Prosthetic hip-associated cobalt toxicity: a systematic review of case series and case reports.

Prosthetic hip-associated cobalt toxicity (PHACT) is caused by elevated blood cobalt concentrations after hip arthroplasty. The aim of this study is to determine which symptoms are reported most frequently and in what type of bearing. We also try to determine the blood level of cobalt concentrations associated with toxicological symptoms. A systematic review was conducted on the 10th of July according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A methodological quality assessment (risk of bias (RoB)) was performed. Primary outcomes were the reported symptoms of cobalt toxicity and the level of cobalt concentrations in blood. These levels were associated with toxicological symptoms. A total of 7645 references were found of which 67 relevant reports describing 79 patients. The two most used bearings in which PHACT was described were metal-on-metal (MoM) bearings (38 cases) and revised (fractured) ceramic-on-ceramic (CoC) bearings where the former ceramic head was replaced by a metal head (32 cases). Of all reported symptoms, most were seen in the neurological system, of which 24% were in the sensory system and 19.3% were in central/peripheral system, followed by the cardiovascular (22.1%) system. The mean cobalt concentration for MoM-bearings was 123.7 ± 96.8 ppb and 1078.2 ± 1267.5 ppb for the revised fractured CoC-bearings. We recommend not to use a metal-based articulation in the revision of a fractured CoC bearing and suggest close follow-up with yearly blood cobalt concentration controls in patients with a MoM bearing or a revised fractured CoC bearing. Level of Evidence: Level V, systematic review.

Necrosome-positive granulovacuolar degeneration is associated with TDP-43 pathological lesions in the hippocampus of ALS/FTLD cases.

AIM: Granulovacuolar degeneration (GVD) in Alzheimer's disease (AD) involves the necrosome, which is a protein complex consisting of phosphorylated receptor-interacting protein kinase 1 (pRIPK1), pRIPK3 and phosphorylated mixed lineage kinase domain-like protein (pMLKL). Necrosome-positive GVD was associated with neuron loss in AD. GVD was recently linked to the C9ORF72 mutation in amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration with transactive response DNA-binding protein (TDP-43) pathology (FTLD-TDP). Therefore, we investigated whether GVD in cases of the ALS-FTLD-TDP spectrum (ALS/FTLD) shows a similar involvement of the necrosome as in AD, and whether it correlates with diagnosis, presence of protein aggregates and cell death in ALS/FTLD. METHODS: We analysed the presence and distribution of the necrosome in post-mortem brain and spinal cord of ALS and FTLD-TDP patients (n = 30) with and without the C9ORF72 mutation, and controls (n = 22). We investigated the association of the necrosome with diagnosis, the presence of pathological protein aggregates and neuronal loss. RESULTS: Necrosome-positive GVD was primarily observed in hippocampal regions of ALS/FTLD cases and was associated with hippocampal TDP-43 inclusions as the main predictor of the pMLKL-GVD stage, as well as with the Braak stage of neurofibrillary tangle pathology. The central cortex and spinal cord, showing motor neuron loss in ALS, were devoid of any accumulation of pRIPK1, pRIPK3 or pMLKL. CONCLUSIONS: Our findings suggest a role for hippocampal TDP-43 pathology as a contributor to necrosome-positive GVD in ALS/FTLD. The absence of necroptosis-related proteins in motor neurons in ALS argues against a role for necroptosis in ALS-related motor neuron death.

No added value for Computer-Assisted surgery to improve femoral component positioning and Patient Reported Outcomes in Hip Resurfacing Arthroplasty; a multi-center randomized controlled trial.

BACKGROUND: Computer Assisted Surgery (CAS) has proven to improve the accuracy in several orthopedic procedures. Therefore we used this technique to evaluate femoral component positioning in Hip Resurfacing Arthroplasty (HRA). The aim of this study was to evaluate imageless CAS compared to manually implanted femoral components and subsequently evaluates Patient Related Outcome Measures (PROMs). We hypothesized that the use of CAS optimizes the position of the femoral component and improves PROMs. METHODS: This is a multicenter, single-blinded, randomized, controlled trial of two groups. In the CAS group guiding of the femoral component was done with imageless navigation. In the Conventional (control) group the femoral component was placed manually according to the preplanned position. The primary outcome measure consists of a maximum of 3 degrees difference between the postoperative Stem Shaft Angle (SSA) and preplanned SSA. Secondary outcome measures consist of the Hip disability and Osteoarthritis Outcome Scale (HOOS), the Harris Hip Score (HHS) and Visual Analogue Scale (VAS) pain score. RESULTS: A total of 122 patients were randomized, 61 in the CAS group and 61 in the conventional group. There was no significant differences in accuracy of femoral implant position. The mean difference between the postoperative- and preplanned SSA was - 2.26 and - 1.75 degrees (more varus) respectively in the CAS and Conventional group. After surgery both groups show significant improvement in all PROMs compared to the baseline measurements, with no significant differences between the groups. CONCLUSION: Our cohort indicates no benefit for the use of CAS in accuracy of placement of the femoral component in HRA compared to manual implantation. There are no clinical differences in PROMs after 1 year follow up. This study showed no added value and no justification for the use of CAS in femoral component positioning in HRA. TRIAL REGISTRATION: This trial is registered at ClinicalTrails.gov ( https://clinicaltrials.gov/ ) on the 25th of October 2006: NCT00391937. LEVEL OF INCIDENCE: Level IIb, multicenter randomized controlled trial.

Clinical and Wear Analyses of 9 Large Metal-on-Metal Total Hip Prostheses.

BACKGROUND: Metal-on-Metal (MoM) total hip arthroplasties (THA) are associated with pseudotumor formation and high revision rates. This prospective study analysed the clinical and wear analyses of 9 large Metal-on-Metal (MoM) total hip arthroplasties (THA) to understand the underlying mechanisms of failure. The MoM bearings were revised for multiple reasons; the main reason was pseudotumor formation. MATERIALS AND METHODS: From 2006 till 2010 the Reinier de Graaf Hospital implanted 160 large head M2a-Magnum™ (Biomet Inc. Warsaw, Indiana, USA) THAs in 150 patients. The first year, 9 bearings were revised and analysed at the Biomechanics Section, Hamburg University of Technology, Germany. We performed clinical (Harris Hip Score, radiographic analysis, blood cobalt and chromium) and wear analysis (implant, tissue and fluid) of the 9 bearings. Since this study did not fall under the scope of the Medical Research Involving Human Subjects Act in The Netherlands, no ethical approval was necessary. In this prospective study all patient details were anonymized by the corresponding author, all other authors were blinded during the research and wear analyses. Patients with bilateral MoM implants were excluded. RESULTS: The 9 bearings had a median (IQR) survival of 41.0 (25) months in situ. From these bearings, three showed no noticeable wear. The median (IQR) head wear volume was 3.2 (3.6) mm3 and maximum wear depth 0.02 (0.02) mm. For the cup the median (IQR) wear volume was 0.23 (0.3) mm3 with a maximum wear depth of 0.03 (0.05) mm. CONCLUSION: An early identification of parameters related to failure of the MoM THA, such as pain, decreased range of motion, radiographic changes and high levels of blood cobalt and chromium is of great importance for patient's quality of life. Especially now patients and surgeons face the long term effects of all these bearings still in situ. This study reports the clinical and wear analyses of 9 MoM THA. In the majority of this group the reason for revision was pseudotumor formation. Most bearings showed signs of wear, however with a great diversity in clinical analysis, in inclination angle, serum cobalt and chromium levels as well as wear analysis. For a better understanding of the underlying mechanisms related with failure, more wear analyses of revised MoM bearings are necessary as well as a frequent follow-up of the patients with a MoM bearing.

Palladium-gold catalyst for the electrochemical reduction of CO2 to C1-C5 hydrocarbons.

Copper is a unique electrocatalyst for CO2 reduction, since it is one of the few catalysts able to produce methane, ethylene and ethane from CO2 with decent faradaic efficiencies. Here we report on the design and synthesis of a new non-copper-containing catalyst able to reduce CO2 to C1 to C5 hydrocarbons. This catalyst was designed by combining a metal that binds CO strongly, Pd, with a metal that binds CO weakly, Au, in an attempt to tune the binding energy of CO. We show that a mixture of C1-C5 hydrocarbons and soluble products are produced from an onset potential of -0.8 VRHE. We propose that the higher hydrocarbons are formed via a polymerization of -CH2 groups adsorbed on the catalyst surface.

Severe Wear and Pseudotumor Formation Due to Taper Mismatch in a Total Hip Arthroplasty: A Case Report.

CASE: We describe the case of a seventy-six-year-old woman who had undergone bilateral total hip arthroplasty with Zweymüller-Metasul prostheses in 1996. After a fall sixteen years after the index procedures, radiographs suggested a taper fracture of the left total hip arthroplasty. However, revision surgery showed pseudotumor formation, with no evidence of taper fracture. Analysis of the prosthesis showed massive wear of the male stem taper caused by a mismatch between the stem taper and the head taper. CONCLUSION: This case vividly demonstrates how taper size mismatch can cause dramatic metal wear and increased release of metal ions, resulting in pseudotumor formation.

Physical and chemical nature of the scaling relations between adsorption energies of atoms on metal surfaces.

Despite their importance in physics and chemistry, the origin and extent of the scaling relations between the energetics of adsorbed species on surfaces remain elusive. We demonstrate here that scalability is not exclusive to adsorbed atoms and their hydrogenated species but rather a general phenomenon between any set of adsorbates bound similarly to the surface. On the example of the near-surface alloys of Pt, we show that scalability is a result of identical variations of adsorption energies with respect to the valence configuration of both the surface components and the adsorbates.

Removing polyvinylpyrrolidone from catalytic Pt nanoparticles without modification of superficial order.

Herein, we report a simple methodology for cleaning Pt nanoparticles, prepared by a colloidal synthesis and coated with polyvinylpyrrolidone, without loss of crystalline surface structure. To prove the removal of the polyvinylpirrolidone from a Pt surface without disturbing the superficial order, a cleaning method using a solution of H(2)O(2)/H(2)SO(4) was tested successfully for a Pt(111) single-crystal electrode. The decontamination method was then tested for two different types of nanoparticles by mixing the suspension of nanoparticles with H(2)O(2)/H(2)SO(4) and subsequent centrifugation. The resulting voltammetric profiles of platinum particles synthesized by the colloidal method employing PVP show a marked presence of the adsorption-state characteristic of (111) ordered surface domains. The presence of the well-ordered domains present on the surface of the nanoparticles was confirmed by using the irreversible adsorption of bismuth, tellurium and germanium.

Impedance spectroscopy of H and OH adsorption on stepped single-crystal platinum electrodes in alkaline and acidic media.

The adsorption kinetics of hydrogen and hydroxyl on Pt(111) and stepped Pt[n(111) × (110)] electrodes with n = 29, 9, and 4 in acidic and alkaline electrolytes have been studied using impedance spectroscopy. We found a potential dependent charge transfer resistance, R(ct), (∼30 Ω cm(2) to ∼1 kΩ cm(2)) for hydrogen underpotential deposition in alkaline media (0.05 M NaOH), whereas in acidic media (0.025 M HClO(4)) R(ct) was too low to be determined accurately. Assuming simple (mean field) isotherms to fit our data, we obtain repulsive interactions between H(upd) at the (111) terrace and effective attractive interactions at the steps. The adsorption of OH on (111) terraces is fast in both acidic and alkaline media.

A sublattice-model isotherm for the competitive coadsorption of hydrogen and bromide on a Pt(100) electrode.

Previous work demonstrated that the Frumkin isotherm is inadequate to model the competitive coadsorption of species with different saturation coverages, such as hydrogen and bromide coadsorption on Pt(100) [N. Garcia-Araez et al., J. Electroanal. Chem., 2006, 588, 1]. Therefore, Monte Carlo simulations were necessary to determine meaningful values of the microscopic parameters (namely, energies of adsorption and interaction). In the present work, an alternative analytical isotherm is developed, by taking into account the occupation of two sublattices, which together compose the whole lattice of adsorption sites. Despite its relatively simple mathematical form, this isotherm presents, under certain conditions, a significant improvement over the classical Frumkin isotherm for the modeling of competitive adsorption processes, thus providing a closer agreement with results from Monte Carlo simulations. Finally, it is demonstrated that the sublattice-model isotherm will be generally applicable to systems in which the formation of segregated adlayers, whose structure is not explicitly taken into account in the model, is energetically unfavorable.

Fourier transform infrared spectroscopy study of CO electro-oxidation on Pt(111) in alkaline media.

In this work we investigate the electro-oxidation of CO on Pt(111) in alkaline solution by using Fourier transform infrared spectroscopy (FTIRS), to determine the adsorption sites of the CO, the intermediate species and the final oxidation product as a function of the applied potential. Multiple CO vibration bands (on-top, bridge and 3-fold hollow site) are observed on the Pt(111) electrode, their distribution and potential dependence being strongly dependent on the surface treatment. Spectroscopic results show that the final reaction product is carbonate and suggest that adsorbed carbonate blocks the access of CO from the (111) terrace to the active sites (i.e., step and kink sites).

Media portrayal of herbal remedies versus pharmaceutical clinical trials: impacts on decision.

The use of Complementary and Alternative Medicines (CAM) in Europe and North America is increasing significantly with a concomitant growth in business interest. Users are educated and self-empowered and rely on information sources beyond mainstream medical practitioners. Not surprisingly, media coverage, much of dubious quality, has increased to meet demand for information. Here we present data from a study that explores how knowledge is translated in the socioeconomic-political context of CAM as compared to conventional pharmaceuticals. Specifically, we are interested in the nature of the information provided by clinical trials and the media and how this might impact decision-making regarding the use of CAM versus conventional pharmaceuticals and the reporting of conflicts of interest and industry funding of research. Our results suggest that, in the media, there were significant errors of omission in describing clinical trial quality and a serious under-reporting of risks of herbal remedies. Consumers, who often self-administer CAM are not being provided with information sufficient to make informed choices about treatment alternatives. The next step in the research is to determine whether these reporting dynamics in describing CAM clinical trials differ from those of reporting on pharmaceutical clinical trials.

CO oxidation on Pt-modified Rh(111) electrodes.

The CO electro-oxidation reaction was studied on platinum-modified Rh(111) electrodes in 0.5 M H2SO4 using cyclic voltammetry and chronoamperometry. The Pt-Rh(111) electrodes were generated during voltammetric cycles at 50 mV s(-1) in a 30 microM H2PtCl6 and 0.5 M H2SO4 solution. Surfaces generated by n deposition cycles were investigated (Ptn-Rh(111) with n=2, 4, 6, 8, 10, and 16). The blank cyclic voltammograms of these surfaces are characterized by a pronounced sharpening of the hydrogen/(bi)sulfate adsorption/desorption peaks, typical for Rh(111), and the appearance of contributions between 0.1 and 0.4 V, which were ascribed to hydrogen/(bi)sulfate adsorption/desorption on the deposited platinum. At higher potentials, the surface oxidation of Rh(111) is enhanced by the presence of platinum. The structure of the Pt-modified electrodes was investigated by STM imaging. At low Pt coverages (Pt2-Rh(111)), monoatomically high islands are formed, which grow three dimensionally as the number of deposition cycles increases. After eight cycles, the monolayer islands have grown in diameter and range from mono- to multiatomic height. At even higher Pt coverage (Pt16-Rh(111)), the islands grow to particles of approx. 10 nm in diameter, which are 5-6 atoms high. The CO stripping voltammetry on these surfaces is characterized by two peaks: A low-potential, structure-insensitive peak, ascribed to CO reacting at the platinum monolayer islands, whose onset is shifted 150, 250, and 100 mV negatively with respect to pure Rh(111), Pt(111), and polycrystalline Pt, respectively, indicating the enhanced CO electro-oxidation properties of the Pt overlayer system. A peak at higher potentials displays strong structure sensitivity (particle-size effect) and was ascribed to CO reacting on the islands of multiatomic height. Current-time transients recorded on the surface with the highest amount of monolayer islands (Pt4-Rh(111)) also indicate enhanced CO-oxidation kinetics. Comparison of the Pt4-Rh(111) current-time transients recorded at 0.635, 0.675, and 0.750 V versus RHE (reversible hydrogen electrode) with those of pure Rh(111) and Pt(111) shows greatly reduced reaction times. A Cottrellian decay at long times indicates surface-diffusion-limited CO oxidation on the bare Rh(111) surface, while the peak visible at short times is indicative of CO reacting at the monolayer platinum islands. The results presented here show that, as indicated by density functional theory (DFT) calculations, the CO-adlayer oxidation for this system is enhanced compared to both pure Rh and Pt.

[Analysis of cardiotocographic recordings preceding intrauterine death of fetus with non-immunological hydrops]. / Analiza kardiotokogramu poprzedzajacego smierc plodu z nieimmunologicznym obrzekiem uogólnionym.

Continuous, 12 hours-long cardiotocographic recordings preceding intrauterine death of fetus (in 29 week) with non immunological hydrops were analysed. The features of CTG recordings were: absence of short and long-term variability, absence of tachycardia, presence of late decelerations, and terminal bradycardia of short duration.

Meningitis following spinal anaesthesia - a coincidental infection?

We report a case of meningitis developing a number of days after a subarachnoid block for caesarean section. No organisms were grown but the clinical picture was suggestive of bacterial meningitis, the clinical course of which had been modified by the administration of antibiotics for presumed wound infection. The possible aetiology is discussed.

Determination of the minimal amount of Tat activity required for human immunodeficiency virus type 1 replication.

The Tat protein of human immunodeficiency virus type 1 (HIV-1) is a potent trans-activator of transcription from the viral LTR promoter. Previous mutagenesis studies have identified domains within Tat responsible for binding to its TAR RNA target and for transcriptional activation. The minimal Tat activation domain is composed of the N-terminal 48 residues, and mutational analyses identified a cluster of critical cysteines. The importance of four highly conserved aromatic amino acids within the activation domain has not been thoroughly investigated. We have systematically substituted these aromatic residues (Y26, F32, F38, Y47) of the HIV-1 LAI Tat protein with other aromatic residues (conservative mutation) or alanine (nonconservative mutation). The activity of the mutant Tat constructs was measured in different cell lines by transfection with a LTR-CAT reporter plasmid. The range of transcriptional activities measured for this set of Tat mutants allowed careful assessment of the level of Tat activity required for optimal viral replication. To test this, the mutant Tat genes were introduced into the pLAI infectious molecular clone and tested for their effect on virus replication in a T-cell line. We found that a twofold reduction in Tat activity already affects viral replication, and no virus replication was measured for Tat mutants with less than 15% activity. This strict correlation between Tat activity and viral replication demonstrates the importance of the Tat function to viral fitness. Interestingly, a less pronounced replication defect was observed in primary cell types. This finding may correlate with the frequent detection of proviruses with Tat-inactivating mutations in clinical samples.