The medium- and long-term outcome of total shoulder arthroplasty for primary glenohumeral osteoarthritis in middle-aged patients.

AIMS: Promising medium-term results from total shoulder arthroplasty (TSA) have been reported for the treatment of primary osteoarthritis in young and middle-aged patients. The aim of this study was to evaluate the long-term functional and radiological outcome of TSA in the middle-aged patient. PATIENTS AND METHODS: The data of all patients from the previous medium-term study were available. At a mean follow-up of 13 years (8 to 17), we reviewed 21 patients (12 men, nine women, 21 shoulders) with a mean age of 55 years (37 to 60). The Constant-Murley score (CS) with its subgroups and subjective satisfaction were measured. Radiological signs of implant loosening were analysed. RESULTS: Two shoulders (two patients) were revised and in two shoulders of two different patients, revision surgery was recommended. The mean CS increased from 23.3 (10 to 45) pre-operatively to 56.5 (26 to 81; p < 0.0001), but with a decrease in CS from 62.8 (38 to 93) to 56.5 (26 to 81) between medium- and long-term follow-up (p = 0.01). Without revision surgery, 18 patients (95%) rated their result as good or very good. The mean radiolucent line score for the glenoid components increased from 1.8 (0 to 6) to 8.2 (2 to 18) between medium- and long-term follow-up (p < 0.001). CONCLUSION: TSA in young and middle-aged patients leads to improvement in clinical function and a relatively high satisfaction rate. However, clinical or radiological glenoid loosening worsens in the long term. Further studies are needed to optimise the treatment options in this patient population. Cite this article: Bone Joint J 2017;99-B:939-43.

Return to sports and work after partial shoulder replacement surgery.

BACKGROUND: Shoulder hemiarthroplasty is a particularly attractive treatment option in young active patients, where revision surgery is an issue and a glenoid replacement might be necessary in the long run. These patients often ask about the possibility of returning to sport and work after surgery. OBJECTIVE: The purpose of this investigation was to analyze whether patients undergoing shoulder hemiarthroplasty (HSA) are able to successfully return to sports activities and work after surgery. MATERIALS AND METHODS: This study included 42 patients treated with HSA. Two subgroups were built: patients who had participated in sports less than 5 years prior to surgery (group A: n = 29, 69%) and those who had not done so (group B: n = 13, 31%). Evaluation was based on a questionnaire asking about types of sports, frequency of sports activity, and the time taken to return to sports and work, as well as about limitations in occupational life. RESULTS: Patients' mean age at the time of surgery was 56.3 ± 12.7 years in group A and 66.9 ± 13.8 years in group B. Mean follow-up was 5.5 years (range 2.5-12 years). In group A, 18 patients (62%) had participated in sports up to the time of surgery and 12 (41%) had returned to the same level of sports activity at final follow-up. The rate of return to preoperative sports activity was 67%. Swimming was one of the most favorable sports (92%). Of the cohort patients, 2 (5%) had to change their profession due to surgery. Most patients were retired at follow-up. CONCLUSION: Patients who were sportingly active prior to HSA were able to return to sports after surgery in 67% of cases. This study confirms that patients treated by hemiarthroplasty of the shoulder joint can return to sports and work, even at medium-term follow-up.

Pressurisation leads to better cement penetration into the glenoid bone: a cadaveric study.

The aim of this study was to compare a third-generation cementing procedure for glenoid components with a new technique for cement pressurisation. In 20 pairs of scapulae, 20 keeled and 20 pegged glenoid components were implanted using either a third-generation cementing technique (group 1) or a new pressuriser (group 2). Cement penetration was measured by three-dimensional (3D) analysis of micro-CT scans. The mean 3D depth of penetration of the cement was significantly greater in group 2 (p < 0.001). The mean thickness of the cement mantle for keeled glenoids was 2.50 mm (2.0 to 3.3) in group 1 and 5.18 mm (4.4 to 6.1) in group 2, and for pegged glenoids it was 1.72 mm (0.9 to 2.3) in group 1 and 5.63 mm (3.6 to 6.4) in group 2. A cement mantle < 2 mm was detected less frequently in group 2 (p < 0.001). Using the cement pressuriser the proportion of cement mantles < 2 mm was significantly reduced compared with the third-generation cementing technique.

Variations in metallothionein, Zn, Cu, and Fe concentrations and ceruloplasmin activity in pregnant rat dams and their fetuses.

Growing rat fetuses have great need for Zn, Cu, and Fe. In fetal livers (FL) large accumulations of Zn and Cu connected with increased metallothionein (MT) synthesis take place. In dams, serum changes in metals concentrations with increased ceruloplasmin (Cp) activity are observed. The aim of this study was to determine (1) mutual relationships in the accumulation of MT, Zn, Cu, and Fe in fetal livers; (2) changes in Zn, Cu, and Fe concentrations in dam serum; and (3) the day with the maximum Cp activity. Sections of rat dams were taken on 16th-21st day of gestation, twice a day, and MT, Zn, Cu, and Fe concentrations in liver, spleen, kidneys, and placenta of dams and in liver and brain in fetuses were determined. In fetal livers high correlations between MT and Zn and between Zn and Cu were obtained. The investigated Cp activity was always high, reaching its maximum on the 20th day and minimum on the 21st day. Significant correlation between Cp activity and Cu concentration in dam serum was also revealed. In conclusion it is suggested that Zn accumulation in FL is strictly connected with MT synthesis but Cu content in FL is rather dependent on Cp activity in dam serum. Iron accumulation in fetal livers is connected with the diminution of iron concentrations in dam serum.

Cadmium interaction with essential metals (Zn, Cu, Fe), metabolism metallothionein, and ceruloplasmin in pregnant rats and fetuses.

Cadmium administered to rats per os is accumulated in the duodenal mucosa in the form of metallothionein (MT). Therefore, this toxic metal can influence the efficiency of essential metal absorption, especially their concentration in the maternal organism, which plays an essential role during fetal development. The aim of this study is to elucidate the mechanism of the origin of Zn, Cu, and Fe deficiency in fetal rat livers after maternal exposure to cadmium in drinking water and to investigate the roles of MT and ceruloplasmin (Cp) in this phenomenon. Cadmium was given to pregnant dams exposed for 0-20 days of gestation in drinking water at concentrations of 6. 25-100 microg Cd/ml. After cessation of exposure, at the lowest dose, a decrease in Cu and Fe concentrations in the duodenal mucosa was found. Simultaneously, diminution in concentration of two cited metals and Cp activity in serum of dam blood was noted. The lowest dose of cadmium developed a drop tendency in microsomal fetal liver iron. Significant correlations were observed between fetal liver Cu contents and Cp activity in serum of dams and Cu concentrations in serum of dams. Diminished Cp activity in serum of dams is related to reduced availability of Cu and Fe in fetuses. In conclusion, it is suggested that the mechanism of Cu and Fe deficit content in fetuses is based on the diminution of absorption of these metals by dam intestines exposed to cadmium on the reduction of metal concentrations in blood serum and, in consequence, their decreasing availability in fetuses.

Mechanisms of binding of Brucella abortus to mononuclear phagocytes from cows naturally resistant or susceptible to brucellosis.

During the course of bovine brucellosis, Brucella abortus adheres to and infects cells of the mononuclear phagocyte system. Potential mechanisms of binding, as measured by numbers of phagocytosed bacteria, were studied in two populations of cattle genetically resistant (R) or susceptible (S) to infection with B. abortus. Live B. abortus gained entry into cultured bovine macrophages without organism-specific opsonization. Bacterial entry into macrophages from R was inhibited by the peptide RGDS, outer membrane-peptidoglycan complex from B. abortus strain RB51, anti-LFA-1 monoclonal antibody, anti-C3 antiserum, fibronectin, purified O-antigen from B. abortus lipopolysaccharide, mannan and heat-aggregated IgG. Bacterial entry into macrophages from S was inhibited by outer membrane-peptidoglycan complex, anti-LFA-1 monoclonal antibody, O-antigen and heat-aggregated IgG. The peptide RGES did not inhibit entry into macrophages from R or S. These data support the existence of organism-related receptors on monocyte-derived macrophages for B. abortus which mediate binding in the absence of serum. Secondly, there are demonstrable differences in mechanisms of binding of B. abortus to cells from cattle genetically resistant or susceptible to infection by this organism. These findings further substantiate the importance of phagocytosis and clearance functions of the mononuclear phagocyte system in resistance to bovine brucellosis. Perpetuation of infection in susceptible cattle may occur by establishing an intracellular reservoir of viable organisms. Further studies are necessary to investigate receptor affinities, and the potential for an alternate receptor for this organism in S cattle.

Epidemiology of psychiatric disorders in Edmonton. Phobic disorders.

3258 randomly selected adult household residents of the city of Edmonton were interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS). Using DMS-III criteria, hierarchy-free, the lifetime prevalence for all phobias was 8.9%. Rates for women (11.7%) were almost twice those for men (6.1%). The age at which first phobic symptoms had been reported by 50% of subjects was 12 years for men and 6 years for women. High rates of comorbidity with depression, alcohol abuse/dependence, drug abuse/dependence and obsessive-compulsive disorder were found in all types of phobia, an important point in clinical management.

Type I keratinocyte transglutaminase: expression in human skin and psoriasis.

A 92-kD transglutaminase (TGase K), expressed in human cultured keratinocytes and stratum corneum, catalyzes a critical step in the formation of the cornified envelope of terminal differentiation. A rabbit polyclonal antibody to TGase K was used to isolate overlapping cDNA clones from a human keratinocyte cDNA expression library. The cDNA clones were sequenced and unequivocally identified as TGase K by comparison to the N-terminal amino acid sequences of two cyanogen bromide fragments from the purified enzyme. The mRNA for Tgase K is expressed in cultured keratinocytes but not in A431 squamous carcinoma cells, in fibroblasts, or in other non-epithelial tissues and cells. Although TGase K protein expression is limited to the upper layers of normal epidermis, the mRNA is generally present throughout the epidermis, suggesting the possibility of post-transcriptional regulation. Precocious expression of TGase K protein occurs in psoriasis, and quantitative Northern blot analysis of TGase K mRNA from normal and involved epidermal biopsies from psoriasis patients suggests that TGase K mRNA levels are increased in psoriatic lesions. By using quantitative laser scanning confocal microscopy (LSCM) and in situ hybridization, the increase of the TGase K mRNA was in the range of 3-7 times in the psoriatic epidermis and was significantly higher compared with normal skin and with paired adjacent skin. Quantitative LSCM provides a powerful and direct method for analysis of gene expression in skin.

Virulence associated proteins of Brucella abortus identified by paired two-dimensional gel electrophoretic comparisons of virulent, vaccine and LPS deficient strains.

To identify molecular determinants of virulence, the proteins of Brucella abortus strains 2308 (virulent), S19 (vaccine) and lipopolysaccharide deficient rough mutants derived from each (RB51 and S19M3 respectively) were compared by 2-D gel electrophoresis. A total of 996 proteins were identified on autoradiographs of 2-D gels containing [35S]-labeled proteins from these four strains. Proteins differing qualitatively or quantitatively (greater than or equal to 10X) between 2308 and S19 are implicated in virulence and are identified by Mr and pI. Paired comparisons of proteins present in both 2308 and RB51 and missing in both S19 and M3 were used to make tentative identification of 14 putative virulence proteins representing primary expression of genetic differences between virulent and vaccine strains. 28 proteins and/or core lipopolysaccharide-protein complexes involved in the biosynthesis of lipopolysaccharide were identified by paired comparisons of proteins present in both smooth strains and missing in both rough strains.

SDS-soluble and peptidoglycan-bound proteins in the outer membrane-peptidoglycan complex of Brucella abortus.

Outer membrane-peptidoglycan complex from Brucella abortus was separated from cytoplasmic membrane and cytosol by either sucrose density gradient fractionation or differential (rate) centrifugation of surface labeled cells disrupted by sonication without the use of detergents. The outer membrane-peptidoglycan complex had a buoyant density of 1.22 gm/ml and contained 67 labeled SDS-soluble proteins when examined by SDS-PAGE. Included were four major bands exhibiting molecular masses of 88k, 40k, 35.7k and 26k daltons corresponding to previously described group 1, 2 and 3 outer membrane proteins. Lysozyme treatment of outer membrane-peptidoglycan complex increased its buoyant density to 1.25 gm/ml and released eight additional peptidoglycan-linked proteins.

Histology and morphometry of Strongylus vulgaris-mediated equine mesenteric arteritis.

Histological and morphometric evaluation of equine cranial mesenteric arteries was performed on 239 and 89 arteries, respectively. Histological examination revealed that thrombosis and the severity of inflammation varied on a seasonal basis and were directly associated with larval presence. Intimal and adventitial fibrosis were generally of greater severity than medial fibrosis. Fibrosis of the vasa vasorum was less frequent than fibrosis of the artery itself. Morphometry revealed a significant increase in intimal, adventitial and, to a lesser extent, medial area in affected as compared with normal arteries. This change was due to the accumulation of collagen and was considered to result in decreased arterial elasticity. The luminal area varied widely among affected arteries.

Inhibition of copper-associated erythrocyte ghost membrane lipid peroxidation by hepatic cytosolic low molecular weight proteins.

Male weanling Fischer rats were injected ip once daily with either 12.5 mg/kg body weight cupric chloride or 2 ml/kg body weight saline for up to 70 days. As the hepatic cytosolic copper increased in copper-treated rats, copper bound to proteins of different molecular weights; this was determined by gel filtration chromatography. Hepatic cytosolic copper from rats treated with cupric chloride for 14 days eluted in 3 peaks. These included a 150,000 + dalton peak, a 29,000 dalton peak and an 11,000-12,800 dalton peak. In addition to these peaks, hepatic cytosolic copper from rats treated with cupric chloride for greater than or equal to 28 days also eluted in a 4th, but shorter, 6,000-7,000 dalton peak. Hepatic cytosolic copper from saline-treated rats eluted only in a single 29,000 dalton peak. Experiments using an erythrocyte ghost membrane model of copper-associated lipid peroxidation demonstrated that incubation of membranes with protein-bound copper eluted in the 11,000-12,000 dalton peak was associated with less lipid peroxidation than incubation of membranes with cupric chloride or protein-bound copper eluted in the 150,000+ dalton peak. Experimental results suggest that the ability of copper to catalyze lipid peroxidation is significantly reduced by binding with hepatic cytosolic low molecular weight proteins but not by binding with hepatic cytosolic high molecular weight proteins.

Induction of lymphocyte responsiveness by the outer membrane-peptidoglycan complex of rough strains of Brucella abortus.

The outer membrane-peptidoglycan complex (OM-PG) from rough strains of Brucella abortus was tested for its ability to induce lymphocyte responsiveness in cattle. Six groups of heifers were immunized with varying doses and administration schedules of rough OM-PG and assayed for responsiveness of their lymphocytes in proliferation assays in vitro. All OM-PG preparations were emulsified in a commercial adjuvant for administration. Two other groups of heifers were immunized with strain 19 vaccine or adjuvant alone. Three groups of heifers received two inoculations of OM-PG antigens from a naturally-occurring rough strain at a 57-day interval. The doses of OM-PG given in these three groups were 400 micrograms, 1200 micrograms, and 4000 micrograms at each inoculation. The frequency of cows that responded in lymphocyte proliferation assays increased with the dose of OM-PG given. Two groups received single inoculations of OM-PG, either 2400 micrograms or 8000 micrograms. Although there were responsive cows in these immunization groups, their frequency was lower than in the groups receiving the same total dose in two inoculations. A sixth group of cows was inoculated with OM-PG from a rough transposon mutant of B. abortus, and the frequency of responsive cows in this immunization group was comparable to that of responsive cows immunized with the same dose of OM-PG from the spontaneous rough mutant. In comparisons of cows inoculated with strain 19 to those inoculated with OM-PG preparations, differences were observed in the relative responsiveness of their lymphocytes to whole cells and OM-PG in the in vitro lymphocyte proliferation assays. These differences suggested that lymphocytes stimulated by strain 19 vaccination have different specificities than those stimulated by immunization with OM-PG of rough mutant strains of B. abortus.

Genetic variation at the omp2 porin locus of the brucellae: species-specific markers.

The omp2 locus of Brucella abortus is composed of two closely related genes (omp2a and omp2b) that encode, and potentially both express, homologous porin proteins. Genetic variation at this locus is revealed in the form of restriction-fragment-length polymorphisms which can be used to distinguish the type strains of all six Brucella species. Five of the six species contain single copies of omp2a and omp2b, whereas Brucella ovis appears to have two copies of the omp2a gene. The implications of these results with regard to the physiological functions of the omp2a and the omp2b gene products, phylogeny of the genus, and species-specific adaptation are discussed.

Immunogenicity of subcellular fractions of Brucella abortus: measurement by in vitro lymphocyte proliferative responses.

Five groups of heifers were immunized with various subcellular fractions of Brucella abortus and tested for their responsiveness in lymphocyte proliferative responses in vitro. The five subcellular fractions used as immunogens were: (1) a mixture of recombinant outer membrane proteins fused to Escherichia coli beta-galactosidase, (2) a mixture of outer membrane proteins BaomI, BaomIIB1, and BaomIII1, (3) a mixture of outer membrane proteins 7.5 kDa and 8.8 kDa, (4) a complex of smooth lipopolysaccharide and proteins, and (5) a complex of outer membranes and peptidoglycan (OM-PG complex) from a rough strain. All immunogens were emulsified in adjuvant and administered twice at a 61-day interval. Two other groups of cows were included; one immunized with strain 19 and the other with adjuvant only. Strain 19 and the rough OM-PG complex induced responsiveness in lymphocyte proliferation assays in a high percentage of immunized cows. The smooth lipopolysaccharide-protein complex induced responsiveness in fewer cows. The lowest frequencies of responding cows were found in groups that received either recombinant proteins or purified protein mixtures. Based on these results, we concluded: (1) cellular immunity, as measured by in vitro lymphocyte proliferative responses, can be induced with subcellular fractions of B. abortus and (2) the more complex the immunogen, the greater the frequency of responding cows.

Enzymatic synthesis of dihydrosirohydrochlorin (precorrin-2) and of a novel pyrrocorphin by uroporphyrinogen III methylase.

Uroporphyrinogen III methylase was purified from a recombinant hemB-strain of E. coli harbouring a plasmid containing the cysG gene. N-terminal analysis of this purified protein gave an amino acid sequence corresponding to that predicted from the genetic code. From the u.v./visible spectrum of the reaction catalysed by this SAM dependent methylase it was possible to observe the sequential appearance of the chromophores of a dipyrrocorphin and subsequently of a pyrrocorphin. Confirmation of this transformation was obtained from 13C-NMR studies when it was demonstrated, for the first time directly, that uroporphyrinogen is initially converted into dihydrosirohydrochlorin (precorrin-2) and then, by further methylation, into a novel trimethylpyrrocorphin.