Decidual factors and vasoactive intestinal peptide guide monocytes to higher migration, efferocytosis and wound healing in term human pregnancy.

AIM: To explore the functional profile of circulating monocytes and decidual macrophages at term human pregnancy and their contribution to tissue repair upon stimulation ex vivo with decidual factors and the vasoactive intestinal peptide (VIP). METHODS: Peripheral blood monocytes were isolated from pregnant and non-pregnant volunteers and tested in vitro with decidual explants from term placenta and VIP. The effect of VIP on decidual explants and the effect of its conditioned media on monocytes or decidual macrophages isolated by magnetic beads was carried out by RT-qPCR and ELISA for cytokines expression and release. Migration assays were performed in transwell systems. Efferocytosis was assessed in monocytes or decidual macrophages with CFSE-labelled autologous apoptotic neutrophils and quantified by flow cytometry. Monocyte and decidual macrophages wound healing capacity was evaluated using human endometrial stromal cell monolayers. Immunohistochemistry was performed in serial tissue sections of different placentas. RESULTS: VIP is expressed in the villi as well as in trophoblast giant cells distributed within the decidua of term placenta. VIP induced the expression of antiinflmammatory markers and monocyte chemoattractant CCL2 and CCL3 in decidual tissues. Monocytes presented higher migration towards decidual explants than CD4 and CD8 cells. VIP-conditioned monocytes displayed an enhanced efferocytosis and wound healing capacity comparable to that of decidual macrophages. Moreover limited efferocytosis of pregnant women monocytes was restored by VIP-induced decidual factors. CONCLUSION: Results show the conditioning of monocytes by decidual factors and VIP to sustain processes required for tissue repair and homeostasis maintenance in term placenta.

Accuracy and reliability of different methods to evaluate the acetabular cup version from plain radiographs.

PURPOSE: The purpose of this study was to compare different methods of evaluating the version of a metallic acetabular cup from plain radiographs and to compare them regarding their accuracy, inter- and intra-observer reliability. METHODS: Conventional anterior-posterior radiographs were taken of a phantom-model at different defined ante- and retroversion angles of the acetabular cup. The version angles of the acetabular cup were derived according to four different established methods from the radiographs by five independent examiners. RESULTS: We were able to determine the radiographic version with the greatest accuracy according to a modified technique of Pettersson et al. Furthermore, we found the highest intra- and inter-observer reliability using this technique. CONCLUSIONS: A modified technique of Pettersson et al. broadens the spectrum of applicability for the radiographic evaluation of the version angle of metal-backed acetabular cups in comparison to the originally introduced method. In clinical practice, however, the significance of deriving the cup position from standard radiographs should not be over-estimated and therefore a computed tomography should be performed in certain critical cases.

Treatment of recurrent dislocation associated with impingement after revision total hip arthroplasty.

The authors report a case of total hip replacement in which, following several revision operations ending up in a Girdlestone arthroplasty, a patient presented recurrent episodes of posterior dislocation of his total hip prosthesis after revision using an antiprotrusio cage. The main causes for dislocation were anterior impingement of the neck against the anterior wall of the antiprotrusio cage and slackness of the periarticular musculature, due to shortening and reduced femoral offset. In order to avoid further major reconstruction and minimise the risk of infection recurrence, a limited revision operation was performed to address the factors responsible for the instability: the anterior wall of the antiprotrusio cage was removed and an extension module was added to the femoral component. Good stability of the arthroplasty was achieved with this limited procedure.