Revision total knee arthroplasty for failed high tibial osteotomy and unicompartmental knee arthroplasty have similar patient-reported outcome measures in a two-year follow-up study.

AIMS: Little is known about the relative outcomes of revision of unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) to total knee arthroplasty (TKA). The aim of this study is to compare the outcomes of revision surgery for the two procedures in terms of complications, re-revision and patient-reported outcome measures (PROMs) at a minimum of two years follow-up. PATIENTS AND METHODS: This study was a retrospective review of data from an institutional arthroplasty registry for cases performed between 2001 and 2014. A total of 292 patients were identified, of which 217 had a revision of HTO to TKA, and 75 had revision of UKA to TKA. While mean follow-up was longer for the HTO group compared with the UKA group, patient demographics (age, body mass index and Charlson co-morbidity index) and PROMs (Short Form-36, Oxford Knee Score, Knee Society Score, both objective and functional) were similar in the two groups prior to revision surgery. Outcomes included the rate of complications and re-operation, PROMS and patient-reported satisfaction at six months and two years post-operatively. We also compared the duration of surgery and the need for revision implants in the two groups. RESULTS: At two-year follow-up, both groups of patients had made significant improvement in terms of PROMs compared with pre-operative scores. PROMs and satisfaction rates were similar in the two groups. Complications requiring re-operation were significantly more frequent in the HTO group whilst more revision implants were used in the UKA group, resulting in a longer operative duration. CONCLUSION: Revision of HTO and UKA achieve similar post-operative PROMs and satisfaction. Revision of UKA more frequently requires revision components with increased operation duration but fewer complications requiring re-operation compared with revision of HTO. Cite this article: Bone Joint J 2017;99-B:1329-34.

Characterization of MUDENG, a novel anti-apoptotic protein.

MUDENG (Mu-2-related death-inducing gene, MuD) is revealed to be involved in cell death signaling. Astrocytes, the major glial cell type in the central nervous system, are a source of brain tumors. In this study, we examined MuD expression and function in human astroglioma cells. Stimulation of U251-MG cells with tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) resulted in a 40% decrease in cell viability and a 33% decrease in MuD protein levels, although not in MuD mRNA levels. To study the functional relevance of MuD expression, stable transfectants expressing high levels of MuD were generated. Stimulation of these transfectants with TRAIL resulted in enhanced cell survival (77% for stable and 46% for control transfectants). Depletion of MuD led to a marked reduction upon TRAIL stimulation in cell viability (22% in MuD-depleted cells and 54% in control cells). In addition, we observed that MuD depletion increased the susceptibility of the cells to TRAIL by enhancing the cleavage of caspase-3/-9 and BH3-interacting domain death agonist (Bid). A unique 25-kDa fragment of B-cell lymphoma 2 (Bcl-2) lacking BH4 was observed 60-180 min post TRAIL treatment in MuD-depleted cells, suggesting that Bcl-2 is converted from its anti-apoptotic form to the truncated pro-apoptotic form. Importantly, the TRAIL-mediated decrease in cell viability in MuD-depleted cells was abrogated upon Bid depletion, indicating that the role of MuD in apoptotic signaling takes place at the Bid and Bcl-2 junction. MuD localizes predominantly in the endoplasmic reticulum and partly in the mitochondria and its amounts are reduced 6 h post TRAIL stimulation, presumably via caspase-3-mediated MuD cleavage. Collectively, these results suggest that MuD, a novel signaling protein, not only possesses an anti-apoptotic function but may also constitute an important target for the design of ideal candidates for combinatorial treatment strategies for glioma cells.

Musculoskeletal sequelae of Varicella-zoster infection: two case reports.

Varicella-zoster is a common paediatric viral infection that usually runs a benign self-limiting course but has a risk of complications. The most common sequelae are bacterial skin infections, which are usually mild. However, bacteraemia/septic shock, toxic shock syndrome, pneumonia, ataxia, encephalitis and purpura fulminans are also possible. Although rare, musculoskeletal sequelae (osteomyelitis, septic arthritis, pyomyositis and necrotizing fasciitis) can occur in otherwise healthy children. These latter complications are potentially life- and limb-threatening and must be considered in a child post-varicella with pain in a limb or joint. We describe two patients who had musculoskeletal complications after varicella: (1) a 16-month-old boy who developed pyomyositis of the thigh and septic arthritis of the hip and (2) a two-year-seven-month-old girl who developed septic arthritis of the hip and knee and a 'bare area' subperiosteal abscess of the femur. Their clinical presentations, detailed management plans and outcomes are reported. These cases highlight the importance of prompt diagnosis, appropriate investigation (including the important role of magnetic resonance imaging) and surgery when an otherwise healthy post-varicella child deteriorates.

Assessment of the relative number of copies of the gene encoding human neutrophil antigen-2a(HNA-2a), CD177, and a homologous pseudogene by quantitative real-time PCR.

Human neutrophil antigen-2a (HNA-2a; NB1) is located on the 58-64 kD NB1 glycoprotein (GP) and is encoded by the gene CD177. Searches of human genome databases have revealed that a pseudogene highly homologous to exons 4-9 of CD177 is located adjacent to CD177 on chromosome 19. The purpose of this study was to document the presence of the pseudogene and determine whether the polymorphic expression of NB1 GP is due to CD177 gene deletions and duplications. Genomic DNA was isolated from leukocytes of 12 subjects. The number of copies of exon 2 of CD177, an exon that is unique to this gene, and the number of copies of exon 9, an exon that is found in both CD177 and the pseudogene, was assessed with quantitative real-time PCR. The ratio of the number of copies of sequences homologous to CD177 exon 9 to the number of copies of exon 2 was 1.5 or greater in 7 of the 12 subjects, suggesting that both CD177 and the homologous pseudogene were present. The ratio of exon 9 to exon 2 in the other 5 subjects ranged from 1 to 1.25, suggesting that the pseudogene was not present in these subjects. However, results of assays were variable and we could not exclude the possibility that all subjects carried the pseudogene. These studies confirmed the presence of the pseudogene homologous to CD177, but quantitative real-time PCR was not precise enough to detect CD177 duplications or deletions.

Emerging antimicrobial resistance, plasmid profile and pulsed-field gel electrophoresis pattern of the endonuclease-digested genomic DNA of Neisseria gonorrhoeae.

Resistant gonococci are very prevalent in many countries, particularly in Asia. This study was conducted to determine the trend of resistance, the effect of decreasing the ciprofloxacin susceptibilities of gonococci on the prevalence of penicillinase-producing N. gonorrhoeae (PPNG), and to compare the epidemiology of strains with the previous studies. A total of 602 strains of gonococci were isolated from prostitutes in 1997-1999. Antimicrobial susceptibility was tested by NCCLS disk diffusion and agar dilution methods. For epidemiologic analysis, plasmid analysis and pulsed-field gel electrophoresis (PFGE) were performed. The proportion of PPNG remained high (79%), and the strains with decreased susceptibility to ciprofloxacin increased significantly from 67% in 1997 to 84% in 1999. Compared to our previous study, the PFGE patterns were similar, while the proportion of strain with the 3.2-MDa plasmid markedly decreased. In conclusion, a rapid increase in ciprofloxacin-nonsusceptible strains may suggest difficulties in the treatment of gonococcal infections in the near future with the drug. The recent decrease of PPNG with the 3.2-MDa plasmid may suggest that there is an epidemiological change in gonococcal infections, and the prevalence of related PFGE patterns suggests the dissemination of a few clones among the high risk populations.

Nonhypercholesterolemic effects of a palm-oil diet in Malaysian volunteers.

The effects on serum lipids of diets prepared with palm olein, corn oil, and coconut oil supplying approximately 75% of the fat calories were compared in three matched groups of healthy volunteers (61 males, 22 females, aged 20-34 y). Group I received a coconut-palm-coconut dietary sequence; group II, coconut-corn-coconut; and group III, coconut oil during all three 5-wk dietary periods. Compared with entry-level values, coconut oil raised the serum total cholesterol concentration greater than 10% in all three groups. Subsequent feeding of palm olein or corn oil significantly reduced the total cholesterol (-19%, -36%), the LDL cholesterol (-20%, -42%%) and the HDL cholesterol (-20%, -26%) concentrations, respectively. Whereas the entry level of the ratio of LDL to HDL was not appreciably altered by coconut oil, this ratio was decreased 8% by palm olein and 25% by corn oil. Serum triglycerides were unaffected during the palm-olein period but were significantly reduced during the corn-oil period.