A process-based recovery indicator for anthropogenically disturbed river system.

The present paper utilizes entropy theory and Google earth engine cloud computing technique to investigate system state and river recovery potential in two large sub-basins of the Mahanadi River, India. The cross-sectional intensity entropy (CIE) is computed for the post-monsoon season (October-March) along the selected reaches. Further, a normalized river recovery indicator (NRRI) is formulated to assess the temporal changes in river health. Finally, NRRI is related to a process-based variable-LFE (low flow exceedance) to comprehend the dominating system dynamics and evolutionary adjustments. The results highlight the existence of both threshold-modulated and filter-dominated systems based on CIE and NRRI variabilities. In addition, the gradual decline in CIE and subsequent stabilization of vegetated landforms can develop an 'event-driven' state, where floods exceeding the low-flow channel possess a direct impact on the river recovery trajectory. Finally, this study emphasizes the presence of instream vegetation as an additional degree of freedom, which further controls the hierarchy of energy dissipation and morphological continuum in the macrochannel settings.

Stochastic resonance in the human vestibular system - Noise-induced facilitation of vestibulospinal reflexes.

BACKGROUND: There is strong evidence that the presence of noise can enhance information processing in sensory systems via stochastic resonance (SR). OBJECTIVES: To examine the presence of SR in human vestibulospinal reflex function. METHODS: Healthy subjects were stimulated with 1 Hz sinusoidal GVS of varying amplitudes (0-1.9 mA). Coherence between GVS input and stimulation-induced motion responses was determined and psychometric function fits were subsequently used to determine individual vestibulospinal reflex thresholds. This procedure was repeated with additional application of imperceptible white noise GVS (nGVS). RESULTS: nGVS significantly facilitated the detectability of weak subthreshold vestibular inputs (p < 0.001) and thereby effectively lowered the vestibulospinal threshold in 90% of participants (p < 0.001, mean reduction: 17.5 ± 14.6%). CONCLUSION: This finding provides evidence for the presence of SR-dynamics in the human vestibular system and gives a functional explanation for previously observed ameliorating effects of low-intensity vestibular noise stimulation on balance control in healthy subjects and patients with vestibular hypofunction.

Body weight, egg production, and egg quality traits of gray, brown, and white varieties of Japanese quail (Coturnix coturnix japonica) in coastal climatic condition of Odisha.

AIM: The present study was conducted to evaluate the performance of gray, brown, and white varieties of Japanese quail (Coturnix coturnix japonica) with respect to body weight, egg production, and egg quality traits in the coastal climatic condition of Odisha. MATERIALS AND METHODS: A total of 500-day-old straight run Japanese quail chicks of three varieties, viz., gray, brown, and white were randomly selected and reared in deep litter system at Central Poultry Development Organization, Eastern Region, Bhubaneswar. The weekly body weight of the birds was recorded till their egg production stage (up to 6 weeks of age). The average egg production was recorded every biweekly from 6(th) to 20(th) week. Exterior and interior quality of eggs from each variety was determined at 6 weeks of age. RESULTS: The initial average weekly body weight of three varieties did not differ (p>0.05) among the varieties. However, from 1(st) to 6(th) week significantly higher body weight was observed in gray than white and brown. Brown varieties had reached 50% egg production 1 week earlier than gray and white. Brown had higher peak hen day (HD) production or hen-housed egg production followed by white and gray. External quality such as: Egg weight, egg length, egg width, volume, shape index, shell weight, shell thickness depicted no significant difference among the varieties except circumference length and circumference width, which were significantly higher (p≤0.05) in gray varieties than brown varieties. Internal egg characteristics such as: Albumen length, albumen width, albumen height, albumen index, yolk length, yolk width, yolk height, yolk index, albumen weight, yolk weight, Haugh unit revealed no significance difference among the varieties. CONCLUSION: It may be summarized from the findings that gray excelled in body weight followed by white and brown. Egg production potential in terms of hen house egg production or HD egg production was higher for brown followed by white and gray in the coastal climatic condition of Odisha.

Studies of the macroscopic and microscopic morphology (hippocampus) of brain in Vencobb broiler.

AIM: The aim of this study was to study the anatomy of different parts of brain and histology of hippocampus of Vencobb broiler chicken. MATERIALS AND METHODS: A 12 adult experimental birds were sacrificed by cervical dislocation. After separation of the brain, gross anatomy features were studied. Brain tissue was fixed in 10% buffered neutral formalin for 2-3 days, and then routine dehydration process in ascending grades of ethyl alcohol was done. After xylene cleaning, paraffin impregnation was prepared. Paraffin blocks were cut, and slides were stained by Harris hematoxylin and eosin. Photography was carried out both under lower (×10) and higher (×40) magnifications. RESULTS: The brain structure (dorsal view) of Vencobb bird resembled the outline of a playing card symbol of a "spade." The brain subdivisions are cerebrum, cerebellum, and medulla oblongata. Cerebrum was devoid of usual convolutions (elevations), gyri, depressions (grooves), and sulci. The cerebral hemispheres were tightly apposed along a median sulcus called interhemispheric fissure and cerebrum and cerebellum were separated by a small transverse fissure. The olfactory bulb was small structures, and the pineal body was clearly visible. The optic lobes were partially hidden under cerebral hemispheres, but laterally, it was large, prominent rounded or spherical bodies of the midbrain. The hippocampal area appeared as dorso-medial protrusion. Different types of neurons were distinguished in the hippocampus were pyramidal neurons, pyramidal-like neurons, and multipolar neurons, etc. There was rich vascularization in the form of blood capillaries throughout the hippocampus. CONCLUSION: Cerebrum was pear shaped and largest part of the brain. Cerebrum hemisphere was smooth devoid of convolutions, gyri, and depressions, but in the surface of cerebellum, there was the presence of a number of transverse depression (grooves) and sulci subdividing into many folds. Olfactory bulb was poorly developed, whereas optic lobes were rounded and large. The exact boundary line of the hippocampus was not discernable. In hippocampus histology, two categories of neuron local circuit neurons and projection neurons, high vascularization and epididymal lining of lateral ventricle were observed. Hippocampal neurons were comparatively larger without any distinct layers. The afferent neurons projected to the medium septum.

Effect of dietary supplementation of prebiotic, probiotic, and synbiotic on growth performance and carcass characteristics of broiler chickens.

AIM: The aim was to investigate the effects of dietary supplementations of prebiotic, probiotic, and synbiotic on growth performance and carcass characteristics of broiler chickens. MATERIALS AND METHODS: A total of 360 1-day-old Vencobb broiler chickens of either sex were randomly assigned to four dietary treatments each consisting of three replicates and each replicate having 30 birds for 6 weeks. The dietary treatments were (1) control group with basal diet, (2) basal diet supplemented with prebiotic (at 400 g/tonne of starter as well as finisher ration), (3) basal diet supplemented with probiotic (at 100 g/tonne of starter ration and 50 g/tonne of finisher ration), and (4) basal diet supplemented with synbiotic(at 500 g/tonne of starter as well as finisher ration). The birds were provided with ad-libitum feed and drinking water during the entire experimental period. RESULTS: The highest body weight observed in asynbiotic group, which was non-significantly (p>0.05) higher than thecontrol group. Prebiotic and probiotic groups showed lower body weight than synbiotic and control groups. A total feed intake did not show any significant (p>0.05) difference between experimental groups. There were no significant (p>0.05) differences in feed conversion ratio of broiler chickens in prebiotic, probiotic, and synbiotic groups as compared with control group. There was no significant (p>0.05) difference in the carcass traits with respect to dressing percentage, carcass percentage, heart weight, liver weight and gizzard weight, wing percentage, breast percentage, back percentage, thigh percentage, and drumstick percentage in Cobb broilers under study. CONCLUSION: The growth performance and percentage of carcass yield did not show any significant increase by the dietary inclusion of prebiotic, probiotic, and synbiotic compared with unsupplemented control in a commercial broiler chicken.

Prevalence of gastrointestinal helminths in Banaraja fowls reared in semi-intensive system of management in Mayurbhanj district of Odisha.

AIM: Studies on the prevalence of gastrointestinal helminths infection in Banaraja fowls of three blocks (Chandua, Shamakhunta and Bangriposi) of Mayurbhanj district in Odisha with respect to semi-intensive system of rearing. MATERIALS AND METHODS: A total of 160 Banaraja birds (30 males and 130 females) belonging to two age groups (below 1 month age and above 1 month) were examined for the presence of different species of gastrointestinal helminth infection over a period of 1-year. The method of investigation included collection of fecal sample and gastrointestinal tracts, examination of fecal sample of birds, collection of parasites from different part of gastrointestinal tract, counting of parasites, and examination of the collected parasites by standard parasitological techniques followed by morphological identification as far as possible up to the species level. RESULTS: Overall, 58.75% birds were found infected with various gastrointestinal helminths. Total five species of parasites were detected that included Ascaridia galli (25.63%), Heterakis gallinarum (33.75%), Raillietina tetragona (46.25%), Raillietina echinobothrida (11.87%), and Echinostoma revolutum (1.87%). Both single (19.15%) as well as mixed (80.85%) infection were observed. Highest incidence of infection was observed during rainy season (68.88%) followed by winter (66.66%) and least in summer season (41.81%). Sex-wise incidence revealed slightly higher occurrence among females (59.23%) than males (56.67%). Age-wise prevalence revealed that chicks were more susceptible (77.77%) than adults (51.30%) to gastrointestinal helminths infection. CONCLUSIONS: Present study revealed that mixed infection with gastrointestinal helminths of different species was more common than infection with single species and season-wise prevalence was higher in rainy season followed by winter and summer. Chicks were found to be more prone to this parasitic infection and a slight higher prevalence among female birds was observed.

Exploring the effects of inclusion of dietary fresh Azolla on the performance of White Pekin broiler ducks.

AIM: The objective of this study was to investigate the dietary advantages of inclusion of unconventional nutrient source, i.e., Azolla in the basal diet of White Pekin broilers. MATERIALS AND METHODS: All ducklings were randomly distributed into three treatment groups with three replicates each and each replicate having 12 ducklings and were reared in deep litter system. Groups were subjected to three dietary treatments such as G1: Basal diet, G2: Basal diet + 5% fresh Azolla of basal diet, G3: Basal diet + 10% fresh Azolla of basal diet. During experimental period, parameters, such as bodyweight, bodyweight gain, feed consumption,feed conversion ratio(FCR), and economic of production,wererecorded. RESULTS: The result showed that body weights in every week, except the 5(th) week, did not differ significantly between groups. However, no significant difference was observed between the groups in any week in terms of absolute body weight gain and feed consumption. As regard to FCR, the 10% Azolla group (G3) showed the best feed efficiency followed by the 5% Azolla group (G2) and the control group (G1). On the basis of profit/bird or profit/kg live weight, each of the Azolla-fed group showed a higher economic efficiency than the control. CONCLUSION: From the experiment, it was concluded that Azollaat 5 or 10% level can be included in the diet to economize the White Pekin broiler farming, and it can be great impetus to poultry farming to include unconventional nutrient source as a dietary supplement.

Effect of partial supplementation of sun-dried Azolla as a protein source on the immunity and antioxidant status of commercial broilers.

AIM: The present study was conducted to evaluate the effect of partial supplementation of sun-dried Azolla as a protein source on the immunity of commercial broilers in coastal Odisha. MATERIALS AND METHODS: A 180 day-old broiler chicks were distributed in six dietary treatments viz. C1: Basal diet, C2: Basal diet + enzyme, T1: Basal diet +5% protein from Azolla, T2: Basal diet + 5% protein from Azolla + enzyme, T3: Basal diet +10% protein from Azolla, and T4: Basal diet + 10% protein from Azolla + enzyme. Cutaneous basophilc hypersensitivity (CBH) and humoral immunity response were determined at the 38(th) day of age. At 42(nd) day, the weight of lymphoid organs, an antioxidant enzyme, and lipid peroxidation activity were determined. RESULTS: The CBH response did not differ significantly among the treated groups, but the sheep red blood cells response was significantly higher in T4. The weight of lymphoid organs or immune organs of all the treated groups did not differ significantly (p>0.05). The erythrocyte catalase level of T4 group was found to be significantly higher than rest of the treated groups except T3. CONCLUSION: It may be concluded that supplementation of Azolla at 10% of dietary protein requirement along with enzyme supplementation in an isonitrogenous diet showed a better immune response in broilers.

Results of Birmingham hip resurfacing at 12 to 15 years: a single-surgeon series.

We report a 12- to 15-year implant survival assessment of a prospective single-surgeon series of Birmingham Hip Resurfacings (BHRs). The earliest 1000 consecutive BHRs including 288 women (335 hips) and 598 men (665 hips) of all ages and diagnoses with no exclusions were prospectively followed-up with postal questionnaires, of whom the first 402 BHRs (350 patients) also had clinical and radiological review. Mean follow-up was 13.7 years (12.3 to 15.3). In total, 59 patients (68 hips) died 0.7 to 12.6 years following surgery from unrelated causes. There were 38 revisions, 0.1 to 13.9 years (median 8.7) following operation, including 17 femoral failures (1.7%) and seven each of infections, soft-tissue reactions and other causes. With revision for any reason as the end-point Kaplan-Meier survival analysis showed 97.4% (95% confidence interval (CI) 96.9 to 97.9) and 95.8% (95% CI 95.1 to 96.5) survival at ten and 15 years, respectively. Radiological assessment showed 11 (3.5%) femoral and 13 (4.1%) acetabular radiolucencies which were not deemed failures and one radiological femoral failure (0.3%). Our study shows that the performance of the BHR continues to be good at 12- to 15-year follow-up. Men have better implant survival (98.0%; 95% CI 97.4 to 98.6) at 15 years than women (91.5%; 95% CI 89.8 to 93.2), and women < 60 years (90.5%; 95% CI 88.3 to 92.7) fare worse than others. Hip dysplasia and osteonecrosis are risk factors for failure. Patients under 50 years with osteoarthritis fare best (99.4%; 95% CI 98.8 to 100 survival at 15 years), with no failures in men in this group.

Differential effects of absent visual feedback control on gait variability during different locomotion speeds.

Healthy persons exhibit relatively small temporal and spatial gait variability when walking unimpeded. In contrast, patients with a sensory deficit (e.g., polyneuropathy) show an increased gait variability that depends on speed and is associated with an increased fall risk. The purpose of this study was to investigate the role of vision in gait stabilization by determining the effects of withdrawing visual information (eyes closed) on gait variability at different locomotion speeds. Ten healthy subjects (32.2 ± 7.9 years, 5 women) walked on a treadmill for 5-min periods at their preferred walking speed and at 20, 40, 70, and 80 % of maximal walking speed during the conditions of walking with eyes open (EO) and with eyes closed (EC). The coefficient of variation (CV) and fractal dimension (α) of the fluctuations in stride time, stride length, and base width were computed and analyzed. Withdrawing visual information increased the base width CV for all walking velocities (p < 0.001). The effects of absent visual information on CV and α of stride time and stride length were most pronounced during slow locomotion (p < 0.001) and declined during fast walking speeds. The results indicate that visual feedback control is used to stabilize the medio-lateral (i.e., base width) gait parameters at all speed sections. In contrast, sensory feedback control in the fore-aft direction (i.e., stride time and stride length) depends on speed. Sensory feedback contributes most to fore-aft gait stabilization during slow locomotion, whereas passive biomechanical mechanisms and an automated central pattern generation appear to control fast locomotion.

Inadequate interaction between open- and closed-loop postural control in phobic postural vertigo.

Phobic postural vertigo (PPV) is characterized by a subjective dizziness and postural imbalance. Changes in postural control strategy may cause the disturbed postural performance in PPV. A better understanding of the mechanisms behind this change in strategy is required to improve the diagnostic tools and therapeutic options for this prevalent disorder. Here we apply stabilogram diffusion analysis (SDA) to examine the characteristics and modes of interaction of open- and closed-loop processes that make up the postural control scheme in PPV. Twenty patients with PPV and 20 age-matched healthy controls were recorded on a stabilometer platform with eyes open and with eyes closed. Spatio-temporal changes of the center of pressure (CoP) displacement were analyzed by means of SDA and complementary CoP amplitude measures. (1) Open-loop control mechanisms in PPV were disturbed because of a higher diffusion activity (p < 0.001). (2) The interaction of open- and closed-loop processes was altered in that the sensory feedback threshold of the system was lowered (p = 0.010). These two changes were comparable to those observed in healthy subjects during more demanding balance conditions such as standing with eyes closed. These data indicate that subjective imbalance in PPV is associated with characteristic changes in the coordination of open- and closed-loop mechanisms of postural control. Patients with PPV use sensory feedback inadequately during undisturbed stance, and this impairs postural performance. These changes are compatible with higher levels of anti-gravity muscle activity and co-contraction during the conscious concentration on control of postural stability.

Hairy root cultures of butterfly pea (Clitoria ternatea L.): Agrobacterium × plant factors influencing transformation.

Transformed rhizoclones were developed from Agrobacterium-treated explants of the medicinally important twinning legume Clitoria ternatea L. Several key factors influencing transformation events were optimized. A4T was the most infectious among the strains employed. Internode segments were more responsive than leaves, outdoor-grown explants preferred to those from in vitro cultures. High frequency transformation, resulting in up to 85.8% rhizogenesis, was attained using pre-pricked internodal explants for immersion (10 min) in Agrobacterium rhizogenes suspension grown overnight with acetosyringone (100 µM) to an OD(660) â‰… 0.6, diluted to a density of 10(9) cells ml(-1), followed by 5-day co-cultivation. Roots were individually cultured in MS0 supplemented with the bacteriostatic antibiotic cefotaxime (500 µg ml(-1)). Rhizoclones were renewed through successive subcultures in MS0 under diffused illumination. The T ( L )-DNA rolB and rolC ORF were detected in rhizoclones through PCR amplification. The T ( R )-DNA gene encoding mannopine synthase (man2) was revealed by positive amplification and opine gene expression substantiated by agropine and mannopine biosynthesis in all selected transformed rhizoclones. The implication of such findings is discussed on the context of utilization of such genetically transformed root cultures towards sustainable production of medicinally useful phytocompounds, besides providing a means for plant conservation.

Clinical efficacy of a novel new injectable diclofenac formulation designed for intradeltoid use in post-operative pain management.

OBJECTIVE: A randomized study comparing efficacy and safety of a new 75 mg/1 ml formulation of injectable diclofenac sodium designed for intra-deltoid use with the conventional 75 mg/3 ml formulation given by the intra-gluteal route. DESIGN: This was an open-label, multicentric, randomized clinical trial. METHODS: A total of 250 adult patients with post-operative pain were randomized to receive either an injection diclofenac 75 mg/1 ml or diclofenac 75 mg/3 ml. Primary efficacy criteria were time to onset of analgesia and reduction in pain intensity. Severity of pain at site of injection and side effects were also evaluated. RESULTS: 232 patients completed the study. The mean times to onset of anal-gesia were comparable (16.17 ± 12.70 min in the diclofenac 75 mg/1 ml group and 19.16 ± 11.79 min in the diclofenac 75 mg/3 ml group). However, significantly more patients achieved analgesia in less than 5 min and had less pain at the site of injection with the 1 ml formulation. The need for rescue medication was also lower with the 1 ml formulation (2.5% vs. 9.82%). No side effects were reported. A significantly larger number of patients and physicians rated the efficacy and safety of injectable diclo-fenac 75 mg/1 ml as excellent. CONCLUSION: Both formulations were effective and safe in the management of post-operative pain with a significantly lower need for rescue analgesia and less pain at site of injection with diclofenac 75 mg/1 ml formulation. The 1 ml formulation had an added advantage of intra-deltoid use. This would be specially helpful in obese/overweight patients with a thick subcutaneous pad of fat over the gluteal region.

Quantitative analysis of heart rate variability in patients with absence epilepsy.

BACKGROUND: There are no studies quantifying the nature of autonomic changes in absence epilepsy. Aims : We characterized the heart rate variability (HRV) during pre-interictal epileptiform discharges (IED), IED and post-IED states in absence epilepsy. MATERIAL AND METHODS: Electroencephalogram (EEG) records with generalized 3-Hz spike-wave discharges in 8 patients (M: F: 3 : 5; mean age: 13.0 ± 2.5 years) with absence epilepsy were identified and corresponding electrocardiogram (ECG) time series were obtained. The time domain HRV measures were applied to pre-IED, IED and post-IED simultaneous ECG tracing. RESULTS: There was slight tachycardia during the IED phase (pre-IED: 90.15 ± 3.45 bpm, IED: 94.82 ± 4.63 bpm, P = 0.09) which returned to baseline during the post-IED phase (post-IED: 89.65 ± 3.78 bpm). There was significant decrease in the standard deviation of RR interval (pre-IED: 40.0 ± 4.15 ms, IED: 30.4 ± 4.19 ms, P = 0.032) and trend in reduction of triangular index (pre-IED: 0.05 ± 0.01, IED: 0.04 ± 0.004, P = 0.08) during the IED phase when compared to pre-IED phase. The percentage of RR intervals >50 ms was lower during the IED phase and achieved significance when compared to post-IED phase (IED: 10.08 ± 4.89, post-IED: 18.74 ± 6.17, P = 0.050). While mean HR and RR interval significantly correlated with the duration of IEDs, there was no significant correlation between its duration with change in HRV parameters between the groups. There was no significant difference in HRV parameters between patients with long (>10s) and short (<10s) duration of IED. CONCLUSIONS: Transient increase in heart rate during IED phase was noted in patients with absence epilepsy. Longer duration of IED seems to be linked with significant tachycardia. While most HRV parameters did not reach statistical significance, standard deviation of RR intervals and triangular index was noted to be decreased during the IED phase and returns to pre-IED levels after the episode.

Indications and results of hip resurfacing.

The best indication for hip resurfacing is a young active patient with severe hip arthritis, good hip morphology and reasonable bone quality. With revision of either component for any reason as the endpoint, there were 68 revisions in our series of 3,095 consecutive Birmingham Hip Resurfacings (BHR) (1997-2009), including all diagnoses in all ages. This equates to a revision rate of 2.2% and survivorships of 99, 97 and 96% at five, ten and 13 years, respectively. In patients under 55 years with osteoarthritis, the survivorship is 99 and 98% at ten and 13 years. These results provide medium-term evidence that BHR when performed well in properly selected patients offers excellent outcomes and implant survivorship. Small changes to implant materials and design can affect joint function and survivorship significantly as seen from the withdrawal of certain resurfacing devices recently from clinical use. The clinical history of one device cannot be extrapolated to other devices.

Pulmonary function tests and diaphragmatic compound muscle action potential in patients with sporadic amyotrophic lateral sclerosis.

BACKGROUND: Respiratory failure is the primary cause of death in patients with amyotrophic lateral sclerosis (ALS). Diaphragmatic compound muscle action potentials (DCMAP) are valid parameters to assess the respiratory muscle innervation. AIM: In this study we propose to establish evidence of pulmonary dysfunction in patients with ALS and its relation to DCMAP parameters among patients with sporadic ALS. MATERIALS AND METHODS: Twenty nine patients (M-20, F-9) diagnosed to have sporadic ALS by El. Escorial criteria, without symptoms of pulmonary dysfunction, and able to perform the PFT satisfactorily, were studied. Thirty controls (M-20, F-10) were selected from patient's relatives. Forced vital capacity (FVC), forced expiratory volume in one second (FEV(1)), peak expiratory flow rate (PEFR) and maximum voluntary ventilation (MVV) were measured by spirometry. Maximum expiratory pressure (MEP) was measured by digital peak pressure monitor. Right phrenic nerve conductions (DCMAP) were performed and the latencies and amplitude of diaphragmatic com-pound action potential (DCMAP) was recorded in controls and ALS patients. RESULTS: The mean age of patients was 51.41 +/- 10.72 years (37-82) and control was 53.57 +/- 8.85 years (30-68). None of the patients had symptoms or clinical evidence of respiratory dysfunction. The FVC, FEV1, PEFR, MVV, MIP and MEP were significantly (P < 0.001) reduced in ALS. The mean DCMAP amplitude was reduced among patients (610 +/- 506.231 muv) as compared to controls (1303.33 +/- 584.56, P < 0.001) and mean latency was increased in patients (9.73 +/- 2.57 ms) compared to controls (7.69 +/- 0.87, P = 0.001). There was significant negative correlation between PFTs and latencies of DCMAP. Amplitude of DCMAP did not correlate with PFTs. CONCLUSION: There is significant negative correlation between DCMAP latencies and PFTs suggesting early loss of myelinated fibres and diaphragmatic dysfunction. DCMAP latencies may be a good indicator of early respiratory muscle involvement and also of disease progression in ALS.

Ten-year results of a double-heat-treated metal-on-metal hip resurfacing.

Second-generation metal-on-metal bearings were introduced as a response to the considerable incidence of wear-induced failures associated with conventional replacements, especially in young patients. We present the results at ten years of a consecutive series of patients treated using a metal-on-metal hip resurfacing. A distinct feature of the bearings used in our series was that they had been subjected to double-heat treatments during the post-casting phase of their manufacture. In the past these bearings had not been subjected to thermal treatments, making this a unique metal-on-metal bearing which had not been used before in clinical practice. We report the outcome of 184 consecutive hips (160 patients) treated using a hybrid-fixed metal-on-metal hip resurfacing during 1996. Patients were invited for a clinicoradiological follow-up at a minimum of ten years. The Oxford hip score and anteroposterior and lateral radiographs were obtained. The mean age at operation was 54 years (21 to 75). A series of 107 consecutive hips (99 patients) who received the same prosthesis, but subjected to a single thermal treatment after being cast, between March 1994 and December 1995, were used as a control group for comparison. In the 1994 to 1995 group seven patients (seven hips) died from unrelated causes and there were four revisions (4%) for osteolysis and aseptic loosening. In the 1996 group nine patients died at a mean of 6.9 years after operation because of unrelated causes. There were 30 revisions (16%) at a mean of 7.3 years (1.2 to 10.9), one for infection at 1.2 years and 29 for osteolysis and aseptic loosening. Furthermore, in the latter group there were radiological signs of failure in 27 (24%) of the 111 surviving hips. The magnitude of the problem of osteolysis and aseptic loosening in the 1996 cohort did not become obvious until five years after the operation. Our results indicate that double-heat treatments of metal-on-metal bearings can lead to an increased incidence of wear-induced osteolysis.

Six-year results of a prospective study of metal ion levels in young patients with metal-on-metal hip resurfacings.

We describe the findings at six years in an ongoing prospective clinicoradiological and metal ion study in a cohort of 26 consecutive male patients with unilateral Birmingham Hip Resurfacing arthroplasties with one of two femoral head sizes (50 mm and 54 mm). Their mean age was 52.9 years (29 to 67). We have previously shown an early increase in the 24-hour urinary excretion of metal ions, reaching a peak at six months (cobalt) and one year (chromium) after operation. Subsequently there is a decreasing trend in excretion of both cobalt and chromium. The levels of cobalt and chromium in whole blood also show a significant increase at one year, followed by a decreasing trend until the sixth year.