The iliac stemmed cup in reconstruction of the acetabular defects secondary to tumor resection: a systematic review of literature

Introduction Stemmed acetabular cups are suitable for reconstruction in case of important bone loss. Nevertheless, their use is not so common, because generally judged very invasive and technically difficult to implant. The aim of the present review is to verify the results of their use and to evaluate indications and complications. Materials and methods Literature research was performed in the main healthcare databases; indications, surgical technique, related complications, functional results and implant survival were valued and analyzed for every selected paper. Results 13 studies were selected, for a population of 424 patients and 428 hips. The main indication was reconstruction after tumor removal; the primary non-oncologic indication was revision for aseptic loosening. The most frequent complications were aseptic loosening and implant failure (16.2%), followed by deep infection (11.3%) and dislocation (9.8%). The average MSTS score was 65.9%; while data regarding functional results for degenerative cases are quite fragmented. The 5-years implant survival was 73.6%. Conclusions Data regarding SAC prostheses are quite rare in the literature; no prospective studies with comparisons with other reconstruction techniques are available so their use is mainly based on the experience of single centers. While data for tumors are more consistent and supported by studies, information on revisions of hip prosthesis implanted for degenerative problems is quite scarce. Preliminary results on the SAC prosthesis as a valid alternative both for tumoral and degenerative revision cases are encouraging. Prospective randomized studies are advocated to value results compared to alternative techniques

Prognostic value of combined use of biomarkers of inflammation, endothelial dysfunction, and myocardiopathy in patients with ESRD

Prognostic value of combined use of biomarkers of inflammation, endothelial dysfunction, and myocardiopathy in patients with ESRD.BackgroundCardiovascular risk stratification is important in the clinical management of patients with end-stage renal diseases (ESRD) and biomarkers are increasingly used in these patients.MethodsIn a cohort of 246 dialysis patients without heart failure at baseline we tested the combined prognostic power of three well-established biomarkers: brain natriuretic peptide (BNP), C-reactive protein (CRP), and asymmetric dimethyl arginine (ADMA). The independent prognostic value of individual and combined biomarkers was estimated in separate Cox models, including standard risk factors in dialysis patients and comorbidities.ResultsWhen the prediction power of the three biomarkers was evaluated individually, BNP, ADMA, and CRP added significant predictive value (P≤ 0.01) to all-cause and cardiovascular mortality models and the explanatory gain attributable to these biomarkers were of similar degree (ranging from 3.3% to 5.7%). When the biomarkers were evaluated jointly, a score based on the BNP-CRP combination, increased by 9.9% (all-cause) and by 10.5% (cardiovascular) the explained mortality variance of standard Cox models and such gain in power was similar to that achieved by the CRP-ADMA combination (all-cause death 9.0% and cardiovascular death 8.4%). Of note, the explanatory gain derived by the simultaneous use of the three biomarkers was very similar (all-cause death 11.6% and cardiovascular death 10.5%) to that achieved by the use of two biomarkers.ConclusionThese findings indicate a potential role for CRP, BNP, and ADMA to be incorporated into diagnostic and therapeutic strategies aimed at detection and treatment of atherosclerotic complications and at preventing heart failure in the dialysis population

Plasma adrenomedullin during acute changes in intravascular volume in hemodialysis patients

Plasma adrenomedullin during acute changes in intravascular volume in hemodialysis patients.BackgroundAdrenomedullin, is a potent vasorelaxant that is highly expressed in the adrenal medulla, kidney, heart and lung. Since there is indirect evidence that hypervolemia enhances the release of this peptide, we measured plasma adrenomedullin in 9 uremic patients on chronic dialysis treatment and in 10 healthy subjects matched for age and gender.MethodsMeasurements were performed in baseline conditions, after isotonic fluid subtraction (by isolated ultrafiltration) and during a 70° tilt. Tilt was performed in volume-depleted state, that is, after isolated ultrafiltration (UF). In the control experiment patients underwent sham UF (UF = 0) followed by a period of supine resting identical to the one they had spent in tilted position in the active experiment. Adrenomedullin was measured on pre-extracted plasma samples (Sep-Pak C-18 cartridges) by a specific RIA for human adrenomedullin 1-52.ResultsThe average plasma adrenomedullin was 2.6 times higher (P < 0.01) in uremic patients (103 ± 8pg/ml) than in healthy subjects (39 ± 7pg/ml). After fluid subtraction (-2.6 ± 0.2 liter) adrenomedullin fell to 79. ± 8pg/ml (P = 0.02) but remained well above the upper limit of the 95% CI in normal subjects (52pg/ml). There was no relationship between adrenomedullin and ANF changes. In the control experiment sham UF did not modify plasma adrenomedullin. Tilt did not significantly change plasma adrenomedullin either in dialysis patients or healthy subjects.ConclusionsPlasma adrenomedullin is markedly raised in uremic patients on dialysis, which confirms that the kidney has a major role in the clearance of this peptide. However, the fall in plasma adrenomedullin after isolated UF indicates that the plasma concentration of this peptide is influenced by the body fluid volume status. Whether or not adrenomedullin participates in the counter-regulatory response to fluid subtraction in uremic patients remains to be explored by specific antagonists of this substance

Photometry of a Galactic field at l = 232, b = -6. The old open cluster Auner 1, the Norma-Cygnus spiral arm and the signature of the warped Galactic Thick Disk

We perform a detailed photometric study of the stellar populations in a Galactic Field at l = 232, b = -6 in the Canis Major (CMa) constellation. We present the first U,B,V,I photometry of the old open cluster Auner1 and determine it to be 3.25 Gyr old and to lie at 8.9 kpc from the Sun. In the background of the cluster, at more than 9 kpc, we detect a young population most probably associated to the Norma Cygnus spiral arm. Furthermore, we detect the signature of an older population and identify its Turn Off and Red Giant Branch. This population is found to have a mean age of 7 Gyrs and a mean metallicity of Z = 0.006 . We reconstruct the geometry of the stellar distribution and argue that this older population - often associated to the Canis Major {\it galaxy}- belongs in fact to the warped old thin/thick disk component along this line of sight.Comment: 19 pages, 7 eps figures (some degraded), accepted for publication in the Astronomical Journa

Inflammation and outcome in end-stage renal failure: Does female gender constitute a survival advantage?

Inflammation and outcome in end-stage renal failure: Does female gender constitute a survival advantage?BackgroundElevated C-reactive protein (CRP) is a strong predictor of cardiovascular events and all-cause mortality in end-stage renal disease (ESRD) patients. However, although sex hormones may influence serum levels of inflammatory proteins, gender has not been taken into consideration in previous studies of inflammation and outcome in ESRD patients.MethodsWe included 663 (374 males) ESRD patients (59 ± 1 year) from three European renal centers (Sweden, Germany and Italy) in which CRP levels and outcome data (follow-up 33 ± 1 months) were available. The relation between outcome and serum levels of the soluble intercellular adhesion molecule (sICAM-1) was evaluated in 312 of the patients.ResultsThe present study shows that elevated CRP is a strong predictor of outcome, but whereas no difference in all-cause mortality was observed between non-inflamed (CRP ≤3.4 mg/L) males and females, inflamed males had a significantly (log rank 6.1; P = 0.01) higher mortality rate than inflamed females. A strong positive correlation between CRP and sICAM-1 was found in the combined patient material (ρ = 0.37; P < 0.0001) as well as in the male (ρ = 0.25; P < 0.01) and female (ρ = 0.52; P < 0.0001) subgroups. The Cox proportional hazard model showed that whereas both elevated sICAM-1 and log CRP predicted outcome in males, neither predicted outcome significantly in females.ConclusionsAs inflamed female patients have a better outcome that inflamed males the present observation suggests that sex hormones may have important cardioprotective effects that limit the effect of inflammation on vascular injury in female ESRD patients

Sleep‐Disordered Breathing and 24‐Hour Ambulatory Blood Pressure Monitoring in Renal Transplant Patients: Longitudinal Study

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Effect of Vitamin D Receptor Activation on the AGE/RAGE System and Myeloperoxidase in Chronic Kidney Disease Patients

Vitamin D receptor (VDR) activation has been reported to increase circulating levels of the advanced glycation end products (AGE) and their decoy receptor (RAGE). However, until now, the effect of VDR activation on AGE and RAGE has not been tested in the setting of a randomized, double-blind clinical trial. We have therefore analyzed the effect of VDR activation by paricalcitol on pentosidine, S100A12/ENRAGE, and RAGE and on established biomarkers of oxidative stress like myeloperoxidase in CKD patients in the PENNY trial. At baseline, human S100A12/ENRAGE, RAGE, and myeloperoxidase, but not pentosidine, were intercorrelated, and the association between S100A12/ENRAGE and myeloperoxidase (r=0.71, P<0.001) was the strongest among these correlations. Paricalcitol failed to modify biomarkers of the AGE/RAGE system and myeloperoxidase in unadjusted and adjusted analyses by the generalized linear model (GLM). No effect modification by other risk factors was registered. Paricalcitol does not modify biomarkers of the AGE/RAGE system and myeloperoxidase in CKD patients. The apparent increase in RAGE levels by VDR activation reported in previous uncontrolled studies is most likely due to confounding factors rather than to VDR activation per se. This trial is registered with NCT01680198

The ENPP1 Q121 Variant Predicts Major Cardiovascular Events in High-Risk Individuals: Evidence for Interaction With Obesity in Diabetic Patients

Insulin resistance (IR) and cardiovascular disease may share a common genetic background. We investigated the role of IR-associated ENPP1 K121Q polymorphism (rs1044498) on cardiovascular disease in high-risk individuals