Warming during embryogenesis induces a lasting transcriptomic signature in fishes.

Exposure to elevated temperatures during embryogenesis can influence the plasticity of tissues in later life. Despite these long-term changes in plasticity, few differentially expressed genes are ever identified, suggesting that the developmental programming of later life plasticity may occur through the modulation of other aspects of transcriptomic architecture, such as gene network organisation. Here, we use network modelling approaches to demonstrate that warm temperatures during embryonic development (developmental warming) have consistent effects in later life on the organisation of transcriptomic networks across four diverse species of fishes: Scyliorhinus canicula, Danio rerio, Dicentrarchus labrax, and Gasterosteus aculeatus. The transcriptomes of developmentally warmed fishes are characterised by an increased entropy of their pairwise gene interaction networks, implying a less structured, more 'random' set of gene interactions. We also show that, in zebrafish subject to developmental warming, the entropy of an individual gene within a network is associated with that gene's probability of expression change during temperature acclimation in later life. However, this association is absent in animals reared under 'control' conditions. Thus, the thermal environment experienced during embryogenesis can alter transcriptomic organisation in later life, and these changes may influence an individual's responsiveness to future temperature challenges.

Thompson Hemiarthroplasty for Femoral Neck Fracture Is Associated With Increased Risk of Dislocation.

BACKGROUND: This contemporaneous large multicenter retrospective study reflective of current practice, assesses the impact of patient factors, prosthesis selection, and implant features on the risk of dislocation after hip hemiarthroplasty for femoral neck fracture. METHODS: Radiographic records for 4116 consecutive patients who underwent a hip hemiarthroplasty between January 1, 2009 and September 30, 2017 at 3 acute hospitals (including a regional major trauma center) for a neck of femur fracture were reviewed in conjunction with United Kingdom National Hip Fracture Database records. RESULTS: In total, 4116 patients were eligible for inclusion in the study; 63 of 4116 (1.5%) dislocations were identified. Patient age, gender, preoperative abbreviated mental test score, postoperative abbreviated mental test score, and American Society of Anaesthesiologists grade were not found to be significant predictors of dislocation rates (P < .05). The Furlong prosthesis was the most commonly used implant (2280/4116, 55.4%) followed by the Exeter V40 + Unitrax head (1179/4116, 28.6%), other implants used during the study period were the monoblock Austin-Moore and Thompson implants. Hemiarthroplasty operations undertaken with the Thompson (24/273, 3.7%) were found to have significantly higher dislocation rates (P < .05). Cemented vs uncemented, variable vs fixed offset, and monoblock vs modular implant designs did not contribute to higher dislocation rates (P < .05). Surgeon seniority was also not a significant risk factor for subsequent dislocation (P < .05). CONCLUSIONS: Thompson hip hemiarthroplasties are associated with higher dislocation rates when compared to a contemporaneous cohort of implant choices and considerations for their use should be made in conjunction with this major risk factor for the need for subsequent operations.

Twins! Microsatellite analysis of two embryos within one egg case in oviparous elasmobranchs.

Elasmobranchs display various reproductive modes, which have been key to their evolutionary success. In recent decades there has been a rise in the number of reported cases of foetal abnormalities including fertilised, double-embryos held within one egg capsule, hereafter referred to as twins. Previously, the occurrences of twin egg cases have been reported in two batoid and one shark species. We report the first cases of twins in three species of oviparous elasmobranchs: the undulate ray (Raja undulata), the nursehound (Scyliorhinus stellaris), and the small-spotted catshark (Scyliorhinus canicula). We investigated the genetic relationships between the twins in S. stellaris, and S. canicula using microsatellite markers. Whilst the S. stellaris twins displayed the same genotypes, we found that the S. canicula twin individuals arose through heteropaternal superfecundation. This is the first reported incidence of such a paternity in elasmobranchs. The relationship between environmental change and reproductive strategy in elasmobranchs is unclear and further research is needed to determine its effect on the prevalence and mechanisms of formation of elasmobranch twins.

Recognition software successfully aids the identification of individual small-spotted catsharks Scyliorhinus canicula during their first year of life.

Eighteen captive small-spotted catsharks Scyliorhinus canicula were successfully identified from hatching to 1 year of age using the free computer recognition software, I3 S classic. The effect of increasing the time interval between recognition attempts on the accuracy of the software was investigated, revealing that recognition fiedelity decreases with increasing time intervals for younger (0 to 15 weeks), but not older (15 weeks onwards) sharks. Identification by I3 S was validated using genetic analyses of seven microsatellite markers, revealing a 100% success rate. Thus, this non-invasive recognition method can be used as an inexpensive and effective alternative to invasive tagging, improving animal welfare and complementing ex-situ conservation methods.

Departmental induction and the simulated surgical ward round.

BACKGROUND: Departmental induction for junior doctors is a very important part of the process of handover, so as to facilitate continuity of care and patient safety. Historically this is led by senior doctors within the department, and may not cover the topics that are most needed. CONTEXT: An audit of induction of our junior doctors highlighted concerns, including inadequate training on surgical ward rounds and preparedness for their role. Consultant feedback suggested ward rounds were often of poor quality, causing delays, potentially affecting patient care and limiting the time for teaching. INNOVATION: A new near-peer induction including simulated ward rounds was introduced. An updated written survival guide was also developed. The induction included a presentation of common cases. The simulated ward round included the use of a high-fidelity simulation suite to allow realistic scenarios. Results demonstrated an improvement in the perceived preparedness of junior doctors for their role within the department. Overall preparedness improved from 5.80/10 to 8.75/10 (0, not prepared at all; 10, fully prepared for all day-to-day tasks). Overall satisfaction at the end of the placement was high, with all juniors recommending the placement. Consultant feedback demonstrated an 83 per cent improvement in their ward rounds. An audit of induction of junior doctors highlighted concerns IMPLICATIONS: A near-peer departmental induction using simulated ward rounds may improve the preparedness of junior doctors for their role within a new department, potentially improving patient care and the junior doctors' learning experiences.

Revision total hip arthroplasty: the femoral side using cemented implants.

Advances in surgical technique and implant technology have improved the ten-year survival after primary total hip arthroplasty (THA). Despite this, the number of revision procedures has been increasing in recent years, a trend which is predicted to continue into the future. Revision THA is a technically demanding procedure often complicated by a loss of host bone stock which may be compounded by the need to remove primary implants. Both cemented and uncemented implant designs are commonly used in the United Kingdom for primary and revision THA and much controversy still exists as to the ideal method of stem fixation. In this article we discuss revision of the femur using cemented components during revision THA. We focus on three clinical scenarios including femoral cement-in-cement revision where the primary femoral cement-bone interface remains well fixed, femoral cement-in-cement revision for peri-prosthetic femoral fractures, and femoral impaction grafting. We discuss the clinical indications, surgical techniques and clinical outcomes for each of these procedures.

Cemented polished tapered stems in patients less than 50 years of age: a minimum 10-year follow-up.

We report the outcome of 58 consecutive polished tapered stems in 47 patients younger than 50 years, with a minimum of 10 years of follow-up. No stems were revised for aseptic loosening or osteolysis. The Harris hip scores were good or excellent in 76% of the patients. There was excellent preservation of proximal bone. Despite higher patient weight and frequent previous surgery, the outcome of polished tapered stems in patients younger than 50 years is comparable to the general population undergoing total hip arthroplasty and superior to other non-polished tapered stem designs in young patients. Cup wear and cup failure were significantly worse in this group, with a higher incidence of periarticular osteolysis. Polished tapered stem designs are the benchmark for comparison to other arthroplasty options in young patients.

The use of post-operative reverse camber shoes following scarf osteotomy.

BACKGROUND: Reverse camber shoes are a popular choice for immobilization following scarf osteotomy. There are no reports in the literature giving guidance on the duration of shoe use. METHODS: Seventy-eight patients were reviewed. All had been advised to remain in reverse camber shoes until point of radiographic follow up. Data regarding time spent in shoes, associated adverse symptoms of shoes, and complications were recorded. RESULTS: Three groups emerged. Group 1 (65 patients) wore the shoes for the instructed period of time. Group 2 (six patients) were those who removed the shoes early. Group 3 (seven patients) were those who wore the shoes following review. There were no differences in complication rates between the groups. CONCLUSION: The use of post-op shoes is for symptom control. Our practice now is to advise patients to wear their shoes for as long as they feel necessary rather than giving them a prescriptive time limit.

Letters and notes in orthopaedic surgery.

INTRODUCTION: Accurate written communication is essential in orthopaedic surgery. Incomplete and poorly structured letters can lead to poor knowledge of a patient's diagnosis. MATERIALS AND METHODS: Structured and traditional letter formats were compared for speed of reading and preference by general practitioners (GPs), consultants, registrars and out-patient nursing staff. In addition, out-patient clinic letters and notes were analysed and compared for speed of reading and ease of assimilating information and content. RESULTS: There was overwhelming preference for the structured letter format. This style of letter could be read significantly more quickly with information better assimilated and relevant data included more frequently. However, only 26% of letters generated contained a complete set of information sought by GPs and hospital staff. CONCLUSIONS: Structured letters are better in orthopaedics because it is easier to access the contents. The structured format disciplines medical staff to address essential information. Even with a structured format the majority of letters omitted essential information. Training in letter writing is necessary. A structured letter format next to dictating machines might improve the quality of letters generated.

Severe anemia in a 25-day-old infant due to gastric teratoma with focal neuroblastoma.

Gastric teratoma is an extremely rare embryonic neoplasm containing tissue from all three germ layers (ectoderm, endoderm, and mesoderm). A 25-day-old infant presented with anemia and a palpable abdominal mass. Computed tomography (CT) scanning showed a solid and cystic multiloculated tumor of mixed echogenicity and calcifications. An encapsulated bleeding tumor localized to the posterior wall of the stomach with extension to a bowel segment was promptly excised. Histology revealed a grade III immature teratoma with small foci of neuroblastoma. To the best of our knowledge, this is the first infant with gastric teratoma containing foci of neuroblastoma causing bleeding and anemia as presentation symptoms at neonatal age.