Risk Factors Associated With Femorotomy or Fracture During Cementless Stem Removal and Generation of an Individual Predictive Risk Score.

BACKGROUND: Femorotomy is a commonly used technique during cementless stem removal but should be preferred in selective revision cases to prevent intraoperative femoral fracture associated with deteriorated clinical outcome. Our aim was to assess the risk factors for fracture or femorotomy and develop a predictive risk stratification score. METHODS: A monocentric retrospective cohort including 202 patients was analyzed. Thirty six candidate prognostic factors were assessed. RESULTS: The following independent predictors of fracture or femorotomy were identified: presence of a "bracket sign" (Odds Ratio [OR]: 10.857; 95% Confidence interval [CI]: 2.613-45.115; P = .001) defined as a distal spot weld between the surface of the implant and closest endosteum, bone contact in zone 2 (OR: 4.700; 95% CI: 1.827-12.089; P = .001), 6 (OR: 4.966; 95% CI: 1.823-13.530; P = .002), 12 (OR: 9.660; 95% CI: 3.715-25.116; P < .0001), 13 (OR: 2.958; 95% CI: 1.009-8.021; P = .033), and global hypertrophy (OR: 0.170; 95% CI: 0.036-0.806; P = .026). The prognostic score, named Femorotomy INcidence Numeric scoring system, had good performance and discriminability; the area under the curve of the model was 0.924 (95% CI: 0.878-0.969). CONCLUSION: The only independent risk factors were those assessed on X-ray (eg, bracket sign, bone contact in zones 2, 6, 12, and 13), while global hypertrophy was protective. We noticed the importance of differentiating pedestals and "bracket signs"; the latter is an indicator of fixation of the stem. We developed a risk prediction score (Femorotomy INcidence Numeric score) of fracture or femorotomy that can be used as a companion tool to assess the risk for doing an early osteotomy of the femur.

Adlercreutzia equolifaciens Is an Anti-Inflammatory Commensal Bacterium with Decreased Abundance in Gut Microbiota of Patients with Metabolic Liver Disease.

Non-alcoholic fatty liver disease (NAFLD) affects about 20-40% of the adult population in high-income countries and is now a leading indication for liver transplantation and can lead to hepatocellular carcinoma. The link between gut microbiota dysbiosis and NAFLD is now clearly established. Through analyses of the gut microbiota with shotgun metagenomics, we observe that compared to healthy controls, Adlercreutzia equolifaciens is depleted in patients with liver diseases such as NAFLD. Its abundance also decreases as the disease progresses and eventually disappears in the last stages indicating a strong association with disease severity. Moreover, we show that A. equolifaciens possesses anti-inflammatory properties, both in vitro and in vivo in a humanized mouse model of NAFLD. Therefore, our results demonstrate a link between NAFLD and the severity of liver disease and the presence of A. equolifaciens and its anti-inflammatory actions. Counterbalancing dysbiosis with this bacterium may be a promising live biotherapeutic strategy for liver diseases.

Fructose malabsorption induces cholecystokinin expression in the ileum and cecum by changing microbiota composition and metabolism.

Current fructose consumption levels often overwhelm the intestinal capacity to absorb fructose. We investigated the impact of fructose malabsorption on intestinal endocrine function and addressed the role of the microbiota in this process. To answer this question, a mouse model of moderate fructose malabsorption [ketohexokinase mutant (KHK)-/-] and wild-type (WT) littermate mice were used and received a 20%-fructose (KHK-F and WT-F) or 20%-glucose diet. Cholecystokinin (Cck) mRNA and protein expression in the ileum and cecum, as well as preproglucagon (Gcg) and neurotensin (Nts) mRNA expression in the cecum, increased in KHK-F mice. In KHK-F mice, triple-label immunohistochemistry showed major up-regulation of CCK in enteroendocrine cells (EECs) that were glucagon-like peptide-1 (GLP-1)+/Peptide YY (PYY-) in the ileum and colon and GLP-1-/PYY- in the cecum. The cecal microbiota composition was drastically modified in the KHK-F in association with an increase in glucose, propionate, succinate, and lactate concentrations. Antibiotic treatment abolished fructose malabsorption-dependent induction of cecal Cck mRNA expression and, in mouse GLUTag and human NCI-H716 cells, Cck mRNA expression levels increased in response to propionate, both suggesting a microbiota-dependent process. Fructose reaching the lower intestine can modify the composition and metabolism of the microbiota, thereby stimulating the production of CCK from the EECs possibly in response to propionate.-Zhang, X., Grosfeld, A., Williams, E., Vasiliauskas, D., Barretto, S., Smith, L., Mariadassou, M., Philippe, C., Devime, F., Melchior, C., Gourcerol, G., Dourmap, N., Lapaque, N., Larraufie, P., Blottière, H. M., Herberden, C., Gerard, P., Rehfeld, J. F., Ferraris, R. P., Fritton, J. C., Ellero-Simatos, S., Douard, V. Fructose malabsorption induces cholecystokinin expression in the ileum and cecum by changing microbiota composition and metabolism.

The links between the gut microbiome and non-alcoholic fatty liver disease (NAFLD).

NAFLD is currently the main cause of chronic liver disease in developed countries, and the number of NAFLD patients is growing worldwide. NAFLD often has similar symptoms to other metabolic disorders, including type 2 diabetes and obesity. Recently, the role of the gut microbiota in the pathophysiology of many diseases has been revealed. Regarding NAFLD, experiments using gut microbiota transplants to germ-free animal models showed that fatty liver disease development is determined by gut bacteria. Moreover, the perturbation of the composition of the gut microbiota has been observed in patients suffering from NAFLD. Numerous mechanisms relating the gut microbiome to NAFLD have been proposed, including the dysbiosis-induced dysregulation of gut endothelial barrier function that allows for the translocation of bacterial components and leads to hepatic inflammation. In addition, the various metabolites produced by the gut microbiota may impact the liver and thus modulate NAFLD susceptibility. Therefore, the manipulation of the gut microbiome by probiotics, prebiotics or synbiotics was shown to improve liver phenotype in NAFLD patients as well as in rodent models. Hence, further knowledge about the interactions among dysbiosis, environmental factors, and diet and their impacts on the gut-liver axis can improve the treatment of this life-threatening liver disease and its related disorders.

The intestinal microbiota regulates host cholesterol homeostasis.

BACKGROUND: Management of blood cholesterol is a major focus of efforts to prevent cardiovascular diseases. The objective of this study was to investigate how the gut microbiota affects host cholesterol homeostasis at the organism scale. RESULTS: We depleted the intestinal microbiota of hypercholesterolemic female Apoe-/- mice using broad-spectrum antibiotics. Measurement of plasma cholesterol levels as well as cholesterol synthesis and fluxes by complementary approaches showed that the intestinal microbiota strongly regulates plasma cholesterol level, hepatic cholesterol synthesis, and enterohepatic circulation. Moreover, transplant of the microbiota from humans harboring elevated plasma cholesterol levels to recipient mice induced a phenotype of high plasma cholesterol levels in association with a low hepatic cholesterol synthesis and high intestinal absorption pattern. Recipient mice phenotypes correlated with several specific bacterial phylotypes affiliated to Betaproteobacteria, Alistipes, Bacteroides, and Barnesiella taxa. CONCLUSIONS: These results indicate that the intestinal microbiota determines the circulating cholesterol level and may thus represent a novel therapeutic target in the management of dyslipidemia and cardiovascular diseases.

Microbial impact on cholesterol and bile acid metabolism: current status and future prospects.

Recently, the gut microbiota has emerged as a crucial factor that influences cholesterol metabolism. Ever since, significant interest has been shown in investigating these host-microbiome interactions to uncover microbiome-mediated functions on cholesterol and bile acid (BA) metabolism. Indeed, changes in gut microbiota composition and, hence, its derived metabolites have been previously reported to subsequently impact the metabolic processes and have been linked to several diseases. In this context, associations between a disrupted gut microbiome, impaired BA metabolism, and cholesterol dysregulation have been highlighted. Extensive advances in metagenomic and metabolomic studies in this field have allowed us to further our understanding of the role of intestinal bacteria in metabolic health and disease. However, only a few have provided mechanistic insights into their impact on cholesterol metabolism. Identifying the myriad functions and interactions of these bacteria to maintain cholesterol homeostasis remain an important challenge in such a field of research. In this review, we discuss the impact of gut microbiota on cholesterol metabolism, its association with disease settings, and the potential of modulating gut microbiota as a promising therapeutic target to lower hypercholesterolemia.

Reduced obesity, diabetes, and steatosis upon cinnamon and grape pomace are associated with changes in gut microbiota and markers of gut barrier.

Increasing evidence suggests that polyphenols have a significant potential in the prevention and treatment of risk factors associated with metabolic syndrome. The objective of this study was to assess the metabolic outcomes of two polyphenol-containing extracts from cinnamon bark (CBE) and grape pomace (GPE) on C57BL/6J mice fed a high-fat diet (HFD) for 8 wk. Both CBE and GPE were able to decrease fat mass gain and adipose tissue inflammation in mice fed a HFD without reducing food intake. This was associated with reduced liver steatosis and lower plasma nonesterified fatty acid levels. We also observed a beneficial effect on glucose homeostasis, as evidenced by an improved glucose tolerance and a lower insulin resistance index. These ameliorations of the overall metabolic profile were associated with a significant impact on the microbial composition, which was more profound for the GPE than for the CBE. At the genus level, Peptococcus were decreased in the CBE group. In the GPE-treated group, several key genera that have been previously found to be linked with HFD, metabolic effects, and gut barrier integrity were affected: we observed a decrease of Desulfovibrio, Lactococcus, whereas Allobaculum and Roseburia were increased. In addition, the expression of several antimicrobial peptides and tight junction proteins was increased in response to both CBE and GPE supplementation, indicating an improvement of the gut barrier function. Collectively, these data suggest that CBE and GPE can ameliorate the overall metabolic profile of mice on a high-fat diet, partly by acting on the gut microbiota.

Ultra-narrow photonic nanojets through a glass cuboid embedded in a dielectric cylinder.

A glass cuboid, embedded inside a dielectric cylinder is studied when illuminated with a monochromatic plane wave. A photonic nanojet (PNJ) with a full-width at half-maximum (FWHM) waist of around 0.25λ0 is obtained outside the external surface of the cuboid. The influence of the parameters of a square section cuboid is studied. Three particular phenomena can be obtained and are discussed: an ultra-narrow PNJ on the external surface of the cuboid, a long photonic jet and the excitation of whispering gallery modes (WGMs). A parametric study, over the width and the height of a rectangular section cuboid, shows that these parameters can be used to control the photonic jet properties. We also study several other geometries of the insert, which shows that the key parameter is the refractive index of the inserted material. Finally, we show that by changing the incident angle we can obtain a curved photonic jet.

Chromatic analysis of harmonic Fresnel lenses by FDTD and angular spectrum methods.

In this paper, we present a detailed and rigorous study of cylindrical harmonic Fresnel lenses (HFLs) using the finite difference time domain method (FDTD) and angular spectrum method (ASM). The HFL is a kind of diffractive lens that can have maximum diffraction efficiency at several discrete harmonic wavelengths, which is suitable for some broadband applications. Previous studies on HFLs were investigated mainly in the domain of paraxial approximation. By using our proposed calculation method, we have determined the efficiency, focal length, maximum focus intensity, and full width at half maximum (FWHM) of the focal spot for several harmonic numbers and for F-numbers of 0.5, 1, and 3. To compare with the paraxial approximation, we have presented the response to both s-polarized and p-polarized light with constant refractive index and real dispersive material, BK7. Moreover, we have also analyzed the cases with oblique illumination. We have shown that the harmonic wavelengths do not change with F/# and that the diffraction efficiency and FWHM of the focus increase as F/# increases. New results on harmonic wavelengths shift and oblique angle of incidence response have been detailed.

Rapid analysis of bile acids in different biological matrices using LC-ESI-MS/MS for the investigation of bile acid transformation by mammalian gut bacteria.

Bile acids are important signaling molecules that regulate cholesterol, glucose, and energy homoeostasis and have thus been implicated in the development of metabolic disorders. Their bioavailability is strongly modulated by the gut microbiota, which contributes to generation of complex individual-specific bile acid profiles. Hence, it is important to have accurate methods at hand for precise measurement of these important metabolites. Here, a rapid and sensitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for simultaneous identification and quantitation of primary and secondary bile acids as well as their taurine and glycine conjugates was developed and validated. Applicability of the method was demonstrated for mammalian tissues, biofluids, and cell culture media. The analytical approach mainly consists of a simple and rapid liquid-liquid extraction procedure in presence of deuterium-labeled internal standards. Baseline separation of all isobaric bile acid species was achieved and a linear correlation over a broad concentration range was observed. The method showed acceptable accuracy and precision on intra-day (1.42-11.07 %) and inter-day (2.11-12.71 %) analyses and achieved good recovery rates for representative analytes (83.7-107.1 %). As a proof of concept, the analytical method was applied to mouse tissues and biofluids, but especially to samples from in vitro fermentations with gut bacteria of the family Coriobacteriaceae. The developed method revealed that the species Eggerthella lenta and Collinsella aerofaciens possess bile salt hydrolase activity, and for the first time that the species Enterorhabdus mucosicola is able to deconjugate and dehydrogenate primary bile acids in vitro.

Gut microbiota and obesity.

The human intestine harbors a complex bacterial community called the gut microbiota. This microbiota is specific to each individual despite the existence of several bacterial species shared by the majority of adults. The influence of the gut microbiota in human health and disease has been revealed in the recent years. Particularly, the use of germ-free animals and microbiota transplant showed that the gut microbiota may play a causal role in the development of obesity and associated metabolic disorders, and lead to identification of several mechanisms. In humans, differences in microbiota composition, functional genes and metabolic activities are observed between obese and lean individuals suggesting a contribution of the gut microbiota to these phenotypes. Finally, the evidence linking gut bacteria to host metabolism could allow the development of new therapeutic strategies based on gut microbiota modulation to treat or prevent obesity.

Cystathionine ß-synthase genetic variant rs2124459 is associated with a reduced risk of cleft palate in French and Belgian populations.

BACKGROUND: Orofacial cleft (OFC) is the most prevalent craniofacial birth defect. Genes involved in one-carbon, folate and vitamin B12 metabolisms have been associated with OFC but no study performed a concomitant assessment on genes involved in these three pathways. OBJECTIVE: We looked for potential genetic variants associated with OFC using an exhaustive gene panel of one-carbon metabolism. METHODS: We performed a case-control discovery study on children with OFC (236 cases, 145 controls) and their related mothers (186 cases, 127 controls). We performed a replication study on the top significant genetic variant in an independent group from Belgium (248 cases, 225 controls). RESULTS: In the discovery study on 'mothers', the CBS locus reached array-wide significance (p=9.13×10-6; Bonferroni p=4.77×10-3; OR 0.47 (0.33 to 0.66)) among the 519 haplotypes tested for their association with OFC risk. Within the CBS haplotype block (rs2124459, rs6586282, rs4920037, rs234705, rs234709), the rs2124459 was the most significantly associated with a reduced risk of OFC (p=1.77×10-4; Bonferroni p=2.00×10-2; OR 0.53 (0.38 to 0.74), minor allele). The rs2124459 was associated with a reduced risk of cleft palate (CP) (p=6.78×10-5; Bonferroni p=7.80×10-3; OR 0.40 (0.25 to 0.63)). In the 'children' group, the rs2124459 was associated with a reduced risk of CP (p=0.02; OR 0.61 (0.40 to 0.93), minor allele). The association between rs2124459 and reduced risk of CP was replicated in an independent children population from Belgium (p=0.02; OR 0.64 (0.44 to 0.93), minor allele). CONCLUSIONS: The CBS rs2124459 was associated with a reduced risk of CP in both French and Belgian populations. These results highlight the prominent involvement of the vitamin B6-dependent transsulfuration pathway of homocysteine in OFC risk and the interest for evaluating vitamin B6 status in further population studies.

Smart multifunction diffractive lens experimental validation for future PV cell applications.

Recently, diffractive optical elements (DOE's) have attracted more attention for applications to third generation PV cells. Some DOE types can provide multiple functions such as spectrum splitting and beam concentration (SSBC) simultaneously. An off-axis diffractive lens has been designed and its ability to achieve the SSBC proved experimentally. This lens can be used to separate the solar spectrum in the Vis-NIR range into two bands with a low concentration factor, and about 70% optical efficiency. It is expected that this kind of lens can be integrated with the lateral multijunction PV cells to build an effective compact solar system.

Design of a large field-of-view see-through near to eye display with two geometrical waveguides.

A novel waveguide near to eye display (WGNED), with new in-coupling and propagation subsystems, is proposed for the first time, to our knowledge, to enlarge the vertical field-of-view (FOV) and the vertical size of the eye box. Two waveguides are stacked-one is for in-coupling and the other for out-coupling. A freeform prism is used to correct the aberrations. These components are combined to form the WGNED. We have simulated such a system; as a result, we show that it achieves a FOV of 30°horizontal (H)×60°vertical (V) and an eye box of about 15 mm (H)×12 mm (V). The modulation transfer function of the system is larger than 0.3 at 33 lp/mm and the distortion is smaller than 5%.

Iterative scalar nonparaxial algorithm for the design of Fourier phase elements.

We propose an iterative algorithm based on our scalar nonparaxial propagator for the design of Fourier diffractive optical elements (DOEs) having features on the order of the illumination wavelength. The simulation results show that our algorithm, using iterative Fourier transform and iterative projection, obtains higher-performance DOEs than a purely scalar paraxial design with the same order of calculation time. Upon verification with the experimental results, we find that our scalar-based design method is valid for DOEs with surprisingly small feature sizes (about half the wavelength) and diffraction angles up to about 37°.

Computationally efficient scalar nonparaxial modeling of optical wave propagation in the far-field.

We present a scalar model to overcome the computation time and sampling interval limitations of the traditional Rayleigh-Sommerfeld (RS) formula and angular spectrum method in computing wide-angle diffraction in the far-field. Numerical and experimental results show that our proposed method based on an accurate nonparaxial diffraction step onto a hemisphere and a projection onto a plane accurately predicts the observed nonparaxial far-field diffraction pattern, while its calculation time is much lower than the more rigorous RS integral. The results enable a fast and efficient way to compute far-field nonparaxial diffraction when the conventional Fraunhofer pattern fails to predict correctly.

Effect of prebiotic carbohydrates on growth, bile survival and cholesterol uptake abilities of dairy-related bacteria.

BACKGROUND: Three strains of lactic acid bacteria and one probiotic Bifidobacterium strain sourced from milk origin were considered to select for the best synbiotic-like combination for cholesterol uptake ability. For that purpose, fermentative characteristics, bile salt hydrolase activity, bile survival and cholesterol removal were assessed in the presence of different carbohydrates. RESULTS: Carbohydrate fermentability was highly variable among the different strains, and lactulose was the only prebiotic to favour growth of all strains, whereas pectin led to low population regardless of the strain. Bile survival of bacteria could be improved by the preferred carbon source and was related to their bile salt hydrolase activities. All together, our results showed that the most advantageous synbiotic-like combinations to achieve cholesterol uptake abilities were Lactobacillus delbrueckii subsp. bulgaricus LB 340 with raffinose, Streptococcus thermophilus TA040 or Lactobacillus rhamnosus LBRE-LSAS with lactulose, and Bifidobacterium animalis subsp. lactis Bb12 with mannitol. CONCLUSION: The suggested synbiotics may represent new promising functional dairy additives.

Intestinal microbiota determines development of non-alcoholic fatty liver disease in mice.

OBJECTIVE: Non-alcoholic fatty liver disease (NAFLD) is prevalent among obese people and is considered the hepatic manifestation of metabolic syndrome. However, not all obese individuals develop NAFLD. Our objective was to demonstrate the role of the gut microbiota in NAFLD development using transplantation experiments in mice. DESIGN: Two donor C57BL/6J mice were selected on the basis of their responses to a high-fat diet (HFD). Although both mice displayed similar body weight gain, one mouse, called the 'responder', developed hyperglycaemia and had a high plasma concentration of pro-inflammatory cytokines. The other, called a 'non-responder', was normoglycaemic and had a lower level of systemic inflammation. Germ-free mice were colonised with intestinal microbiota from either the responder or the non-responder and then fed the same HFD. RESULTS: Mice that received microbiota from different donors developed comparable obesity on the HFD. The responder-receiver (RR) group developed fasting hyperglycaemia and insulinaemia, whereas the non-responder-receiver (NRR) group remained normoglycaemic. In contrast to NRR mice, RR mice developed hepatic macrovesicular steatosis, which was confirmed by a higher liver concentration of triglycerides and increased expression of genes involved in de-novo lipogenesis. Pyrosequencing of the 16S ribosomal RNA genes revealed that RR and NRR mice had distinct gut microbiota including differences at the phylum, genera and species levels. CONCLUSIONS: Differences in microbiota composition can determine response to a HFD in mice. These results further demonstrate that the gut microbiota contributes to the development of NAFLD independently of obesity.

Low pelvic incidence with low lordosis and distal apex of lumbar lordosis associated with higher rates of abnormal spinopelvic mobility in patients undergoing THA.

Aims: The risk factors for abnormal spinopelvic mobility (SPM), defined as an anterior rotation of the spinopelvic tilt (∆SPT) ≥ 20° in a flexed-seated position, have been described. The implication of pelvic incidence (PI) is unclear, and the concept of lumbar lordosis (LL) based on anatomical limits may be erroneous. The distribution of LL, including a unusual shape in patients with a high lordosis, a low pelvic incidence, and an anteverted pelvis seems more relevant. Methods: The clinical data of 311 consecutive patients who underwent total hip arthroplasty was retrospectively analyzed. We analyzed the different types of lumbar shapes that can present in patients to identify their potential associations with abnormal pelvic mobility, and we analyzed the potential risk factors associated with a ∆SPT ≥ 20° in the overall population. Results: ΔSPT ≥ 20° rates were 28.3%, 11.8%, and 14.3% for patients whose spine shape was low PI/low lordosis (group 1), low PI anteverted (group 2), and high PI/high lordosis (group 3), respectively (p = 0.034). There was no association between ΔSPT ≥ 20° and PI ≤ 41° (odds ratio (OR) 2.01 (95% confidence interval (CI)0.88 to 4.62), p = 0.136). In the multivariate analysis, the following independent predictors of ΔSPT ≥ 20° were identified: SPT ≤ -10° (OR 3.49 (95% CI 1.59 to 7.66), p = 0.002), IP-LL ≥ 20 (OR 4.38 (95% CI 1.16 to 16.48), p = 0.029), and group 1 (OR 2.47 (95% CI 1.19; to 5.09), p = 0.0148). Conclusion: If the PI value alone is not indicative of SPM, patients with a low PI, low lordosis and a lumbar apex at L4-L5 or below will have higher rates of abnormal SPM than patients with a low PI anteverted and high lordosis.