Galvanically enhanced fretting-crevice corrosion of cemented femoral stems.

The Ultima TPS MoM THR was designed and developed as a 2nd generation MoM THR specifically aimed at younger more active patients due to the anticipated low wear rates and increased longevity of MoM THRs. In 2010, published clinical data highlighted the early failure of the Ultima TPS MoM due to fretting-crevice corrosion at the stem-cement interface. Since 2010 similar observations have been reported by other clinical centres implicating competitor products as well as the Ultima TPS MoM THR. In an attempt to replicate the electrochemical reaction and interactions established across MoM THR systems, fretting-crevice corrosion tests subjected to galvanic coupling were conducted. Galvanic coupling was seen to significantly increase the rates of corrosion under static and dynamic conditions. This was due to the large potential differences developed across the system between active and passive areas, increasing the rates of corrosion and metallic ion release from the stem-cement interface.

Characterisation of the surface topography, tomography and chemistry of fretting corrosion product found on retrieved polished femoral stems.

This study presents the characterisation of the surface topography, tomography and chemistry of fretting corrosion product found on retrieved polished femoral stems. Scanning Electron Microscopy (SEM), X-ray Photoelectron Spectroscopy (XPS), Transmission Electron Microscopy (TEM) and Fourier Transform Infrared Spectroscopy (FI-IR) were utilised in order to assess the surface morphology of retrieved Metal-on-Metal Total Hip Replacements and surface chemistry of the films found on the surface. Gross slip, plastic deformation and directionality of the surface were extensively seen on the proximal surfaces of the retrievals. A more corrosive phenomenon was observed in the distal regions of the stem, demonstrating a seemingly intergranular attack. Tribochemical reactions were seen to occur within the stem-cement interfaces with tribofilms being observed on the femoral stem and counterpart PMMA bone cement. XPS, TEM-EDX and FT-IR analyses demonstrated that the films present in the stem surfaces were a complex mixture of chromium oxide and amorphous organic material. A comparison between current experimental and clinical literature has been conducted and findings from this study demonstrate that the formation and chemistry of films are drastically influenced by the type of wear or degradation mechanism. Films formed in the stem-cement interface are thought to further influence the biological environment outside the stem-cement interface due to the formation of Cr and O rich films within the interface whilst Co is free to migrate away.

The influence of design, materials and kinematics on the in vitro wear of total knee replacements.

Debris-induced osteolysis due to surface wear of ultra high molecular weight polyethylene (UHMWPE) bearings is a potential long-term failure mechanism of total knee replacements (TKR). This study investigated the effect of prosthesis design, kinematics and bearing material on the wear of UHMWPE bearings using a physiological knee simulator. The use of a curved fixed bearing design with stabilised polyethylene bearings reduced wear in comparison to more flat-on-flat components which were sterilised by gamma irradiation in air. Medium levels of crosslinking further improved the wear resistance of fixed bearing TKR due to resistance to strain softening when subjected to multidirectional motion at the femoral-insert articulating interface. Backside motion was shown to be a contributing factor to the overall rate of UHMWPE wear in fixed bearing components. Wear of fixed bearing prostheses was reduced significantly when anterior-posterior displacement and internal-external rotation kinematics were reduced due to decreased cross shear on the articulating surface and a reduction in AP displacement. Rotating platform mobile bearing prostheses exhibited reduced wear rates in comparison to fixed bearing components in these simulator studies due to redistribution of knee motion to two articulating interfaces with more linear motions at each interface. This was observed in two rotating platform designs with different UHMWPE bearing materials. In knee simulator studies, wear of TKR bearings was dependent on kinematics at the articulating surfaces and the prosthesis design, as well as the type of material.

A comparison of the visual symptoms between ADD/ADHD and normal children.

BACKGROUND: Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) are commonly diagnosed conditions that affect the lives of many individuals Diagnosis of ADD/ADHD is based primarily on observation, although more-objective tests are being developed. Ritalin is the most-popular treatment for ADD/ADHD. Literature indicates the ADD/ADHD patient may experience visual system dysfunctions. The purpose of this article is to document visual system symptoms that may coexist with treated ADD/ADHD. METHODS: Forty-three subjects were separated into two groups, which were matched for age and gender The experimental group had previously been diagnosed as ADD/ADHD and was under pharmacological treatment. The control group was comprised of non-ADD/ADHD children. A modified College of Optometrists in Vision Development (COVD) Quality of Life Outcomes Assessment was given to the parents of each child, which the child and parent completed together. The results between the experimental and control group were then compared. RESULTS: Results show that ADD/ADHD subjects report and/or experience more symptoms of visual system dysfunction than age-matched norms. Fourteen of the 33 symptoms were found to be significantly more severe in the ADD/ADHD group than in the control group. These symptoms were relatively evenly divided between four major symptom groups. CONCLUSIONS: ADD/ADHD children, even with current medical treatment, exhibit more visual and quality of life symptoms than do a similar group of non-ADD/ADHD children.

A novel low wearing differential hardness, ceramic-on-metal hip joint prosthesis.

Osteolysis and loosening of artificial joints caused by polyethylene wear debris has prompted renewed interest in alternative bearing materials for hip prosthesis designs. Lower wearing metal-on-metal (MOM) and ceramic-on-ceramic prostheses are being used more extensively, and there is considerable interest in further improving on their performance. This study investigated the wear properties and debris morphology of a novel differential hardness ceramic-on-metal (COM) prosthesis, in comparison with MOM articulations in a physiological anatomical hip joint simulator. The COM pairings were found to have wear rates approximately 100-fold lower than the MOM pairings. The MOM pairings showed a higher "bedding in" wear rate (3.09+/-0.46mm(3)/10(6) cycles) in the first million cycles, which then reduced to a steady state wear rate of 1.23+/-0.5mm(3)/10(6) cycles. The wear rate of the COM pairings over the duration of the test was approximately 0.01mm(3)/10(6) cycles with very little wear detected on the surface of the prosthesis components. The wear particles from both articulations were oval to round in shape and in the nanometer size range. After one million cycles the mean maximum diameter of the MOM and COM wear particles were 30+/-2.25 and 17.57+/-1.37nm, respectively. After five million cycles the wear particles were statistically significantly smaller than at one million cycles, 13.9+/-0.72nm for the MOM pairings and 6.11+/-0.40nm for the COM pairings. The wear rates of the MOM prostheses were representative of clinical values. The use of differential hardness COM pairings dramatically reduced the wear rate compared to MOM hip prostheses. The wear particles from the MOM articulation were similar to particles found in retrieved tissues from around MOM prostheses. The extremely low wearing differential hardness COM bearings presented in this study produced far smaller volumetric particle loads compared to MOM prostheses currently used clinically.

Quantitative analysis of wear and wear debris from metal-on-metal hip prostheses tested in a physiological hip joint simulator.

Osteolysis and loosening of artificial joints caused by UHMWPE wear debris has prompted renewed interest in metal-on-metal (MOM) hip prostheses. This study investigated the wear and wear debris morphology generated by MOM prostheses in a physiological anatomical hip simulator for different carbon content cobalt chrome alloys. The low carbon pairings demonstrated significantly higher "bedding in" and steady state wear rates than the mixed and high carbon pairings. The in vitro wear rates reported here were up to one or two orders of magnitude lower than the clinical wear rates for first-generation MOM hip prostheses. Two methods for characterising the metal wear debris were developed, involving digestion, scanning electron microscopy and transmission electron microscopy. The metal wear particles characterised by the two methods were similar in size, 25-36 nm, and comparable to particles isolated from periprosthetic tissues from first and second-generation MOM hip prostheses. Due to the small size of the metal particles, the number of particles generated per year for MOM prostheses in vitro was estimated to be up to 100 times higher than the number of polyethylene particles generated per year in vivo. The volumetric wear rates were affected by the carbon content of the cobalt chrome alloy and the material combinations used. However, particle size and morphology was not affected by method of particle characterisation, the carbon content of the alloy or material combination.

Influence of simulator kinematics on the wear of metal-on-metal hip prostheses.

There is now considerable interest in metal-on-metal bearings for hip prostheses. Extremely low wear rates (0.1 mm3/10(6) cycles) have been reported in some simulator studies, while in vivo studies, although still very low, have shown wear rates of the order of 1 mm3/10(6) cycles. The aim of this study was to compare wear rates of metal-on-metal bearings in two hip simulators with different kinematic inputs. In the simulator with three independent input motions which produced an open elliptical wear path with a low level of eccentricity, the wear rates were very low as recorded previously in other simulators. In the simulator with two input motions which produced an open elliptical wear path with greater eccentricity the wear rate was at least ten times higher and closer to clinical values. The motion and kinematic conditions in the contact are critical determinants of wear in metal-on-metal bearings.

Contact mechanics of a novel metal-on-metal total hip replacement.

The contact mechanics of a novel metal-on-metal total hip replacement (THR) were investigated in this study. The metal-on-metal prosthesis considered consists of a cobalt-chrome acetabular insert connected to a titanium shell through a taper contact, articulating against a cobalt-chrome femoral head. Both the experimental measurement of the displacement of the acetabular insert and the contact area between the two bearing surfaces, and the corresponding numerical predictions using the finite element method have been conducted. Excellent agreement has been demonstrated between the experimental measurement and the finite element prediction under various loads up to 3 kN. The maximum contact pressure at the articulating surfaces has been predicted to be about 31 MPa from a simple axisymmetric finite element model, significantly lower than that of a similar cup but with a monoblock construct. This has been mainly attributed to the flexibility of the insert, leading to an increase in the conformity between the femoral head and the acetabular insert. In addition, the predicted maximum contact pressure is only slightly increased to 37 MPa, from a more realistic three-dimensional anatomical finite element model. The design features on metal-on-metal THRs have been shown to reduce contact stresses and may improve tribological performances of these hard-on-hard bearing couples.

Maximal power across the lifespan.

BACKGROUND: Previous investigators have reported that maximal power increases during growth and decreases with aging. These age-related differences have been reported to persist even when power is scaled to body mass or muscle size. We hypothesized that age-related differences in maximal power were primarily related to differences in muscle size and fiber-type distribution rather than to age per se. METHODS: Maximum cycling power (Pmax) and optimal pedaling rate (Vopt, a surrogate measure for muscle fiber type) were determined for 195 boys and men, 8-70 years of age, by using inertial load cycle ergometry. Anthropometric dimensions were used to estimate lean thigh volume (LTVest) of all subjects, and magnetic resonance imagery was used to determine thigh and hip muscle volume (MRIvol) for 24 subjects. RESULTS: Pmax was highly related to the product of LTVest and Vopt (LTVest X Vopt; r2 = .83). Multiple regression revealed that Pmax was significantly related to both LTVest x Vopt and age (R2 = .84). Power scaled by LTVest X Vopt was stable during growth and exhibited a small but significant decrease with aging. MRIvol was highly correlated with LTVest, and the ratio of LTVest to MRIvol was independent of age. CONCLUSIONS: These results suggest that muscle volume and optimal pedaling rate are the main determinants of maximal power across the lifespan and that the contractile properties of muscle are developed early in childhood and remain nearly intact late into the lifespan.

Analysis and modelling of wear of cobalt-chrome alloys in a pin-on-plate test for a metal-on-metal total hip replacement.

The complex interaction between wear and bearing surfaces of two contacting solids was investigated in this study, with particular reference to the use of metal-on-metal material combinations for artificial hip joint replacements. The contact mechanics model was coupled with the wear model and solved simultaneously as a function of time for a simple case of a uniaxial pin-on-plate wear test. Both a spherical pin and a flat-ended spherical pin were considered. It was shown that the contact pressure between the pin and the plate was substantially reduced by the wear process, particularly during the initial running-in period and for the spherical pin. The theoretical prediction of the worn profiles of the pin and the plate was found to be in good agreement with previous experimental measurements by Tipper et al. in 1999.

Quantitative analysis of the wear and wear debris from low and high carbon content cobalt chrome alloys used in metal on metal total hip replacements.

The biological reactions to polyethylene wear debris have been shown to result in osteolysis and loosening of total hip arthroplasties. This has led to renewed interest in the use of metal on metal bearings in hip prostheses. This study employed uniaxial and biaxial multistation pin on plate reciprocators to assess how the carbon content of the cobalt chrome alloy and the types of motion affected the wear performance of the bearing surfaces and the morphology of the wear debris generated. The low carbon specimens demonstrated higher wear factors than both the mixed carbon pairings and the high carbon pairings. The biaxial motion decreased the wear rates of all specimens. Plate wear was significantly reduced by the biaxial motion, compared to pin wear. The metal wear particles isolated were an order of magnitude smaller than polyethylene particles, at 60-90 nm, and consequently, 100-fold more particles were produced per unit volume of wear compared to polyethylene. The low carbon specimens produced significantly larger particles than the other material combinations, although it is thought unlikely that the difference would be biologically significant in vivo. The volumetric wear rates were affected by the carbon content of the cobalt chrome alloy, the material combination used and type of motion applied. However, particle morphology was not affected by the carbon content of the alloy or the type of motion applied.

Effect of chronic electrical stimulation and beta-GPA diet on GLUT4 protein concentration in rat skeletal muscle.

The present study investigated whether alterations in the muscle high energy phosphate state initiates the contraction-induced increase in skeletal muscle GLUT4 protein concentration. Sprague-Dawley rats were provided either a normal or a 2% beta-guanidinoproprionic acid (beta-GPA) diet for 8 weeks and then the gastrocnemius of one hind limb was subjected to 0, 14 or 28 days of chronic (24 h day-1) low-frequency electrical stimulation (10 Hz). The beta-GPA diet, in the absence of electrical stimulation, significantly reduced ATP, creatine phosphate, creatine and inorganic phosphate and elevated GLUT4 protein concentration by 60% without altering adenylate cyclase activity or cAMP concentration. Following 14 days of electrical stimulation, GLUT4 protein concentration was elevated above non-stimulated muscle in both groups but was significantly more elevated in the beta-GPA group. Concurrent with this greater rise in GLUT4 protein concentration was a greater decline in the high energy phosphates and a greater rise in cAMP. After 28 days of electrical stimulation, GLUT4 protein concentration and cAMP stabilized and was not different between diet treatments. However, the high energy phosphates were significantly higher in the normal diet rats as opposed to the beta-GPA rats. These findings therefore suggest that a reduction in cellular energy supply initiates the contraction-induced increase in muscle GLUT4 protein concentration, but that a rise in cAMP may potentiate this effect.

Effects of chronic moderate and heavy ethanol consumption on myocardial recovery from ischemia.

The purpose of this study was to determine the effects of chronic moderate and heavy ethanol consumption on myocardial ischemia/ reperfusion injury. Three groups (n = 18) of 6-month-old female Sprague-Dawley rats were fed a nutritionally balanced liquid diet. Control, moderate alcohol, and heavy alcohol groups consumed 0%, 20%, and 35% of their calories from ethanol, respectively. After 10 weeks of feeding, hearts were isolated and subjected to 21.5 min of ischemia alone, or 21.5 min of ischemia followed by 30 min reperfusion. Hearts were evaluated for hemodynamic characteristics and high-energy phosphate content. Hearts from animals exposed to moderate and heavy amounts of ethanol recovered significantly less (30.61% and 29.45%, respectively) of their preischemic cardiac external work than control hearts (65.52%). Postischemic diastolic stiffness was increased approximately 7-fold, and high-energy phosphate content, both creatine phosphate and adenosine triphosphate, decreased >25% by both chronic moderate and heavy ethanol consumption. In conclusion, both chronic moderate and heavy ethanol consumption exacerbate myocardial ischemia/reperfusion injury. The ethanol-induced reduction in postischemic energy status may be the mechanism of increased diastolic stiffness and subsequent reduced cardiac external work.

Higher mitochondrial fatty acid oxidation following intermittent versus continuous endurance exercise training.

It has been well documented that skeletal muscle fatty acid oxidation can be elevated by continuous endurance exercise training. However, it remains questionable whether similar adaptations can be induced with intermittent interval exercise training. This study was undertaken to directly compare the rates of fatty acid oxidation in isolated subsarcolemmal (SS) and intermyofibrillar (IMF) mitochondria following these different exercise training regimes. Mitochondria were isolated from the gastrocnemius-plantaris muscles of male Sprague-Dawley rats following exercise training 6 days per week for 12 weeks. Exercise training consisted of either continuous, submaximal, endurance treadmill running (n = 10) or intermittent, high intensity, interval running (n = 10). Both modes of training enhanced the oxidation of palmityl-carnitine-malate in both mitochondrial populations (p < 0.05). However, the increase associated with the intermittent, high intensity exercise training was significantly greater than that achieved with the continuous exercise training (p < 0.05). Also, the increases associated with the IMF mitochondria were greater than the SS mitochondria (p < 0.05). These data suggest that high intensity, intermittent interval exercise training is more effective for stimulation of fatty acid oxidation than continuous submaximal exercise training and that this adaptation occurs preferentially within IMF mitochondria.

Uncoupling of changes in skeletal muscle beta-adrenergic receptor density and aerobic capacity during the aging process.

The results of the present study indicate that the density of the beta-adrenergic receptors in the skeletal muscle does not decline with age, despite declines in oxidative capacity both in the skeletal muscle and whole body oxygen consumption. When young rats and old rats of equal body weight trained daily at the same duration and speed for 6 months on the treadmill, skeletal muscle of young and old rats reached the same aerobic capacity. The young demonstrated a significant rise in Bmax of the beta receptors, while the old rats did not change their density of receptors. When both young and old rats had the contractile activity of their skeletal muscle raised to the same level through chronic tonic electrical stimulation, the aerobic-capacity and beta receptor density rose to the same levels in the skeletal muscle. Thus, the contraction-dependent pathway in the senescent muscle appears to function normally given a maximal chronic stimulus via electrical stimulation. These data indicate that the relationship between oxidative capacity, beta-adrenergic receptor properties, exercise training, and aging does not appear to be readily explicable by a single unifying mechanism, but probably resides in the interaction of age with a differential responsiveness of the beta-adrenergic and/or contraction dependent pathway for stimulation of aerobic capacity in the aging skeletal muscle.

Contraction-induced intracellular signals and their relationship to muscle GLUT-4 concentration.

This investigation used a model of increased skeletal muscle contractile activity to evaluate whether the adenylate cyclase-adenosine 3',5'-cyclic monophosphate (cAMP) pathway and/or the high-energy phosphate state of the muscle might be temporally related to the contraction-induced increase in skeletal muscle GLUT-4 protein concentration. Plantaris and gastrocnemius muscles of Sprague-Dawley rats were subjected to 3, 7, 14, or 28 days of chronic low-frequency electrical stimulation (10 Hz, 24 h/day). GLUT-4 protein concentration was slightly reduced after 3 days of electrical stimulation, similar to control values at 7 days and significantly elevated above control at 14 days (53%, P < 0.05) and 28 days (338%, P < 0.05) of stimulation. ATP, creatine phosphate, creatine, and P, were inversely related to GLUT-4 protein concentration. Adenylate cyclase activity increased with electrical stimulation and was significantly related to the increased GLUT-4 protein. cAMP was significantly increased at 14 days of stimulation and remained elevated through 28 days. These results demonstrate that both the adenylate cyclase-cAMP pathway and the high-energy phosphate state of the muscle are temporally related to elevations in skeletal muscle GLUT-4 protein concentration in response to chronic low-frequency electrical stimulation and, as such, suggest that both may comprise a component of the intracellular signal that regulates the contraction-induced increase in skeletal muscle GLUT-4 protein concentration.

Growth hormone supplementation increases skeletal muscle mass of old male Fischer 344/brown Norway rats.

Growth hormone (GH) supplementation can increase the body weight of old rats, but the individual tissues affected were previously unidentified. Therefore, the masses of the heart, spleen, kidney, epididymal fat pads, and five skeletal muscles were assessed in male Fischer 344/Brown Norway rats (9, 20, 31, months) injected with recombinant human GH (0.7 mg/kg) or vehicle twice daily for 10 days. Muscle composition (fiber type, protein concentration, dry weight/wet weight ratio, citrate synthase activity) was also evaluated. Muscle mass was increased with GH treatment, and this increment was undiminished in old age. Fiber type, protein concentration, and dry weight/wet weight ratio were unaffected by GH. Citrate synthase activity declined in the plantaris and increased in the soleus with GH treatment. GH supplementation elevated heart and spleen mass, but not fat pad or kidney weight. The data demonstrate that the capacity for GH-induced hypertrophy of skeletal muscle, myocardium, and spleen is retained during old age.

Brugia pahangi: differential granulomatous reactivity of infected jirds (Meriones unguiculatus) to fractions of adult worm extract.

Soluble extracts of adult Brugia pahangi (SSE) were fractionated by lectin affinity chromatography, followed by reversed phase HPLC. The immunologic and in vivo inflammatory reactivity of the resulting fractions were compared in jirds with acute and chronic infections of B. pahangi. When separated by SDS-PAGE, all fractions possessed bands which were recognized in Western blots by antibodies from jirds with both acute and chronic infections. Fractions were coupled to sized Sepharose beads that were subsequently embolized into the lungs of infected and uninfected control jirds. Granulomas were induced by SSE, the lectin column eluate, and HPLC fractions E, F, and G in acutely infected jirds. These reactions were significantly reduced in chronically infected jirds. HPLC fractions B, C, and D did not elicit an in vivo inflammatory response. A perivascular infiltrate of eosinophils and mononuclear cells was also observed in lungs of acutely infected jirds which received granuloma-inducing coated beads but not in lungs of similar jirds which received beads that did not induce this inflammatory response. Proliferative responses of splenocytes stimulated with SSE or the lectin eluate and lymph node cells and splenocytes stimulated with HPLC fractions B, C, or D corresponded to the in vivo granulomatous response to homologously coated beads. Correlations between in vivo inflammatory responses and in vitro proliferative responses were not seen using other fractions in these assays. These data indicate that varying degrees of granulomatous inflammation are induced by different filarial proteins mixtures and that the in vivo granuloma induction by antigen-coated beads will be useful in the identification of specific proteins involved in the induction, maintenance, and regulation of filariae-elicited inflammatory reactions. Although the size of these granulomas corresponds to severity of granulomatous inflammatory responses visualized within the jird lymphatics during the course of infection, the reaction does not correlate in all instances to lymphoproliferative responses of cells from peripheral lymph nodes or the spleen. Distinct differences between antibody and granulomatous reactivity to some fractions were noted.

Edema control in the management of disabling chronic venous insufficiency.

This study was undertaken to assess the biomedical and socioeconomic rationale of edema control in disabling chronic venous insufficiency (CVI). In this 15-year retrospective survey (1974 through 1988) edema control was achieved by use of Unna's boot for leg ulcerations and by compressive hosiery for prevention of ulcerations. The study included 2,317 self- or physician-referred patients with disabling CVI, of whom 998 presented with venous stasis ulcers, many with recurrent ulcerations. Two hundred thirty-six patients were seen and treated only once and never returned. They were listed as not healed. Including patients who never returned after the first visit, the overall healing rate was 60.9%. Excluding the nonreturning patients, the overall rate of verified healing was 73.3%. The healing rate was 91% for first ulcers of complaint patients (patients treated at least 12 times in 32 weeks). The Unna's boot, being a functional substitute for the failing muscle pump in CVI, is a noninvasive and ambulatory method of controlling edema and treating ulcers in CVI. It does not interfere with patients' activities, it is inexpensive, and it is adaptable to middle aged and elderly ambulatory populations.

Transcriptional regulation of muscle fatty acid-binding protein.

Heart fatty acid-binding protein (H-FABP) is present in a wide variety of tissues but is found in the highest concentration in cardiac and red skeletal muscle. It has been proposed that the expression of H-FABP correlates directly with the fatty acid-oxidative capacity of the tissue. In the present study, the expression of H-FABP was measured in red and white skeletal muscle under two conditions in which fatty acid utilization is known to be increased: streptozotocin-induced diabetes and fasting. Protein concentration, mRNA concentration and transcription rate were measured under both conditions. The level of both protein and mRNA increased approximately 2-fold under each condition. The transcription rate was higher in red skeletal muscle than in white muscle, was increased 2-fold during fasting, but was unchanged by streptozotocin-induced diabetes. In addition to supporting the hypothesis that H-FABP is induced during conditions of increased fatty acid utilization, these findings demonstrate that the regulation of H-FABP expression may or may not be at the level of transcription depending on the stimulus.