Pulse-lavage brushing followed by hydrogen peroxide-gauze packing for bone-bed preparation in cemented total hip arthroplasty : a bovine model

To compare the effectiveness of pulse-lavage brushing followed by hydrogen peroxide-gauze packing with either technique alone or normal-saline irrigation in bone-bed preparation for cemented total hip arthroplasty. 44 fresh-frozen ox femoral canals were prepared for cemented total hip arthroplasty using 4 techniques: normal-saline irrigation, pulse-lavage brushing, hydrogen peroxide-soaked gauze packing, and a combination of the latter 2 techniques. The maximum tensile pull-out force required to separate the prosthesis from the femoral canal was measured as an indicator of the strength of the cement-bone interface. The mean pull-out force to separate the prosthesis from the femoral canal was significantly higher in specimens prepared with pulse-lavage brushing followed by hydrogen peroxide-soaked gauze packing or pulse-lavage brushing alone than those prepared with normal-saline irrigation or hydrogen peroxide-soaked gauze packing alone 300(p&lt;0.001). Pulse-lavage brushing is more effective at cleansing the femoral canal and increasing mechanical strength at the cement-bone interface than preparation with normal-saline irrigation or hydrogen peroxide-soaked gauze packing.<br /

α2β1 integrin affects metastatic potential of ovarian carcinoma spheroids by supporting disaggregation and proteolysis

Background: Ovarian cancer is characterized by a wide-spread intra-abdominal metastases which represents a major clinical hurdle in the prognosis and management of the disease. A significant proportion of ovarian cancer cells in peritoneal ascites exist as multicellular aggregates or spheroids. We hypothesize that these cellular aggregates or spheroids are invasive with the capacity to survive and implant on the peritoneal surface. This study was designed to elucidate early inherent mechanism(s) of spheroid survival, growth and disaggregation required for peritoneal metastases.Methods: In this study, we determined the growth pattern and adhesive capacity of ovarian cancer cell lines (HEY and OVHS1) grown as spheroids, using the well established liquid overlay technique, and compared them to a normal ovarian cell line (IOSE29) and cancer cells grown as a monolayer. The proteolytic capacity of these spheroids was compared with cells grown as a monolayer using a gelatin zymography assay to analyze secreted MMP-2/9 in conditioned serum-free medium. The disaggregation of cancer cell line spheroids was determined on extracellular matrices (ECM) such as laminin (LM), fibronectin (FN) and collagen (CI) and the expression of &alpha;2, &alpha;3, &alpha;v, &alpha;6 and &beta;1 interin was determined by flow cytometric analysis. Neutralizing antibodies against &alpha;2, &beta;1 subunits and &alpha;2&beta;1 integrin was used to inhibit disaggregation as well as activation of MMPs in spheroids.Results: We demonstrate that ovarian cancer cell lines grown as spheroids can sustain growth for 10 days while the normal ovarian cell line failed to grow beyond 2 days. Compared to cells grown as a monolayer, cancer cells grown as spheroids demonstrated no change in adhesion for up to 4 days, while IOSE29 cells had a 2&ndash;4-fold loss of adhesion within 2 days. Cancer cell spheroids disaggregated on extracellular matrices (ECM) and demonstrated enhanced expression of secreted pro-MMP2 as well as activated MMP2/MMP9 with no such activation of MMP\u27s observed in monolayer cells. Flow cytometric analysis demonstrated enhanced expression of &alpha;2 and diminution of &alpha;6 integrin subunits in spheroidsversus monolayer cells. No change in the expression of &alpha;3, &alpha;v and &beta;1 subunits was evident. Conversely, except for &alpha;v integrin, a 1.5&ndash;7.5-fold decrease in &alpha;2, &alpha;3, &alpha;6 and &beta;1 integrin subunit expression was observed in IOSE29 cells within 2 days. Neutralizing antibodies against &alpha;2, &beta;1 subunits and &alpha;2&beta;1 integrin inhibited disaggregation as well as activation ofMMPs in spheroids.Conclusion: Our results suggest that enhanced expression of &alpha;2&beta;1 integrin may influence spheroid disaggregation andproteolysis responsible for the peritoneal dissemination of ovarian carcinoma. This may indicate a new therapeutic targetfor the suppression of the peritoneal metastasis associated with advanced ovarian carcinomas.<br /

Relative body weight and standardised brightness-mode ultrasound measurement of subcutaneous fat in athletes: an international multicentre reliability study, under the auspices of the IOC Medical Commission.

Introduction: Fat is a metabolic fuel, but excess body fat is ballast mass and therefore many elite athletes reduce body fat to dangerously low levels. Uncompressed subcutaneous adipose tissue (SAT) thickness measured by brightness-mode ultrasound (US) provides an estimate of body fat content. Methods: The accuracy for determining tissue borders is about 0.1-0.2 mm and reliability (experienced measurers) was within ±1.4 mm (95% limit of agreement, LOA). We present here inter- and intra-measurer scores of three experienced US measurers from each of the centres C1 and C2, and of three novice measurers from each of the centres C3-C5. Each of the five centres measured 16 competitive adult athletes of national or international level, except for one centre where the number was 12. The following sports were included: artistic gymnastics, judo, pentathlon, power lifting, rowing, kayak, soccer, tennis, rugby, basketball, field hockey, water polo, volleyball, American football, triathlon, swimming, cycling, long distance running, mid distance running, hurdles, cross country skiing, snowboarding, and ice hockey. SAT-contour was detected semi-automatically: typically, 100 thicknesses of SAT at a given site (i.e. in a given image), with and without fibrous structures, were measured. Results: At SAT thickness sums DI (of eight standardised sites) between 6.0 and 70.0 mm, the LOA of experienced measurers was 1.2 mm, and the intra-class correlation coefficient ICC was 0.998; novice measurers: 3.1 mm and 0.988. Intra-measurer differences were similar. The median DI-value of all 39 female participants was 51 mm (11% fibrous structures) compared to 17 mm (18%) in the 37 male participants. Discussion: DI measurement accuracy and precision enables detection of fat mass changes of approximately 0.2 kg. Such reliability has not been reached with any other method. Although females' median body mass index and mass index were lower than those of males, females' median DI was three-times higher, and their percentage of fibrous structures was lower. The standardised US method provides a highly accurate and reliable tool for measuring SAT and thus changes in body fat, but training of measurers is important

Portrait of Richard Wherrett, 1988 [picture] /

Title from accession record.; This painting was a finalist in the 1988 Archibald Prize.; R11376

Correlation of clinical and radiographic findings with outcomes in acute cervical discoligamentous trauma manifesting as persistent midline cervical tenderness.

According to current international practice, the presence of midline cervical tenderness following trauma mandates cervical spine imaging. Whilst this aspect of trauma management is unambiguous, difficulties arise when midline tenderness is persistent, and computed tomography (CT) imaging is negative for acute injury. The extent to which this clinical sign is an indication of occult discoligamentous injury, undetectable on CT imaging, is unclear. The identification of such injury and the determination of clinical significance are essential in the avoidance of missed injury, the assignment of an appropriate management strategy and the mitigation of post-acute morbidity. Magnetic resonance imaging (MRI) is the optimal radiographic modality for the identification of injuries to the cervical soft tissue structures. As a result, this project sought to ascertain the prevalence of acute occult cervical discoligamentous injury in alert, sober and neurologically intact patients with persistent midline cervical tenderness, and without painful distracting injury. Additionally, with the hypothesis that acute findings would correlate with post-acute outcomes, the project aimed to assess the associations of demographic, injury mechanism, clinical and radiographic factors with acute injury, post-acute morbidity and the costs of investigation and symptom management. In a Level 1 trauma centre with approximately 15,000 trauma presentations per year, the integrity of the cervical discs, ligaments and spinal cord were assessed using early MRI in alert patients (Glasgow Coma Scale = 15) with persistent midline cervical tenderness following negative CT imaging in a prospective cohort study. Exclusion criteria comprised (i) base of skull or upper thoracic fractures (ii) painful distracting injury, intoxication or persistent focal neurologic deficit according to the criteria of the National Emergency X‐Radiography Utilisation Study (NEXUS)(iii) history of cervical spine injury or surgery and (iv) MRI conducted > 96 hours post presentation. Patients with minor, isolated low thoracic or lumbar fracture were included, as were patients with transient neurologic deficit fully resolving shortly after presentation to the emergency department. De-identified MR images were reviewed by two independent senior trauma radiologists, and injuries were identified and graded. Patients were reviewed in the outpatient clinic following discharge, and were subsequently reassessed at 6 and 12 months. Ordinal logistic regression was used to determine the associations of demographic, injury mechanism, clinical and radiographic factors with acute injury and post-acute neck pain and disability, while survival analysis was used to analyse the rate of return to normal daily activities. Health service utilisation cost data for the 12 month period for the subset of patients involved in road trauma, who had not sustained additional injuries, were collated and assessed for factors associated with higher acute and post-acute costs, using multivariate linear regression analysis. There were 178 patients recruited to the study over a 2 year period. Of these, 78 patients (44%) were found to have acute injuries detected on MRI. There were 48 single column injuries, 15 two- column injuries and 5 three-column injuries. The remaining abnormalities included posterior muscle oedema, alar ligamentous oedema, epidural haematoma or atlanto‐occipital oedema. In 38 cases (21%), injuries were clinically managed: 5 patients underwent surgical stabilisation for cord oedema and/or contusion and 33 patients were treated in cervical collars for 2‐12 weeks. Factors associated with more extensive injury, according to the number of spinal columns involved, included advanced CT‐detected cervical spondylosis, minor, isolated thoracolumbar fractures and multidirectional cervical spine forces during the trauma incident. There were 162 patients (91%) available for assessment at 12 months, of whom 43% reported neck pain and neck-related disability. Neck disability was associated with pre-morbid depressive symptoms, workers’ compensation and low annual income level, while delay in return to work was associated with pre-morbid depressive symptoms and the presence of minor additional injury. Patients on high annual incomes returned to work significantly more quickly than those on low or medium income levels. Neither mechanism of injury nor MRI findings were associated with post-acute outcomes. There were 64 patients included in the health resource utilisation cost analysis, and transient neurologic deficit was associated with higher mean acute and post‐acute costs in these patients. Low education standard and the presence of neck pain at 6 months were also associated with higher costs in the post-acute period. Non‐osseous cervical spine injury requiring clinical management can remain undetected on high quality CT imaging. However, MRI is not necessary in all cases of acute persistent midline tenderness when CT findings are negative following trauma. Instead, this resource can be rationalised for use in patients with advanced cervical spondylosis, and consideration of MRI should be made when thoracolumbar fractures are present, or when multidirectional spine forces had occurred during the trauma. The presence of transient neurologic deficit may be indicative of the presence of subclinical injury, and as such, may require greater intervention in the acute and post-acute settings in order to mitigate costs. Regardless of radiographic imaging findings, patients with post-acute neck pain following trauma may benefit from an individual, targeted care plan involving general practice and allied health collaboration, in order to expedite the early return to normal activities and to mitigate chronic morbidity

Correlation of clinical and radiographic findings with outcomes in acute cervical discoligamentous trauma manifesting as persistent midline cervical tenderness.

According to current international practice, the presence of midline cervical tenderness following trauma mandates cervical spine imaging. Whilst this aspect of trauma management is unambiguous, difficulties arise when midline tenderness is persistent, and computed tomography (CT) imaging is negative for acute injury. The extent to which this clinical sign is an indication of occult discoligamentous injury, undetectable on CT imaging, is unclear. The identification of such injury and the determination of clinical significance are essential in the avoidance of missed injury, the assignment of an appropriate management strategy and the mitigation of post-acute morbidity. Magnetic resonance imaging (MRI) is the optimal radiographic modality for the identification of injuries to the cervical soft tissue structures. As a result, this project sought to ascertain the prevalence of acute occult cervical discoligamentous injury in alert, sober and neurologically intact patients with persistent midline cervical tenderness, and without painful distracting injury. Additionally, with the hypothesis that acute findings would correlate with post-acute outcomes, the project aimed to assess the associations of demographic, injury mechanism, clinical and radiographic factors with acute injury, post-acute morbidity and the costs of investigation and symptom management. In a Level 1 trauma centre with approximately 15,000 trauma presentations per year, the integrity of the cervical discs, ligaments and spinal cord were assessed using early MRI in alert patients (Glasgow Coma Scale = 15) with persistent midline cervical tenderness following negative CT imaging in a prospective cohort study. Exclusion criteria comprised (i) base of skull or upper thoracic fractures (ii) painful distracting injury, intoxication or persistent focal neurologic deficit according to the criteria of the National Emergency X‐Radiography Utilisation Study (NEXUS)(iii) history of cervical spine injury or surgery and (iv) MRI conducted > 96 hours post presentation. Patients with minor, isolated low thoracic or lumbar fracture were included, as were patients with transient neurologic deficit fully resolving shortly after presentation to the emergency department. De-identified MR images were reviewed by two independent senior trauma radiologists, and injuries were identified and graded. Patients were reviewed in the outpatient clinic following discharge, and were subsequently reassessed at 6 and 12 months. Ordinal logistic regression was used to determine the associations of demographic, injury mechanism, clinical and radiographic factors with acute injury and post-acute neck pain and disability, while survival analysis was used to analyse the rate of return to normal daily activities. Health service utilisation cost data for the 12 month period for the subset of patients involved in road trauma, who had not sustained additional injuries, were collated and assessed for factors associated with higher acute and post-acute costs, using multivariate linear regression analysis. There were 178 patients recruited to the study over a 2 year period. Of these, 78 patients (44%) were found to have acute injuries detected on MRI. There were 48 single column injuries, 15 two- column injuries and 5 three-column injuries. The remaining abnormalities included posterior muscle oedema, alar ligamentous oedema, epidural haematoma or atlanto‐occipital oedema. In 38 cases (21%), injuries were clinically managed: 5 patients underwent surgical stabilisation for cord oedema and/or contusion and 33 patients were treated in cervical collars for 2‐12 weeks. Factors associated with more extensive injury, according to the number of spinal columns involved, included advanced CT‐detected cervical spondylosis, minor, isolated thoracolumbar fractures and multidirectional cervical spine forces during the trauma incident. There were 162 patients (91%) available for assessment at 12 months, of whom 43% reported neck pain and neck-related disability. Neck disability was associated with pre-morbid depressive symptoms, workers’ compensation and low annual income level, while delay in return to work was associated with pre-morbid depressive symptoms and the presence of minor additional injury. Patients on high annual incomes returned to work significantly more quickly than those on low or medium income levels. Neither mechanism of injury nor MRI findings were associated with post-acute outcomes. There were 64 patients included in the health resource utilisation cost analysis, and transient neurologic deficit was associated with higher mean acute and post‐acute costs in these patients. Low education standard and the presence of neck pain at 6 months were also associated with higher costs in the post-acute period. Non‐osseous cervical spine injury requiring clinical management can remain undetected on high quality CT imaging. However, MRI is not necessary in all cases of acute persistent midline tenderness when CT findings are negative following trauma. Instead, this resource can be rationalised for use in patients with advanced cervical spondylosis, and consideration of MRI should be made when thoracolumbar fractures are present, or when multidirectional spine forces had occurred during the trauma. The presence of transient neurologic deficit may be indicative of the presence of subclinical injury, and as such, may require greater intervention in the acute and post-acute settings in order to mitigate costs. Regardless of radiographic imaging findings, patients with post-acute neck pain following trauma may benefit from an individual, targeted care plan involving general practice and allied health collaboration, in order to expedite the early return to normal activities and to mitigate chronic morbidity