Long term survivorship following Scorpio Total Knee Replacement.

BACKGROUND: The Scorpio Total Knee Replacement (TKR) is one of the most commonly used prosthesis in the United Kingdom. Concerns arose at our institution that there was a high revision rate for this prosthesis. No study has assessed survivorship of this prosthesis over 10 years. METHODS: Four hundred and fifty-six consecutive patients, who underwent a primary Scorpio TKR, were clinically and radiologically evaluated. WOMAC, Oxford Knee Score and all complications including the reason for revision surgery were recorded. The Knee Society Roentgenographic Evaluation and Scoring System was used to evaluate all radiographs for prosthesis alignment and degree of subsequent lucency. Survival analysis for the prosthesis was calculated using Kaplan-Meier curves, with revision as an end-point. Patient reported outcome measures were compared against radiographic evaluation. RESULTS: At a mean of 12.5 years (range 10-14 years), 196 (43.0%) patients were available for review; 124 (27.2%) were lost to follow-up and 136 (29.8%) patients had died of unrelated causes. Seven (3.6%) patients required revision surgery at a mean of 5.4 years; five because of aseptic loosening and two because of septic loosening. Cumulative survival for the prosthesis was 99.5% for any cause at five years and 97.4% at 14 years. The mean OKS and WOMAC score at final follow-up was 30.64 (range 12-48) and 74 (18.9-100) respectively. CONCLUSION: The Scorpio TKR has good long term survivorship and functional outcomes. There is no apparent increased revision rate for this prosthesis in our study. LEVEL OF EVIDENCE: Level IV case series.

Obesity and recurrent intervertebral disc prolapse after lumbar microdiscectomy.

INTRODUCTION: The primary aim of this study was to investigate the relationship between obesity and recurrent intervertebral disc prolapse (IDP) following lumbar microdiscectomy. METHODS: A retrospective review of case notes from 2008 to 2012 was conducted for all patients who underwent single level lumbar microdiscectomy performed by a single surgeon. All patients were followed up at two weeks and six weeks following surgery, and given an open appointment for a further six months. RESULTS: A total of 283 patients were available for analysis: 190 (67%) were in the non-obese group and 93 (32.9%) in the obese group. There was no statistical difference in postoperative infection, dural tear or length of stay between the non-obese and obese groups. Recurrent symptomatic IDP was seen in 27 patients (9.5%) confirmed by magnetic resonance imaging. Nineteen (10.0%) were in the non-obese group and eight (8.6%) in the obese group (p>0.8). CONCLUSIONS: In our study, obesity was not a predictor of recurrent IDP following lumbar microdiscectomy. Our literature review confirmed that this study reports the largest series to date analysing the relationship between obesity and recurrent IDP following lumbar microdiscectomy in the British population.

Disability in patients with chronic patellofemoral pain syndrome: a randomised controlled trial of VMO selective training versus general quadriceps strengthening.

This study was a prospective single blind randomised controlled trial to compare the effects of rehabilitation with emphasis on retraining the vastus medialis (VMO) component of the quadriceps femoris muscle and rehabilitation with emphasis on general strengthening of the quadriceps femoris muscles on pain, function and Quality of Life in patients with patellofemoral pain syndrome (PFPS). Patients with PFPS (n=69) were recruited from a hospital orthopaedic clinic and randomised into three groups: (1) physiotherapy with emphasis on selectively retraining the VMO (Selective); (2) physiotherapy with emphasis on general strengthening of the quadriceps femoris muscles (General); and (3) a no-treatment control group (Control). The three groups were then compared before and after an eight-week rehabilitation period. The Selective and General groups demonstrated statistically significant and 'moderate' to 'large' effect size reductions in pain when compared to the Control group. Both the Selective and General groups displayed statistically significant and 'moderate' and 'large' effect size improvements in subjective function and Quality of Life compared to the Control group. Knee flexion excursion during the stance phase of gait, demonstrated that there were no statistical significant differences and only 'trivial' to 'small' effect size differences between the Selective or General groups and the Control group. A large number of PFPS patients can experience significant improvements in pain, function and Quality of Life, at least in the short term, with quadriceps femoris rehabilitation, with or without emphasis on selective activation of the VMO component. Both approaches would seem acceptable for rehabilitating patients with PFPS. It may be appropriate to undertake exercises involving selective activation of the vastus medialis early in the rehabilitation process, however, clinicians should not overly focus on selective activation before progressing rehabilitation, especially in more chronic cases with significant participation restrictions.

A systems approach to the evaluation of natural resource management initiatives.

Adopting a new paradigm for natural resource and environmental policy that emphasises continuous change, adaptation and learning demands a new approach to evaluation to enable improvements in the way these initiatives contribute to sustainable resource use. Evaluation is fundamental to identifying change, supporting an adaptive approach that is flexible enough to meet the challenge of change, and enabling learning at individual, community, institutional and policy levels. Based on a consideration of changing approaches to natural resource management (NRM) policy and observations and experiences in the practical assessment of on-the-ground initiatives, the authors develop a set of principles for evaluation in NRM that: (a) addresses evaluation from a systems perspective, (b) links objective to consequence, (c) considers the fundamental assumptions and hypotheses that underpin core policy or program objectives, (d) is grounded in the natural resource, policy/institutional, economic, socio-cultural and technological contexts of implementation in practice, (e) establishes practical and valid evaluation criteria by which change can be monitored and assessed, (f) involves methodological pluralism including both quantitative and qualitative methods to ensure rigour and comprehensiveness in assessment, and (g) integrates different disciplinary perspectives (i.e. social, economic, environmental, policy and technological). The paper develops a systems-based evaluation framework that incorporates these principles and also recognises the multiple levels and nested nature of NRM policy, namely: problem characterisation, policy formulation and intent, program logic, and on-ground implementation. Finally, we demonstrate its utility through application to three contrasting Australian case studies: a community-based Integrated Catchment Management policy implementation; a resource information delivery system; and the development of a Decision Support System.

Ecological risks and community perceptions of fairness and justice: a cross-cultural model.

Intergenerational justice is implicit in international commitments to sustainability. If ecological, economic, and social components of sustainability are to be achieved, there is a necessity for intergenerational justice considerations to be included in decision making. The present generation's risk judgments should include consideration of the possible outcomes for their children. But intergenerational issues cannot be considered in isolation from other current risk and fairness concerns. This article reports on a community-based integrative model that describes justice and other attitudes and motivations that determine community and individual proenvironmental behavior in two nations: Germany and Australia. This model can account for a considerable amount of the variance in political compliance as well as various proenvironmental behaviors. Group or individual self-interests have nearly no effects on global protective behavior. It is shown that universal as well as contextual principles, including distributive (within or between generations), procedural, and interactive justice, play a crucial role in fairness judgments. Other principles are also taken into account, such as efficiency, environmental rights, and rights to economic welfare. The results are discussed in relation to the importance of complex community fairness judgments in predicting and evaluating acceptance of political decisions, and for promoting proenvironmental behavior.

Facing the unacceptable: the emotional response to infertility.

The emotional response to infertility, a major circumstantial loss, is frequently likened to bereavement. It is described as circumstantial because it does not happen to everyone, unlike a necessary loss, such as being weaned both nutritionally and emotionally. Another circumstantial loss is the death of someone, particularly if one has close emotional ties to this person. It is not surprising to find that a conceptual framework, developed to understand mourning a death, is used to make sense of the reaction to infertility; but this framework alone is not sufficient. The understanding of stigmatization and learned helplessness also assist helping the infertile to come to terms with their loss. It is suggested that the pronatalist tendency of British society results in denial of the stressful nature of infertility which compounds the difficulty in the loss being recognized and makes it exceptionally difficult to grieve.

Maternal grieving response after perinatal death.

The nature and incidence of psychological and related physical disturbances were investigated in 110 mothers who had lost a child in the perinatal period. The mothers were interviewed six to 36 months after their loss. The demographic characteristics, hospital experiences, effects of bereavement and perceived social support system of the women were assessed. A pathological bereavement outcome, which was defined as a marked deterioration in health and evidence of increased social adjustment problems, was identified in 21% of the women. A pathological bereavement outcome was found to be related to two main factors--a reported crisis during pregnancy and the perceived support of the husband and/or family. Whether the mother saw but did not hold her baby was also a factor. These results suggest that the loss of a baby may have at least as severe an effect on a woman as the death of her husband. The implication of these findings is that women who are at risk of a pathological outcome of bereavement may be identified soon after their loss.

Personality and problem gambling.

Matched groups of problem and social gamblers were compared in terms of their locus of control and their responses to the Myers Briggs Type Indicator. Contrary to previous studies no significant differences occurred on the locus of control measure. It was hypothesized that problem gamblers would be more extraverted and intuitive than social gamblers. However, none of the four scales on the Myers Briggs Type Indicator showed a significant difference between the groups. These findings and the results of earlier studies are compared and discussed. Earlier studies are difficult to interpret because of inappropriate or inconsistent controls. It is suggested that future personality studies of problem gamblers differentiate between different types of gambling and different types of problem gamblers.

Effect of diet upon enterocyte differentiation in the rat jejunum.

Positional and temporal correlates for the development of microvillus membranes and for two of the hydrolytic enzymes they contain have been determined and compared with the ability of enterocytes to transport valine during migration from crypt base to villus tip in jejunal tissue taken from rats maintained on diets containing different amounts of protein. Microvillus elongation and the appearance of both aminopeptidase N (APN) and isomaltase (IM) activities reached maximal rates of expression in enterocytes located 16 +/- 5 micron from the crypt-villus junction. This close positional correlation was not found for the later development of the valine transport function. Feeding rats isoenergetic diets containing 20% instead of 5% protein caused significant increases in both villus height and crypt depth without changing the positional correlations described above. The maximal rates for microvillus elongation and APN and IM appearance were greater and occurred earlier in enterocytes taken from rats fed a high-protein diet. The time of onset and capacity to transport valine were found to be closely correlated for rats maintained on high- and low-protein diets. The ratio of APN to IM activity in fully differentiated enterocytes was either 0.7 or 1.2 depending on whether rats had been fed a low- or high-protein diet. The maximal length of microvillus membranes in fully differentiated enterocytes from rats on a low-protein diet was 1.4 times that found in rats maintained on a high-protein diet. Possible ways in which the microvillus membrane structure of enterocytes, enzyme activity and the ability to transport amino acids might be controlled are discussed. Relative estimates are also made of the probable effects that changes in diet will have on the capacity of the intestine to digest and absorb nutrients.

The effect of protein-deficient isoenergetic diets on the growth of rat jejunal mucosa.

1. Newly weaned 21-d-old male rats were given isoenergetic diets containing 200, 100 and 50 g protein/kg for 7, 14, 28 or 70 d. The mid-jejunum was removed from the rats and a micrometric analysis of the mucosa was made. The following measurements were made: number of villi/mm2, villus dimensions, villus surface area, crypt depth, crypt: villus, the number of cells/crypt in metaphase arrest per h. 2. Comparison were made between animals of the same age but on different diets, and animals on the same diet but of different ages. The latter comparison gave information on the effect of protein deficiency on the pattern of maturation of each feature of the villus or crypt studied. 3. The effect of protein deficiency was not consistent at each stage of maturation. For instance villus height was decreased when compared with the controls following 28 d on a protein-deficient diet but not after 7 or 70 d. 4. The only measurement to be unaffected by protein deficiency was the number of villi per unit area. 5. In general the 50 g protein/kg diet had a more pronounced effect than the 100 g protein/kg diet. Protein deficiency delayed maturation by either slowing or inhibiting changes seen in normal maturation. 6. In rats given 50 g protein/kg diet, although the villus surface area did not increase as the rats matured there were increases in epithelial cell production rate and number of crypts per villus.

Functional differentiation of enterocytes in the follicle-associated epithelium of rat Peyer's patch.

The ability of the follicle-associated epithelium (FAE) of rat Peyer's patch to accumulate valine has been measured using a new technique of autoradiographic analysis. Maximum uptake of valine was achieved by enterocytes present in the dome region of the FAE. Valine uptake was not seen in enterocytes present on the lower slopes of the FAE or in follicle-associated crypts. The ability of the FAE to absorb valine was generally much less than that seen in enterocytes present on adjacent villi. The main reason for this discrepancy lay in the apparent inability of the FAE to develop a second phase of amino acid transport similar to that seen in villus enterocytes. It is suggested that this failure results from some unexplained interaction taking place between the FAE and its underlying lymphoid tissue.

Cell differentiation and L-ornithine decarboxylase activity in the small intestine of rats fed low and high protein diets.

L-Ornithine decarboxylase activity is higher in enterocytes from rats fed low protein rather than high protein diets. Intestinal cell proliferation rate is 50% higher in rats fed high protein than low protein diets. This is not consistent with a direct role of ornithine decarboxylase in intestinal proliferation. It is shown that ornithine decarboxylase is preferentially associated with differentiating villus cells in intestine from rats fed low protein diets.

Effects of azaperone and acetylpromazine on social and environmental behaviour in sheep.

1 Acetylpromazine (Acp, 0.05, 0.1 and 0.5 mg/kg) and azaperone (Azp, 1.0, 1.25 and 1.5 mg/kg) were given by intramuscular injection to separate groups of seven familiar Romney ewes. Thirty minutes after injection the sheep were led into a featureless arena and spatial distribution, activity and shade preference were monitored for 20 min by overhead photography. 2 Behavioural response was complex with both stimulant and depressant effects being seen. The response trends with increasing time for all three measures were significantly different for the two drugs. In particular, Azp tended to increase animal dispersion and Acp to decrease it, in agreement with earlier predictions. 3 The dosage range for Azp was adequate for reduction of individual movement and inter-animal distance but steady state effect was not reached in the time period studied. All doses of Azp initially caused disorientation, as measured by shade preference,, but this improved as sedation deepened. 4 The highest dose of Acp (0.5 mg/kg) achieved steady state effect on individual movement within the study period. The three doses of ACp caused either no change or a slight increase in inter-animal distance. Disorientation with Acp was less and briefer than that seen with Azp.

The validity of assessing changes in intestinal absorption mechanisms for dietary sugars with non-metabolizable analogues (glucalogues).

1. Transfer potentials were obtained from everted jejunal sacs prepared from fed euthyroid, fasted euthyroid, fed hypothyroid and fasted hypothyroid rats by addition of serial concentrations of the dietary sugars glucose and galactose and the glucalogues 3-0-methyl glucose, alpha-methyl glucoside and 6-deoxy-D-glucose to the incubation fluids. The kinetic parameters of 'apparent Michaelis constant' (apparent Km) and maximum transfer potential difference (pdmax) obtained from the results were used to characterize the changes in the electrogenic transfer mechanisms for these substrates. 2. Analysis of the significant differential changes in values for 'apparent Km' and pdmax for the two dietary sugars and the three glucalogues indicated heterogeneity in the mechanisms for sugar transfer across the intestine and suggested a minimum of four possible carriers. 3. The validity of using glucalogues to characterize changes in the transfer mechanisms for the dietary sugars in different dietary and hormonal states was assessed. None of the kinetic parameters for electrogenic glucalogue transfer matched those for the dietary sugars in all the experimental conditions. The employment of glucalogues to assess changes in electrogenic transfer mechanisms for dietary sugars can thus lead to invalid conclusions. 4. Fasting decreased the 'apparent Km' of dietary sugars and the glucalogues. However, the pdmax values for glucose, galactose, and alpha-methyl glucoside decreased whereas those for 3-0-methyl glucose and 6-deoxy-D-glucose did not. 5. Hypothyroidism showed different effects in fed and fasted intestine. Because hypothyroidism induced a reduction in food intake, separation of the direct effects of the condition on electrogenic transfer from reduced food intake effect was not possible.

Inhibition of activity in rats by rubidium chloride.

Effects of two dosages of rubidium chloride on exploration, locomotion, rearing and immobility were assessed for male and female rats in an exploration box and an open field. In contrast to previous findings, rubidium was found to decrease locomotion and rearing in the exploratory box, and also to decrease locomotion in the open field. Further research in a variety of experimental settings is required before the effects of rubidium on activity can be fully evaluated.

Sex differences in birth patterns of schizophrenics.

Birth patterns of non-aboriginal, first admission, Western Australian psychiatric patients born between 1920 and 1950 were compared statistically with those of the general population. Three I. C. D. categories were examined: schizophrenia, anxiety neurosis, and depressive neurosis. For both categories of neurosis no deviations from normal birth patterns were observed. For males, marked excesses in schizophrenic births were observed in June, and for females a similar excess occurred in September. Possible explanations for this sex difference are examined.