Position of the greater trochanter and functional femoral antetorsion: Which factors matter in the management of femoral antetorsion disorders?

Aims: The primary aim of this study was to define and quantify three new measurements to indicate the position of the greater trochanter. Secondary aims were to define 'functional antetorsion' as it relates to abductor function in populations both with and without torsional abnormality. Patients and Methods: Three new measurements, functional antetorsion, posterior tilt, and posterior translation of the greater trochanter, were assessed from 61 CT scans of cadaveric femurs, and their reliability determined. These measurements and their relationships were also evaluated in three groups of patients: a control group (n = 22), a 'high-antetorsion' group (n = 22) and a 'low-antetorsion' group (n = 10). Results: In the cadaver group, the mean anatomical antetorsion was 14.7° (sd 8.5; 0 to 36.5) and the functional antetorsion 21.5° (sd 8.1; 3.6 to 44.3): the posterior tilt was 73.3° (sd 10.8; 46.9 to 88.7) and the posterior translation 0.59 (sd 0.2; 0.2 to 0.9). These measurements had excellent intra and interobserver agreement with a range from 0.93 to 0.99. When the anatomical antetorsion decreased, the greater trochanter was more tilted and translated posteriorly in relation to the axis of the femoral neck, and the difference between functional and anatomical antetorsion increased. The results the three patient groups were similar to those of the cadaver group. Conclusion: The position of the greater trochanter and functional antetorsion varied with anatomical antetorsion. In the surgical management of femoral retrotorsion, subtrochanteric osteotomy can result in an excessively posterior position of the greater trochanter and an increase in functional antetorsion. Cite this article: Bone Joint J 2018;100-B:712-19.

EDTA is superior to DTT treatment for overcoming the prozone effect in HLA antibody testing.

A limitation of solid-phase human leukocyte antigen (HLA) antibody assays is the falsely low/negative result of samples with high-titer antibodies, a phenomenon known as the prozone effect. Here we compared the efficacy of ethylenediaminetetraacetic acid (EDTA) and dithiothreitol (DTT) treatment of serum samples in overcoming the prozone effect. A total of 21 serum samples were treated with either EDTA or DTT before HLA single antigen bead assay. The efficacy of prozone effect reversal, compared with untreated samples, was examined on fourfold, serially diluted samples, from neat to 1:256, using PBS as diluent. EDTA reversed the prozone effect in all tested samples, with an efficiency of greater than 84%, estimated by the ratio of undiluted sample mean fluorescence intensity (MFI) to peak MFI, for any given dilution. In contrast, the efficiency of DTT treatment was as low as 47%. These results show superior prozone effect reversal with EDTA treatment, compared with DTT.

Inducible nitric oxide synthase expression is increased in the alveolar compartment of asthmatic patients.

INTRODUCTION: Increased exhaled nitric oxide (NO) levels in asthma are suggested to be through inducible NO synthase (iNOS). The aim of this study was to investigate the expression of iNOS in bronchoalveolar lavage (BAL) cells and tissue from central and peripheral airways and compare it with the exhaled bronchial and alveolar NO levels in patients with asthma vs a control group. METHODS: Thirty-two patients with asthma (defined as controlled or uncontrolled according to Asthma Control Test score cut-off: 20) and eight healthy controls were included. Exhaled NO was measured, and alveolar concentration and bronchial flux were calculated. iNOS was measured in central and peripheral lung biopsies, as well as BAL cells. Bronchoalveolar lavage macrophages were stimulated in vitro, and iNOS expression and NO production were investigated. RESULTS: Expression of iNOS was increased in central airway tissue and the alveolar compartment in uncontrolled as compared to controlled asthmatics and healthy controls. There were no differences, however, in iNOS mRNA levels in total BAL cells in uncontrolled as compared to controlled asthma. Bronchoalveolar lavage cell mRNA levels of iNOS or iNOS expression in central and alveolar tissue did not relate to alveolar NO, nor to bronchial flux of NO. In vitro stimulation with leukotriene D4 increased iNOS mRNA levels and NO production in cultured BAL macrophages. CONCLUSION: The levels of both bronchial and alveolar iNOS are increased in uncontrolled as compared to controlled asthma. However, levels of iNOS in BAL macrophages were not reflected by alveolar NO. Both central and distal iNOS levels may reflect responsiveness to steroid treatment.

The confounding effect of the development of idiopathic orthostatic edema and thyrotoxcosis on weight fluctuation related to effects on free water clearance in a woman with long-standing surgically induced panhypopituitarism and diabetes insipidus.

PURPOSE: To evaluate the effect of idiopathic orthostatic edema and the effect of thyrotoxicosis on weight fluctuation and fluid retention in the presence of surgically induced panhypopituitarism and diabetes insipidus controlled with hormone replacement. MATERIALS AND METHODS: Dextroamphetamine sulfate was used for weight gain when no other etiologic factor was found. Methimazole was used when weight loss occurred when serum T4 and free T4 indicated thyrotoxicosis. RESULTS: Sympathomimetic amine therapy very effectively controlled the weight gain and methimazole controlled the weight loss. CONCLUSIONS: Hypopituitarism and diabetes insipidus controlled with hormone replacement do not protect against fluid retention from idiopathic edema.

GABAergic signalling in the immune system.

The GABAergic system is the main inhibitory neurotransmitter system in the central nervous system (CNS) of vertebrates. Signalling of the transmitter γ-aminobutyric acid (GABA) via GABA type A receptor channels or G-protein-coupled type B receptors is implicated in multiple CNS functions. Recent findings have implicated the GABAergic system in immune cell functions, inflammatory conditions and diseases in peripheral tissues. Interestingly, the specific effects may vary between immune cell types, with stage of activation and be altered by infectious agents. GABA/GABA-A receptor-mediated immunomodulatory functions have been unveiled in immune cells, being present in T lymphocytes and regulating the migration of Toxoplasma-infected dendritic cells. The GABAergic system may also play a role in the regulation of brain resident immune cells, the microglial cells. Activation of microglia appears to regulate the function of GABAergic neurotransmission in neighbouring neurones through changes induced by secretion of brain-derived neurotrophic factor. The neurotransmitter-driven immunomodulation is a new but rapidly growing field of science. Herein, we review the present knowledge of the GABA signalling in immune cells of the periphery and the CNS and raise questions for future research.

Marked improvement of the autoimmune syndrome associated with autoimmune hepatitis by treatment with sympathomimetic amines.

PURPOSE: To evaluate the effect of sympathomimetic amine therapy for a life threatening autoimmune disorder. MATERIALS AND METHODS: Dextroamphetamine sulfate was used to treat edema, myalgia, and chronic fatigue associated with autoimmune hepatitis (AIH). RESULTS: Sympathomimetic amine therapy completely abrogated the symptoms associated with AIH. CONCLUSIONS: AIH should be added to the long list of chronic treatment-refractory conditions that respond quickly and effectively to treatment with sympathomimetic amines.

225Ac and 223Ra production via 800 MeV proton irradiation of natural thorium targets.

Cross sections for the formation of (225,227)Ac, (223,225)Ra, and (227)Th via the proton bombardment of natural thorium targets were measured at a nominal proton energy of 800 MeV. No earlier experimental cross section data for the production of (223,225)Ra, (227)Ac and (227)Th by this method were found in the literature. A comparison of theoretical predictions with the experimental data shows agreement within a factor of two. Results indicate that accelerator-based production of (225)Ac and (223)Ra is a viable production method.

Proton-induced cross sections relevant to production of 225Ac and 223Ra in natural thorium targets below 200 MeV.

Cross sections for (223,)(225)Ra, (225)Ac and (227)Th production by the proton bombardment of natural thorium targets were measured at proton energies below 200 MeV. Our measurements are in good agreement with previously published data and offer a complete excitation function for (223,)(225)Ra in the energy range above 90 MeV. Comparison of theoretical predictions with the experimental data shows reasonable-to-good agreement. Results indicate that accelerator-based production of (225)Ac and (223)Ra below 200 MeV is a viable production method.

Inversion and crossover recombination contributions to the spacing between two functionally linked genes.

The roles of inversion and crossover recombination in determining the spacing between two functionally linked genes on an individual strand of DNA and the resulting genetic organization throughout the population is not well understood. We employ a computer simulation to look at the spacing between functionally linked genes after many generations of a population of haploid individuals, each with a single chromosome. Simulations show that inversion and crossover recombination combine to create four attractors in gene spacing. The two major attractors include one in which the linked genes are forced to be near each other and one in which the linked genes are forced to be separated by one third of the chromosome length. Multiplicative functional linkage between two linked genes also causes a decreased average spacing compared to additive and random functional linkage.

The science of recalls.

Morbidity due to foodborne illnesses in the US has decreased over the last ten years. During the same time period recalls affecting the meat and poultry industry have increased from 38 in 1993 to a peak of 128 in 2002. Recalls due to L. monocytogenes (LM) and E. coli O157:H7 have accounted for the majority of recalls in recent years, while incidence rates for these pathogens have decreased. Incidence of Salmonella and E. coli O157:H7 cases since 1996 have decreased 17% and 42% respectively while product positives in ready to eat foods for LM has decreased from 3% in 1995 to 0.75% in 2003. In response to the increasing number of recalls, members of the meat and poultry industry have developed recall plans to effectively manage a recall crisis. A detailed recall plan which is tested through mock scenarios is essential to reducing the economic and negative consumer confidence impact of recalls.

The petromastoid canal on computed tomography.

The objective was to assess visibility and anatomy of the petromastoid canal in high-resolution CT. Computed tomography images of 188 patients were reviewed for delineation of the petromastoid canal. This bony canal connects the mastoid antrum with the cranial cavity and houses the subarcuate artery and vein. The diameter, obtained in the middle portion of the canal, was compared with the diameter of the vestibular and cochlear aqueduct in all patients, and absolute values measured in 20 cases. Collimation was 1 mm in 164 and 2 mm in 24 examinations. Additionally, temporal bone of a cadaver was imaged and microdissected. The petromastoid canal was identified bilaterally in all 164 scans that were obtained with a slice thickness of 1 mm. In 5 of the 24 patients imaged with a collimation of 2 mm, the canal was not visible, most probably due to partial-volume effects. The petromastoid canal had the same diameter as the cochlear aqueduct in 42/44 (right/left), exceeded it in 66/61 and was smaller in 75/78 cases. In comparison to the vestibular aqueduct it had an equal diameter in 38/41 (right/left), exceeded it in 63/61, and was rated as smaller in 82/81 temporal bones. Diameters for the canals were: petromastoid canal 0.51+/-0.04 mm; cochlear aqueduct 0.57+/-0.03; and vestibular aqueduct 0.63+/-0.06 mm. Microdissection of the specimen revealed the entire course of the canal and demonstrated a similar appearance of the structure as in the images. The petromastoid canal can easily be identified on high-resolution, thin-slice CT images. Knowledge of the anatomy of this bony canal prevents misinterpretation as pathological structure, such as fracture line, which might occur if this structure is not known.

Mental stimulation increases circulating CD4-positive T lymphocytes: a preliminary study.

To stimulate the dorsolateral frontal cortex, 12 healthy, adult, human females played contract bridge for 1.5 h between initial and final blood sample collections. Flow cytometric analyses of samples, performed in triplicate, showed a significant increase in CD4-positive T lymphocytes. The dorsolateral frontal cortical thickness is significantly and bilaterally reduced in immune-incompetent female, nude mice. Thymic transplants reverse the deficient cortical thickness and CD4-positive cell numbers.

[Panorama ultrasonography of the abdominal wall for delineation of the anatomy and diagnosis of pathological findings]. / Panorama-Ultraschall der Bauchwand zur Darstellung der Anatomie und pathologischer Befunde.

PURPOSE: To assess extended field-of-view sonography for delineation of the anatomic structures of the abdominal wall and for the diagnosis of hernia. MATERIAL AND METHODS: In 34 cases (24 probands, 10 patients with abdominal wall defects) extended field-of-view sonography of the abdominal wall was performed with a 7.5 MHz transducer. Dynamic alignment of real-time images allows for depiction of regions of up to 60 cm in a single extended field-of-view image. A standardized axial image was obtained above and below the arcuate line and at the level of the defect, respectively. All images were evaluated by two blinded readers regarding the visibility of the anatomic structures and the delineation and extent of pathological changes. RESULTS: The abdominal wall was delineated with extended field-of-view sonography in all patients with a good image quality. The linea alba, the rectus muscle and the three lateral abdominal muscles, the rectus sheath, the peritoneum, and the subcutaneous fatty tissue were visible. In the patients with abdominal wall defects, the hernial sac with its contents, the extension of the defect, and the surrounding structures were clearly delineated. CONCLUSION: Extended field-of-view sonography allows for easily surveyed and reproducible documentation of the ultrasound examination of the abdominal wall. It is especially useful for the preoperative planning in patients with abdominal wall defects.

Structure of the P700(+ )A1(-) radical pair intermediate in photosystem I by high time resolution multifrequency electron paramagnetic resonance: analysis of quantum beat oscillations.

The geometry of the secondary radical pair P700(+)A1(-), in photosystem I (PSI) from the deuterated and 15N-substituted cyanobacterium Synechococcus lividus, has been determined by high time resolution electron paramagnetic resonance (EPR), performed at three different microwave frequencies. Structural information is extracted from light-induced quantum beats observed in the transverse magnetization of P700(+)A1(-) at early times after laser excitation. A computer analysis of the two-dimensional Q-band experiment provides the orientation of the various magnetic tensors of with respect to a magnetic reference frame. The orientation of the cofactors of the primary donor in the g-tensor system of is then evaluated by analyzing time-dependent X-band EPR spectra, extracted from a two-dimensional data set. Finally, the cofactor arrangement of P700(+)A1(-) in the photosynthetic membrane is deduced from angular-dependent W-band spectra, observed for a magnetically aligned sample. Thus, the orientation of the g-tensor of P700(+) with respect to a chlorophyll based reference system could be determined. The angle between the g1(z) axis and the chlorophyll plane normal is found to be 29 +/- 7 degrees, while the g1(y) axis lies in the chlorophyll plane. In addition, a complete structural model for the reduced quinone acceptor, A1(-), is evaluated. In this model, the quinone plane of is found to be inclined by 68 +/- 7 degrees relative to the membrane plane, while the P700(+)-A1(-) axis makes an angle of 35 +/- 6 degrees with the membrane normal. All of these values refer to the charge separated state, observed at low temperatures, where forward electron transfer to the iron-sulfur centers is partially blocked. Preliminary room temperature studies of P700(+)A1(-), employing X-band quantum beat oscillations, indicate a different orientation of A1(-) in its binding pocket. A comparison with crystallographic data provides information on the electron-transfer pathway in PSI. It appears that quantum beats represent excellent structural probes for the short-lived intermediates in the primary energy conversion steps of photosynthesis.