Rare presentation of bilateral thumb psoriatic arthritis treated with arthrodesis: a case report.

Psoriatic arthritis (PsA) is a seronegative inflammatory arthritis that occurs concomitantly with cutaneous manifestations and tendinous pathology that affects up to 1% of the general population. While the majority of cases are mild, nearly 20% of PsA patients will progress to severe disease manifesting as debilitating polyarticular inflammation and joint destruction. PsA is most commonly asymmetric and bilateral severe disease involving the same joints in each hand has rarely been reported in the literature. It is estimated that PsA only presents bilaterally in a quarter of patients. The recent increase in popularity and efficacy of disease-modifying anti-rheumatic drugs (DMARDs) has led to increasing rarity of such severe disease progression. We present a case of a 47-year-old male with PsA who had a unique pattern of bilateral first metacarpophalangeal (MP) and interphalangeal (IP) involvement with minimal erosion leading to significant joint pain, instability, dislocation, and loss of function. After failure of conservative treatment that included both DMARDs and non-steroidal anti-inflammatory drugs (NSAIDs), the patient opted for surgical management. The purpose of this report is to identify a rare presentation of PsA and consider the significance of MP joint arthrodesis as a viable treatment to restore functional status and improve quality of life.

The effects of PTH, loading and surgical insult on cancellous bone at the bone-implant interface in the rabbit.

Enhancing the quantity and quality of cancellous bone with anabolic pharmacologic agents may lead to more successful outcomes of non-cemented joint replacements. Using a novel rabbit model of cancellous bone loading, we examined two specific questions regarding bone formation at the bone-implant interface: (1) does the administration of intermittent PTH, a potent anabolic agent, and mechanical loading individually and combined enhance the peri-implant cancellous bone volume fraction; and, (2) does surgical trauma enhance the anabolic effect of PTH on peri-implant bone volume fraction. In this model, PTH enhanced peri-implant bone volume fraction by 30% in loaded bone, while mechanical loading alone increased bone volume fraction modestly (+10%). Combined mechanical loading and PTH treatment had no synergistic effect on any cancellous parameters. However, a strong combined effect was found in bone volume fraction with combined surgery and PTH treatment (+34%) compared to intact control limbs. Adaptive changes in the cancellous bone tissue included increased ultimate stress and enhanced remodeling activity. The number of proliferative osteoblasts increased as did their expression of pro-collagen 1 and PTH receptor 1, and the number of TRAP positive osteoclasts also increased. In summary, both loading and intermittent PTH treatment enhanced peri-implant bone volume, and surgery and PTH treatment had a strong combined effect. This finding is of clinical importance since enhancing early osseointegration in the post-surgical period has numerous potential benefits.

Phytoavailability of cadmium in long-term biosolids-amended soils.

Agronomic use of biosolids has raised concern that plant availability of biosolids-Cd will increase with time after cessation of biosolids application. It has been demonstrated that chemical extractability of Cd is persistently decreased in biosolids-amended soils. This study was conducted to determine if Cd phytoavailability in long-term biosolids-amended soils was also persistently decreased. Paired control and biosolids-amended soils were collected from three experimental sites where large cumulative rates of biosolids were applied about 20 yr ago. The pH of all soils [in 0.01 mol L(-1) Ca(NO(3))(2)] was adjusted to 6.5 +/- 0.2. Increasing rates of Cd-nitrate (from 0 to 10.0 mg Cd kg(-1) soil) enriched in (111)Cd stable isotope were added to all soils, and Romaine lettuce (Lactuca sativa L. var. longifolia Lam.) was grown in pots to bioassay phytoavailable Cd. After harvest, Cd concentrations in shoots and labile pool of Cd (Cd(L)) in soils were determined. The relationship between added salt-Cd and Cd concentrations in lettuce shoots was linear for all soils tested. Ratios of (shoot Cd):(soil Cd) slopes were highest in the control soils. Biosolids amendment decreased (shoot Cd):(soil Cd) slopes to varied extent depending on biosolids source, properties, and application rate. The decrease in slope in comparison to the control was an indication of the lower phytoavailability of Cd in biosolids-amended soils. A significant negative correlation existed between Cd uptake slopes and soil organic matter, free and amorphous Fe and Al oxides, Bray-P, and soil and plant Zn. Biosolids-Cd was highly labile (%L 80-95) except for Fulton County soil (%L = 61).

Failure of the Patellar Tendon with the Patella Everted versus Noneverted in a Matched-Pair Cadaver Model.

Avoidance of patellar eversion during total knee arthroplasty may help to prevent injury to the patellar tendon. The purpose of this study was to compare the load-to-failure of the everted versus the noneverted patella in a cadaveric model. Fourteen cadaver knees (seven pairs) were loaded to failure with the patella everted in one knee and not everted in the other. Mean load-at-ultimate failure in the patella-everted group was 1,111 ± 572 N, and in the patella-noneverted group was 1,621 ± 683 N (p = 0.01). Additionally, loads-at-initial-partial failure were lower (p = 0.04) in the patella-everted compared to the patella-noneverted group, 573 ± 302 N versus 1,115 ± 358 N, respectively. A partial failure of the patellar tendon occurred in 100% of the everted specimens, whereas only 57% of the noneverted specimens had partial failure. These findings suggest patella eversion may lead to failure of the patellar insertion at lower loads than when the patella is not everted.

Accuracy of computer navigation for acetabular component placement in THA.

The accuracy and precision of any computer-aided surgical device is critical to its utility. We asked the following question: how accurate and precise are the values measured by an imageless computer navigation system as compared with those measured using postoperative CT scans? Twenty-five patients (26 hips) underwent primary THA using an imageless computer navigation system for placement of the acetabular component. Inclination and anteversion were measured in the operative coordinate system as defined by Murray. Accuracy, precision, and bias were computed, and Bland-Altman analysis was used to assess levels of agreement. The accuracy (mean +/- standard deviation of the absolute difference between computer-assisted navigation and CT) was 1.8 degrees +/- 1.2 degrees for inclination and 2.0 degrees +/- 2.0 degrees for anteversion. Precision was 3.4 degrees for inclination and 5.5 degrees for anteversion. Bias was 0.52 degrees for inclination and 0.35 degrees for anteversion. Limits of agreement were 4.26 degrees for inclination and 5.58 degrees for anteversion. An imageless computer navigation system can precisely determine acetabular cup position.

Mechanical compression of articular cartilage induces chondrocyte proliferation and inhibits proteoglycan synthesis by activation of the ERK pathway: implications for tissue engineering and regenerative medicine.

Articular cartilage is recalcitrant to endogenous repair and regeneration and is thus a focus of tissue engineering and regenerative medicine strategies. A prerequisite for articular cartilage tissue engineering is an understanding of the signal transduction pathways involved in mechanical compression during trauma or disease. We sought to explore the role of the extracellular signal-regulated kinase 1/2 (ERK 1/2) pathway in chondrocyte proliferation and proteoglycan synthesis following acute mechanical compression. Bovine articular cartilage explants were cultured with and without the ERK 1/2 pathway inhibitor PD98059. Cartilage explants were statically loaded to 40% strain at a strain rate of 1/s for 5 s. Control explants were cultured under similar conditions but were not loaded. There were four experimental groups: (a) no load, without inhibitor; (b) no load, with the inhibitor PD98059; (c) loaded, without the inhibitor; and (d) loaded, with the inhibitor PD98059. The explants were cultured for varying durations from 5 min to 5 days and were then analysed by biochemical and immunohistochemical methods. Mechanical compression induced phosphorylation of ERK 1/2, and this was attenuated with the ERK 1/2 pathway inhibitor PD98059 in a dose-dependent manner. Chondrocyte proliferation was increased by mechanical compression. This effect was blocked by the inhibitor of the ERK 1/2 pathway. Mechanical compression also led to a decrease in proteoglycan synthesis that was reversed with inhibitor PD98059. In conclusion, the ERK 1/2 pathway is involved in the proliferative and biosynthetic response of chondrocytes following acute static mechanical compression.

Doublecortin is expressed in articular chondrocytes.

Articular cartilage and cartilage in the embryonic cartilaginous anlagen and growth plates are both hyaline cartilages. In this study, we found that doublecortin (DCX) was expressed in articular chondrocytes but not in chondrocytes from the cartilaginous anlagen or growth plates. DCX was expressed by the cells in the chondrogenous layers but not intermediate layer of joint interzone. Furthermore, the synovium and cruciate ligaments were DCX-negative. DCX-positive chondrocytes were very rare in tissue engineered cartilage derived from in vitro pellet culture of rat chondrosarcoma, ATDC5, and C3H10T1/2 cells. However, the new hyaline cartilage formed in rabbit knee defect contained mostly DCX-positive chondrocytes. Our results demonstrate that DCX can be used as a marker to distinguish articular chondrocytes from other chondrocytes and to evaluate the quality of tissue engineered or regenerated cartilage in terms of their "articular" or "non-articular" nature.

Determining speciation of Pb in phosphate-amended soils: method limitations.

Determining the effectiveness of in situ immobilization for P-amended, Pb-contaminated soils has typically relied on non-spectroscopic methods. However in recent years, these methods have come under scrutiny due to technical and unforeseen error issues. In this study, we analyzed 18 soil samples via X-ray diffraction (XRD), selective sequential extraction (SSE), and a physiologically based extraction test (PBET). The data were compared against each other and to previous data collected for the soil samples employing X-ray absorption fine structure spectroscopy coupled with linear combination fitting (XAFS-LCF), which spectroscopically speciates and quantifies the major Pb species in the samples. It was observed that XRD was incapable of detecting pyromorphite, the hopeful endpoint of the immobilization strategy for reduced Pb bioavailability in our studies. Further, the SSE and PBET extraction methods demonstrated an increase of recalcitrant Pb forms in comparison to the XAFS-LCF results suggesting that SSE and PBET methods induced the precipitation of pyromorphite during the extraction procedures. The theme of this paper illustrates the experimental concerns of several commonly employed methods to investigate immobilization strategies of amended, metal-contaminated systems which may not be in true equilibrium. We conclude that appropriate application of spectroscopic methods provides more conclusive and accurate results in environmental systems (i.e., Pb, Zn, Cd, etc.) examining P-induced immobilization.

Spectroscopic speciation and quantification of lead in phosphate-amended soils.

The immobilization of Pb in contaminated soils as pyromorphite [Pb(5)(PO(4))(3)Cl, OH, F] through the addition of various phosphate amendments has gained much attention in the remediation community. However, it is difficult to fully determine the speciation and amount of soil Pb converted to pyromorphite by previously employed methods, such as selective sequential extraction procedures and scanning electron microscopy coupled with energy dispersive X-ray spectroscopy, which often lead to erroneous results in these non-equilibrated and heterogeneous systems. Statistical analysis by linear combination fitting (LCF) applied to X-ray absorption fine structure (XAFS) spectroscopic data of Pb-contaminated soil samples relative to known Pb reference material provides direct, in situ evidence of dominate Pb species in the amended soils without chemical or physical disruption to the Pb species as well as a weighted quantification output. The LCF-XAFS approach illustrated that pyromorphite concentration ranged from 0% (control soil) to 45% (1% phosphoric acid amendment, residence time of 32 mo) relative to the total Pb concentration. The Pb speciation in the nonamended control soil included Pb-sulfur species (galena + angelsite = 53%), adsorbed Pb (inner-sphere + outer-sphere + organic-bound = 45%), and Pb-carbonate phases (cerussite + hydrocerussite = 2%). The addition of P promoted pyromorphite formation and the rate of formation increased with increasing P concentration (up to 45%). The supplemental addition of an iron amendment as an iron-rich byproduct with triple superphosphate (TSP) enhanced pyromorphite formation relative to independent TSP amendment of like concentrations (41 versus 29%). However, the amendment of biosolids and biosolids plus TSP observed little pyromorphite formation (1-16% of total Pb), but a significant increase of sorbed Pb was determined by LCF-XAFS.

Lead sorption on ruthenium oxide: a macroscopic and spectroscopic study.

The sorption and desorption of Pb on RuO2.xH2O were examined kinetically and thermodynamically via spectroscopic and macroscopic investigations. X-ray absorption spectroscopy (XAS) was employed to determine the sorption mechanism with regard to identity and interaction of nearest atomic neighbors, bond distances (R), and coordination numbers (N). The kinetics of the Pb-Ru-oxide sorption reaction are rapid with the equilibrium loading of Pb on the surface achieving approximately 1:1 wt/wt (129 micromol m(-2)). XAS data indicate that Pb adsorbed as bidentate innersphere complexes with first shell Pb-O parameters of RPb-O = 2.27 A and NPb-O = 2.1-2.5. Pb-Ru interatomic associations suggest two distinct bidentate surface coordinations of Pb to edges (RPb-RuI approximately 3.38 A, NPb-RuI approximately 1.0) and shared corners (RPb-RuII approximately 4.19 A, NPb-RuII approximately 0.8) on RuO2 octahedra (cassiterite-like structure), and an additional second neighbor backscattering of Pb indicates the formation of Pb-Pb dimers (RPb-Pb degrees 3.89 A, NPb-Pb approximately 0.9). Desorption studies as a function of aging time (1 h to 1 year) using a continuous stirred-flow reactor with a background electrolyte (0.01 M NaNO3, pH 6) demonstrated that Pb was tightly bound (99.7-99.9% retained). The Pb sorption capacity and retention on RuO2.xH2O is greater than that of other metal oxides examined in the literature. The results of this study imply that RuO2.xH2O may serve as a high capacity remediation treatment media.

In situ soil treatments to reduce the phyto- and bioavailability of lead, zinc, and cadmium.

A study was established near a former Zn and Pb smelter to test the ability of soil amendments to reduce the availability of Pb, Zn, and Cd in situ. Soil collected from the field was amended in the lab with P added as 1% P-H3PO4, biosolids compost added at 10% (referred to hereafter as "compost"), and a high-Fe by-product (referred to hereafter as "Fe") + P-triple superphosphate (TSP) (2.5% Fe + 1% P-TSP) and incubated under laboratory conditions at a constant soil pH. Changes in Pb bioavailability were measured with an in vitro test and a feeding study with weanling rats. Field-amended and incubated soils using these plus additional treatments were evaluated using the in vitro extraction and tall fescue (Festuca arundinacea Schreb. cv. Kentucky-31) metal concentration. Reductions were observed across all parameters but were not consistent. In the feeding study, the 1% P-H3PO4 and compost treatments resulted in a decrease of 26% in rat tissue Pb concentration compared with the control soil. The 2.5% Fe + 1% P-TSP showed a 39% decrease. The 1% P-H3PO4 treatment caused the greatest reduction in in vitro extractable Pb from field samples (pH 2.2) with a measured reduction of 66%, while the compost treatment had a 39% reduction and the 2.5% Fe + 1% P-TSP treatment a 50% reduction. The in vitro extraction (pH 1.5) run on field samples showed no reduction in the compost or Fe treatments. The 1% P-H3PO4 treatment was the most effective at reducing plant Pb, Zn, and Cd.

Outcome of gastrocnemius recession and tendo-achilles lengthening in ambulatory children with cerebral palsy.

Preoperative and postoperative gait analysis data were retrospectively studied for 54 children with cerebral palsy who had undergone either gastrocnemius recession (GR) or tendo-achilles lengthening (TAL) as part of multi-level surgery. Decision-making between GR and TAL was based on the Silfverskiöld test. The TAL group had greater equinus preoperatively than the GR group. Both groups showed significant improvement in static and dynamic dorsiflexion and in outcome measured by a modified Physician Rating Scale (PRS) postoperatively. Calf spasticity decreased and push-off power increased after GR. Both GR and TAL are effective in appropriately selected patients. However, a potential for over- and under-correction with both GR and TAL was demonstrated.

Potential role for antiangiogenic proteins in the myocardial infarction repair process.

OBJECTIVE: Although angiogenic proteins have been identified as positive modulators of myocardial revascularization following acute myocardial infarction, little if anything is known regarding the role that antiangiogenic proteins have in myocardial revascularization. We explored the temporospatial distribution of endothelial-monocyte activating polypeptide (EMAP) II to determine whether antiangiogenic proteins have a role in the repair of myocardial tissue following infarction. METHODS: A rat model of myocardial infarction was utilized to examine EMAP II distribution (in situ hybridization) and protein expression (Western analysis) over a 6-week period. RESULTS: At baseline, EMAP II protein and mRNA are minimally expressed with transcription products localizing predominately to the perivascular stroma region in the normal rat myocardium. Six hours following myocardial infarction, EMAP II changes its distribution from the perivascular stroma to an invading inflammatory cell population. This is associated with a 2-fold (P < 0.0009) increase in EMAP II protein and its transcription primarily localized to the infarct region. EMAP II protein expression remains elevated throughout the weeks following the infarction with transcription limited to the infarct region and a notable decrease in EMAP II transcription products noted in the viable vasculature surrounding the infarct zone. Six weeks following myocardial infarction, EMAP II protein is elevated above control, changes its location of transcription from the inflammatory cell population to that of the fibroblasts located in the relative avascular scar tissue, and has resumed its perivascular stromal distribution in the viable periinfarct tissue. CONCLUSIONS: Thus, the temporospatial distribution of this antiangiogenic protein suggests that negative vascular modulators may have a function in the revascularization process following acute myocardial infarction.

An improved understanding of soil Cd risk to humans and low cost methods to phytoextract Cd from contaminated soils to prevent soil Cd risks.

We believe greater consideration should be given the agronomic and nutritional/bioavailability factors that influence risk from Cd-contaminated soils. We have argued that the ability of rice to accumulate soil Cd in grain while excluding Fe, Zn and Ca (even though the soil contains 100-times more Zn than Cd) was important in adverse effects of soil Cd is farm families in Asia. Further, polished rice grain is deficient in Fe, Zn and Ca for humans, which promotes Cd absorption into duodenal cells. New kinetic studies clarified that dietary Cd is absorbed into duodenum enterocytes; 109Cd from a single meal remained in the duodenum for up to 16 days; part of the turnover pool 109Cd moved to the liver and kidneys by the end of the 64-day 'chase' period. Thus malnutrition induced by subsistence rice diets caused a higher absorption of dietary Cd and much higher potential risk from soil Cd than other crops. Because rice-induced Fe-Zn-Ca-malnutrition is so important in soil Cd risk, it seems evident that providing nutritional supplements to populations of exposed subsistence rice farmers could protect them against soil Cd during a period of soil remediation. In the long term, high Cd rice soils need to be remediated. Remediation by removal and replacement of contaminated soil is very expensive (on the order of $3 million/ha); while phytoextraction using the high Cd accumulating ecotypes of the Zn-Cd hyperaccumulator, Thlaspi caerulescens, should provide low cost soil Cd remediation.

Sorption and desorption of cadmium by different fractions of biosolids-amended soils.

To evaluate the importance of both the inorganic and organic fractions in biosolids on Cd chemistry, a series of Cd sorption and desorption batch experiments (at pH 5.5) were conducted on different fractions of soils from a long-term field experimental site. The slope of the Cd sorption isotherm increased with rate of biosolids and was different for the different biosolids. Removal of organic carbon (OC) reduced the slope of the Cd sorption isotherm but did not account for the observed differences between biosolids-amended soils and a control soil, indicating that the increased adsorption associated with biosolids application was not limited to the increased OC from the addition of biosolids. Removal of both OC and Fe/Mn further reduced the slopes of Cd sorption isotherms and the sorption isotherm of the biosolids-amended soil was the same as that of the control, indicating both OC and Fe/Mn fractions added by the biosolids were important to the increased sorption observed for the biosolids-amended soil samples. Desorption experiments failed to remove from 60 to 90% of the sorbed Cd. This "apparent hysteresis" was higher for biosolids-amended soil than the control soil. Removal of both OC and Fe/Mn fractions was more effective in removing the observed differences between the biosolids-amended soil and the control than either alone. Results show that Cd added to biosolids-amended soil behaves differently than Cd added to soils without biosolids and support the hypothesis that the addition of Fe and Mn in the biosolids increased the retention of Cd in biosolids-amended soils.

Treatment of contaminated soil with phosphorus and manganese oxide reduces lead absorption by Sprague-Dawley rats.

This study was conducted to determine the extent of Pb absorption into young rats (Rattus norvegicus var. Sprague-Dawley) fed untreated Pb-contaminated soil or Pb-contaminated soil treated with two different sources of P and P + Mn oxide. Data were compared from an in vitro, physiologically based extraction test (PBET) with the animal data to support the validity of the in vitro test to assess bioavailable Pb from a treated Pb-contaminated soil. Soil with a total Pb concentration of 2290 mg kg(-1) was used. Rats were fed 19 different test diets for 21 consecutive days. The test diets represented 95 g AIN93G rat meal kg(-1) diet with varying proportions of silica sand or soil to provide low, medium, or high doses of Pb from either Pb acetate, treated, or untreated soil. Blood, liver, kidney, and bone Pb concentrations were examined. For all four tissues, Pb concentrations for the Pb acetate groups were significantly higher than concentrations for all the soil groups. In general, either triple superphosphate (TSP) or phosphate rock (PR) treatments resulted in significant reductions in tissue Pb concentrations compared with untreated soil. Blood and kidney Pb concentrations for the PR + Mn oxide group were significantly lower than those of the PR group at the low and high doses. Relative bioavailability of Pb, as measured in all tissues, was significantly reduced when comparing untreated with amended soil. Correlation between the in vitro and in vivo tests, based on bone and liver tissue, showed that the in vitro test is successful at predicting Pb bioavailability.

Sorption of arsenate and arsenite on RuO2 x xH2O: a spectroscopic and macroscopic study.

The sorption reactions of arsenate (As(V)) and arsenite (As(III)) on RuO2 x xH2O were examined using macroscopic and spectroscopic techniques. Constant solid:solution isotherms were constructed from batch sorption experiments and sorption kinetics assessed at pH 7. X-ray absorption near edge spectroscopy (XANES) was employed to elucidate the solid-state speciation of sorbed As. At all pH values studied (pH 4-8), RuO2 x xH2O showed a high affinity for As regardless of the initial As species present. Sorption was higher at all pH values when the initial As species was As(III). Oxidation of As(III) (250 mg/L solution) to As(V) was virtually complete (98-100%) within 5 s. XANES results showed the presence of only As(V) on the RuO2 x xH2O regardless of the initial As oxidation state. There was no change in the As oxidation state on the solid phase for 4 weeks in both oxic and anoxic environments. It is speculated that changes in the RuO2 x xH2O structure, due to oxidation reactions, caused the higher total As sorption capacity when As(III) was the initial species. The As sorption capacity of RuO2 x xH2O is greater than that of other metal oxides reviewed in this study. The ability of RuO2 x xH2O to rapidly oxidize As(III) is much greater than other oxides, such as MnO2.

Assessment of a sequential extraction procedure for perturbed lead-contaminated samples with and without phosphorus amendments.

Sequential extraction procedures are used to determine the solid-phase association in which elements of interest exist in soil and sediment matrixes. Foundational work by Tessier et al. (Tessier, A.; Campbell, P. G. C.; Bisson, M. Anal. Chem. 1979, 51, 844-851) has found widespread acceptance and has been employed as an operational definition for metal speciation in solid matrixes. However, a major obstacle confronting sequential extraction procedures is species alteration of extracted metals before, during, and after separation of solids from solution. If this occurs, the results obtained from sequential extraction do not provide an accurate account of metal speciation within the matrix because the metal forms are altered from their field state. Many researchers dismiss this drawback since several sorption and precipitation processes are believed to occur at time scales much longer than any particular extraction step. This assumption may not be valid. The objectives of this study were to investigate the potential formation of pyromorphite (Pb5(PO4)3Cl) during the sequential extraction steps of Pb-spiked samples with and without calcium phosphate amendments and to examine the differences in the operationally defined distribution of Pb in samples with and without the presence of P. The systems that were examined in the absence of phosphate behaved, for the most part, adequately according to the operational definitions of the extraction procedure. However, when the samples were amended with phosphate, results were drastically changed with a significant shift of extractable Pb to the residual phase. This redistribution was due to pyromorphite formation during the extraction procedure as confirmed by X-ray diffraction and X-ray absorption (XAS) spectroscopies. These results indicate that sequential extraction methods may not be suitable for Pb speciation in perturbed environmental systems (i.e., fertilized agricultural soils or amended contaminated soils) and that rigorous interpretation should be avoided, if not supported by methods to definitively prove metal speciation (e.g., XAS).