Biological augmentation of graft healing in anterior cruciate ligament reconstruction: a systematic review.

Aims: The success of anterior cruciate ligament reconstruction (ACLR) depends on osseointegration at the graft-tunnel interface and intra-articular ligamentization. Our aim was to conduct a systematic review of clinical and preclinical studies that evaluated biological augmentation of graft healing in ACLR. Materials and Methods: In all, 1879 studies were identified across three databases. Following assessment against strict criteria, 112 studies were included (20 clinical studies; 92 animal studies). Results: Seven categories of biological interventions were identified: growth factors, biomaterials, stem cells, gene therapy, autologous tissue, biophysical/environmental, and pharmaceuticals. The methodological quality of animal studies was moderate in 97%, but only 10% used clinically relevant outcome measures. The most interventions in clinical trials target the graft-tunnel interface and are applied intraoperatively. Platelet-rich plasma is the most studied intervention, but the clinical outcomes are mixed, and the methodological quality of studies was suboptimal. Other biological therapies investigated in clinical trials include: remnant-augmented ACLR; bone substitutes; calcium phosphate-hybridized grafts; extracorporeal shockwave therapy; and adult autologus non-cultivated stem cells. Conclusion: There is extensive preclinical research supporting the use of biological therapies to augment ACLR. Further clinical studies that meet the minimum standards of reporting are required to determine whether emerging biological strategies will provide tangible benefits in patients undergoing ACLR. Cite this article: Bone Joint J 2018;100-B:271-84.

The effect of bearing surface on risk of periprosthetic joint infection in total hip arthroplasty: a systematic review and meta-analysis.

AIMS: Periprosthetic joint infection (PJI) is a serious complication of total hip arthroplasty (THA). Different bearing surface materials have different surface properties and it has been suggested that the choice of bearing surface may influence the risk of PJI after THA. The objective of this meta-analysis was to compare the rate of PJI between metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), and ceramic-on-ceramic (CoC) bearings. PATIENTS AND METHODS: Electronic databases (Medline, Embase, Cochrane library, Web of Science, and Cumulative Index of Nursing and Allied Health Literature) were searched for comparative randomized and observational studies that reported the incidence of PJI for different bearing surfaces. Two investigators independently reviewed studies for eligibility, evaluated risk of bias, and performed data extraction. Meta-analysis was performed using the Mantel-Haenzel method and random-effects model in accordance with methods of the Cochrane group. RESULTS: Our search strategy revealed 2272 studies, of which 17 met the inclusion criteria and were analyzed. These comprised 11 randomized controlled trials and six observational studies. The overall quality of included studies was high but the observational studies were at high risk of bias due to inadequate adjustment for confounding factors. The overall cumulative incidence of PJI across all studies was 0.78% (1514/193 378). For each bearing combination, the overall incidence was as follows: MoP 0.85% (1353/158 430); CoP 0.38% (67/17 489); and CoC 0.53% (94/17 459). The meta-analysis showed no significant difference between the three bearing combinations in terms of risk of PJI. CONCLUSION: On the basis of the clinical studies available, there is no evidence that bearing choice influences the risk of PJI. Future research, including basic science studies and large, adequately controlled registry studies, may be helpful in determining whether implant materials play a role in determining the risk of PJI following arthroplasty surgery. Cite this article: Bone Joint J 2018;100-B:134-42.

Bias in congenital malformations information from the birth certificate.

An analysis of 1983 data from California birth certificates, and from the California Birth Defects Monitoring Program case registry, showed that there is a bias in reporting of congenital malformations on the birth certificate. Hospitals with many births erroneously report lower malformation rates than do hospitals with few births. The bias is partly due to the source of information; larger hospitals are more likely to get their information about malformations from the obstetrician than from the pediatrician. Since malformation data recorded on the birth certificate is both incomplete and biased, at present it is advisable to use these data for epidemiologic analyses with great caution.

Evaluation of the hospital discharge diagnoses index and the birth certificate as sources of information on birth defects.

The hospital discharge diagnoses index (DI) for newborns and the birth certificate were evaluated as sources of information about birth defects by comparing them with the same births in the case registry of the California Birth Defects Monitoring Program (CBDMP). The CBDMP is an active surveillance system; the staff visit hospitals to identify children with birth defects diagnosed in the first year of life. The study population comprised 66,481 live births to residents of five counties in the San Francisco Bay area in 1983. Of these infants, 2,543 had at least one birth defect noted on the DI, and 1,623 were in the CBDMP registry; 1,020 with defects noted on the DI were also in the CBDMP registry. For this same population, 399 infants had one or more defects noted on the birth certificate; 304 of these were also in the CBDMP registry. Reporting of birth defects on the birth certificate was poor for every condition. Reporting on the DI was most reliable for oral clefts and chromosomal defects; for these defects, the DI omitted one-third of the cases but had identified only about 10 percent false-positive (that is, unverified) cases. Major central nervous system malformations were less well reported, with about one-third of them false-positive. For all other birth defects, the DI either omitted more than half of the cases, or more than half of the cases reported were false-positive cases. These findings raise questions about the validity of analytic studies of birth defects if the data are obtained only from the DI or the birth certificate.

Repeatability of infant deaths in Korea.

Using data from the world fertility survey for Korea, repeatability of infant death in the family was investigated applying the log-linear model. There is a strong association in survivorship between any two consecutive births. No such association is observed in nonconsecutive birth orders. There is a suggestion however, that the survival of the first birth is related to that of the third or even the fourth birth order.

A study on the effects of induced abortion on subsequent pregnancy outcome.

Presented here is the pregnancy outcome of 2,081 women who had one or more previous induced abortions compared with the outcome of 4,098 matched control subjects without a history of abortion. Data were collected from records and interviews of women delivering spontaneously at nine California hospitals during a 16-month period, 1976 to 1978. Women with a history of previous induced abortion showed a small but statistically significant increase in incidence of subsequent pregnancy failure. The increased risk associated with previous abortion was substantially smaller than the increase associated with several other social, economic, and behavioral indicators measured at the same time.

PIP: The pregnancy outcomes of 2081 women who had 1 or more previous induced abortion were compared with the outcomes of 4098 matched controls without a history of abortion. The data were collected from 9 California hospitals during a 16-month period, 1976 to 1978. Chi-square tests of 2-by-2 tables and multivariate analysis (multiple logistic regression) were performed. Mean ages of case and control subjects were 24.1 and 24.0 respectively. One prior spontaneous abortion had occurred in 8.4% of the cases and in 8.1% of controls. There were no differences in the outcomes rates of ectopic pregnancy, spontaneous abortion ( 20 weeks), congenital anomalies and infants of low birthweight. A small but statistically significant increase in incidence of subsequent pregnancy failure was observed in women with a history of previous abortion. 6 other variables in the study demonstrated a stronger association with pregnancy failure, as indicated by the odds ratio, with higher significance levels for each. A parodoxical finding was the positive relation of good prenatal care and high economic status with pregnancy failure. A possible explanation was that the study included many women with Spanish surnames who tended to have late or no prenatal care and fall into the low-income category, but throughout the study showed a significantly better than average outcome.

The risk of low birthweight.

Descriptive analyses of birthweight for single live births in the United States during 1974, using birth certificate information, show that several factors are associated with a high incidence of low birthweight babies. Multivariate analyses were performed to determine correlates of low birthweight. When other factors are held constant, race not white, previous reproductive loss, short interpregnancy interval, out-of-wedlock birth, no prenatal care, and maternal age under 18 years or over 35 years each increase the risk of having an infant of low birthweight. High birth order and maternal education under 12 years of schooling were not consistent risk factors for low birthweight. Odds ratios are presented and the method for combining these, to estimate the risk for an individual mother having a low-birthweight infant, is illustrated.

Improvement in infant and perinatal mortality in the United States, 1965--1973: I. Priorities for intervention.

Changes in United States infant and perinatal mortality in the period 1965--1973 were examined by race, age at death or length of gestation, and degree of urbanization. The decline of postneonatal mortality rates was greater than the declines of fetal and neonatal mortality rates. Other-than white infant and fetal mortality rates improved more than the white rates, except in the first day of life. Postneonatal mortality rates improved more in rural than in urban areas, while neonatal and perinatal mortality rates improved more in urban areas than in rural. These improvements in mortality rates have occurred at the same time as changes in medical techniques and the organization and availability of health services, improvements in economic conditions and standards of living, and changes in the demographic characteristics of the child-bearing population of the United States. Each of these changes was in a direction expected to have a favorable effect on infant and perinatal mortality. Nevertheless, the improvement of infant mortality rates has not changed the relative position of the United States in comparison with other countries. Programs to improve infant and perinatal mortality can use the data in this study to define high priority target groups using a method based on the size of the problem in the target group, the severity of the problem, and the amount and direction of change.

Effects of DDT on reproduction in multiple generations of beagle dogs.

The effects of chronic oral exposure to 1, 5, and 10 mg of technical DDT/kg/day on: 1) age at puberty, length of gestation, fertility, success of pregnancy, litter size, and lactational ability of dams; 2) viability, survival to weaning, sex distribution and growth of pups; and 3) morbidity, mortality, organ/body weight ratios, gross and histologic abnormalities in all animals were studied through three generations of Beagle dogs. There were a total of 135 adult female and 63 adult male dogs in the project which produced 650 pups. There were no statistically significant differences among control and DDT-treated dogs in any of the reproductive variables, with the exception of age at puberty of the females. DDT-treated females had their first estrous cycles 2 to 3 months earlier (P less than .001) than the control dogs. Selected DDT-treated females, held for a second breeding period, had normal anestrous periods between their first and second estrous cycles. There was no effect of DDT on survival, growth, and sex distribution of pups, nor was there any influence on morbidity, mortality, gross or histologic findings in any of the dogs. All organ/body weight ratios were normal, with the possible exception of an increase in liver/body weight ratio in some DDT-treated animals.