Bone Joint Res 2017;6:499-505. DOI: 10.1302/2046-3758.68.BJR-2017-0005.R1.

Spontaneous formation of compound X chromosomes in Drosophila melanogaster.

Males carrying different X chromosomes were tested for the ability to produce daughters with attached-X chromosomes. This ability is characteristic of males carrying an X chromosome derived from 59b-z, a multiply marked X chromosome, and is especially pronounced in males carrying the unstable 59b-z chromosomes Uc and Uc-lr. Recombination experiments with one of the Uc-lr chromosomes showed that the formation of compound chromosomes depends on two widely separated segments. One of these is proximal to the forked locus and is probably proximal to the carnation locus. This segment may contain the actual site of chromosome attachment. The other essential segment lies between the crossveinless and vermilion loci and may contain multiple factors that influence the attachment process.

Hypertension after lung transplantation.

Hypertension is a recognized side effect of cyclosporine administration after kidney, heart, and bone-marrow transplantation. The incidence has not been previously reported after lung transplantation. We reviewed the incidence and potential causes of hypertension in recipients of single and double lung transplants. Twenty-one previously normotensive, stable recipients of lung transplants were reviewed retrospectively to determine the incidence of hypertension. Renal function as measured by blood urea nitrogen, creatinine, prednisone, and cyclosporine levels and dosages were determined at time of onset of hypertension. Hypertension developed in 14 of 21 previously normotensive patients (66%) followed from 4 to 64 months after transplantation (mean onset 11 months after transplantation). Renal function was diminished in all patients after transplantation. Neither the level of renal dysfunction nor cyclosporine dosage or level predicted the development of hypertension. The incidence of hypertension in lung transplant recipients was comparable to that reported in cyclosporine-treated kidney transplant patients (67%) and bone-marrow transplant patients (60%) but was less than that in heart transplant recipients (90%). Preserved cardiac innervation may explain the lower incidence of hypertension in lung compared with heart transplant recipients in the presence of comparable immunosuppressives and renal function. Time to onset of hypertension in lung transplant recipients is delayed compared with that in other organ transplants. This suggests that additional mechanisms as yet unexplored may be invoked.

Nitric oxide effects on shortening velocity and power production in the rat diaphragm.

The present experiments tested nitric oxide (NO) effects on shortening velocity and power production in maximally activated rat diaphragm. Diaphragm fiber bundles (n = 10/group) were incubated at 37 degrees C in Krebs-Ringer solution containing no added drug (control), the NO synthase inhibitor N omega-nitro-L-arginine (L-NNA; 10 mM), the NO donor sodium nitroprusside (SNP; 1 mM), or a combination (L-NNA + SNP) Loaded shortening velocity was measured via the load-clamp technique over a range of afterloads. Force-velocity data were fitted to the Hill equation to determine maximum velocity of shortening (Vmax). Unloaded shortening velocity was measured in control and L-NNA-treated bundles (n = 12/group) by using the slack test. Maximal isometric force and unloaded shortening velocity were not altered by L-NNA. In contrast, L-NNA decreased maximum velocity of shortening (P < 0.05), loaded shortening velocity (P < 0.0001), and power production (P < 0.0001). All L-NNA effects were prevented by coincubating fiber bundles with L-NNA + SNP. SNP alone had no effect on any variable. These data indicate that endogenous NO is essential for optimal myofilament function during active shortening.

Airway simulation to guide stent placement for tracheobronchial obstruction in lung cancer.

BACKGROUND: To effectively palliate large airway obstruction in advanced unresectable lung cancer (stage IIIB or IV), we developed an airway imaging technique to guide selective endobronchial metallic stent placement. METHODS: Fourteen consecutive patients with severe dyspnea (American Thoracic Society grade 4) had a combination of fiberoptic bronchoscopy, chest roentgenography, computed tomographic scanning, helical computed tomography with three-dimensional reconstruction, and intraluminal bronchography with selective bronchial guidewire placement under fluoroscopy to visually reconstruct and simulate the abnormal airway before and during stent placement. Wallstent or Gianturco intraluminal stents were used alone or in combination (up to five stents) to establish patency of the distal trachea and the major bronchi. RESULTS: All 14 patients had successful deployment with initial relief of airway stenosis (>75% predicted diameter). No procedural complications were noted. However, technical problems included stent foreshortening and imprecision of placement, misinterpretation of bronchography (mucous versus tumor), and airway maintenance during manipulation. Length of stay attributable to the procedure averaged 4 days. Stent placement initially improved the dyspnea score in 7 of 14 patients. Five of 14 died in less than 1 month, with the remainder alive at up to 8 months' follow-up. Of those surviving more than 1 month, the Karnofsky score improved in 4 and was unchanged in 5, with 2 dependent (Karnofsky score <50), 3 functional (Karnofsky score, 50 to 70), and 4 active (Karnofsky score >70). CONCLUSIONS: A protocol combining helical computed tomography with three-dimensional reconstruction, bronchography, and bronchoscopy allows accurate assessment of malignant airway obstruction to facilitate intralumenal stent placement for relief of stenosis. Patient selection to favor effective palliation and cost effectiveness has yet to be defined.

Organochlorine contaminants in the estuarine and coastal marine environments of the Fiji Islands.

No information has been published on the presence of organochlorine pesticides and polychlorinated biphenyls in the Fiji Islands. This paper reports the first data on the concentration of a range of organochlorine compounds in sediments and shellfish in the estuarine and coastal marine environment around Fiji. Twenty-three sediment and two shellfish samples were analysed for 22 pesticides and related residues, and PCBs. While a significant number of organochlorines (20 pesticide related species and PCBs) was detected, the concentrations were generally very low (< 10 ng g), indicative of a relatively 'less contaminated' marine environment. Relatively high concentrations were observed only near the two major ports (Suva and Lautoka), with Suva harbour samples having the largest number of detectable species and the largest total concentrations of organochlorines (up to 91 ng g). No PCBs were detected in areas away from major industrial centres. The variations in the concentrations found, and the possible sources and movement of the organochlorine contaminants are discussed.

Changes in the marine environment of Port Kembla Harbour, NSW, Australia, 1975-1995: a review.

Data on water quality, sediment quality and aquatic organisms in Port Kembla Harbour from the 1970s to the 1990s are reviewed. In the 1970s, the marine environment of Port Kembla Harbour was in poor condition as a result of pollution from heavy industries. Elevated concentrations of pollutants were found in water, sediment and fish in the harbour; aquatic biodiversity was limited and many fish kills were reported. With the implementation of pollution reduction programs (required by legislation changes) by the industries surrounding the harbour since the 1970s, pollution in the harbour has been reduced dramatically, and the quality of the marine environment of the harbour has noticeably improved. Large reductions in the concentrations of certain toxic wastes and heavy metals in water have occurred. Marine life has returned to the whole harbour (parts were described in 1977 as abiotic). Contaminants in fish have decreased. Despite this achievement, however, there is still considerable room for improvement in the quality of the marine environment of the harbour.

Trace element studies in Laucala Bay, Suva, Fiji.

The trace metal distribution in the sediments of Laucala Bay, a coastal lagoon with a barrier reef and significant freshwater input, adjacent to Suva, the capital of Fiji (150,000 people), was studied from the point of view of assessing the significance of anthropogenic sources relative to natural ones. Surface sediments from 25 sites in the Bay were analysed for particle size distribution, organic carbon and major (Si, Al, Fe, Ca, Mg) and trace metal (Mn, Zn, Cu, Pb, Cd, Hg) contents. Suspended sediments from one site and shellfish samples from five sites were also analysed. The sediments were found to be mostly of terrigenous origin. Particle size distribution, organic carbon and major elemental composition of the sediments were generally related to location within the Bay. A significant natural source of trace metals in the sediments is the suspended solids transported into the Bay by rivers. The spatial distribution of trace metals could not be fully explained by the particle size distribution and mineral composition of the sediments. Contributions from anthropogenic sources were also suspected, but the degree of enrichment from such sources is not great at the present time.

Developing human capital for successful implementation of international marine scientific research projects.

The oceans play a crucial role in the global environment and the sustainability of human populations, because of their involvement in climate regulation and provision of living and non-living resources to humans. Maintenance of healthy oceans in an era of increasing human pressure requires a high-level understanding of the processes occurring in the marine environment and the impacts of anthropogenic activities. Effective protection and sustainable resource management must be based, in part, on knowledge derived from successful research. Current marine research activities are being limited by a need for high-quality researchers capable of addressing critical issues in broad multidisciplinary research activities. This is particularly true for developing countries which will require the building of capacity for marine scientific research. This paper reviews the current activities aimed at increasing marine research capacity in developing and emerging countries and analyses the challenges faced, including: appropriate alignment of the research goals and societal and policy-relevant needs; training in multidisciplinary research; increasing capacity for overall synthesis of scientific data; building the capacity of technical staff; keeping highly qualified personnel in marine scientific research roles; cross-cultural issues in training; minimising duplication in training activities; improving linkages among human capital, project resources and infrastructure. Potential solutions to these challenges are provided, along with some priorities for action aimed at improving the overall research effort.

Familial ossification of the stylohyoid ligament in a three generation family--a new clinical entity displaying autosomal dominant inheritance.

Ossification of the stylohyoid ligament is very common in the Caucasian population. More than 9000 descriptions of apparently isolated case reports on PubMed have been cited over the last 20 years, often associated with an incidental finding on imaging after neck trauma. No cases of familial ossification have been described. We document a family with several affected members, each with an ossified stylohyoid ligament, confirming that ossification may be hereditary in some families and is most likely due to an autosomal dominant gene.

The treatment of complex tibial shaft fractures by the Ilizarov method.

We report on the use of the Ilizarov method to treat 40 consecutive fractures of the tibial shaft (35 AO 42C fractures and five AO 42B3 fractures) in adults. There were 28 men and 12 women with a mean age of 43 years (19 to 81). The series included 19 open fractures (six Gustilo grade 3A and 13 grade 3B) and 21 closed injuries. The mean time from injury to application of definitive Ilizarov frame was eight days (0 to 35) with 36 fractures successfully uniting without the need for any bone-stimulating procedure. The four remaining patients with nonunion healed with a second frame. There were no amputations and no deep infections. None required intervention for malunion. The total time to healing was calculated from date of injury to removal of the frame, with a median of 166 days (mean 187, (87 to 370)). Minor complications included snapped wires in two patients and minor pin-site infections treated with oral antibiotics in nine patients (23%). Clinical scores were available for 32 of the 40 patients at a median of 55 months (mean 62, (26 to 99)) post-injury, with 'good' Olerud and Molander ankle scores (median 80, mean 75, (10 to 100)), 'excellent' Lysholm knee scores (median 97, mean 88, (29 to 100)), a median Tegner activity score of 4 (mean 4, (0 to 9)) (comparable to 'moderately heavy labour / cycling and jogging') and Short Form-12 scores that exceeded the mean of the population as a whole (median physical component score 55 (mean 51, (20 to 64)), median mental component score 57 (mean 53, (21 to 62)). In conclusion, the Ilizarov method is a safe and reliable way of treating complex tibial shaft fractures with a high rate of primary union.