Stemless Hemiarthroplasty of the Shoulder Using the SMR® System: Summary of Six-Year Experience and Surgical Technique.

PURPOSE OF THE STUDY In the last number of years, the anatomic hemiarthoplasty has gradually been pushed out of clinical practice by modern reverse shoulder arthroplasty (RSA) designs. This is due to the clear excellent functional results of RSAs in a wide spectrum of indication criteria. Nevertheless, RSAs have several possible complications that cannot occur in an anatomic hemiarthroplasty. In anatomic hemiarthoplasty, the importance of correct indication criteria and observing correct operative technique including soft tissue reconstruction is much more important than in RSA. Furthermore, there is a clear recent trend of increased use of humeral components fixed only in the proximal metaphyseal cancellous bone. Our aim was to summarise our six-year experience with the SMR® Stemless (LimaCorporate, Italy) system which is one of the most modern ones. MATERIAL AND METHODS Twenty cases of SMR® Stemless anatomic shoulder hemiarthroplasty performed between 2016 and 2021 were included in the study. All patients were followed up prospectively. The function was evaluated preoperatively and at the last follow-up. We evaluated the range of active elevation, classic Constant Score (CS) and pain level according to the visual analogue scale (VAS). Statistical evaluation was performed by using basic statistical methods and the statistical significance of the results was assessed with a paired t-test. Level of statistical significance was set at p= 0.01. RESULTS The mean follow-up in our cohort was 3.01 years (range 0.32-5.69, Median 2.82, SD 1.56) All cases were indicated for surgery due to primary osteoarthritis with a limitation of movement and pain. The mean postoperative CS was 85.7 (range 70-96, Median 86, SD 6.83). The mean active elevation postoperatively was 143° (range 100-170°, Median 150°, SD 20.76). Mean postoperative pain according to VAS was 1.05 (range 0-4, Median 1, SD 1.02). The mean preoperative elevation was 60.5° (range 30-100°, Median 65°, SD 18.83). After surgery the mean elevation increased to 143° (range 100-170°, Median 150°, SD 20.76). Statistical evaluation showed a statistically significant increase in the CS (41.7 preoperatively to 85.7 postoperatively), range of active elevation (60.5° preoperatively to 143° postoperatively) and a statistically significant decrease in pain (VAS 6.95 preoperatively to 1.05 postoperatively). We observed no cases of failure or loosening of the implant. A statistically significant increase in post-operative range of motion was demonstrated. DISCUSSION Most modern shoulder arthroplasty designs now include implants allowing for proximal humerus metaphyseal fixation in hemiarthroplasty and even RSA designs. The advantage of metaphyseal fixation without the use of a longer stem is clear. Notably, treatment of periprosthetic humeral fractures is simpler, extraction of the implant for any reason is easier and the preoperative anatomic position of the humeral head can be respected. As with any anatomic shoulder arthroplasty, the functional result is dependent on correct indication criteria, precise surgical technique, correct humeral head position and soft tissue reconstruction - primarily the rotator cuff. CONCLUSIONS Between 2016 and 2021, we performed 20 SMR® stemless shoulder hemiarthroplasties for primary osteoarthritis. The mean follow up was 3 years. The shoulder function improved significantly post-operatively in all patients. There were no cases of implant loosening or failure. Radiographic evaluation showed no implant loosening or change in implant position in the humeral metaphysis. Key words: shoulder joint replacement, reverse shoulder arthroplasty, SMR, stemless, total shoulder arthroplasty, shoulder hemiarthroplasty, EPOCA, wear.

Relationship between periodontal outcomes and serum biomarkers changes after non-surgical periodontal therapy.

The systemic effect of chronic periodontitis (CP) has been suggested by several studies as an etiologic factor and modulator of diseases based on the changes in the inflammatory marker levels. This study aimed to investigate the relationship between the changes in clinical periodontal outcomes and serum biomarkers (CRP, IL-6, albumin and percentage of leukocytes) after non-surgical periodontal therapy in systemically healthy adults. An interventional study was conducted with a sample of 29 individuals without CP (control group) and 33 with CP (CP group). Periodontal clinical variables were recorded, and the serum levels of inflammatory markers were measured. Statistical analysis included the chi-square and Student's t-tests and Pearson's correlation analysis. After 90 days of non-surgical periodontal treatment, a reduction of periodontal parameters and IL-6 in both groups could be observed (P < 0.001). The correlation analysis revealed a directly proportional correlation between changes in the probing depth (r = 0.349, P = 0.049) and clinical attachment level (r = 0.374, P = 0.034) with CRP in the CP group. The findings suggest a reduction of IL-6 serum concentration and periodontal clinical measures 90 days after periodontal therapy in both groups.

Fruit Fly (Diptera: Tephritidae) Diversity and Host Relationships in Diverse Environments Estimated with Two Sampling Methods.

Knowledge of the diversity of fruit flies is essential for understanding aspects of their community ecology. However, the effectiveness of sampling methods in representing species diversity and relationships with hosts in a diverse environment has not been adequately assessed. This study aimed to determine the optimum method to represent the diversity of fruit flies and assess their relationships with host fruits. Species of Anastrepha sampled with both traps and fruits in the same area were comprehensively analyzed. Data were analyzed by Hill's numbers (species diversity in both sampling methods), heat map graph (interaction of species with methods), and rank clocks (population fluctuations of the most abundant species). We also measured the interaction strength of the species. Our results showed that estimated parameters of species diversity in an area may differ when sampled with traps or fruits. However, the most abundant species appeared to interact similarly in both methods. Fruits of members of the families Myrtaceae and Anacardiaceae contributed highly to the presence of Anastrepha. The optimum strategy to represent Anastrepha diversity in an area is the combined use of both sampling methods.

Geostatistics and Geographic Information System to Analyze the Spatial Distribution of the Diversity of Anastrepha Species (Diptera: Tephritidae): the Effect of Forest Fragments in an Urban Area.

Fruit flies are among the most damaging insect pests of commercial fruit in Brazil. It is important to understand the landscape elements that may favor these flies. In the present study, spatial data from surveys of species of Anastrepha Schiner (Diptera: Tephritidae) in an urban area with forest fragments were analyzed, using geostatistics and Geographic Information System (GIS) to map the diversity of insects and evaluate how the forest fragments drive the spatial patterns. The results indicated a high diversity of species associated with large fragments, and a trend toward lower diversity in the more urbanized area, as the fragment sizes decreased. We concluded that the diversity of Anastrepha species is directly and positively related to large and continuous forest fragments in urbanized areas, and that combining geostatistics and GIS is a promising method for use in insect-pest management and sampling involving fruit flies.

Feasibility of using a Caribbean screwworm for SIT campaigns in Brazil.

The screwworm, Cochliomyia hominivorax (Coquerel), remains one of the most damaging parasites of livestock in South America, causing millions of dollars in annual losses to producers. Recently, South American countries demonstrated interest in controlling this pest using the Sterile Insect Technique, and a pilot-project was conducted near the Brazil-Uruguay border in 2009. Since molecular studies have suggested the existence of C. hominivorax regional groups, crossing tests were conducted to evaluate mating competitiveness, mating preference and reproductive compatibility between a C. hominivorax strain from the Caribbean (Jamaica-06) and one from Brazil. Mating rates between Jamaican males and Brazilian females ranged between 82 and 100%, and each male inseminated from 3.3 to 3.95 females. Sterile males, regardless of the strain, competed equally against the fertile males for Brazilian females. Jamaican sterile males and Brazilian fertile males mated randomly with fertile or sterile females. No evidence of genetic incompatibility or hybrid dysgenesis was found in the hybridization crosses. Mating barriers should not compromise the use of Jamaican sterile males for Sterile Insect Technique campaigns in Brazil.

A new generation of X ray irradiators for insect sterilization.

Recent fears of terrorism have provoked an increase in delays and denials of transboundary shipments of radioisotopes. This represents a serious constraint to sterile insect technique (SIT) programs around the world as they rely on the use of ionizing radiation from radioisotopes for insect sterilization. To validate a novel X ray irradiator, a series of studies on Ceratitis capitata (Wiedemann) and Anastrepha fraterculus (Wiedemann) (Diptera: Tephritidae) were carried out, comparing the relative biological effectiveness (RBE) between X rays and traditional gamma radiation from 60Co. Male C. capitata pupae and pupae of both sexes of A. fraterculus, both 24-48 h before adult emergence, were irradiated with doses ranging from 15 to 120 Gy and 10-70 Gy, respectively. Estimated mean doses of 91.2 Gy of X and 124.9 Gy of gamma radiation induced 99% sterility in C. capitata males. Irradiated A. fraterculus were 99% sterile at approximately 40-60 Gy for both radiation treatments. Standard quality control parameters and mating indices were not significantly affected by the two types of radiation. The RBE did not differ significantly between the tested X and gamma radiation, and X rays are as biologically effective for SIT purposes as gamma rays are. This work confirms the suitability of this new generation of X ray irradiators for pest control programs that integrate the SIT.

Pupal development of Ceratitis capitata (Diptera: Tephritidae) and Diachasmimorpha longicaudata (Hymenoptera: Braconidae) at different moisture values in four soil types.

This study aimed to evaluate adult emergence and duration of the pupal stage of the Mediterranean fruit fly, Ceratitis capitata (Wiedemann), and emergence of the fruit fly parasitoid, Diachasmimorpha longicaudata (Ashmead), under different moisture conditions in four soil types, using soil water matric potential. Pupal stage duration in C. capitata was influenced differently for males and females. In females, only soil type affected pupal stage duration, which was longer in a clay soil. In males, pupal stage duration was individually influenced by moisture and soil type, with a reduction in pupal stage duration in a heavy clay soil and in a sandy clay, with longer duration in the clay soil. As matric potential decreased, duration of the pupal stage of C. capitata males increased, regardless of soil type. C. capitata emergence was affected by moisture, regardless of soil type, and was higher in drier soils. The emergence of D. longicaudata adults was individually influenced by soil type and moisture factors, and the number of emerged D. longicaudata adults was three times higher in sandy loam and lower in a heavy clay soil. Always, the number of emerged adults was higher at higher moisture conditions. C. capitata and D. longicaudata pupal development was affected by moisture and soil type, which may facilitate pest sampling and allow release areas for the parasitoid to be defined under field conditions.

A fast, direct x-ray detection charge-coupled device.

A charge-coupled device (CCD) capable of 200 Mpixels/s readout has been designed and fabricated on thick, high-resistivity silicon. The CCDs, up to 600 microm thick, are fully depleted, ensuring good infrared to x-ray detection efficiency, together with a small point spread function. High readout speed, with good analog performance, is obtained by the use of a large number of parallel output ports. A set of companion 16-channel custom readout integrated circuits, capable of 15 bits of dynamic range, is used to read out the CCD. A gate array-controlled back end data acquisition system frames and transfers images, as well as provides the CCD clocks.

Gastroscopic removal of an adjustable gastric band after partial intragastric migration.

BACKGROUND: Laparoscopic implantation of an adjustable gastric band is being performed widely. One potential complication is the transgastric migration of the band, that should be extracted. METHODS: The authors report a series of 182 patients, followed prospectively, October 1996 - April 2002, who had undergone insertion of the Swedish adjustable gastric band. All implantations had been completed by laparoscopy alone. RESULTS: There were no deaths. 15 complications were detected, of which 7 were intragastric migrations of the band (3.8%) at an average follow-up of 40 months. 6 were treated successfully by gastroscopy only, with a new cutter device and without complications. CONCLUSION: The endoscopic technique is beneficial even when the intraluminal migration is partial.

Sexual behavior and diel activity of citrus fruit borer Ecdytolopha aurantiana.

Males and virgin females of the citrus fruit borer Ecdytolopha aurantiana Lima, displayed two flight peaks during a 24-hr period, one at dawn and the other at dusk in an orange grove near Gavião Peixoto, São Paulo, Brazil. During the day, when temperatures were highest and relative humidity lowest, most individuals rested on leaves in the lower and middle crown. Moths rapidly moved higher in the crown after sunset, and many were observed flying above the tree canopy. This behavior was mainly associated with mating. Males and virgin females marked with fluorescent powder of different colors were observed in the dark with the aid of a black light. Mating was observed only in the upper crown of citrus trees from 6:00 to 9:00 PM, with a peak (64%) between 7:00 and 8:00 PM. Males of E. aurantiana were captured in traps baited either with virgin females or female extracts, suggesting the use of a long-range sex pheromone. At close distance (1-2 cm), males and females displayed a short-range communication behavior, with males exposing hairpencils and vibrating their wings. Females were frequently stimulated to contact the body of a male before copulation. The mean duration of copulation was 1 hr 40 min.

Use of high specific activity StarFire oligonucleotide probes to visualize low-abundance pre-mRNA splicing intermediates in S. pombe.

An oligonucleotide labeling system was developed that can produce radiolabeled hybridization probes with tenfold or more higher specific activity than is obtained by traditional 5'-end-labeling with polynucleotide kinase. Yet the system is as rapid and simple as kinase labeling. The reaction uses the Klenow fragment of E. coli DNA polymerase to add alpha-32P-dA residues to the 3'-end of an oligonucleotide in a primer-extension reaction. Unlike other methods of radioactive tailing (e.g., terminal transferase), a single species is produced of both known length and known specific activity. The reaction is efficient, and over 90% of probe molecules are routinely labeled. Using this method of labeling, an oligonucleotide was shown to be tenfold more sensitive in detecting target DNA sequences in a dot blot hybridization assay, compared to the same oligonucleotide labeled using polynucleotide kinase. Northern blots of Schizosaccharomyces pombe RNA were probed with an oligonucleotide specific for intron 1 of the tf2d gene, a TATA-box binding transcription factor. Kinase-labeled tf2d probe detected only unspliced RNA, while the same oligonucleotide labeled using the new method detected both unspliced tf2d RNA and rare pre-mRNA splicing intermediates.

The misoprostol third stage of labour study: a randomised controlled comparison between orally administered misoprostol and standard management.

OBJECTIVE: To compare misoprostol with standard oxytocic regimens in the prevention of postpartum haemorrhage. DESIGN: Randomised controlled trial. SETTING: Obstetric unit in a large teaching hospital. METHODS: One thousand women randomised to 500 microg misoprostol given orally or to standard oxytocic regimens of oxytocin, oxytocin with ergometrine, or ergometrine. MAIN OUTCOME MEASURES: Incidence of postpartum haemorrhage and the incidence and severity of side effects. RESULTS: Postpartum haemorrhage occurred in 12% of women given misoprostol and in 11% of women given standard oxytocic drugs (relative risk (RR) 1.10, 95% confidence interval (CI) 0.79, 1.55). Blood loss of 1000 mL or more occurred in 2% of women in each group. Nausea, headache, dizziness and tiredness were less frequent with misoprostol (RR (95% CI) 0.71 (0.59, 0.84); 0.53 (0.38, 0.74); 0.73 (0.61, 0.87) and 0.88 (0.83, 0.94) respectively). The main side effects of misoprostol were shivering (RR 1.95, 95% CI 1.69, 2.25) and a rise in temperature (difference in mean rise 0.34 degrees C, 95% CI 0.26, 0.42). CONCLUSION: Oral misoprostol for the prevention of postpartum haemorrhage was comparable to standard oxytocics. Many side effects were less common with misoprostol but shivering and pyrexia were more common. Larger randomised trials are needed before establishing the equivalence between misoprostol and standard oxytocic drugs in the prevention of postpartum haemorrhage.

Misoprostol: preventing postpartum haemorrhage.

Postpartum haemorrhage is an important cause of maternal mortality and morbidity. In the developing world, it is estimated to account for 28% of maternal deaths. Evidence suggests that active management of the third stage of labour using oxytocics, significantly reduces the risk of PPH. Oxytocics are not always used in the developing world, due to storage problems, mode of administration and associated side-effects. Research using misoprostol, a prostaglandin, suggests that it may be effective in the prevention of PPH. It is given orally, does not require refrigeration and has few side-effects. Further research is planned, if misoprostol is found to be an acceptable alternative to other oxytocic agents, then it may be instrumental in reducing world wide deaths from PPH.

Use of oral misoprostol in the prevention of postpartum haemorrhage.

OBJECTIVE: To investigate the use of the oral prostaglandin E1 analogue, misoprostol in the prevention of postpartum haemorrhage. DESIGN: A prospective observational study. SETTING: A university teaching hospital. PARTICIPANTS: Two hundred and thirty-seven consecutive women undergoing vaginal delivery. METHODS: All the women were given 600 micrograms oral misoprostol just after delivery. MAIN OUTCOME MEASURES: Rates of postpartum haemorrhage; need for therapeutic oxytocic drugs; retained placenta and length of the third stage of labour. RESULTS: Postpartum haemorrhage occurred in 6% of the women; the need for therapeutic oxytocics in 5%, retained placenta in 2% and the median length of the third stage was 5 min. Vomiting and diarrhoea in the first hour after delivery occurred in 8% and 3% respectively and shivering in 60%. CONCLUSIONS: Misoprostol may be effective in the prevention of postpartum haemorrhage, and has few side effects. A double blind randomised trial is required.

Prolongation of the intravascular retention of hemoglobin modified with a long-chain fatty acid derivative.

To develop hemoglobin (Hb) derivatives with an increased circulatory half-life, Hb was chemically modified with long chain fatty acid analogs. One compound, sodium 1-hexadecyl 6-(2-iodoacetamido)hexyl phosphate, specifically modified the Cys-93 beta residues of human hemoglobin (HbA) as determined by sulfhydryl titration analysis. The resulting modified Hb derivative, FAHbA, was isolated and was shown to have a two-fold longer circulatory half-life than native HbA in a rat low-dose acute transfusion model.

Use of PCR primers containing a 3'-terminal ribose residue to prevent cross-contamination of amplified sequences.

Cross-contamination with previously amplified products poses a serious limitation in the use of PCR for clinical testing and in certain research applications as well. In the present study we report the use of novel primers containing a 3'-terminal ribose residue to circumvent this problem. Extension of the primer by Taq DNA polymerase generates a cleavable ribonucleotide linkage within the amplified product. Cleavage of the primer by base or with a ribonuclease interferes with further replication of the product should carry over to another sample occur. Primers terminating in any of the 4 ribose residues function equally well as all DNA primers. Taq DNA polymerase is thus able to both efficiently extend and copy the single ribose residue. In translating from all DNA primers to ones containing a 3'-ribose residue no modification of the PCR protocol is required. The products formed can be used in all applications of the PCR. Since neither the original sample DNA, the primers or the extension products are modified by base or ribonuclease treatment both pre- and post-amplification sterilization can be carried out. Pre-amplification treatment with RNase A can yield as high as 10(4)-fold sterilization. Under these conditions the addition of beta-mercaptoethanol or other sulfhydryl reducing agent is necessary to inactivate the enzyme during thermocycling. Post-amplification treatment with NaOH readily yields at least 10(6)-fold sterilization. This alone is sufficient for most, if not all, applications of PCR. It is especially useful for quantitative RT-PCR, since the original target RNA sequence, which may be present in high copy numbers, is also destroyed.