Conversion From Knee Arthrodesis Back to Arthroplasty: A Particular Challenge in Combination With Fungal Periprosthetic Joint Infection.

A 58-year-old female treated at an outside facility with knee arthrodesis due to persistent periprosthetic joint infection fulfilled all prerequisites for a conversion back to arthroplasty, as part of a 2-stage revision. Owing to the detection of Candida parapsilosis, the treatment concept was converted to a three-stage procedure. A scheduled spacer exchange with additional amphotericin B-loaded polymethylmethacrylate was conducted as an intermediate revision before reimplantation. Conversion in the setting of fungal periprosthetic joint infection presents a challenge, and successful treatment hinges on the use of proper antifungal and antimicrobial protocols, advanced surgical techniques, and a multidisciplinary team approach. At the 3-year follow-up, successful infection eradication as measured by the Delphi-based consensus definition was achieved with a range of motion of 0°-100°

Myeloid Mineralocorticoid Receptor During Experimental Ischemic Stroke: Effects of Model and Sex

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139129/1/jah378.pd

Multisectoral Climate Impact Hotspots in a Warming World

The impacts of global climate change on different aspects of humanity's diverse life-support systems are complex and often difficult to predict. To facilitate policy decisions on mitigation and adaptation strategies, it is necessary to understand, quantify, and synthesize these climate-change impacts, taking into account their uncertainties. Crucial to these decisions is an understanding of how impacts in different sectors overlap, as overlapping impacts increase exposure, lead to interactions of impacts, and are likely to raise adaptation pressure. As a first step we develop herein a framework to study coinciding impacts and identify regional exposure hotspots. This framework can then be used as a starting point for regional case studies on vulnerability and multifaceted adaptation strategies. We consider impacts related to water, agriculture, ecosystems, and malaria at different levels of global warming. Multisectoral overlap starts to be seen robustly at a mean global warming of 3 degC above the 1980-2010 mean, with 11% of the world population subject to severe impacts in at least two of the four impact sectors at 4 degC. Despite these general conclusions, we find that uncertainty arising from the impact models is considerable, and larger than that from the climate models. In a low probability-high impact worst-case assessment, almost the whole inhabited world is at risk for multisectoral pressures. Hence, there is a pressing need for an increased research effort to develop a more comprehensive understanding of impacts, as well as for the development of policy measures under existing uncertainty

Scenario set-up and forcing data for impact model evaluation and impact attribution within the third round of the Inter-Sectoral Model Intercomparison Project (ISIMIP3a)

This paper describes the rationale and the protocol of the first component of the third simulation round of the Inter-Sectoral Impact Model Intercomparison Project (ISIMIP3a, www.isimip.org) and the associated set of climate-related and direct human forcing data (CRF and DHF, respectively). The observation-based climate-related forcings for the first time include high-resolution observational climate forcings derived by orographic downscaling, monthly to hourly coastal water levels, and wind fields associated with historical tropical cyclones. The DHFs include land use patterns, population densities, information about water and agricultural management, and fishing intensities. The ISIMIP3a impact model simulations driven by these observation-based climate-related and direct human forcings are designed to test to what degree the impact models can explain observed changes in natural and human systems. In a second set of ISIMIP3a experiments the participating impact models are forced by the same DHFs but a counterfactual set of atmospheric forcings and coastal water levels where observed trends have been removed. These experiments are designed to allow for the attribution of observed changes in natural, human and managed systems to climate change, rising CH4 and CO2 concentrations, and sea level rise according to the definition of the Working Group II contribution to the IPCC AR6

Erratum to \u27Conversion From Knee Arthrodesis Back to Arthroplasty: A Particular Challenge in Combination With Fungal Periprosthetic Joint Infection\u27 [Arthroplasty Today 6 (2020) 1038-1044].

[This corrects the article DOI: 10.1016/j.artd.2020.10.007.]

High‐fat and high‐sodium diet induces metabolic dysfunction in the absence of obesity

ObjectiveExcess dietary fat and sodium (NaCl) are both associated with obesity and metabolic dysfunction. In mice, high NaCl has been shown to block high‐fat (HF) diet–induced weight gain. Here, the impact of an HF/NaCl diet on metabolic function in the absence of obesity was investigated.MethodsWild‐type mice were administered chow, NaCl (4%), HF, and HF/NaCl diets. Metabolic analysis was performed by measuring fasted blood glucose and insulin levels and by glucose tolerance test and insulin tolerance test.ResultsAfter 10 weeks on diets, male and female mice on the HF diet gained weight, and HF/NaCl mice had significantly reduced weight gain similar to chow‐fed mice. In the absence of obesity, HF/NaCl mice had significantly elevated fasting blood glucose and impaired glucose control during glucose tolerance tests. Both NaCl and HF/NaCl mice had decreased pancreas and β‐cell mass. Administration of NaCl in drinking water did not protect mice from HF‐diet‐induced weight gain and obesity. Further analysis revealed that longer administration of HF/NaCl diets for 20 weeks resulted in significant weight gain and insulin resistance.ConclusionsThe data demonstrate that despite early inhibitory effects on fat deposition and weight gain, an HF/NaCl diet does not prevent the metabolic consequences of HF diet consumption.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/170933/1/oby23264.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/170933/2/oby23264-sup-0001-Supinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/170933/3/oby23264_am.pd

Aconitate decarboxylase 1 regulates glucose homeostasis and obesity in mice

ObjectiveThe intersection between immunology and metabolism contributes to the pathogenesis of obesity‐associated metabolic diseases as well as molecular control of inflammatory responses. The metabolite itaconate and the cell‐permeable derivatives have robust anti‐inflammatory effects; therefore, it is hypothesized that cis‐aconitate decarboxylase (Acod1)‐produced itaconate has a protective, anti‐inflammatory effect during diet‐induced obesity and metabolic disease.MethodsWild‐type and Acod1−/− mice were subjected to diet‐induced obesity. Glucose metabolism was analyzed by glucose tolerance tests, insulin tolerance tests, and indirect calorimetry. Gene expression and transcriptome analysis was performed using quantitative reverse transcription‐polymerase chain reaction (qRT‐PCR) and RNA sequencing.ResultsWild‐type and Acod1−/− mice on high‐fat diet had equivalent weight gain, but Acod1−/− mice had impaired glucose metabolism. Insulin tolerance tests and glucose tolerance tests after 12 weeks on high‐fat diet revealed significantly higher blood glucose levels in Acod1−/− mice. This was associated with significant enrichment of inflammatory gene sets and a reduction in genes related to adipogenesis and fatty acid metabolism. Analysis of naive Acod1−/− mice showed a significant increase in fat deposition at 3 and 6 months of age and obesity and insulin resistance by 12 months.ConclusionsThe data show that Acod1 has an important role in the regulation of glucose homeostasis and obesity under normal and high‐fat diet conditions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/174830/1/oby23509-sup-0001-Supinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/174830/2/oby23509_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/174830/3/oby23509.pd

A multi-model analysis of risk of ecosystem shifts under climate change

Climate change may pose a high risk of change to Earth's ecosystems: shifting climatic boundaries may induce changes in the biogeochemical functioning and structures of ecosystems that render it difficult for endemic plant and animal species to survive in their current habitats. Here we aggregate changes in the biogeochemical ecosystem state as a proxy for the risk of these shifts at different levels of global warming. Estimates are based on simulations from seven global vegetation models (GVMs) driven by future climate scenarios, allowing for a quantification of the related uncertainties. 5–19% of the naturally vegetated land surface is projected to be at risk of severe ecosystem change at 2 ° C of global warming (ΔGMT) above 1980–2010 levels. However, there is limited agreement across the models about which geographical regions face the highest risk of change. The extent of regions at risk of severe ecosystem change is projected to rise with ΔGMT, approximately doubling between ΔGMT = 2 and 3 ° C, and reaching a median value of 35% of the naturally vegetated land surface for ΔGMT = 4 °C. The regions projected to face the highest risk of severe ecosystem changes above ΔGMT = 4 °C or earlier include the tundra and shrublands of the Tibetan Plateau, grasslands of eastern India, the boreal forests of northern Canada and Russia, the savanna region in the Horn of Africa, and the Amazon rainforest

Osteology of the ilium revised: illuminating the clinical relevance.

BACKGROUND: Several studies on anterior and posterior pelvic ring fixation have identified a fragile monocortical area located at the iliac wing. However, there are no current studies regarding this structure\u27s dimensions and relation to known anatomic structures. METHODS: Eleven human ilia were dissected from 6 specimens. After debulking soft tissue, photoluminescence was used to indicate the fragile area. The size and thickness of the iliac wing were determined and mapped in relation to the anterior superior iliac spine (ASIS) and the posterior superior iliac spine (PSIS). RESULTS: This photoluminescent unicortical area measured 15.57 cm CONCLUSION: This study provides useful anatomical information regarding a thin unicortical area at the iliac wing that is relevant to anterior and posterior pelvic ring fixation and the potential complications that can arise from iatrogenic perforation of this area