A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures.

AIMS: The aim of this study was to investigate the outcomes of Vancouver type B2 and B3 fractures by performing a systematic review of the methods of surgical treatment which have been reported. MATERIALS AND METHODS: A systematic search was performed in Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials. For inclusion, studies required a minimum of ten patients with a Vancouver type B2 and/or ten patients with a Vancouver type B3 fracture, a minimum mean follow-up of two years and outcomes which were matched to the type of fracture. Studies were also required to report the rate of re-operation as an outcome measure. The protocol was registered in the PROSPERO database. RESULTS: A total of 22 studies were included based on the eligibility criteria, including 343 B2 fractures and 167 B3 fractures. The mean follow-up ranged from 32 months to 74 months. Of 343 Vancouver B2 fractures, the treatment in 298 (86.8%) involved revision arthroplasty and 45 (12.6%) were treated with internal fixation alone. A total of 37 patients (12.4%) treated with revision arthroplasty and six (13.3%) treated by internal fixation only underwent further re-operation. Of 167 Vancouver B3 fractures, the treatment in 160 (95.8%) involved revision arthroplasty and eight (4.8%) were treated with internal fixation without revision. A total of 23 patients (14.4%) treated with revision arthroplasty and two (28.6%) treated only with internal fixation required re-operation. CONCLUSION: A significant proportion, particularly of B2 fractures, were treated without revision of the stem. These were associated with a higher rate of re-operation. The treatment of B3 fractures without revision of the stem resulted in a high rate of re-operation. This demonstrates the importance of careful evaluation and accurate characterisation of the fracture at the time of presentation to ensure the correct management. There is a need for improvement in the reporting of data in case series recording the outcome of the surgical treatment of periprosthetic fractures. We have suggested a minimum dataset to improve the quality of data in studies dealing with these fractures. Cite this article: Bone Joint J 2017;99-B(4 Supple B):17-25.

Recent Advances in Tissue Engineering.

Tissue formation within the body, as part of a development or repair process, is a complex event in which cell populations self-assemble into functional units. There is intense academic, medical, and commercial interest in finding methods of replicating these events outside the body. This interest has accelerated with the demonstration of the engineering of skin and cartilage tissue in the laboratory and there is now worldwide activity in the in vitro regeneration of tissues including nerve, liver, bone, heart valves, blood vessels, bladder, and kidney. Approaches to tissue engineering center on the need to provide signals to cell populations to promote cell proliferation and differentiation. This review considers recent advances in methods of providing these signals to cells using examples of progress in the engineering of complex tissues.

Manipulation and reduction of paediatric fractures of the distal radius and forearm using intranasal diamorphine and 50% oxygen and nitrous oxide in the emergency department: a 2.5-year study.

UNLABELLED: A retrospective study was performed in 100 children aged between two and 16 years, with a dorsally angulated stable fracture of the distal radius or forearm, who were treated with manipulation in the emergency department (ED) using intranasal diamorphine and 50% oxygen and nitrous oxide. Pre- and post-manipulation radiographs, the final radiographs and the clinical notes were reviewed. A successful reduction was achieved in 90 fractures (90%) and only three children (3%) required remanipulation and Kirschner wire fixation or internal fixation. The use of Entonox and intranasal diamorphine is safe and effective for the closed reduction of a stable paediatric fracture of the distal radius and forearm in the ED. By facilitating discharge on the same day, there is a substantial cost benefit to families and the NHS and we recommend this method. TAKE HOME MESSAGE: Simple easily reducible fractures of the distal radius and forearm in children can be successfully and safely treated in the ED using this approach, thus avoiding theatre admission and costly hospital stay.

Do smokers have greater risk of delayed and non-union after fracture, osteotomy and arthrodesis? A systematic review with meta-analysis.

OBJECTIVES: Systematic review and meta-analysis of published observational cohort studies. To quantify the increased risk smokers have of experiencing a delayed and/or non-union in fractures, spinal fusion, osteotomy, arthrodesis or established non-unions. SETTING: Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Allied and Complementary Medicine Database (AMED) and Web of Science Core Collection from 1966 to 2015. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: Observational cohort studies that reported adult smokers and non-smokers with delayed and/or non-union or time to union of the fracture, spinal fusion, osteotomy, arthrodesis or established non-union were eligible. DATA EXTRACTION AND OUTCOME MEASURES: 2 authors screen titles, abstracts and full papers. Data were extracted by 1 author and checked independently by a second. The relative risk ratios of smoking versus non-smoking and the mean difference in time to union patients developing a delayed and/or non-union were calculated. RESULTS: The search identified 3013 articles; of which, 40 studies were included. The meta-analysis of 7516 procedures revealed that smoking is linked to an increased risk of delayed and/or non-union. When considered collectively, smokers have 2.2 (1.9 to 2.6) times the risk of experiencing delayed and/or non-union. In all the subgroups, the increased risk was always ≥1.6 times that of non-smokers. In the patients where union did occur, it was a longer process in the smokers. The data from 923 procedures were included and revealed an increase in time to union of 27.7 days (14.2 to 41.3). CONCLUSIONS: Smokers have twice the risk of experiencing a non-union after fracture, spinal fusion, osteotomy, arthrodesis or treatment of non-union. Time to union following fracture, osteotomy, arthrodesis or treatment of an established non-union is longer in smokers. Smokers should be encouraged to abstain from smoking to improve the outcome of these orthopaedic treatments.

Ecological divergence and speciation between lemur (Eulemur) sister species in Madagascar.

Understanding ecological niche evolution over evolutionary timescales is crucial to elucidating the biogeographic history of organisms. Here, we used, for the first time, climate-based ecological niche models (ENMs) to test hypotheses about ecological divergence and speciation processes between sister species pairs of lemurs (genus Eulemur) in Madagascar. We produced ENMs for eight species, all of which had significant validation support. Among the four sister species pairs, we found nonequivalent niches between sisters, varying degrees of niche overlap in ecological and geographic space, and support for multiple divergence processes. Specifically, three sister-pair comparisons supported the null model that niches are no more divergent than the available background region. These findings are consistent with an allopatric speciation model, and for two sister pairs (E. collaris-E. cinereiceps and E. rufus-E. rufifrons), a riverine barrier has been previously proposed for driving allopatric speciation. However, for the fourth sister pair E. flavifrons-E. macaco, we found support for significant niche divergence, and consistent with their parapatric distribution on an ecotone and the lack of obvious geographic barriers, these findings most strongly support a parapatric model of speciation. These analyses thus suggest that various speciation processes have led to diversification among closely related Eulemur species.

Bone graft substitutes currently available in orthopaedic practice: the evidence for their use.

We reviewed 59 bone graft substitutes marketed by 17 companies currently available for implantation in the United Kingdom, with the aim of assessing the peer-reviewed literature to facilitate informed decision-making regarding their use in clinical practice. After critical analysis of the literature, only 22 products (37%) had any clinical data. Norian SRS (Synthes), Vitoss (Orthovita), Cortoss (Orthovita) and Alpha-BSM (Etex) had Level I evidence. We question the need for so many different products, especially with limited published clinical evidence for their efficacy, and conclude that there is a considerable need for further prospective randomised trials to facilitate informed decision-making with regard to the use of current and future bone graft substitutes in clinical practice.

Marine-freshwater transitions are associated with the evolution of dietary diversification in terapontid grunters (Teleostei: Terapontidae).

The ecological opportunities associated with transitions across the marine-freshwater interface are regarded as an important catalyst of diversification in a range of aquatic taxa. Here, we examined the role of these major habitat transitions and trophic diversification in a radiation of Australasian fishes using a new molecular phylogeny incorporating 37 Terapontidae species. A combined mitochondrial and nuclear gene analysis yielded a well-supported tree with most nodes resolved. Ancestral terapontids appear to have been euryhaline in habitat affiliation, with a single transition to freshwater environments producing all Australasian freshwater species. Mapping of terapontid feeding modes onto the molecular phylogeny-predicted carnivorous dietary habits was displayed by ancestral terapontids, which subsequently diversified into a range of additional carnivorous, omnivorous, herbivorous and detritivorous dietary modes upon transition to freshwater habitats. Comparative analyses suggested that following the freshwater invasion, the single freshwater clade has exhibited an increased rate of diversification at almost three times the background rate evident across the rest of the family. The marine-freshwater transition within Terapontidae appears to have resulted in substantial dietary radiation in freshwater environments, as well as increased lineage diversification rates relative to euryhaline-marine habitats.

Trophic ecology of northern Australia's terapontids: ontogenetic dietary shifts and feeding classification.

The diets of 21 terapontid species from freshwater environments in northern Australia were investigated to determine the similarity and dissimilarity among species and the extent of any ontogenetic shifts. Distinct ontogenetic dietary shifts occurred in all species for which sufficient data were available, with many species passing through several discrete trophic categories during their life histories. Diets of all juvenile terapontids were similar, mainly comprising aquatic insects and zooplankton. Larger size classes of terapontids diverged into a broad spectrum of feeding groups comprising carnivorous dietary modes (including piscivory and lepidophagy), omnivory (including frugivory and consumption of allochthonous prey), herbivory and detritivory. The results indicate that the terapontids represent Australia's most trophically diverse freshwater fish family.

Histopathology grading systems for characterisation of human knee osteoarthritis--reproducibility, variability, reliability, correlation, and validity.

OBJECTIVE: To determine the reliability, reproducibility, variability and validity of the Osteoarthritis Cartilage Histopathology (OACH) assessment system and Mankin Histological-Histochemical Grading System (HHGS) when applied to the characterisation of the osteoarthritic human knee. METHOD: Osteoarthritic knees of 10 patients undergoing unilateral knee arthroplasty were assessed, and assigned Kellgren-Lawrence and Line Drawing Atlas (LDA) radiology scores. The tibial plateaux were scored using the Modified Collins (MC) and Société Française d'Arthroscopie (SFA). Three observers twice scored both the OACH and HHGS across a single complete medial and lateral tibial plateau transect taken to include the region with the most severe osteoarthritis (OA) lesion. Intra- and inter-observer reliability, reproducibility, variability and validity were assessed, and the correlation between the two histopathology scoring systems was calculated. RESULT: Both histopathology scoring systems were determined to be reliable and reproducible exhibiting similar variability, when applied to characterise OA specimens sampled from a well defined patient group with knee OA. A strong correlation between the mean OACH and mean HHGS scores was identified (Spearman's ρ 0.980, P<0.0001). CONCLUSION: Both scoring systems implemented provide useful measures in the characterisation of knee osteoarthritis. It is of note that an additional parameter within the OACH score over the HHGS defines the extent of the disease, where the HHGS is a grade attributed to the most representative level of the biological aggression within the OA lesions. This study has confirmed the OACH system's utility in human knee OA and is supported by a significant correlation with the established HHGS.

Recent advances in tissue engineering: an invited review.

Tissue formation within the body, as part of a development or repair process, is a complex event in which cell populations self-assemble into functional units. There is intense academic, medical, and commercial interest in finding methods of replicating these events outside the body. This interest has accelerated with the demonstration of the engineering of skin and cartilage tissue in the laboratory and there is now worldwide activity in the in vitro regeneration of tissues including nerve, liver, bone, heart valves, blood vessels, bladder, and kidney. Approaches to tissue engineering center on the need to provide signals to cell populations to promote cell proliferation and differentiation. This review considers recent advances in methods of providing these signals to cells using examples of progress in the engineering of complex tissues.

Interactions of 3T3 fibroblasts and endothelial cells with defined pore features.

The colonization of biodegradable polymer scaffolds with cell populations has been established as the foundation for the engineering of a number of tissues, including cartilage, liver, and bone. Within these scaffolds, the cells encounter a porous environment in which they must migrate across the convoluted polymer surface to generate a homogenous cell distribution. Predicting the interactions between cells and pores is important if scaffold characteristics are to be optimized. Therefore, we investigated the behavior of two model cell types over a range of defined pore features. These pore features range from 5 to 90 microm in diameter and have been fabricated by photolithographic techniques. Quantitatively, the behavior of the cells is dependent on three factors: 1) percentage cell coverage of the surface; 2) pore size; and 3) cell type. Fibroblast cells displayed a co-operative pattern of cell spreading in which pores with diameters greater than the cell dimensions were bridged by groups of cells using their neighbors as supports. Endothelial cells were unable to use neighbors as support structures and failed to bridge pores greater than the cell diameter.

A comparison of the adhesion of mammalian cells and Staphylococcus epidermidis on fibronectin-modified polymer surfaces.

The modification of polymer surfaces to mimic the extracellular matrix, and therefore, stimulate cell growth via receptor-mediated interactions, is one approach used to promote the integration of tissue-engineering scaffolds and biomaterials into the body. However, by optimizing surfaces for tissue integration it is likely that bacterial adhesion may also be affected, resulting in a greater risk of biomaterial-related infection. This could be detrimental to both the implant and the patient because biomaterial related infections are particularly resistant to host defenses and antibiotics. In this study, we analyzed the adhesion of a Staphylococcus epidermidis clinical isolate and 3T3 rat fibroblasts to tissue culture plastic coated with varying concentrations of fibronectin (Fn). Bacterial adhesion was always lower than tissue culture plastic and appeared to decrease with increasing Fn concentrations. Mammalian cell adhesion to Fn exceeded adhesion to tissue culture plastic but did not differ significantly over the range of protein concentrations or between 1 and 4 h of incubation. In most cases, the total surface coverage did not vary with time or Fn concentration, indicating that maximal cell adhesion and spreading occurred rapidly and at low protein concentrations. This study suggests that, by controlling the density of proteins or ligands on a surface, we can potentially optimize mammalian cell adhesion without stimulating bacterial adhesion, hence reducing the likelihood of infection.

Historical rainforest contractions, localized extinctions and patterns of vertebrate endemism in the rainforests of Australia's wet tropics.

The spatial patterns in the distributions of vertebrates in the rainforests of the wet tropics biogeographic region of north-eastern Australia were examined to form hypotheses on the processes that have shaped vertebrate assemblages and patterns of species richness and regional endemism. These rainforests occur in a relatively narrow and discontinuous strip along the coast of north-eastern Australia. We found that the number of regionally endemic species and the proportion of regional endemics present in each subregion are both strongly related to the geographic shape of subregional patches of rainforest, independent of rainforest area, within Australian tropical rainforests. Shape has a more significant influence on regional endemism than area, and area has a stronger influence on species richness. These patterns were congruent for all terrestrial vertebrate classes manuals, birds, reptiles and frogst, and for the four groups combined. Our results suggest that the combination of current rainforest area and shape are an index of the relative susceptibility of each area of rainforest to historical contractions, with the implication that historical habitat fluctuations, coupled with subsequent localized extinctions species sifting; have been extremely important processes in determining current patterns of endemism in Australia's wet tropical rainforests. This hypothesis is supported by the highly nested structure of the subregional distribution patterns.

Subjective evaluation of a prototype earmuff exhibiting flat and nonlinear attenuation characteristics.

Subjective user responses were obtained for a test earmuff exhibiting approximately flat (uniform) attenuation of about 25 dB from 500 to 8000 Hz for sound pressure levels (SPLs) less than 120 dB. At SPLs above 120 dB, the test earmuff exhibited nonlinear (level-dependent) attenuation characteristics such that noise reduction increased with increasing sound level. The study population consisted of police officers from the Raleigh, North Carolina, Police Department as they were performing arms requalification by executing a series of firing programs during two sequential and identical relays. The study subjects wore either the test earmuff or a comparable conventional earmuff during the first relay, then the alternate protector for the second relay with the order counterbalanced. Results indicated a significant preference for the test earmuff in three comparison areas: comfort, perceived hearing protection, and speech understanding. The study demonstrates that ammunition type and level of noise exposure contributed significantly to a preference in favor of the test earmuff. The subjects who used the quietest of the ammunition types rated the test earmuff significantly better than the remaining subjects with respect to speech understanding.

Habitat partitioning among the mayfly species (Ephemeroptera) of Yuccabine Creek, a tropical Australian stream.

This study examines the distributions among microhabitats of 12 detritivorous species of mayfly in Yuccabine Creek, an upland tropical rainforest stream. Analysis of data from regular benthic sampling and from in situ experiments using implanted substrata showed that although all species occurred in all the microhabitats examined, different species had significantly different peaks of abundance in different microhabitats, leading to distinct partitioning of the available habitat. The observed patterns of distribution were closely associated with the distribution of fine detritus deposits (FPOM). In the absence of FPOM in fast-flowing regions of the stream, leaf litter was the prime determinant of species distribution. Current velocity and substratum particle size influenced the distribution of the detritus and leaf litter. Abundance of mayflies was greatest in the pool habitat for all except two of the species.

Hearing conservation programs (HCPs): the effectiveness of one company's HCP in a 12-hr work shift environment.

An existing hearing conservation program (HCP), originally designed when an 8-hr work shift schedule was in effect, was evaluated at a plant site where a 12-hr work shift schedule is now utilized. The study included the following phases: a noise analysis of the work environment, HCP evaluation through the use of audiometric data base analysis (ADBA), applying ADBA procedures and a comparison of the shift in hearing threshold levels (HTLs) for the 8-hr and 12-hr work shifts, and an evaluation of the hearing protection devices (HPDs) being used at the facility over the 12-hr work shift by measuring temporary threshold shift (TTS). The mean measured employee time-weighted average (TWA) in the process area where the TTS study was conducted was 92 dBA. It was found that the existing HCP is at best marginal. The most likely causes of this less-than-desirable rating are inadequate audiometric testing procedures and inadequate HPD utilization. Furthermore, it was concluded that, at this time, the introduction of the 12-hr work shift has had no impact on the level of effectiveness of the HCP. In evaluating the three HPDs in use at the facility (3-M foam earplug, E-A-R foam earplug, and Bilsom Soft earplug), it was found that they all offered effective protection from noise at all audiometric test frequencies (0.5 to 6 kHz) except 0.5 kHz. All three HPDs exhibited TTS at 0.5 kHz with the TTS measured significant at the p less than 0.05 level for the E-A-R and 3-M wearer groups.

The contribution of personal radios to the noise exposure of employees at one industrial facility.

An investigation of the contribution made to an employee's noise dose from the output of personal radios was performed at a North Carolina textile manufacturing facility where the daily time-weighted average sound level (TWA) was approximately 87 dB, A-weighted sound pressure level [dB(A)]. The measured mean equivalent diffuse field output level of the personal radios was determined to be 83 dB(A) with a range from 70 to 98 dB(A). The daily TWA of a typical employee who did not use a personal radio was determined to be 86.6 dB(A), whereas the exposure of personal radio users was 88.5 dB(A)--an increase of 1.9 dB(A). This increase in exposure was estimated to result in 4 dB of additional permanent noise-induced hearing loss at 4 kHz for the 5th percentile (most sensitive portion) of the population after 20 years of exposure beginning at age 20. The study concluded that the additional contribution of the personal radios to the employee's daily TWA did not pose a significant additional threat to their hearing. Specific hearing conservation criteria, however, were recommended for continuation of personal radio use at the facility.

Absolute electronegativity and hardness correlated with molecular orbital theory.

The concepts of absolute electronegativity, chi, and absolute hardness, eta, are incorporated into molecular orbital theory. A graphic and concise definition of hardness is given as twice the energy gap between the highest occupied molecular orbital and the lowest unoccupied molecular orbital. Useful correlations can now be made between chemical behavior, visible-UV absorption spectra, optical polarizability, ionization potentials, and electron affinities.