Higher activity level after opening wedge high tibial osteotomy compared to medial unicompartimental knee arthroplasty in a selected cohort of advanced age: A propensity score-matched analysis.

BACKGROUND: High tibial osteotomy (HTO) and medial unicompartmental knee arthroplasty (mUKA) are accepted treatment for medial knee osteoarthritis (OA). Patients often present meeting indications for both procedures. The purpose of this study was to compare results after MOWHTO and UKA in a matched population of patients older than 50 years. METHOD: A retrospective analysis searching for patients older than 50 years meeting indication both for UKA and MOWHTO was performed. A propensity score matching (PSM) based on demographics and clinical data was performed. Tegner activity scale (TAS), Lysholm knee score (LKS) and numeric rating scale for pain (NRS) were recorded prospectively prior to surgery, at 6 months and after a minimum of 4 years. RESULTS: 64 UKA and 71 MOWHTO were found. Mean follow up was similar (54,05 ± 4,80 and 52,62 ± 3,91). A significant improvement was found in both groups for all outcomes at 6 months and at final follow up. PSM yielded 29 pairs. Patients treated with MOWHTO showed superior TAS scores at 6 months (3,41 ± 0,50 vs 3,10 ± 0,56; p < 0,05) and at final follow up (3,83 ± 0,80 vs 3,27 ± 0,59; p < 0,005). NRS and LKS were comparable between groups. CONCLUSIONS: MOWHTO performed using an open wedge technique, with locking plate and a fast rehabilitation protocol guaranteed higher level of activity than UKA in patients older than 50 years. Difference is significant already at 6 months and last longer than 4 years. LEVEL OF EVIDENCE: III.

Simultaneous Bilateral Total Knee Arthroplasty in Elderly: Are There Factors that Can Influence Safety and Clinical Outcome?

Objective: The aim of this study was to look for preoperative patients' related factors correlating with worse clinical outcomes in a cohort of elderly patients undergoing simultaneous bilateral total knee arthroplasty (SiBTKA) to search for risk factors, which may influence clinical outcomes and safety. Subjects and Methods. The hospital database was mined searching for patients older than 70 years that underwent SiBTKA for severe bilateral knee osteoarthritis (OA) between 2012 and 2016. Preoperative clinical information, Oxford Knee Score (OKS), and Knee Injury and Osteoarthritis Outcome Score (KOOS) prior to surgery were recorded. The OKS and the KOOS were submitted again after a minimum of 5 years of follow-up (FU). Results: An improvement was observed in all clinical scores at last FU. The major complication rate was 5.4%. No patients' clinical data showed correlation with perioperative complications or need for transfusions. Functional scores at the last FU were negatively affected by age at surgery and positively affected by preoperative clinical scores. Discussion. In the setting of severe symptomatic bilateral knee OA, SiBTKA seems to be effective in improving symptoms at midterm follow-up, with acceptable rates of perioperative complications in patients older than 70. Higher age at surgery and lower preoperative functional scores are associated with worse clinical outcomes at FU. This could assist surgeons in advising patients that delay of surgical treatment could worsen outcomes.

Axial and rotational alignment of lower limb in a Caucasian aged non-arthritic cohort.

BACKGROUND: The alignment of human lower limb has been an area of ongoing study for decades. The purpose of this study was to analyze the axial and rotational alignment from hip to ankle in a Caucasian aged non-arthritic cohort. METHODS: A non-arthritic cohort of aged patients was retrospectively analyzed by computer tomography. Anatomical-mechanical angle of femur (AMA), femur inclination (FI), femoral anteversion (FA), posterior condylar angle (PCA), proximal tibial torsion (TEAs-PTC and TEAs-PTT) and tibial fibular torsion (PTC-TFA) were measured. RESULTS: The median age of the patients was 76 years (range 67 to 91 years). Regarding axial alignment, the AMA was 5 (2.94; 6.80). No significance differences were reported by side and age. AMA was significantly lower in men. The FI was 125.3 (120.0; 134.8) with no differences in terms of side, age or gender. Regarding torsion alignment, the median values of FA, PTC-TFA and TEAs-PTT were, respectively, 16.8, 28.5 and - 1.4. No differences were reported by age. Right tibia was externally rotated by 1.5 degrees as compared to the left side (P 0.035). CONCLUSION: The broad variability of the parameters analyzed highlights the necessity for a more anatomical and individualized approach during surgery of lower limb. The present study offers the fundament to understand and treat lower limb deformities. Hence, these data can constitute the normal reference values useful to investigate lower limb malalignment. Moreover, it helps to assess the possible changes of axial and rotational alignment in idiopathic OA of lower limb. LEVEL OF EVIDENCE III: Retrospective cohort study.

Synovial and serum levels of NGF in osteoarthritis and rheumatic diseases: a systematic review.

NGF has raised interest as a target molecule in the treatment of OA, after the clinical evidences that antagonization of NGF axis provides symptoms relief in OA. Thus, we conducted a systematic review of the literature to investigate the evidence of NGF being overexpressed during OA. We conducted a database search on Medline using keywords including NGF, serum, synovial fluid, AND osteoarthritis or arthritis. We included study conducted on human, with serum or synovial specimens and an OA cohort. Nine studies met the inclusion criteria. Serum levels ranged from non-detectable to 153.5±28.6 pg/ml. Synovial fluid levels ranged from non-detectable to nearly 210±82 pg/ml. One study supported the evidence of an increased level of NGF in SF and serum of OA patients. The concentration of NGF reported in these studies is controversial and evidence of overexpression of NGF is low.

Skeletal involvement in type 1 Gaucher disease: Not just bone mineral density.

Gaucher disease is characterized by multi-organ infiltration of phospholipid-laden macrophages. Bone involvement is characterized by typical deformities, osteopenia/osteoporosis, pathological fractures, and bone marrow infiltration (avascular osteonecrosis, infarction). Estimation of skeletal disease includes bone quality that contributes substantially to bone strength. We studied 23 type 1 Gaucher patients (median age 22years, range 3-73) on Enzyme Replacement Therapy from 2months to 26years (median 7years); 4 patients had pathological fractures, 10 bone infarctions, 6 avascular osteonecrosis. We noninvasively assessed bone quality by trabecular microarchitecture and macroscopic geometry, using two innovative dual-energy X-ray absorptiometry tools: Trabecular Bone Score (TBS) and Hip Structural Analysis (HSA). Bone quality parameters distinguished the patients with skeletal complications. TBS was significantly lower in patients with avascular osteonecrosis (p=0.049) and pathological fractures (p=0.024), while it could not identify those with bone infarctions. Among HSA parameters, the Cross Sectional Area of the intertrochanteric region and the Buckling Ratio of the narrow neck allowed the distinction of patients with avascular osteonecrosis. BMD was low in 11 patients (50%); neither BMD nor HSA were associated with pathological fractures. The combined evaluation of bone quality and bone quantity is useful to identify GD patients with more severe skeletal involvement.

Spine bone texture assessed by trabecular bone score (TBS) to evaluate bone health in thalassemia major.

Due to the increasing survival of thalassemic patients, osteopathy is a mounting clinical problem. Low bone mass alone cannot account for the high fracture risk described; impaired bone quality has been speculated but so far it cannot be demonstrated noninvasively. We studied bone quality in thalassemia major using trabecular bone score (TBS), a novel texture measurement extracted from spine dual-energy X-ray absorptiometry (DXA), proposed in postmenopausal and secondary osteoporosis as an indirect index of microarchitecture. TBS was evaluated in 124 adult thalassemics (age range 19-56 years), followed-up with optimal transfusional and therapeutical regimens, and in 65 non-thalassemic patients (22-52 years) undergoing DXA for different bone diseases. TBS was lower in thalassemic patients (1.04 ± 0.12 [range 0.80-1.30]) versus controls (1.34 ± 0.11 [1.06-1.52]) (p < 0.001), and correlated with BMD. TBS and BMD values correlated with age, indicating that thalassemia negatively affects both bone quality and quantity, especially as the patient gets older. TBS was 1.02 ± 0.11 [0.80-1.28] in the osteoporotic thalassemic patients, 1.08 ± 0.12 [0.82-1.30] in the osteopenic ones and 1.15 ± 0.10 [0.96-1.26] in those with normal BMD. No gender differences were found (males: 1.02 ± 0.13 [0.80-1.30], females 1.05 ± 0.11 [0.80-1.30]), nor between patients with and without endocrine-metabolic disorders affecting bone metabolism. Our findings from a large population with thalassemia major show that TBS is a valuable tool to assess noninvasively bone quality, and it may be related to fragility fracture risk in thalassemic osteopathy.

Beta-thalassaemia intermedia: evaluation of endocrine and bone complications.

OBJECTIVE: Data about endocrine and bone disease in nontransfusion-dependent thalassaemia (NTDT) is scanty. The aim of our study was to evaluate these complications in ß-TI adult patients. METHODS: We studied retrospectively 70 ß-TI patients with mean followup of 20 years. Data recorded included age, gender, haemoglobin and ferritin levels, biochemical and endocrine tests, liver iron concentration (LIC) from T2*, transfusion regimen, iron chelation, hydroxyurea, splenectomy, and bone mineralization by dual X-ray absorptiometry. RESULTS: Thirty-seven (53%) males and 33 (47%) females were studied, with mean age 41 ± 12 years, mean haemoglobin 9.2 ± 1.5 g/dL, median ferritin 537 (range 14-4893), and mean LIC 7.6 ± 6.4 mg Fe/g dw. Thirty-three patients (47%) had been transfused, occasionally (24/33; 73%) or regularly (9/33; 27%); 37/70 (53%) had never been transfused; 34/70 patients had been splenectomized (49%); 39 (56%) were on chelation therapy; and 11 (16%) were on hydroxyurea. Endocrinopathies were found in 15 patients (21%): 10 hypothyroidism, 3 hypogonadism, 2 impaired glucose tolerance (IGT), and one diabetes. Bone disease was observed in 53/70 (76%) patients, osteoporosis in 26/53 (49%), and osteopenia in 27/53 (51%). DISCUSSION AND CONCLUSIONS: Bone disease was found in most patients in our study, while endocrinopathies were highly uncommon, especially hypogonadism. We speculate that low iron burden may protect against endocrinopathy development.

Thalassemic osteopathy: a new marker of bone deposition.

Osteopathy represents a prominent cause of morbidity in patients with beta-thalassemia major (TM) and manifests as osteopenia/osteoporosis. Biochemical turnover markers (BTMs) are considered a useful, non-invasive tool for the clinical follow-up of osteoporotic patients; they can provide a dynamic view of the remodeling process and give information on the metabolic activity of bone tissue as well as on the pathogenesis of bone loss. The amino-terminal pro-peptide of type I procollagen (P1NP) is a recently introduced marker that is considered the most sensitive index of bone formation. Although demonstrated in several categories of patients with bone disease, there is little information on the clinical usefulness of this bone formation index in thalassemic patients. We evaluated the P1NP levels of 53 adult patients with b-thalassemia major (21 males and 32 females, mean age 34.5 ± 5.7, range 22-46 years) and associated osteopathy. We investigated the correlation between P1NP and bone condition as examined by dual X-ray photon absorptiometry and with BTMs expressing bone resorption and bone mineralization (carboxyterminal collagen cross-linked (CTX) terminal regions of type I collagen and osteocalcin, respectively). P1NP serum levels were correlated with CTX levels (r=0.545, p<0.001); the results were unchanged when males and females, as well as osteoporotic and osteopenic subgroups, were considered separately. No correlation was demonstrated neither between OC and CTX (r=0.17, p=ns), nor between P1NP and OC levels (r=0.11, p=ns). No correlation was demonstrated among the P1NP/CTX ratio and age, OC or densitometric values and no difference was found in the same ratio between osteopenic (0.19 ± 0.16) and osteoporotic (0.15 ± 0.14) patients. Similar results were obtained for the OC/CTX ratio, as it was not correlated with age, P1NP or densitometric values. This is the first report of circulating P1NP in patients with TM-associated osteoporosis. P1NP and CTX assays show good precision and low analytical CV, and, compared to other markers, they can acceptably reflect bone metabolic processes and promptly respond to antiosteoporotic treatments. We trust that this sensitive marker can be useful in the assessment of treatment efficacy and can overcome the pitfalls due to wide variability in the normal values of most BTMs that create difficulty in pinpointing the individual patient's response.

Human exposure to lead, cadmium and mercury through fish and seafood product consumption in Italy: a pilot evaluation.

The presence of selected toxic heavy metals, such as cadmium (Cd), lead (Pb) and mercury (Hg), was investigated in fish and seafood products, namely, blue mussel, carpet shell clam, European squid, veined squid, deep-water rose shrimp, red mullet, European seabass, gilthead seabream, Atlantic cod, European hake, Atlantic bluefin tuna and swordfish so as to assess their human exposure through diet. Metals were detected by quadrupole inductively coupled plasma mass spectrometry (Q-ICP-MS) and hydride generation atomic absorption spectrometry (Hg-AAS). Measurements of Cd, Pb and Hg were performed by means of analytical methods validated in compliance with UNI CEI EN ISO/IEC 17025 [2005. General requirements for the competence of testing and calibration laboratories. Milano (Italy): UNI Ente Nazionale Italiano di Unificazione]. The exposure assessment was undertaken matching the levels of Cd, Pb and total Hg with consumption data related to fish and seafood products selected for this purpose. In order to establish human health implications, the estimated weekly intakes (EWIs) for Cd, Pb and Hg were compared with the standard tolerable weekly intakes (TWI) for Cd and provisional tolerable weekly intakes (PTWIs) for Pb and Hg stipulated by the European Food Safety Authority (EFSA) and the Food and Agriculture Organization/World Health Organization (FAO/WHO) Joint Expert Committee on Food Additives (JECFA). The found metal concentrations were largely below the maximum levels (MLs) established at the European Union level with the exception of Cd. This metal exceeded the MLs in squid, red mullet, European hake and Atlantic cod. Squid and blue mussel showed the highest Pb concentrations which accounted for 60% and 10% of the MLs, respectively. Highest Hg levels were found in predatory fish. The concentrations of Hg in swordfish, Atlantic bluefin tuna and red mullet accounted for 50%, 30% and 30% of the MLs, respectively. The EWIs for Cd, Pb and Hg related to the consumption of fish and seafood products by the median of the Italian total population accounted for 20%, 1.5% and 10% of the standard TWI for Cd as well as PTWIs for Pb and Hg, respectively. Furthermore, the EWIs estimated using consumption data concerning Italian consumers did not exceed the standard TWI and PTWIs, except for Cd at 95th percentile.

Pressure induced magnetic phase separation in La0.75Ca0.25MnO3 manganite.

The pressure dependence of the Curie temperature T(C)(P) in La(0.75)Ca(0.25)MnO(3) was determined by neutron diffraction up to 8 GPa, and compared with the metallization temperature T(IM)(P) (Postorino et al 2003 Phys. Rev. Lett. 91 175501). The behavior of the two temperatures appears similar over the whole pressure range, suggesting a key role of magnetic double-exchange also in the pressure regime where the superexchange interaction is dominant. The coexistence of antiferromagnetic and ferromagnetic peaks at high pressure and low temperature indicates a phase separated regime which is well reproduced with a dynamical mean-field calculation for a simplified model. A new P-T phase diagram has been proposed on the basis of the whole set of experimental data.

Reparability of aged silorane with methacrylate-based resin composite: micro-shear bond strength and scanning electron microscopy evaluation.

OBJECTIVES: To evaluate the compatibility between aged siloranes and methacrylate-based composites by simulating a common repair-technique. METHODS: Twenty substrates were constructed using silorane (Filtek Silorane, 3M ESPE) and methacrylate composites (Filtek Supreme XT, 3M ESPE). Substrates were aged in 0.9% NaCl solution at 37°C for 72 hours. Silorane build-ups were constructed on silorane substrates without any intermediate layer (IL). Methacrylate build-ups were constructed on silorane substrates without any IL, with a methacrylate IL (Heliobond, Ivoclar Vivadent), or with a phosphate-methacrylate IL (Silorane System Adhesive Bond, 3M ESPE). Methacrylate build-ups were also constructed on methacrylate substrates without any IL. The micro-shear bond strength test was carried out after thermocycling. Bond strength data were statistically analyzed using analysis of variance and Tukey post hoc tests. Failure modes were assessed by means of scanning electron microscopy observations. RESULTS: The silorane-methacrylate group without any IL showed the lowest bond strength values (0.4 ± 0.1 MPa). The use of a methacrylate-based IL (1.6 ± 1.7 MPa) led to a slight increase in bond strength, whereas the use of phosphate-methacrylate IL (9.1 ± 5.4 MPa) significantly increased bond strength. There was no statistically significant difference in bond strength between silorane-silorane (7.9 ± 3.6 MPa) and methacrylate-methacrylate (9.5 ± 4.1 MPa) groups without any IL.

Push-out strength of translucent fibre posts cemented using a dual-curing technique or a light-curing self-adhering material.

AIM: To compare by means of a push-out test the interfacial strength of a dual-curing resin cement and a light-curing self-adhering resin composite when used in translucent fibre post cementation. METHODOLOGY: Thirty-four extracted human premolars with single canals were selected and root filled. Translucent fibre posts (RelyX Fiber Post) were luted into the root canal using two resinous luting systems (n = 17). Dual-Curing Technique (DC): the specimens were treated with Excite DSC and RelyX ARC, which were light-cured simultaneously through the post for 60 s. Light-Curing Self-Adhering Technique (LCSA): the specimens were treated with Vertise Flow, which was light-cured through the post for 60 s. The specimens were sectioned transversally into six slices to perform the push-out test at the coronal, middle and apical regions of the root canals. Data were analysed by two-way anova. All specimens were analysed by stereomicroscopy and SEM to determine fracture patterns. RESULTS: There were no significant differences between the DC and LCSA techniques (P = 0.703) in any of the canal regions. Root region was not a significant factor for push-out values (P = 0.255) and group-region interactions were not significant (P = 0.740). For the DC technique, the majority of the fracture patterns (73.3%) were adhesive at the interface between dual-curing resin cement and adhesive. For the LCSA technique, the majority of the fracture patterns (71.7%) were adhesive at the interface between light-curing self-adhering resin composite and dentine. CONCLUSIONS: The interfacial strength between light-curing self-adhering resin composite and root canal walls is equivalent to the interfacial strength between dual-curing cement and root canal walls.

Persistence of Jahn-Teller distortion up to the insulator to metal transition in LaMnO3.

High pressure, low temperature Raman measurements performed on LaMnO3 up to 34 GPa provide the first experimental evidence for the persistence of the Jahn-Teller distortion over the entire stability range of the insulating phase. This result resolves the ongoing debate about the nature of the pressure driven insulator to metal transition (IMT), demonstrating that LaMnO3 is not a classical Mott insulator. The formation of domains of distorted and regular octahedra, observed from 3 to 34 GPa, sheds new light on the mechanism behind the IMT suggesting that LaMnO3 becomes metallic when the fraction of undistorted octahedra domains increases beyond a critical threshold.

A comparison between metabolic syndrome post-hematopoietic stem cell transplantation and spontaneously occurring metabolic syndrome.

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is used in the treatment of several hematological and non-hematological disorders. An increasing number of long-term survivors recover from their primary disease, but they are at risk of adverse late effects, including metabolic syndrome (MS), which seems to be common in long-term survivors of HSCT. AIM: To compare common metabolic parameters and adipohormone profiles in post-transplant and spontaneously occurring or "classic" MS patients. SUBJECTS AND METHODS: Post-transplant MS patients (15 women and 14 men; 49.8±9.3 yr) were compared to "classic" MS patients (15 women and 14 men; 52.9±8.0 yr). For each subject a record of conventional clinical parameters was made; moreover, serum leptin, insulin, quantitative C-reactive protein (CRP), tumor necrosis factor-α [TNF-α], and adiponectin concentrations were measured. RESULTS: The patients with post-HSCT MS had significantly higher levels of leptin, CRP, and TNF-α than the patients with "classic" MS. A generalized linear model comprising serum insulin (p=0.022), body mass index (p<0.001), gender (p<0.001), and group (i.e. healthy, post-HSCT with MS, or suffering from "classic" MS; p<0.001) explained serum leptin variability (adjusted R(2)=0.741). Serum leptin concentrations and BMI were related in the patients with "classic" MS but not in those with post-HSCT MS. CONCLUSIONS: A possible pathogenetic mechanism in the development of MS after HSCT could be hyperleptinemia. A potential interaction among circulating leptin, components of MS, and immune function might explain the role of this adipokine in mediating cardiovascular risk after HSCT.

[Spoilage of a recreational area due to the effects of a sewage dump]. / Deterioro de un área recreacional por efectos del volcado de líquidos cloacales.

Maldonado is the only municipal bathing resort in Bahía Blanca. Its pool receives water from the estuary of Bahia Blanca. The so-called "Planta de Tratamiento de Líquidos Cloacales para la Tercera Cuenca" located nearby, started to operate in September 2008. It is known that the use of fecal contaminated waters increases the disease risk in the population. The aim of this work was to compare current data with the results obtained in previous studies carried out in the Maldonado bathing resort. Five stations were established to assess the presence of Escherichia coli and Enterococcus spp. Results showed an increase in E. coli counts in the area of interest. The results obtained both in the pool and at the floodgate during the period 2008-2009 showed that fecal indicators in the samples exceeded the levels required for recreational waters by approximately 80%. During time the sampling lasted, the treatment plant did not work properly. Therefore, it is necessary for the involved authorities to design the right strategies to ensure the proper operation of the plant, and to raise general awareness of environmental and health issues.

Characterisation and measurement of signals generated by DVB-H 'GAP-filler' repeaters.

DVB-H (Digital Video Broadcasting Handheld) is the standard developed by DVB Project and approved by ETSI with the aim of providing the reception of DVB signals even in mobility but also data transfers and multimedia services. The introduction and development of the DVB-H system is still ongoing. In this context, this work focuses on the temporal trend of electromagnetic impact of an urban DVB-H repeater (called 'gap-filler') for exposure assessment purposes; it also describes a method for its measurement by means of narrow band instrumental chains.

Translational mini-review series on immunology of vascular disease: mechanisms of vascular inflammation and remodelling in systemic vasculitis.

Vessel walls are the primary inflammatory sites in systemic vasculitides. In most cases the initiating event is unknown, and a self-sustaining circuit attracts and activates inflammatory leucocytes in the wall of vessels of various size and anatomical characteristics. Recent studies have revealed homeostatic roles of vascular inflammation and have identified the action of humoral innate immunity, in particular injury-associated signals and acute phase proteins, on the activation of circulating leucocytes, platelets and endothelial cells. These advances have provided clues to the molecular mechanisms underlying the vicious circle that maintains and amplifies vessel and tissue injury.

[Antibiotic resistance patterns of enterococci isolated from estuarine waters]. / Patrones de resistencia a antibióticos de enterococos aislados de aguas estuarinas.

The introduction of antibiotic-resistant bacteria to the environment, affects its hygienic-sanitary quality. The objective of this work is to study the prevalence and the antibiotic resistance patterns of enterococci species isolated from Bahía Blanca estuarine waters. One hundred and three isolates were biochemically identified as Enterococcus spp. The diffusion technique was implemented, by using disks of: vancomycin (Van 30 microg), gentamicin (GenH 120 microg), streptomycin (StrH 300 microg), teicoplanin (T 30 microg), ampicillin (Am 10 microg) and ciprofloxacin (CIP 5 microg) according to the Clinical and Laboratory Standards Institute. Seven Enterococcus species were identified, being Enterococcus faecium and Enterococcus faecalis the most frequent. High level resistance to aminoglycosides was shown by 1.9% of the enterococci whereas 12.6% of the isolates were resistant to CIP. No isolates showed simultaneous resistance to StrH and GenH. Neither resistance to glycopeptides nor to Am was detected. Thirty four per cent of the isolates exhibited susceptibility to all antibiotics tested. Surveillance studies on antimicrobial resistance are usually based upon microorganisms isolated from clinical samples. The findings of this work constitute relevant data for the control of resistant strains, which were believed to be circumscribed to the hospital environment, but are also widespread in the natural sites.