Early Postoperative Displacement of Combined Pelvic Ring Injury With Acetabular Fracture.

Combined pelvic ring and acetabular injuries present a management challenge. The literature on this topic is scarce, with few outcomes studies available. This retrospective study assessed whether the incidence of postoperative displacement and loss of reduction is higher with combined injuries compared with isolated pelvic ring injuries and isolated acetabular fractures. The charts and radiographs of 33 patients with combined pelvic ring and acetabular fractures treated operatively during a 7-year period at a single institution were reviewed. Pelvic ring and acetabular displacements were measured during the early postoperative period and compared with final follow-up measurements (minimum 5 months after surgery). Measurements also were compared with those from isolated pelvic ring fractures (n=33) and isolated acetabular fractures (n=33). Groups were matched for injury pattern and were propensity-matched by age and Injury Severity Score. Patients with combined injuries and patients with isolated pelvic ring injuries had similar initial pelvic ring reductions on anteroposterior and outlet view radiographs. By final follow-up, the combined injury group had experienced significant additional pelvic ring displacement. The presence of combined injury was an independent risk factor for postoperative pelvic ring displacement. Initial postoperative acetabular displacement was higher in the combined injury group compared with the isolated acetabular fracture group (2.6±1.8 vs 1.1±1.1 mm). By final followup, apparent displacement decreased significantly for both groups. Patients with combined pelvic ring and acetabular fractures were more likely to have poorer acetabular reduction and additional displacement of the pelvic ring component during the postoperative period compared with patients with isolated injuries. [Orthopedics. 2017; 40(3):163-168.].

Salt loading increases urinary excretion of linoleic acid diols and triols in healthy human subjects.

Increased dietary linoleic acid has been associated with reduced blood pressure in clinical and animal studies possibly mediated by prostaglandins. Urinary linoleate and prostaglandin metabolite excretion were investigated in subjects exposed to a salt-loading/salt-depletion regimen. Twelve healthy subjects were recruited from the New Orleans population (before Hurricaine Katrina) and admitted to the Tulane-Louisiana State University-Charity Hospital General Clinical Research Center after a 5-day outpatient lead-in phase on a 160-mmol sodium diet. On inpatient day 1, the subjects were maintained on the 160-mmol sodium diet, and a 24-hour urine specimen was collected. On day 2, the subjects received 2 L of IV normal saline over 4 hours and continued on a 160-mmol Na(+) diet (total: 460 mmol of sodium). Two 12-hour urine collections were obtained. On day 3, the subjects received three 40-mg oral doses of furosemide, two 12-hour urine collections were obtained, and the subjects were given a 10-mmol sodium diet. Urinary oxidized lipids were measured by high-performance liquid chromatography-tandem quadrupole mass spectroscopy. The excretion of the urinary linoleate metabolites, dihydroxyoctadecamonoenoic acids, and trihydroxyoctadecamonoenoic acids increased significantly during intravenous salt loading as compared with day 1 and the salt-depleted periods. The urinary excretion of 6-keto- prostaglandin F1alpha was unaffected by salt loading but was dramatically increased 7- to 10-fold by salt depletion. Prostaglandin E2 excretion was positively correlated with sodium excretion. The salt-stimulated production of linoleic acid diols and triols may inhibit tubular sodium reabsorption, thereby assisting in the excretion of the sodium load.

The Prevalence of CYP2C8, 2C9, 2J2, and soluble epoxide hydrolase polymorphisms in African Americans with hypertension.

BACKGROUND: The cytochrome P450 (CYP) epoxygenase pathway produces arachidonic acid metabolites that are vasoactive, that affect renal sodium handling, and that have been proposed to play a mechanistic role in hypertension. Multiple single nucleotide polymorphisms (SNP) in CYP2C8, 2C9, 2J2 and soluble epoxide hydrolase (sEH) have been identified, many of which have altered functional activity in vitro. We performed a case-control study to determine the prevalence of epoxygenase-related SNP in African American individuals and to evaluate whether these SNP are associated with increased risk of hypertension. METHODS: Normotensive African American individuals (N = 107) and African American patients with hypertension (N = 108) were recruited. DNA was extracted from a venous blood sample and genotyped for CYP2C8*2,*3, CYP2C9*2-*5,*8,*11, CYP2J2 *2-*7, L50L, R49S, V113M, N124S, sEH R287Q, and sEH 403Rins variant alleles by allelic discrimination using real-time polymerase chain reaction. Genotype and allele frequencies were calculated and associations with hypertension were estimated using unconditional logistic regression, adjusting for age and sex. RESULTS: No association was found between any of the variant alleles and hypertension. We did find that only the CYP2C8*3and CYP2C9*2 alleles were in strong linkage disequilibrium in both the hypertensive and healthy African American groups, a finding that was reported previously in healthy individuals of white ethnicity. CONCLUSIONS: These results suggest that these epoxygenase-related SNP are not associated with increased risk of hypertension in the African American population. There was significant linkage disequilibrium between CYP2C8*3 and CYP2C9*2 alleles that was not associated with hypertension.