The exercise-related rise in plasma cobalt levels after metal-on-metal hip resurfacing arthroplasty

Wear of metal-on-metal bearings causes elevated levels of cobalt and chromium in blood and body fluids. Metal-on-metal bearings have two distinct wear phases. In the early phase, the wear rate is high. Later, it decreases and the bearing enters a steady-state phase. It is expected that as the wear rates decline, the level of cobalt detected in plasma will also decrease. We studied the baseline and exercise-related cobalt rise in 21 patients (13 men and eight women) with a mean age of 54 years (38 to 80) who had undergone successful hip resurfacing at a mean of 44 months (10 to 96) earlier. Our results showed that circulating baseline cobalt levels were not significantly correlated with the time since implantation (r = 0.08, p = 0.650). By contrast, the exercise-related cobalt rise was directly correlated with the inclination angle of the acetabular component (r = 0.47, p = 0.032) and inversely correlated with the time since implantation (r = −0.5, p = 0.020).

Inclination of the acetabular component should be kept less than 40° to decrease the production of wear debris.

Growth-promoting effects of single-dose intragastrically administered probiotics in chickens

1. Live body weight gain (WG) and food conversion efficiency (FCE) were measured over a 4-week period in chicks (female, Kabir strain), inoculated intragastrically at one week of age with either a single dose (1 ml) of 10(7) live bacterial cells of Lactobacillus fermentum (LBF) or a strain of Lactobacillus spp. (LB), named Autruche 4 (A4), suspended in 1 ml of phosphate-buffered saline (PBS, pH 7.0); controls (n = 10) were inoculated only with PBS. The same commercial chicken feed was used throughout the 4-week experiment. 2. Compared with the control group, WG to 8 and 21 d, and also liver weight, were significantly greater in LBF and A4 treatments and FCE improved in both of the experimental groups. Compared with the A4 treatment group, WG was significantly higher and FCE improved in the LBF-treated group. The effects of A4 treatment on chicks were similar to those in an earlier pilot experiment using the same methodology but with 1-week-old female chicks (Kabir) inoculated with either the A4 strain or strain of LB named Autruche 5. 3. It is concluded that a single dose of Lactobacillus fermentum or Lactobacillus spp. (Autruche 4) administered intragastrically improves WG and FCE of broiler chicks.

Four years of development and field-testing of IHE arsenic removal family filter in rural Bangladesh

UNESCO-IHE has been developing an arsenic removal family filter with a capacity of 100 L/day based on arsenic adsorption onto iron oxide coated sand, a by-product of iron removal plants. The longer term and field conditions performance of the third generation of eleven family filters prototypes were tested in rural Bangladesh for 30 months. All filters achieved initially highly effective arsenic removal irrespective of arsenic concentration and groundwater composition. Arsenic level in filtrate reached 10 mug/l after 50 days of operation at one testing site and after 18 months of continuous operation at other 3 testing sites. Arsenic level at other 7 sites remained below the WHO guideline value till the end of study. Positive correlation was found between arsenic removal capacity of the filter and iron concentration in groundwater. In addition to arsenic, iron present in groundwater at all testing sites was also removed highly effectively. Manganese removal with IHE family filter was effective only when treating groundwater with low ammonia. A simple polishing sand filter, after IHE family filter, resulted in consistent and effective removal of manganese. IHE family filters were easy to operate and were well accepted by the local population.

Can cobalt levels estimate in-vivo wear of metal-on-metal bearings used in hip arthroplasty?

High levels of cobalt and chromium ions are detected in the blood and urine of patients with metal-on-metal (MoM) hip replacement. These elements are released as a result of wear at the bearing surfaces. Wear rates depend on a multitude of factors, which include the bearing geometry, carbon content, manufacturing processes, lubrication, speed and direction of sliding of the surfaces, pattern of loading, and orientation of the components. In-vivo wear of MoM bearings cannot be reliably measured on X-rays because no distinction can be made between the bearing surfaces. Hip simulator studies have shown that wear rates are higher during the initial bedding-in phase and subsequently drop to very low levels. Accordingly, metal ion levels would be expected to decrease with the use of the bearing, measured as implantation time following surgery. However, several clinical studies have found that metal ion levels either gradually rise or fluctuate instead of decreasing to lower levels. Moreover, hip simulator studies predict that large-diameter bearings have lower wear rates than small-diameter bearings. In clinical studies, however, metal levels in patients with large-diameter bearings are unexpectedly higher than those in patients with small-diameter bearings.

As a consequence, high cobalt ion levels in patients do not necessarily imply that their MoM bearings produce much wear debris at the time that their levels were measured; it may simply be due to accumulation of wear debris from the preceding time. Exercise-related cobalt rise may overcome this limitation and give a better assessment of the current wear status of a MoM bearing surface than a measure of cobalt levels only.

Is crow's feet sign a reliable indicator of corneal injury in facial burns?

Facial burns occur commonly, although they rarely result in serious ophthalmological injuries. Despite this, failure to identify and manage minor eye injuries can have serious consequences. When the blink reflex is forcibly suppressed, the cornea is left exposed, resulting in serious injury. One indicator of possible corneal injury is the absence of 'Crow's feet sign'. Crow's feet sign describes the sparing of the skin creases or crow's feet around the eye with forced eyelid closure. The implication is that the patient was conscious at the time of injury and therefore able to protect the eye from ocular injury. We present a consecutive series of 145 people with facial burns attending the burns unit at Selly Oak Hospital, Birmingham over a 2-year period. Demographics, cause, presence of inhalational injury and outcome were examined for all patients. Eleven patients were diagnosed with ocular injury, and none of these patients had crow's feet sign. To date, we have found 100% correlation between the presence of crow's feet sign and the absence of ocular injury. We would recommend that clinicians are alert to the absence of this sign as a marker of possible eye injury.

Hypnosis for schizophrenia

BACKGROUND

Many people with schizophrenia continue to experience symptoms despite conventional treatments being used. Alternative therapies such as hypnosis, in conjunction with conventional treatments, may be helpful.

OBJECTIVES

To investigate the use of hypnosis for people with schizophrenia or schizophrenia-like illnesses compared with standard care and other interventions.

SEARCH STRATEGY

We searched the Cochrane Schizophrenia Group's Register (October 2006), contacted the Cochrane Complementary Medicine Field for additional searching (January 2003), hand searched references of included or excluded studies and made personal contact with authors of relevant trials.

SELECTION CRITERIA

We included all randomised or double blind controlled trials that compared hypnosis with other treatments or standard care for people with schizophrenia.

DATA COLLECTION AND ANALYSIS

We reliably selected studies, quality assessed them and extracted data. We excluded data where more than 50% of participants in any group were lost to follow up. For binary outcomes we calculated a fixed effects risk ratio (RR) and its 95% confidence interval (CI).

MAIN RESULTS

We included three studies (total n=149). When hypnosis was compared with standard treatment no one left the studies between 1-8 weeks (n=70, 2 RCTs, Risk Difference 0.00 CI -0.09 to 0.09). Mental state scores were unaffected (n=60, 1 RCT, MD BPRS by one week -3.6 CI -12.05 to 4.8) as were measures of movement disorders and neurocognitive function. Compared with relaxation, hypnosis was also acceptable (n=106, 3 RCTs, RR leaving the study early 2.00 CI 0.2 to 2.15) and had no discernable effect on mental state (n=60, 1 RCT, MD BPRS by one week -3.4 CI -11.4 to 4.6), movement disorders or neurocognitive function. Hypnosis was as acceptable as music (Sibelius) by four weeks (n=36, RR leaving the study early 5.0, CI 0.3 to 97.4).

AUTHORS' CONCLUSIONS

The studies in this field are few, small, poorly reported and outdated. Hypnosis could be helpful for people with schizophrenia. If we are to find this out, better designed, conducted and reported randomised studies are required. This current update has not revealed any new studies in this area since 2003.

Interplay of reactive oxygen species and nitric oxide in the pathogenesis of experimental lead-induced hypertension

1. Lead is a common environmental and industrial toxin that can cause a variety of acute and chronic illnesses. For example, chronic exposure to low levels of lead has been shown to raise arterial pressure and promote renal and cardiovascular complications. 2. Several mechanisms have been identified by which chronic lead exposure can cause hypertension and cardiovascular disease. In recent years, increasing evidence has emerged pointing to the role of oxidative stress as a major mediator of lead-induced hypertension. 3. The present article provides an overview of the published studies on this subject.

Co-inoculation of nitrogen-fixing and phosphate-solubilizing bacteria to promote growth, yield and nutrient uptake in chickpea

A total of 32 bacterial isolates includingMesorhizobium(N=10),Azotobacter(N=12) and phosphate-solubilizing bacteria (N=10) were isolated and tested for siderophore, HCN, ammonia, indole acetic acid production and phosphate solubilizationin vitro. The bacterial cultures were positive for siderophore, HCN and ammonia. Among the isolates,M. ciceriRC3 andA. chrococcumA4 displayed 35 and 14 μg ml−1of IAA, respectively, whereasBacillusproduced 19 (BacillusPSB1) and 17 μg ml−1(BacillusPSB10) of IAA in Luria Bertani broth. The diameter of the P solubilization zone varied between 4 (BacillusPSB1) and 5 mm (BacillusPSB10) and a considerable amount of tricalcium phosphate (7 and 8 μg ml−1byBacillusPSB1 andBacillusPSB10, respectively) was released in liquid medium, with a concomitant drop in pH. The effects of N2-fixing and PS bacteria on the growth, chlorophyll content, seed yield, grain protein and N uptake of chickpea plants in field trials varied considerably between the treatments. Nodule number and biomass were significantly greater at 90 days after sowing (DAS), decreasing by 145 DAS. Seed yield increased by 250% due to inoculation withM. ciceriRC3 +A. chroococcumA4 +BacillusPSB10, relative to the control treatment. Grain protein content ranged from 180 (BacillusPSB1) to 309 ng g−1(M. ciceriRC3 +A. chroococcumA4 +BacillusPSB10) in inoculated chickpea. The N contents in roots and shoots differed considerably among the treatments.

A phase II trial of RAD001 in patients (Pts) with metastatic renal cell carcinoma (MRCC)

5107

Background: RAD001 is an oral mammalian target of Rapamycin (mTOR) inhibitor. Three mechanisms of anti-tumor activity; shuts down tumor response to nutrients and growth factors; cell cycle arrest at late G1 and anti-angiogenesis via VEGF. Molecular alterations in the mTOR modular pathway increase sensitivity in PTEN deficient tumors such as RCC. Endpoints: time-to-progression (TTP), response rate (RR), overall survival (OS), toxicity, and to assess changes in metabolic imaging utilizing CT-PET. Methods: Eligibility included; predominant clear cell, progressive measurable MRCC, adequate organ/marrow function, zubrod performance status (ZPS) = 2, no more than 1 prior therapy, and no active CNS involvement. RAD001 is given orally at a dose of 10mg daily without an interruption (28-day cycle), with dose modifications for toxicity. Re-evaluation was assessed every 2 cycles (8 weeks). RECIST criteria is utilized. TTP and OS are determined from entry into the study. Results: 41 pts have been enrolled. 37 pts are evaluable for response/toxicity. 2 pts toxicity only. 2 pts screened failures. 31 were male/8 female, median age 60 (38–80) years. 31 pts received prior therapy. 23 pts had a ZPS of 0, 13 /1 and 3/2. Sites of disease included; lung, nodal, liver, bone, adrenal, and kidney. 9 pts had 1 metastatic site, 17 pts/2 and 13 pts/3 or more. 15 pts continue to receive RAD001. 12 pts had partial responses, 19 pts were stable for 3+ months. Median duration of therapy is 8+ (range 01–20+) months. Treatment related adverse events; mucositis, skin rash, pneumonitis, hypophosphatemia, hyperglycemia, hypertriglyceridemia, hypercholesterolemia, thrombocytopenia, anemia and elevated LFTs. PET scans have demonstrated decreased metabolic activity in responding or stable pts. Median overall survival is 11.5+ months (range 01–20+). Conclusion: RAD001 has promising anti-tumor activity in pts with MRCC demonstrated by partial response rate. Anti-tumor activity is further suggested by prolonged TTP =3 months. Anti-tumor activity, toxicity and metabolic imaging correlation will be presented. An additional 40 pts who failed prior sunitinib or sorafenib therapy are being enrolled.

No significant financial relationships to disclose.

Multi-center phase II/III randomized controlled clinical trial using TNFerade combined with chemoradiation in patients with locally advanced pancreatic cancer (LAPC)

4518

Background: TNFerade is a replication-deficient adenoviral vector carrying the transgene for human TNF-a protein, regulated by the radiation-inducible promoter Egr-1. A 50 patient (pt) phase II dose-escalation study in LAPC showed a possible dose-dependent improvement in survival. To confirm these findings, the randomized Pancreatic Cancer Clinical Trial with TNFerade (PACT) study was developed. PACT is a 330 pt study, powered to detect a 20% absolute increase in the primary efficacy endpoint (overall survival at 1 year) compared to standard of care (SOC) chemoradiation. An interim analysis of safety and efficacy was planned after the first 51 pts were randomized. Survival data to 11/15/06 has been evaluated and are reported here. Methods: The TNFerade arm pts received a five- wk treatment of weekly injections of 4 x 1011 pu TNFerade, continuous infusion 5-FU (200 mg/m2/day x 5 days/wk) and 50.4 Gy radiation. TNFerade was administered by percutaneous CT-guided transabdominal injection. The SOC arm received the same regimen, without TNFerade injections. Patients were randomized 2:1 to the TNFerade and SOC arms. The first 51 randomized pts were assessed for evidence of objective response (OR) and overall survival Results: Assessment of response data is still ongoing. TNFerade + SOC was well tolerated. One year survival, the primary endpoint of the study, was 70.5% in the TNFerade + SOC arm versus 28.0% in the SOC arm, an absolute increase of 42.5%. The median survival for TNFerade + SOC pts was 515 days compared to 335 days for the SOC pts. The logrank statistic for comparison between the two arms is X2 = 2.014 (p=0.16). Conclusions: The interim survival data is preliminary. The magnitude of the difference in survival in favor of the TNFerade + SOC arm, however, is encouraging. The data appears to corroborate previous findings from the dose-escalation study, which showed an apparent survival advantage in the 4×1011 pu dose group compared to 4 x 109 pu group. A second interim analysis is planned with larger patient numbers to determine whether this early positive trend is confirmed.

No significant financial relationships to disclose.

A phase II trial of intra-patient dose-escalated sorafenib in patients (pts) with metastatic renal cell cancer (MRCC)

5026

Background: Sorafenib has demonstrated activity with limited toxicity at a dose of 400 mg bid in MRCC pts. This presents an opportunity to explore a more intensive drug administration. This study allowed individual pt titration designed to evaluate the ability for pts to dose escalate. Response rate (RR), time to progression (TTP) and overall survival (OS) will be assessed. Methods: Eligibility included; pathologic diagnosis of a component of clear cell, progressive measurable MRCC, no more than 1 prior therapy, karnofsky performance status (KPS) = 70%, adequate organ/marrow function and no active CNS involvement. Initial dose 400 mg bid, daily. Dose escalation defined in the table below: Re-evaluation is performed every 8 weeks. RECIST criteria is utilized. Results: 46 patients have been enrolled. 44 are evaluable. 37 male/7 female, median age 50 years (43–79). 19 pts received prior therapy. 39 pts had a KPS of 100%, 5/90%. Sites of disease included; lung, nodal, liver, bone, adrenal, pancreas and kidney. 26 pts 1 metastatic site, 12 /2, 6/3 or more. 22 pts continue to receive sorafenib therapy; 2/800 mg, 7/1,200 mg, and 13/1,600 mg. 8 pts complete response (CR), 14 pts/partial response (PR) and 14 pts stable for 3+ months. Median duration of therapy is 6+ (range 0.2+ - 12+) months. 2 pts have not been reevaluated. Treatment related adverse events to-date; hand/foot syndrome, skin rash, diarrhea, alopecia, fatigue, hypertension, hypophosphatemia, and elevated amylase/lipase. Conclusion: 91% of pts were escalated to 1,200 mg or 1,600 mg per day. Dose escalated sorafenib has promising anti-tumor activity in pts with MRCC as demonstrated by a 52% CR/PR rate. Anti-tumor activity is further suggested by prolonged TTP = 3 months for 33% of pts. Independent radiology review is in progress. Intra-patient dose escalation data in association with anti-tumor activity and toxicity will be presented.

[Table: see text]

[Table: see text]