Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Oncology and immunology: Cross reactions between developing sciences

The reciprocal interactions of Oncology and Immunology are outlined, with special reference to cell-mediated immunity and the immunodiagnosis of human cancer

Genetic restriction of the serum factor mediating tolerance in trinitrochlorobenzene hypersensitivity

Serum of mice which are tolerant to trinitrochlorobenzene (picryl chloride) inhibited the expression of hapten-specific cell-mediated immunity in vivo (delayed-type hypersensitivity) and in vitro (leukocyte adherence inhibition). These effects have now been demonstrated in three strains of inbred mice with different H-2 genotypes; in these mice the phenomenon was restricted to syngeneic cell-serum combinations. The serum factor mediating the effects in CBA mice was absorbed by the corresponding anti-Ia antiserum and by the specific hapten. The factor, which is found in serum and is demonstrable both in vivo and in vitro, thus appears to be antigen-binding and to have Ia determinants of the major histocompatibility complex

Cell-mediated immunity and specific serum factors in human cancer: The leukocyte adherence inhibition test

Blood leukocytes from patients with cancer (malignant melanoma; adenocarcinoma of colon, rectum, and breast) reacted with aqueous extracts of tumors of the corresponding type, with the result that adherence of the leu kocytes to glass was diminished. Leukocytes from normal individuals did not react. The leukocyte adherence inhibition (LAI) test could be completed in a few hours. Sera from tumor-bearing patients blocked the LAI reaction of their own leukocytes or leukocytes from other patients with the same type of tumor. Serum blocking activity was lost soon after surgical removal of the tumor; the patient’s serum then became unblocking. The LAI technique gave consistent results in a series of patients, analogous to those reported with the lymphocyte cytotoxicity test, and was easier and quicker

Suppressor cells and soluble factors from the spleens of UV-irradiated mice

Several indices of splenic reactivity were measured daily after ultraviolet (UV) irradiation of mice. Spleen weight increased to a maximum after 5 days. Suppressor cell activity, manifested in various assays, peaked slightly earlier. The ability of passively transferred spleen cells to suppress the induction of contact hypersensitivity (CHS) was maximal after 4 days, as was the production of soluble suppressor factors in culture. The factors were detected by suppression of CHS in vivo and leucocyte adherence inhibition (LAI) in vitro. These assays appeared to detect different factors: an I-J- factor active in CHS assays and an I-J+ factor active in LAI assays. The latter factor required CD4-, CD8+ lymphocytes for its production

Requirement for lymphocyte-macrophage interaction in the response of mouse spleen cultures to pneumococcal polysaccharide

Cell suspensions from the spleens of normal mice were separated into two fractions by their adherence or nonadherence to plastic dishes. Adherent cells ("macrophage-rich") and nonadherent cells ("lymphocyte-rich") did not respond separately to pneumococcal polysaccharide Type III in vitro as judged by a hemolytic plaque test, whereas the original spleen suspension and a suspension reconstituted from the two fractions did respond. A part of the mouse's immune response to this antigen is therefore macrophage dependent, in contradiction to other indirect observations made in vivo

Restricted activity of serum blocking factors related to a common tumour antigen in mice

Mice of four different inbred strains (CBA, Balb/c, C57B1/6 and DBA/2), bearing different transplanted tumours (methylcholanthrene-induced sarcomas, BI6 melanoma and P-815 mastocytoma), were tested for cellular immune reactivity to the synthetic encephalitogcnic peptide of human myelin basic protein by the leucocyte adherence inhibition (LAI) assay. All exhibited reactivity at about the same optimal concentration of peptide. Normal mice of all strains and pregnant CBA mice were non-reactive. Blocking of LAI was detected with serum obtained 10 or more days after tumour transplantation. Sera from mice bearing different transplanted tumours abrogated the adherence-inhibitory effect of peptide on sensitized syngeneic peritoneal leucocytes. The blocking factors were cross-rcactive between different tumours only within the same mouse strain, indicating a requirement for genetic compatibility between donors of the reactive cells and the serum blocking factors

Appearance of three lymphokines in culture supernatants harvested at different times

Peritoneal cells from mice with methylcholanthrene-induced tumours were reacted with the corresponding tumour extract (antigen) and supernatants were prepared after incubation times of 1, 3.5 and 24 h. All the supernatants were then tested simultaneously on the same pools of normal indicator cells for their effects on leucocyte adherence, E-rosette formation and macrophage migration. The leucocyte adherence inhibition factor (LAIF) was consistently detected only in the 1-h supernatant, E-rosette augmentation factor (E-RAF) only in the 3.5-h supernatant and migration inhibition factor (MIF) only in the 24-h supernatant. It is concluded that LAIF, E-RAF and MIF are probably distinct factors, having different stabilities to degradation or inhibition under the conditions of cell culture. A less likely interpretation is that a single factor with multiple activities is affected by a series of distinct inhibitors. In practical terms, the 3 assays correlate only if the appropriate incubation times are used