Total knee arthroplasty after opening- versus closing-wedge high tibial osteotomy. A 135-case series with minimum 5-year follow-up.

INTRODUCTION: High tibial osteotomy (HTO) is effective in treating isolated medial osteoarthritis of the knee, but subsequent deterioration is inevitable, and total knee arthroplasty (TKA) is then an option. The present study sought to compare TKA following medial opening-wedge HTO (OW-HTO) versus lateral closing-wedge HTO (CW-HTO) in terms of intraoperative data and clinical results. The study hypothesis was that there is no significant difference in clinical results or complications in TKA following OW-HTO or CW-HTO. MATERIAL AND METHOD: A retrospective multicenter (9 centers) study was conducted for the French Society of Orthopedic Surgery and Traumatology (SoFCOT), including 135 TKAs following HTO (58 OW and 77 CW) at a minimum 5 years' follow-up. Mean interval between HTO and TKA was 134 months and was longer in case of CW-HTO (P<0.0001). Mean age at TKA was 65.4 years and older in case of CW-HTO (P=0.021). Tibial slope was greater in case of OW-HTO (P=0.024). Prior to TKA, 55.7% of patients could walk without canes, 98.4% found stairs difficult or impossible and only 19.1% could manage a walking distance greater than 1000m. Mean flexion was 110°; 54.2% of patients showed frontal knee stability and 87.8% sagittal stability; 60.1% had a mechanical axis in varus, without difference according to OW- or CW-HTO. RESULTS: Hardware was almost systematically removed (in 98.5% of cases): in the same step for OW-HTO (P=0.018) or often in 2 steps for CW-HTO. The primary approach was generally re-used (54.2%), but less frequently in the CW-HTO group (P=0.0004). Lateral or medial ligament release was not associated in respectively 78.2% and 79.7% of cases. The TKA implant was usually without stem (87.2%) and was fitted using a conventional technique (74.4%). At a mean 87 months' follow-up, 78.5% of patients could walk without canes, stairs were still difficult or impossible for 67%, and 74.1% could now walk further than 1000m; mean flexion was 110.5°. Overall, 91.5% of patients showed frontal knee stability and 98.2% sagittal stability, without difference according to OW- or CW-HTO. There were 15 complications within 3 months, more often in the OW-HTO group (12.3%) although not significantly, and with no difference in severity. Late complications comprised loosening (5.5%) and infection (3.6%) and were more frequent in the CW-HTO group (12%) (P<0.05). DISCUSSION: The study hypothesis was partially confirmed. The only technical differences concerned hardware removal, often performed in two steps in case of CW-HTO, and TKA approach, which differed from the primary approach in case of CW-HTO. Clinical results were comparable between OW- and CW-HTO, but late complications were more frequent in the CW-HTO group. LEVEL OF EVIDENCE: III; comparative retrospective study.

Functionalization of pectin with laccase-mediated oxidation products of ferulic acid.

Pectin is a natural biopolymer extracted mostly from citrus peel, sugar beet and apple pomace. In order to improve its functional properties and then to enlarge the field of its potential applications, functionalization reaction of citrus pectin with ferulic acid (FA)-oxidation products was performed in aqueous medium, at 30°C and pH7.5, in the presence of Myceliophthora thermophila laccase as biocatalyst. The conjugation between FA-oxidation products and pectin was confirmed using FTIR, UV-Vis and LC-MS analyses. The obtained results suggested that covalent bonds were between the pectin carboxyl groups and FA-oxidation products between the pectin carboxyl groups and FA-oxidation products. The determination of the total phenolic content showed that the modified pectin contained 5 times more phenols than the native pectin. In view of these results, this enzymatic procedure appears as a promising way to provide new pectin-based polymers that are expected to present new properties of interest.

Daylight photodynamic therapy with methyl aminolevulinate cream is effective and nearly painless in treating actinic keratoses: a randomised, investigator-blinded, controlled, phase III study throughout Europe.

BACKGROUND: Unmet needs exist in actinic keratosis (AK) treatment. Daylight photodynamic therapy (DL-PDT) has shown good efficacy and safety results compared to conventional PDT (c-PDT) in a recent Phase III multi-centre randomised controlled trial in Australia among 100 subjects with AKs. OBJECTIVES: Demonstrate non-inferior efficacy and superior safety of DL-PDT compared to c-PDT in treating multiple mild and/or moderate facial/scalp AKs. METHODS: Phase III, 12 week, multi-centre, randomised, investigator-blinded, controlled, intra-individual study conducted at different latitudes in Europe. AKs of adult subjects were treated once with methyl aminolevulinate (MAL) DL-PDT on one side of the face and MAL c-PDT contralaterally. Endpoints for DL-PDT concerned efficacy (non-inferiority regarding complete lesion response at week 12) and safety (superiority regarding subject's assessment of pain after treatment, on an 11-point numeric rating scale). Safety evaluation also included incidence of adverse events. Subject satisfaction was described using a questionnaire at baseline and last visit. RESULTS: At week 12, the total lesion complete response rate with DL-PDT was similar (non-inferior) to c-PDT (70% vs. 74%, respectively; 95% CI [-9.5; 2.4] in PP analysis, confirmed in ITT analysis). In addition, efficacy of DL-PDT was demonstrated regardless of weather conditions (sunny or cloudy). DL-PDT was nearly painless compared to c-PDT (0.7 vs. 4.4, respectively; P < 0.001), better tolerated and resulted in higher subject satisfaction. CONCLUSION: DL-PDT in comparison with c-PDT was as effective, better tolerated and nearly painless with high patient satisfaction, and may be considered a treatment of choice to meet needs of patients with mild or moderate facial/scalp AKs.

Vibration-induced compaction of granular suspensions.

We investigate the compaction dynamics of vibrated granular suspensions using both digital imaging technique and MRI measurements. Starting from initialy loose packings, our experimental data suggest the existence of two stages in the compaction dynamics: a fast stage at short times where a rising compaction front propagates through the granular suspension and a slow stage at large times where the packing compacts slowly and homogeneously. The compaction dynamics in each stage can be well fitted to usual stretched exponential laws with stretching exponents equal to 2 and 0.45, respectively. The transition time between these two stages, τ c , depends on the fluid viscosity, vibration intensity and grain diameter. We show that τ c (-1) and the velocity of the front decrease roughly linearly with the lubrication Peclet number, Pe lub related to the competition between the lubrication stress induced by vibrations and the granular pressure.

A review of pre-admission advanced airway management in combat casualties, Helmand Province 2013.

OBJECTIVES: Airway compromise is the third leading cause of potentially preventable combat death. Pre-hospital airway management has lower success rates than in hospital. This study reviewed advanced airway management focusing on cricothyroidotomies and supraglottic airway devices in combat casualties prior to admission to a Role 3 Hospital in Afghanistan. METHODS: This was a retrospective review of all casualties who required advanced airway management prior to arrival at the Role 3 Hospital, Bastion, Helmand Province over a 30-week period identified by the US Joint Theatre Trauma Registry. The notes and relevant X-rays were analysed. The opinions of US and UK clinical Subject Matter Experts (SME) were then sought. RESULTS: Fifty-seven advanced airway interventions were identified. 45 casualties had attempted intubations, 37 (82%) were successful and of those who had failed intubations, one had a King LT Airway (supraglottic device) and seven had a rescue cricothyroidotomy. The other initial advanced airway interventions were five attempted King LT airways and seven attempted cricothyroidotomies. In total, 14 cricothyroidotomies were performed; in this group, there were nine complications/significant events. CONCLUSIONS: The SMEs suggested that dedicated surgical airway kits should be used and students in training should be taught to secure the cricothyroidotomy tube as well as how to insert it. This review re-emphasises the need to 'ensure the right person, with the right equipment and the right training, is present at the right time if we are to improve the survival of patients with airway compromise on the battlefield'. The audit reference number is RCDM/Res/Audit/1036/12/0368.

First Report of Branched Broomrape (Phelipanche ramosa) on Celeriac (Apium graveolens) in Eastern France.

Branched broomrape, Phelipanche ramosa (L.) Pomel (syn. Orobanche ramosa L.), is a chlorophyll-lacking, obligate root parasitic plant that infests Brassicaceae, Solanaceae, and legumes (3). In western France, P. ramosa has invaded oilseed rape fields since the 1990s, causing significant yield losses (1). This crop has now become the primary host for the parasite, along with buckwheat (Fagopyrum esculentum L.), hemp (Cannabis sativa L.), and tobacco (Nicotania tabacum L.). In September 2013, a field survey indicated that a celeriac (Apium graveolens L. var. Prinlz) crop on clay soil in the Champagne-Ardennes region (48°20'19″ N, 04°01'57″ E, 140 m above sea level, eastern France) was infested with branched broomrape where hemp had been grown 4 years before. The celeriac field was planted to wheat (Triticum aestivum L.) in 2012 in rotation with lentils (Lens culinaris Medik.) in 2011. About 2% of the total celeriac field was infested and the estimated yield losses were approximately 25% for this infested area. The host symptoms observed were a slower growth of celeriac, along with leaf chlorosis, lower fruit production, and numerous abortions. The infestation of the celeriac crop was confirmed by verifying the attachment of branched broomrape to the celeriac roots. Broomrape plant heights were between 4.5 and 21 cm. The stems were erect, branched, frail, rather hairy, and bulging. Scale leaves were limited to 4 to 10 mm long, thick, acuminate, alternate scales. The flowers were numerous (between 4 and 51) and were 8.3 to 14.5 mm long. They were borne in the axils of scaly bracts. They had an irregular, curved shape, and a light mauve color. They did not have distinct peduncles and were grouped in rather long floral scapes during advanced flowering. The corolla tube was 10 to 15 mm long and its restricted part stood higher than the divisions of the calyx. It had ciliate, if not hairy, lobes. The calyx was more or less hairy, zygomorphous, with four lobes, and 6 to 8 mm long. Two bracteoles were situated on either side of the calyx. The four stamens observed were didynamous and borne 4 to 5 mm above the corolla base. The dorsifixed bilocularis, longitudinally dehiscent anthers were glabrous or covered with a fine down along sutures. Georges Sallé, (retired) Professor of Botanics at the University Pierre et Marie Curie, Paris, confirmed the identity of P. ramosa based on morphological characteristics (1). Celeriac infection by branched broomrape was confirmed using a developed assay (2). P. ramosa infecting celeriac roots was described by counting the numbers of individuals having reached ontogenic stages according to Gibot-Leclerc et al. (2). To our knowledge, this is the first study reporting P. ramosa infection on celeriac in eastern France. Since celeriac is produced in rotation with lentils, branched broomrape could pose a serious threat to production of these crops. References: (1) M. Blamey and C. Grey-Wilson. La Flore d'Europe Occidentale. Edition Flammarion, Paris, 2003. (2) S. Gibot-Leclerc et al. Flora 207:512, 2012. (3) M. C. Press and G. K. Phoenix. New Phytol. 166:737, 2005.

Off-resonance effects and selectivity profiles in pulsed nitrogen-14 nuclear quadrupole resonance.

In order to alleviate base-line distortions in nitrogen-14 NQR spectra originating from pulse breakthrough, low power radio-frequency (rf) pulses were applied. It is recalled that the required power is four times lower than that for an equivalent NMR experiment. This is easily explained by the fact that, in NMR, half the amplitude of the rf field is active. Moreover, the selectivity profile (i.e. the peak amplitude as a function of the difference between the carrier frequency and the resonance frequency) exhibits a shape which is, in most cases, more favorable in NQR than in NMR. An appropriate theory has been developed for explaining these experimental observations. It is concluded that low power NQR is perfectly feasible and should even be recommended for most applications, provided that the line-width of the NQR signal is not too large.

Reports of abnormal cervical cancer screening tests in systemic sclerosis.

OBJECTIVE: To assess the prevalence of abnormal cervical cancer screening (Pap tests) reported by women with SSc onset before the age of 50 yrs. METHODS: Female members of a Canadian multi-centre SSc cohort completed standardized assessments and were questioned regarding a history of an abnormal Pap test. Potential correlates examined included demographics, reproductive history, smoking, diffuse vs limited SSc type, immunosuppressant exposure and SSc duration. RESULTS: In the 320 women with SSc onset before the age of 50 yrs, the life-time prevalence of an abnormal Pap test (according to self-report) was 25.4% (95% CI CI 20.9, 30.4%). By comparison, self-reported prevalence of abnormal Pap tests among general population Canadian females was recently reported at 13.8% (95% CI 11.6, 16.4%). Women with diffuse SSc (n = 142), tended to have a higher prevalence of self-reported cervical dysplasia (31.7%) compared with those with limited disease (20.7%), but the CIs overlapped. A multivariate logistic regression found a significant positive association between self-reported abnormal Pap test and diffuse disease [odds ratio (OR) 1.87; 95% CI 1.01, 3.47]. An independent association of an abnormal Pap test with smoking (OR 2.43; 95% CI 1.23, 4.78) and with younger age at disease onset was also noted. CONCLUSIONS: We noted a high prevalence of abnormal Pap tests self-reported in our sample. Increased risk was seen among those with diffuse SSc, and also among smokers and those with a younger age at disease onset. Thus, it seems prudent to ensure that adequate attention is paid to cervical cancer screening for women with SSc.

[Vulvar dermatitis and iron deficiency]. / Vulvite par carence en fer.

BACKGROUND: Many mucocutaneous signs associated with iron deficiency are described in the current dermatologic and haematologic literature but genital mucosa involvement has never been reported. CASE REPORT: We report a case of iron deficiency anaemia revealed by psoriasis-like vulvar dermatitis. The vulvar involvement dramatically improved after iron therapy. In the case reported herein, iron deficiency resulted from three mechanisms: increased loss (menorrhagia), inadequate dietary iron intake (vegetarian diet) and inadequate absorption (iron absorption inhibitors such as tea). DISCUSSION: Iron deficiency may be responsible for genital mucosa involvement. Iron deficiency investigation must determine the presence of blood loss and dietary habits (assessment of iron levels and ingestion of iron absorption inhibitors). Certain dietary recommendations are essential to avoid the failure of iron supplementation.

Recurrent erysipelas: 47 cases.

BACKGROUND: Recurrence is a common complication of erysipelas (cellulitis). OBJECTIVES: Todescribe the characteristics of patients with recurrent erysipelas and thereby, identify potential risk factors and evaluate prophylaxis efficacy. METHODS: Data were retrospectively recorded from the files of 47 patients admitted to hospital between 1995 and 2003 for erysipelas recurrence. Studied variables included: general condition, regional and local factors, e.g. broken cutaneous barrier. Patient characteristics were used to construct tree-based models according to the classification and regression tree methodology. RESULTS: Our patients suffered a mean of 4.1 recurrences. Cutaneous barrier disruption was observed in 81%, mainly intertrigo (60%). Antibiotic prophylaxis was taken by 68% of the patients for 30.6 months. After 1 and 2 years, 84 and 72% of the patients, respectively, were recurrence-free. CONCLUSION: Our results showed that erysipelas recurrence has the same risk factors as single episodes and underlines the potential benefit of oral or parenteral antibiotic prophylaxis to prevent recurrences.

Venous thromboembolism prevention in surgery and obstetrics: clinical practice guidelines.

BACKGROUND AND OBJECTIVE: To produce up-to-date clinical practice guidelines on the prevention of venous thromboembolism in surgery and obstetrics. METHODS: A Steering Committee defined the scope of the topic, the questions to be answered, and the assessment criteria. Eight multidisciplinary working groups (total of 70 experts) performed a critical appraisal of the literature in the following disciplines: pharmacology of antithrombotic agents, orthopaedics; general surgery (gastrointestinal (GI) and varicose vein surgery); urology; gynaecology and obstetrics; thoracic, cardiac and vascular surgery; surgery of the head, neck and spine; and surgery of burns patients. The resultant reports and guidelines were submitted for comment and completion of the Appraisal of Guidelines Research & Evaluation questionnaire to a total of 150 peer reviewers, before producing definite guidelines. RESULTS: The report answers the following questions for each type of surgery: (i) What is the venous thromboembolism incidence according to clinical and/or paraclinical criteria in the absence of prophylaxis? (with stratification of venous thromboembolism risk into low, moderate and high categories); (ii) What is the efficacy and safety of the prophylactic measures used? (iii) When should prophylaxis be introduced and how long should it last? (iv) Does ambulatory surgery affect efficacy and safety of prophylaxis? CONCLUSIONS: Apart from answering the above questions, the guidelines provide a summary table for each discipline. This table stratifies types of surgery into the three risk categories, specifies the recommended prophylaxis for venous thromboembolism (pharmacological and/or mechanical) and grades each recommendation. In addition, whenever appropriate, the recommended prophylaxis is adjusted to low- and high-risk patients.

Secretion of Streptomyces tendae antifungal protein 1 by Lactococcus lactis.

Lactococcus lactis, the model lactic acid bacterium, is a good candidate for heterologous protein production in both foodstuffs and the digestive tract. We attempted to produce Streptomyces tendae antifungal protein 1 (Afp1) in L. lactis with the objective of constructing a strain able to limit fungal growth. Since Afp1 activity requires disulfide bond (DSB) formation and since intracellular redox conditions are reportedly unfavorable for DSB formation in prokaryotes, Afp1 was produced as a secreted form. An inducible expression-secretion system was used to drive Afp1 secretion by L. lactis; Afp1 was fused or not with LEISSTCDA, a synthetic propeptide (LEISS) that has been described to be a secretion enhancer. Production of Afp1 alone was not achieved, but production of LEISS-Afp1 was confirmed by Western blot and immunodetection with anti-Afp1 antibodies. This protein (molecular mass: 9.8 kDa) is the smallest non-bacteriocin heterologous protein ever reported to be secreted in L. lactis via the Sec-dependent pathway. However, no anti-fungal activity was detected, even in concentrated samples of induced supernatant. This could be due to a too low secretion yield of Afp1 in L. lactis, to the absence of DSB formation, or to an improper DSB formation involving the additional cysteine residue included in LEISS propeptide. This raises questions about size limits, conformation problems, and protein secretion yields in L. lactis.

Secretion of Streptomyces tendae antifungal protein 1 by Lactococcus lactis

Lactococcus lactis, the model lactic acid bacterium, is a good candidate for heterologous protein production in both foodstuffs and the digestive tract. We attempted to produce Streptomyces tendae antifungal protein 1 (Afp1) in L. lactis with the objective of constructing a strain able to limit fungal growth. Since Afp1 activity requires disulfide bond (DSB) formation and since intracellular redox conditions are reportedly unfavorable for DSB formation in prokaryotes, Afp1 was produced as a secreted form. An inducible expression-secretion system was used to drive Afp1 secretion by L. lactis; Afp1 was fused or not with LEISSTCDA, a synthetic propeptide (LEISS) that has been described to be a secretion enhancer. Production of Afp1 alone was not achieved, but production of LEISS-Afp1 was confirmed by Western blot and immunodetection with anti-Afp1 antibodies. This protein (molecular mass: 9.8 kDa) is the smallest non-bacteriocin heterologous protein ever reported to be secreted in L. lactis via the Sec-dependent pathway. However, no anti-fungal activity was detected, even in concentrated samples of induced supernatant. This could be due to a too low secretion yield of Afp1 in L. lactis, to the absence of DSB formation, or to an improper DSB formation involving the additional cysteine residue included in LEISS propeptide. This raises questions about size limits, conformation problems, and protein secretion yields in L. lactis.

[Multinucleate cells angiohistiocytoma]. / Angiohistiocytome à cellules multinucléées.

INTRODUCTION: Multinucleate cell angiohistiocytoma is a rare entity. We report two unusual cases of this lesion. CASE REPORT: A 39 year-old man had presented since two years an arciform papular eruption of the forehead. A 40 year-old woman had a disseminated maculo-papular eruption since three years. Histological examination of skin samples of the two patients showed a dermal small vessel proliferation, associated with multinucleate cells, and confirmed the diagnosis of multinucleate cell angiohistiocytoma. DISCUSSION: Our cases, typical histologically, have unusual clinical presentation (first case observed in a man, and the second in a disseminated form). Multinucleate cell angiohistiocytoma is a rare benign vascular proliferation individualized in 1985. Clinically, the lesion consists in small circumscribed papules. Acral sites and notably of the dorsum of the hands are the more frequent topography. It generally occurs in women aged over 50 years. Histologically, there is a dermal proliferation of capillaries and venules, and a fibrosis associated with the interstitial mononucleate cells and multinucleate cells.

NMR measurement of self-diffusion coefficients by slice selection.

Most of the time, so-called inversion-recovery experiments concern longitudinal nuclear magnetization of the whole sample, the region of interest being limited by the transmitting-receiving coil. Here we address the question of what occurs if the region of interest is purposely limited to a thin slice selected by means of procedures employing magnetic field gradients. Gradients of both magnetic fields (B(0), the static magnetic field, and B(1), the radio-frequency magnetic field) can be used. In this study we resorted essentially to B(1) gradients and novel procedures, based on the natural inhomogeneity of the B(1) field delivered by a saddle coil, are described. It is obvious that molecules leaving and entering the slice during the evolution (recovery) period should influence the magnetization recovery. Molecular self-diffusion is responsible for such effects, experimentally visible and accounted for by an appropriate theory which has been approximated for by permitting an easy physical assessment. This approach should lead to alternative methods for measuring self-diffusion coefficients.

Members of the nuclear factor 1 family reduce the transcriptional potential of the nuclear receptor LXRalpha promoter.

Expression of the LXRalpha nuclear receptor in liver is predicted to affect cholesterol and lipid metabolism. Here we show that a short fragment from the LXRalpha gene promoter spanning the region from -144 to +43 relative to the mRNA initiation site can drive transcription of a reporter gene. Under basal conditions, in vitro DNase I footprinting demonstrated interaction between nuclear proteins and an NF1 recognition site in close vicinity to the transcriptional initiation. Both supershift, mutational analyses in EMSA and transfections provided evidence that the NF1 (nuclear factor I) transcription factor interacts with the LXRalpha promoter. All four members of the NF1 family were found to suppress the transcriptional activity indicating a general inhibitory effect on LXRalpha expression. A similar regulation by NF1 was also observed when using a fragment from the LXRalpha promoter extending up to position -3033 therefore giving the inhibitory effect of NF1 a significant impact on LXRalpha gene expression.

Coscinosulfate, a CDC25 phosphatase inhibitor from the sponge Coscinoderma mathewsi.

The dual specificity CDC25 phosphatases dephosphorylate two inhibitory phospho-amino acids of cyclin-dependent kinases, a major family of cell cycle regulators. CDC25 inhibitors constitute new anti-mitotic agents with potential anticancer activity. While screening through a collection of natural products derived from marine organisms for CDC25A inhibitors, we purified and identified coscinosulfate 1, a sesquiterpene sulfate from the New Caledonian sponge Coscinoderma matthewsi, along with 4. The purified compound 1 displayed significant inhibitory activity towards CDC25A (IC(50): 3 microM).

Flavonoids as cycline-dependent kinase inhibitors: inhibition of cdc 25 phosphatase activity by flavonoids belonging to the quercetin and kaempferol series.

In an effort to detect potential inhibitors of cdc25 phosphatase, nineteen flavonoids belonging to the quercetin and kaempferol series have been evaluated, using a colorimetric assay of recombinant human cdc25A tyrosine phosphatase as a cell cycle-specific target. Compounds bearing two benzyl or methyl groups in positions 7 and 4' and acetyl on the hydroxy groups of the sugar moiety showed the maximal activity.