Fixed-bearing versus mobile-bearing total knee arthroplasty: a prospective randomised, clinical and radiological study with mid-term results at 7 years

Mobile-bearing (MB) total knee arthroplasty (TKA) was developed as an alternative to the established fixed-bearing (FB) design because of theoretical advantages. Short-term studies comparing these designs have not shown any differences in clinical and radiographic results. We compared the results at 7 years of a randomised study of patients undergoing TKA using either a FB or a MB variant of the same prosthesis. Fifty-two patients (52 knees) with an average age of 70 years received a FB posterior-stabilized prosthesis, and 50 patients (52 knees) with an average age of 72 years, a MB prosthesis. All implants were cemented and the patella was routinely resurfaced. Preoperatively, there were no differences between the two groups, and surgical procedure and postoperative protocol were the same for both. At an average follow-up of 7.1 years, no significant differences of FB over MB design could be demonstrated with respect to the American Knee Society score (AKSS), pain score, a questionnaire of general health (SF-12 score), range of motion (ROM), or complication rates. Radiographs showed no significant difference in prosthetic alignment or evidence of loosening. Two knees with a MB design required reoperation, one for persistent joint stiffness and another to treat septic loosening. One patient with a MB prosthesis with signs of tibial component loosening was asymptomatic. We conclude that at mid-term follow-up there is no evidence to prove the superiority of MB over FB TKA with regard to the clinical and radiographic results.

Hyaluronidases in cancer biology

Hyaluronan is a megadalton glycosaminoglycan polymer critical for maintaining the integrity of the extracellular matrix. It can exist in a protein-bound state with aggregating proteoglycans, where it expands the extracellular matrix and modulates cell-cell interactions. It also exists in lower molecular weight forms that participate in a myriad of biological functions. It is unique in that much of it is degraded within hours of its synthesis. High molecular weight hyaluronan, a reflection of intact healthy tissues, is normally produced by hyaluronan synthases at the plasma membrane. It is catabolized by the action of an extracellular plasma membrane-tethered hyaluronidase that is coordinated with intracellular lysosomal hyaluronidases and exoglycosidases. This occurs in local tissues and lymph, with the remainder being cleared by the sinusoidal liver endothelium upon entering the vascular compartment. Elevated extracellular levels of hyaluronan and its partially catabolized oligomers are found in certain malignancies, potentially due to decoupled synthesis and degradation. Furthermore, partially depolymerized hyaluronan in the extracellular environment may have properties not found in the multivalent high molecular weight polymer in malignancies. Functional perturbations of hyaluronan synthesis and degradation have revealed active roles of the synthases and hyaluronidases in epithelial mesenchymal conversion, stroma and vascular formation, interstitial fluid pressure and chemosensitivity. While at least three confirmed hyaluronidases exist in the human genome (HYAL1, HYALl2 and PH20), functional perturbation of these genes in mice have failed to identify a simple linear catabolic circuit. The family of enzymes responsible for the synthesis and degradation of hyaluronan are being characterized. The fragmented forms of hyaluronan, largely a sign of cellular distress, occur in abundance in many malignancies. These small hyaluronan oligomers are assumed to be largely a result of hyaluronidase activity. Precisely how particular-sized fragments are generated and maintained is not known. Presumably, hyaluronan-binding proteins, in addition to the proteoglycans, participate in this process. Hyaluronidase inhibitors are now recognized, as well as growth factors that enhance the synthetic enzymes. A complete understanding of the anabolic and catabolic systems for hyaluronan may provide new dimensions into our understanding of cancer progression, as well as new opportunities for therapeutic intervention.

Association between cancer and "acid mucopolysaccharides": an old concept comes of age, finally

"Acid mucopolysaccharides" is an old name for the glycosaminoglycans. These carbohydrate polymers of the extracellular matrix provide tissue organization, cell-cell communication and a platform for signaling. They also support tumor cell proliferation, progression and invasion. Among the most prevalent is hyaluronan. Its support of cancer is an old concept, but only now is it recognized as an integral component of the cancerous state. Hyaluronan occurs not only in malignant cells, but also in peritumor stroma. Finally, it is now realized that the association between tumor and stroma must be investigated to fully understand the process of cancer growth and metastasis. Most recently, hyaluronan has been identified as essential to malignant stem cells, and a component of the cancer stem cell niche. While hyaluronan does not give up its secrets easily, recent progress justifies a review of its role in malignancy.

A mouse model of human mucopolysaccharidosis IX exhibits osteoarthritis

Hyaluronidases are endoglycosidases that hydrolyze hyaluronan (HA), an abundant component of the extracellular matrix of vertebrate connective tissues. Six human hyaluronidase-related genes have been identified to date. Mutations in one of these genes cause a deficiency of hyaluronidase 1 (HYAL1) resulting in a lysosomal storage disorder, mucopolysaccharidosis (MPS) IX. We have characterized a mouse model of MPS IX and compared its phenotype with the human disease. The targeted Hyal1 allele in this model had a neomycin resistance cassette in exon 2 that replaced 753 bp of the coding region containing the predicted enzyme active site. As a result, Hyal1(-/-) animals had no detectable wild-type Hyal1 transcript, protein or serum activity. Hyal1 null animals were viable, fertile and showed no gross abnormalities at 1 year and 8 months of age. Histological studies of the knee joint showed a loss of proteoglycans occurring as early as 3 months that progressed with age. An increased number of chondrocytes displaying intense pericellular and/or cytoplasmic HA staining were detected in the epiphyseal and articular cartilage of null mice, demonstrating an accumulation of HA. Elevations of HA were not detected in the serum or non-skeletal tissues, indicating that osteoarthritis is the key disease feature in a Hyal1 deficiency. Hyal3 expression was elevated in Hyal1 null mice, suggesting that Hyal3 may compensate in HA degradation in non-skeletal tissues. Overall, the murine MPS IX model displays the key features of the human disease.

A pilot effectiveness study: placebo-controlled trial of adjunctive L-triiodothyronine (T3) used to accelerate and potentiate the antidepressant response

The aim was to evaluate whether adjunctive T3 can help accelerate the antidepressant response and improve overall outcomes when used under naturalistic conditions. Fifty consecutive psychiatric outpatients diagnosed with major depressive disorder who were initiated on antidepressant therapy were randomized to receive adjunctive T3 or placebo in a double-blind manner over the course of 6 wk. There were no restrictions placed on the selection of antidepressant agent, dosing, ancillary medications, or psychotherapy, and there were few exclusion criteria. A positive response was defined as a > or = 50% reduction in Montgomery-Asberg Depression Rating Scale scores. Response rates were higher for the adjunctive T3 cohort compared to the adjunctive placebo cohort after 1 wk (45% vs. 24%) and 2 wk (57% vs. 33%) of treatment. The likelihood of experiencing a positive response at any point over the 6-wk trial was 4.5 times greater in the adjunctive T3 cohort (95% CI 1.3-15.7). The study provides preliminary evidence that T3 can successfully be used in clinical practice to accelerate the antidepressant response and improve overall outcomes. The effectiveness model may be an untapped mechanism for evaluating the value of psychopharmacological agents.

Cryogenic NMR spectroscopy of endohedral hydrogen-fullerene complexes

We have observed 1H NMR spectra of hydrogen molecules trapped inside modified fullerene cages under cryogenic conditions. Experiments on static samples were performed at sample temperatures down to 4.3 K, while magic-angle-spinning (MAS) experiments were performed at temperatures down to 20 K at spinning frequencies of 15 kHz. Both types of NMR spectra show a large increase in the intramolecular 1H-1H dipolar coupling at temperatures below 50 K, revealing thermal selection of a small number of spatial rotational states. The static and MAS spectra were compared to estimate the degree of sample heating in high-speed cryogenic MAS-NMR experiments. The cryogenic MAS-NMR data show that the site resolution of magic-angle-spinning NMR may be combined with the high signal strength of cryogenic operation and that cryogenic phenomena may be studied with chemical site selectivity.

The many ways to cleave hyaluronan

Hyaluronan is being used increasingly as a component of artificial matrices and in bioengineering for tissue scaffolding. The length of hyaluronan polymer chains is now recognized as informational, involving a wide variety of size-specific functions. Inadvertent scission of hyaluronan can occur during the process of preparation. On the other hand, certain size-specific hyaluronan fragments may be desirable, endowing the finished bioengineered product with specific properties. In this review, the vast arrays of reactions that cause scission of hyaluronan polymers is presented, including those on an enzymatic, free radical, and chemical basis.

Hyaluronan levels during laparoscopic versus open colonic resections

BACKGROUND

Plasma hyaluronan binds to fibrinogen, affecting intravascular fibrin polymerization and fibrin clot formation. It has been hypothesized that alterations in fibrin clot formation influence the risk of thromboembolism in those undergoing surgery. The aim of this study is to quantify the intravascular components, especially plasma hyaluronan levels, in laparoscopic and conventional colorectal resections that contribute to thromboembolism formation.

METHODS

Prospective cohort analysis of consecutive patients which were participating in the prospective randomized multi-center trial Lapkon II comparing the long-term effects of laparoscopic and conventional resection for colon cancer. Plasma samples were obtained from 15 patients at the beginning and the end of laparoscopic or conventional colorectal resections. Concentrations and activities of tissue plasminogen activator(t-PA), plasminogen activator inhibitor type 1(PAI-1), t-PA/PAI complex, fibrinogen, d-dimers and hyaluronan were determined by using commercial enzyme-linked immunosorbent assay (ELISA) kits.

RESULTS

No differences in age, sex and type of resection between the laparoscopic and conventional-surgery groups were observed. Laparoscopic procedures lasted longer (p < 0.05). Concentration and activities of t-PA, PAI-1, t-PA/PAI complex, fibrinogen and d-dimers did not vary between the two groups. Plasma hyaluronan decreased from 28.6 to 17.9 IU/ml (p < 0.05) during laparoscopic compared to conventional procedures. Plasma hyaluronan levels were significantly different at the end of operation between the two groups (p < 0.05) .

CONCLUSIONS

Plasma hyaluronan levels were decreased in patients undergoing laparoscopic colorectal resections, compared to those undergoing conventional procedures. Therefore, interactions between plasma hyaluronan and fibrinogen may be lower, with a sequential decrease in fibrin polymerization, and a possibly reduced risk of deep venous thrombosis.

Bilateral intralobar pulmonary sequestration in a newborn, case report and review of the literature on bilateral pulmonary sequestrations

We describe a rare case of bilateral intralobar pulmonary sequestration in a newborn with both sequestrations vascularized from a vessel arising from the celiac trunk of the abdominal aorta. The larger sequestration on the right side was diagnosed antenatally, the left side postnatally. At the age of 7 months, the child underwent successful bilateral thoracotomy. In follow-up at the age of more than 1 year, no complications have occurred.

Complicated hyaluronan patterns in skin: enlightenment by UVB?

Hyaluronan has a complex metabolism with rapid turnover in skin, with wide differences occurring in dermal and epidermal compartments. Analyses of acute UVB irradiation of skin, as documented in cultured human fibroblast and immortalized keratinocyte cell culture media, confirm that no simple patterns are present. A systematic approach has been initiated in the studies by Averbeck et al.

Solid-state NMR of endohedral hydrogen–fullerene complexes

We present an overview of solid-state NMR studies of endohedral H(2)-fullerene complexes, including (1)H and (13)C NMR spectra, (1)H and (13)C spin relaxation studies, and the results of (1)H dipole-dipole recoupling experiments. The available data involves three different endohedral H(2)-fullerene complexes, studied over a wide range of temperatures and applied magnetic fields. The symmetry of the cage influences strongly the motionally-averaged nuclear spin interactions of the endohedral H(2) species, as well as its spin relaxation behaviour. In addition, the non-bonding interactions between fullerene cages are influenced by the presence of endohedral hydrogen molecules. The review also presents several pieces of experimental data which are not yet understood, one example being the structured (1)H NMR lineshapes of endohedral H(2) molecules trapped in highly symmetric cages at cryogenic temperatures. This review demonstrates the richness of NMR phenomena displayed by H(2)-fullerene complexes, especially in the cryogenic regime.

A case of Churg-Strauss syndrome associated with antiphospholipid antibodies

Churg-Strauss syndrome (CSS) is a systemic vasculitis affecting both small- and medium-sized blood vessels, almost invariably affecting the lung, and frequently associated with cutaneous involvement. Microvascular vaso-occlusion leading to digital gangrene is not a feature of CSS. We report an unusual case of a patient with CSS with antiphospholipid antibodies who developed severe digital gangrene in addition to cutaneous vasculitis. The presence of antiphospholipid antibodies is not a feature usually seen in association with CSS. While the full clinical spectrum of CSS is still being defined, the identification of additional features associated with this syndrome might help to better understand the pathogenesis of the disease and to have an impact on both management and prognosis.

Treatment of bone and joint infections caused by Gram-negative bacilli with a cefepime-fluoroquinolone combination

A 3-year retrospective study evaluated the effectiveness and safety of cefepime plus a fluoroquinolone for treating bone and joint infections caused by Gram-negative bacilli (GNB) in 28 patients. Intra-operative cultures yielded primarily Pseudomonas spp. and Enterobacter cloacae. Full recovery (cure) was observed in 79% of patients. There were no serious adverse effects and no resistant organisms were isolated. The results of the study confirmed the safety and effectiveness of cefepime combined with a fluoroquinolone for the treatment of bone and joint infections caused by Gram-negative bacilli.

Hyaluronic acid: a natural biopolymer with a broad range of biomedical and industrial applications

Hyaluronic acid (hyaluronan, HA) is a linear polysaccharide formed from disaccharide units containing N-acetyl-D-glucosamine and glucuronic acid. It has a high molecular mass, usually in the order of millions of Daltons, and interesting viscoelastic properties influenced by its polymeric and polyelectrolyte characteristics. HA is present in almost all biological fluids and tissues. In clinical medicine, it is used as a diagnostic marker for many diseases including cancer, rheumatoid arthritis and liver pathologies, as well as for supplementation of impaired synovial fluid in arthritic patients by means of intra-articular injections. It is also used in certain ophthalmological and otological surgeries and cosmetic regeneration and reconstruction of soft tissue. Herein we present an overview of the occurrence and physiological properties of HA, as well as of the recent advances in production biotechnology and preparation of the HA-based materials for medical application.