ECTOPIC OSSIFICATION FOLLOWING TOTAL HIP ARTHROPLASTY: IS DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS A RISK FACTOR?

Total hip a≪hroplasty may be followed by ectopic bone formation. An increased frequency has been suspected in patients with diffuse idiopathic skeletal hypcrostosis (DISH). In 204 patients we found that, of the 38 subjects with pre-existing DISH, 29% developed postoperative ossification compared with only 10% in those without DISH (p ≪; 0.01). DISH is therefore a risk factor for postoperative ectopic bone formation. In a separate study of 1325 patients (not analysed for spinal DISH), we looked for correlations between the severity of postoperative ectopic bone and clinical measurements. Even for the more severe ossification grades (n = 112), only 10% reported serious pain and only 26% had reduced hip flexion (≪70°). Thus, periprosthetic ectopic bone is not sufficiently important to justify the routine use of preventative drugs such as bisphosphonates in patients with DISH undergoing total hip replacemen

Cracking the BAFF code.

The tumour necrosis factor (TNF) family members B cell activating factor (BAFF) and APRIL (a proliferation-inducing ligand) are crucial survival factors for peripheral B cells. An excess of BAFF leads to the development of autoimmune disorders in animal models, and high levels of BAFF have been detected in the serum of patients with various autoimmune conditions. In this Review, we consider the possibility that in mice autoimmunity induced by BAFF is linked to T cell-independent B cell activation rather than to a severe breakdown of B cell tolerance. We also outline the mechanisms of BAFF signalling, the impact of ligand oligomerization on receptor activation and the progress of BAFF-depleting agents in the clinical setting

Gray wolves not out of the woodsyet

In April 2009, the U.S. Fish and Wildlife Service (FWS) removed the northern Rocky Mountain population of gray wolves (Canis lupus) from all protections under the Endangered Species Act (ESA). Following the ESA\u27s mandate to base listing determinations “solely on the…best scientific and commercial data available,” FWS conducted an extensive analysis of regional threats to wolves. They concluded that while “[p]ublic hostility toward wolves led to excessive human-caused mortality that extirpated the species,” subsequent improvement in attitudes toward wolves ensured the long-term viability of the species. We agree that human behaviors (and the attitudes and values underlying them) ultimately caused the extirpation of wolves in the northern Rockies, but we find little support for FWS\u27s conclusion that attitudes toward wolves have improved, or are improving. Indeed, the larger body of research points to the opposite conclusion (1–5). Although FWS provided more than 200 citations in their analysis, they cited just one empirical study that examined attitudes toward wolves (4). [This cannot be explained by a lack of published literature; a recent review identified 50 publications that specifically addressed the topic (6).] Thus, it appears FWS was either unaware of the extensive body of research on attitudes toward wolves, or chose to ignore this research. In fact, the only empirical article cited by FWS—a meta-analysis—comes to a very different conclusion: “Across the 37 attitude surveys we studied, the reported statistics were stable over the last 30 years…[t]his contradicts a recent perception among some ecologists that wolf support has recently grown” (4). The FWS\u27s analysis of the threat posed by negative attitudes toward wolves is wholly inadequate. When threats to a species\u27 continued survival are primarily social in nature, FWS must use the same standard that goes into analyzing biological and ecological threats. It is time for FWS to expand its view of what constitutes “science” and fully incorporate the social sciences into listing determinations

Are gray wolves endangered inthe Northern Rocky Mountains? A role for social science in endangered species listingdeterminations

Conservation scientists increasingly recognize the need to incorporate the social sciences into policy decisions. In practice, however, considerable challenges to integrating the social and natural sciences remain. In this article, we review the US Fish and Wildlife Service\u27s (FWS) 2009 decision to remove the northern Rocky Mountain population of gray wolves from the federal list of endangered species. We examine the FWS\u27s arguments concerning the threat posed by humans\u27 attitudes toward wolves in light of the existing social science literature. Our analysis found support for only one of four arguments underlying the FWS\u27s assessment of public attitudes as a potential threat to wolves. Although we found an extensive literature on attitudes toward wolves, the FWS cited just one empirical research article. We conclude that when listing decisions rest on assumptions about society, these assumptions should be evaluated using the best available natural and social science research

Results of endovenous ClosureFast treatment for varicose veins in an outpatient setting

OBJECTIVE: Endovenous methods are increasingly used to treat varicose veins. We evaluated the outcome of patients treated with the new radiofrequency ablation (RFA)-ClosureFast catheter in an outpatient setting. METHOD: Retrospective analysis of postinterventional duplex ultrasound (DUS), complication rate and quality of life of patients treated for incompetent saphenous veins. RESULTS: Between 2007 and 2009, 155 patients had been treated with ClosureFast. DUS was available from 73 (47%) patients (102 great [GSV] and 16 small [SSV] saphenous veins). After a mean follow-up of 12.2 months (range 1-29 months), DUS showed six (5.9%) open GSV and an occlusion of all treated SSV. One pulmonary embolism had occurred. Mean patient's satisfaction was 8.7 (10 = very satisfied), pain after one week 2.0 (no pain = 0, maximal = 10) and absence of work was 0.9 day (range 0-14 days). CONCLUSION: RFA for incompetent saphenous veins can safely be performed in an outpatient setting with a low complication rate, minimal pain and fast recovery