Comparison of bone remodelling around short stem and conventional straight stem in total hip replacement: a prospective randomized radiographic and dual-energy X-ray absorptiometric study.

OBJECTIVE: The aim of study was to evaluate periprosthetic bone mineral density (BMD) changes of proximal femur, osseointegration and clinical outcomes after implantation of short-stemmed and conventional straight-stemmed prostheses. METHODS: This prospective, randomized study included 50 patients with unilateral total hip replacement. The patients were randomized into 2 cohorts: patients with a cementless short stem Metha (n=25) and patients with a cementless conventional straight stem Bicontact evaluated as the control (n=25). Periprosthetic BMD changes were measured using a DEXA performed at one-week, 3-monts, 6-months and 1-year follow up. Clinical evaluation with Harris hip score (HHS) and radiographic assessment were performed through a 1 year follow up. RESULTS: Compared to 1-week postoperative assessment, there were differences in BMD changes between the groups at the final follow-up in all ROIs, with statistical significances in ROI 1, 2, 3, 6 and 7. The loss of periprosthetic BMD in all ROIs around straight stems at each time-point was observed. There was a tendency towards a regain of BMD in all ROIs at 1-year follow-up compared to the 3-months postoperative assessment with the short stems. Less pronounced bone loss was observed around the short stems that the straight stems in ROI 1 (‒2.9 % % vs ‒16.2 %), 5 (‒4.7 % vs ‒8.9 %) and 7 (‒8.6 % vs ‒20 %). The periprosthetic BMD exceeded baseline values in the short stem cohort in ROI 2 (+4.4 % vs ‒5 %), 3 (+5.6 % vs ‒2.5 %) and 6 (+4.3 % vs ‒10 %). All stems had a radiographically stable fixation. Stress shielding-related bone resorption was markedly lower in the short stem cohort. The HHS score was comparable between the two cohorts. CONCLUSION: The implant-specific stress shielding altered the proximal loading condition for both stems; however, the results of this study suggest a more physiological strain distribution with the short stems versus the straight stems (Tab. 3, Fig. 3, Ref. 25).

Iris and ciliary body cysts and phakic intraocular lenses.

Phakic intraocular lenses are used to correct refractive errors. The procedure is predictable and potentially reversible. The procedure is not free of complications though. The occurrence of iris cyst after implantation of a phakic intraocular lens was not described previously in the literature. We describe two cases of iris cysts in the presence of a phakic intraocular lens; the first case describes a cyst which was not present prior to the anterior chamber phakic intraocular lens implantation. The second case describes a hidden iris cyst that affected the posterior chamber phakic intraocular lens position and lead to glaucoma.

Transplantation of mesenchymal stem cells genetically engineered to overexpress interleukin-10 promotes alternative inflammatory response in rat model of traumatic brain injury.

BACKGROUND: Traumatic brain injury (TBI) is a major cause for long-term disability, yet the treatments available that improve outcomes after TBI limited. Neuroinflammatory responses are key contributors to determining patient outcomes after TBI. Transplantation of mesenchymal stem cells (MSCs), which release trophic and pro-repair cytokines, represents an effective strategy to reduce inflammation after TBI. One such pro-repair cytokine is interleukin-10 (IL-10), which reduces pro-inflammatory markers and trigger alternative inflammatory markers, such as CD163. In this study, we tested the therapeutic effects of MSCs that were engineered to overexpress IL-10 when transplanted into rats following TBI in the medial frontal cortex. METHODS: Thirty-six hours following TBI, rats were transplanted with MSCs and then assessed for 3 weeks on a battery of behavioral tests that measured motor and cognitive abilities. Histological evaluation was then done to measure the activation of the inflammatory response. Additionally, immunomodulatory effects were evaluated by immunohistochemistry and Western blot analyses. RESULTS: A significant improvement in fine motor function was observed in rats that received transplants of MSCs engineered to overexpress IL-10 (MSCs + IL-10) or MSCs alone compared to TBI + vehicle-treated rats. Although tissue spared was unchanged, anti-inflammatory effects were revealed by a reduction in the number of glial fibrillary acidic protein cells and CD86 cells in both TBI + MSCs + IL-10 and TBI + MSC groups compared to TBI + vehicle rats. Microglial activation was significantly increased in the TBI + MSC group when compared to the sham + vehicle group. Western blot data suggested a reduction in tumor necrosis factor-alpha in the TBI + MSCs + IL-10 group compared to TBI + MSC group. Immunomodulatory effects were demonstrated by a shift from classical inflammation expression (CD86) to an alternative inflammation state (CD163) in both treatments with MSCs and MSCs + IL-10. Furthermore, co-labeling of both CD86 and CD163 was detected in the same cells, suggesting a temporal change in macrophage expression. CONCLUSIONS: Overall, our findings suggest that transplantation of MSCs that were engineered to overexpress IL-10 can improve functional outcomes by providing a beneficial perilesion environment. This improvement may be explained by the shifting of macrophage expression to a more pro-repair state, thereby providing a possible new therapy for treating TBI.

[Magnetic resonance imaging in the diagnosis of intra-articular lesions of the knee]. / Prínos MRI v diagnostike intraartikulárnych lézií kolenného klbu.

PURPOSE OF THE STUDY: Magnetic resonance imaging (MRI) has the highest sensitivity of all methods for the diagnosis of intra-articular knee injuries. In spite of this, its benefit for the decision-making algorithm is questionable. The aim of this study was to evaluate the real situation in our regional conditions. MATERIAL AND METHODS: The medical records of the patients who underwent knee arthroscopy in 2008 and 2009, and had pre-operative MRI examination, were retrospectively reviewed. The group included 92 patients (46 women and 46 men; average age, 41.7 years) of whom 49 had knee injury in their medical history. RESULTS: In medial meniscus (MM) injuries, the MRI examination had a sensitivity of 0.92 and a specificity of 0.44, and the congruence of MRI and arthroscopic findings was 0.73. In lateral meniscus (LM) tears, the values were 0.70 for sensitivity, 0.81 for specificity and 0.87 for congruence. In injury to the anterior cruciate ligament (ACL), MRI sensitivity was 0.66, specificity was 0.85 and congruence was 0.79. In evaluation of articular chondral lesions, the values were 0.45 for sensitivity, 0.87 for specificity and 0.60 for congruence. DISCUSSION: In our examination of knee structures for MM, LM, ACL and cartilage injuries, the diagnostic value of MRI was lowest for cartilage damage, with sensitivity being only 0.45. This was in agreement with the findings of other authors. Although this fact is known, our arthroscopic findings in patients with no MRI evidence of injury were very high: 22 knees with grade III or grade IV chondral lesions. Therefore, MRI examination is not considered to be sensitive enough to replace arthroscopy in the diagnosis of cartilage injuries. MRI examination is most frequently indicated in suspected meniscal damage. Its sensitivity reported in the literature varies; generally, it is about 0.90 in MM injuries, and about 0.75 in LM lesions, and this is in agreement with our results. However, in view of our previous experience, the high sensitivity of MRI in the diagnosis of MM lesions was an unexpected finding. A detailed statistical analysis showed that its high value was at the expense of a relatively high negative positivity (0.56) and a low predictive value of the positive test (0.65). In LM injuries these values were even worse: in addition to low sensitivity (0.70), the predictive value of the positive test was only 0.50. In the diagnosis of ACL injuries, MRI examination is reported to have a high sensitivity ranging from 0.85 to 0.90. This study showed poorer results; sensitivity was 0.66 and the predictive value of the positive test was 0.62. For injuries in which the orthopaedist is sure about the diagnosis and indicates arthroscopy, it is doubtful to indicate also MRI examination. This should be reserved for clinical presentations that are not clear, for post-operative conditions, serious knee injuries or combined injuries. However, patients with chronic problems and unclear clinical presentations should benefit from MRI examination which can make the diagnosis more accurate and thus reduce the number of arthroscopic procedures done entirely for diagnostic purposes. CONCLUSIONS: There is no consensus regarding the role of MRI in the diagnosis of intra-articular lesions of the knee. To a certain extent, its use is related to local conditions. It can be concluded that MRI examination is not currently as important for the diagnosis of knee injuries as expected by both medical and lay communities.

Variation in repeat caesarean section complication rates among 3 hospitals in northern Jordan.

We investigated the complication rates of repeat caesarean deliveries in 3 hospitals (national health, military, university) in Irbid by examining the obstetric records of 989 women from 1 December 1999 to 30 March 2004. There was a statistically significant difference between the number of previous caesarean sections and hospital. In total, 579 (58.5%) patients underwent elective caesarean section. There were statistically significant differences between hospitals for "failure to progress in labour" and "other" indications for caesarean section. After adjusting for the number of caesarean sections, regression analysis revealed that women from the military and university hospitals were more likely to have placenta praevia. There were no statistically significant differences between hospitals as regards post-operative complications.

Variation in repeat caesarean section complication rates among 3 hospitals in northern Jordan

We investigated the complication rates of repeat caesarean deliveries in 3 hospitals [national health, military, university] in Irbid by examining the obstetric records of 989 women from 1 December 1999 to 30 March 2004. There was a statistically significant difference between the number of previous caesarean sections and hospital. In total, 579 [58.5%] patients underwent elective caesarean section. There were statistically significant differences between hospitals for "failure to progress in labour" and "other" indications for caesarean section. After adjusting for the number of caesarean sections, regression analysis revealed that women from the military and university hospitals were more likely to have placenta praevia. There were no statistically significant differences between hospitals as regards post- operative complications

Full-term viable abdominal pregnancy: a case report and review.

A full-term abdominal pregnancy culminating in the birth of a live healthy baby by laparotomy is described.

[The role of infection and inflammation in the pathogenesis of atherosclerosis]. / Uloha infekcie a zápalu v patogenéze aterosklerózy.

Pathogenesis of the atherosclerotic process is deemed as multifactorial. To the most important risk factors, besides certain family predisposition, there belongs hypercholesterolemia, arterial hypertension, obesity, diabetes mellitus, smoking and others. In the last years there are more and more data about the role of inflammation and infection in the whole development of atherosclerosis. The witness for this hypothesis is the findings of high parameters of inflammation in involved vessels as well as in the blood of atherosclerosis suffering persons. Opinions about the inflammation theory appear from the 90th. Local sterile inflammation in the subendotelium of the middle and big arteries has been proved to consist of specific immune reaction (activation of the T-lymphocytes) as well as nonspecific characteristic by elevated monocytes in the artery wall during the whole process of atherogenesis. Inflammation in the plaque can trigger and hold several factors engaged in the atherosclerotic process, such as oxidized LDL cholesterol, elevated production of various superoxides, activated macrophages, activated T-lymphocytes, cytokines (IL-1, IL-6, interferon gamma) and lipoprotein Lp (a). In this inflammation process levels of CRP (acute phase protein), fibrinogen and erythrocyte sedimentation are elevated as a reaction of the organism to nonspecific chronic infections. Because of this it is thought that elevated fibrinogen and erythrocyte sedimentation are markers of the cardiovascular risk. Some papers deal with antiinflammatory effects of statins, because these lower CRP levels so they also lower atherosclerotic risk through not only lowering of cholesterol levels. Also asprine, as an antiinflammation agent, changing the CRP levels, would be of benefit for patients with vascular disease because its antiaggregation and antiinflammatory effects. ACE inhibitors are also antiinflamatory through blocking of tissue production of angiotensin II (artery wall and atherosclerotic plaque). Enzymatic inhibitors changing angiotensin can also have a partial antiinflammatory effect. The infection theory is supported also by tracing of some microorganisms in the atherosclerotic plaque or in the blood, as e.g. Helicobacter pylori or Chlamydia pneumoniae; to the autoimmune origin is indicated the presence of the specific immunity reaction against heat shock proteins (HSP) or oxidized LDL. This infection theory offers new therapy possibilities. Therefore eradication for example by antibiotics can lead to stabilization of the atherosclerotic plaque with positive consequences, as it was discovered by many studies.

Characterization of lipid fatty acids in whole-cell microorganisms using in situ supercritical fluid derivatization/extraction and gas chromatography/mass spectrometry.

In situ supercritical fluid derivatization and extraction was used as a sample preparation technique for the classification of bacteria using fatty acid profiling. Addition of a quaternary ammonium salt such as phenyltrimethylammonium hydroxide under static supercritical conditions directly to lyophilized, whole-cell bacteria in an extraction vessel resulted in the saponification of the bacterial lipids and derivatization of their fatty acids. The derivatized fatty acid methyl esters (FAMEs) were then extracted with supercritical CO2 and analyzed without additional treatment using GC/MS. Iso and anteiso C15:0 and C17:0 along with C18:0 were predominant in Gram-positive bacteria, while C16:1, C16:0, C18:1, and cyclopropyl cyC17:0 and cyC19:0 were significant in Gram-negative bacteria. Application of principal components analysis to the FAME GC/MS data resulted in the differentiation between Gram-positive and Gram-negative type bacteria. Differentiation between species among the same genera was also observed.

Bioequivalence of two oral dosage forms prepared from different polymorphic modifications of tenoxicam.

The bioavailability of two pharmaceutical dosage forms formulated using different polymorphs of tenoxicam were compared. Serum levels of TNX were analysed using high performance liquid chromatography. The pharmacokinetic parameters were estimated following the oral administration of a single dose (20 mg) of the drug as two different polymorphs to 12 healthy volunteers. The differences between formulations were statistically insignificant.

Analysis and bioequivalency study on two tablet formulations of co-trimoxazole.

This paper describes an analytical procedure for simultaneous quantification of trimethoprim (TMP) and sulphamethoxazole (SMZ) in serum. Serum samples were rendered alkaline with glycine-sodium hydroxide buffer (pH 9.1) and extracted with ethyl acetate. The reconstituted sample was analysed using reversed-phase C-18 column high-performance chromatography. The mobile phase consisted of 75% triethyl ammonium acetate buffer, 20% methanol and 5% acetonitrile. The analytes were monitored at 289 nm and tetroxoprim was used as an internal standard. The maximum values for intra-day coefficients of variation (CV) for TMP-and SMZ were 5.7 and 2.1%, respectively. Interday CV values were 6.4 and 2.2%, respectively. The method was used to compare the bioavailability of two tablet formulations in terms of their pharmacokinetic parameters following oral administration of the tablets to 18 volunteers.

Bioequivalency studies on tablet formulation of tetroxoprim and sulphadiazine.

The paper describes a comparative bioavailability study on two tablet formulations containing 100 mg of tetroxoprim and 250 mg of sulphadiazine. The comparison was based on the estimated pharmacokinetic parameters from time--serum concentration profiles obtained following the administration of the tablets to 12 healthy volunteers. Statistical analysis performed on the parameters showed that the differences are statistically insignificant and the formulations are bioequivalent.

High-performance liquid chromatographic determination of floctafenine and its major metabolite, floctafenic acid in plasma.

A simple, rapid and selective high-performance liquid chromatographic method for the determination of floctafenine and its major metabolite, floctafenic acid, in plasma is reported. Plasma samples were purified using the mobile phase as a protein precipitant. The supernatant containing parent compounds and diazepam (internal standard) were eluted from a 5 micron C 18 reversed-phase column at ambient temperature. The mobile phase consisted of 0.05 M sodium acetate:acetonitrile: methanol (200:100:100 v/v/v) adjusted to pH 5 and pumped isocratically at a flow rate of 1.5 ml/min. The effluent was monitored at 350 nm. Quantification was achieved by the measurement of the peak-height ratio of each drug to the internal standard. The mean percentage recoveries from plasma samples spiked with floctafenine and floctafenic acid ranged from 88.13 to 101.93%. Detection limits were 100 ng/ml for floctafenine and 50 ng/ml for floctafenic acid. The coefficients of variation (RSD, %) for within-day and day-to-day analysis were less than 8%.

High-performance liquid chromatographic determination of methotrexate in plasma.

A procedure for the determination of methotrexate in human plasma is reported. The analysis involved extraction of methotrexate as an ion pair in ethyl acetate. Reconstituted residue was analyzed using reverse phase C-18 column and a mobile phase consisting of acetate buffer (87%), methanol (6.5%), and acetonitrile (6.5%). The methotrexate recovery range was 95-97%. Theophylline was used as internal standard with a recovery of 96%. The intraday coefficient of variation for the assay ranged from 1.8-3.0%, while interday variation coefficient range was 3.5-3.7%. The method is selective, reproducible, and covers a wide range of methotrexate concentrations in patient's plasma.

Bioequivalency of ranitidine tablets.

The bioavailability of two brands of ranitidine tablets was studied in 10 healthy volunteers. Formulation factors were compared by performing disintegration, dissolution and content uniformity tests. Plasma concentrations of ranitidine were measured using a sensitive and precise high pressure liquid chromatographic (HPLC) procedure. Pharmacokinetic parameters were determined for both formulations and included: Cmax, AUCt, AUC infinity, tmax, t1/2 and the terminal rate of elimination (k). Statistical analysis revealed that differences between the brands were not significant. The two formulations can be considered to be bioequivalent.

High-performance liquid chromatographic analysis of ranitidine in plasma and urine.

A high-performance liquid chromatographic method for the analysis of ranitidine in plasma and urine is described. Plasma samples were extracted with dichloromethane while urine samples were injected directly after dilution. The mobile phase consisted of: 0.05 M ammonium acetate buffer containing 0.01 M octane sulphonate, 5.3%; methanol, 31.6%; and acetonitrile, 63.1%. Detection was carried out at 330 nm. Metoclopramide was used as the internal standard. Peak height ratios were measured. Absolute recovery from plasma was 83-85%. Within and between day coefficients of variation ranged from 0.79 to 2.42% and 1.09-2.95% respectively. Plasma and urine samples from a healthy volunteer were analysed.

Determination of total iron in foods by isotope dilution fast atom bombardment mass spectrometry.

A method employing isotope dilution fast atom bombardment mass spectrometry has been developed for the quantitative determination of iron in foods. Samples were spiked with an enriched source of 54Fe, digested with concentrated HNO3/H2SO4 and the iron extracted from 6 M HCl into diethyl ether. Bracketing procedures gave precisions ranging from 1.30-4.49% relative standard deviation (RSD) for isotope ratio measurements and 1.26-6.44% RSD for iron measurements.