A Prospective Study of Venous Thromboembolic Prophylaxis Using Foot Pumps Following Total Knee Replacement in a Chinese Population

AbstractPurposeThe purpose of this study was to evaluate foot pumps as mechanical prophylaxis for deep vein thrombosis (DVT) following total knee replacement (TKR) in a Chinese population.MethodsAll consecutive patients following TKR during 2002–2006 received routine duplex ultrasound surveillance for DVT 9 days postoperatively. The demographic data and risk factors were recorded. No medication was given for DVT prophylaxis in all patients.ResultsWe evaluated 91 consecutive TKRs in 85 patients. Although 44 knee replacements (Group 1) done before December 2004 were not given foot pumps, 47 knee replacements (Group 2) done afterwards were given foot pumps. All patients were followed up for more than 6 months. DVT was detected in three cases (6.8%) in Group 1 compared with four knees (8.5%) in Group 2. Proximal thrombosis was observed in two knees (4.5%) in Group 1 compared with two knees (4.3%) in Group 2. No patient had pulmonary embolism. Six out of 59 (10.2%) patients who underwent the operations under general anaesthesia suffered from DVT, whereas one in 28 (3.6%) patients operated under spinal anaesthesia had DVT. All had no statistical significance.ConclusionThe rate of proximal DVT after TKR was low (4.5%) without pharmacological prophylaxis. We advise against the use of pharmacological prophylaxis in Chinese population for TKRs because of the low risk of proximal DVT and its possible bleeding complications. Foot pump did not lower the rate of DVTfurther, and its use for DVT prophylaxis in TKR is not necessary

The effect of different dosing regimens of motesanib on the gallbladder: a randomized phase 1b study in patients with advanced solid tumors

Extent: 11 p.BACKGROUND: Gallbladder toxicity, including cholecystitis, has been reported with motesanib, an orally administered small-molecule antagonist of VEGFRs 1, 2 and 3; PDGFR; and Kit. We assessed effects of motesanib on gallbladder size and function. METHODS: Patients with advanced metastatic solid tumors ineligible for or progressing on standard-of-care therapies with no history of cholecystitis or biliary disease were randomized 2:1:1 to receive motesanib 125 mg once daily (Arm A); 75 mg twice daily (BID), 14-days-on/7-days-off (Arm B); or 75 mg BID, 5-days-on/2-days-off (Arm C). Primary endpoints were mean change from baseline in gallbladder size (volume by ultrasound; independent review) and function (ejection fraction by CCK-HIDA; investigator assessment). RESULTS: Forty-nine patients received ≥1 dose of motesanib (Arms A/B/C, n = 25/12/12). Across all patients, gallbladder volume increased by a mean 22.2 cc (from 38.6 cc at baseline) and ejection fraction decreased by a mean 19.2% (from 61.3% at baseline) during treatment. Changes were similar across arms and appeared reversible after treatment discontinuation. Three patients had cholecystitis (grades 1, 2, 3, n = 1 each) that resolved after treatment discontinuation, one patient developed grade 3 acute cholecystitis requiring cholecystectomy, and two patients had other notable grade 1 gallbladder disorders (gallbladder wall thickening, gallbladder dysfunction) (all in Arm A). Two patients developed de novo gallstones during treatment. Twelve patients had right upper quadrant pain (Arms A/B/C, n = 8/1/3). The incidence of biliary “sludge” in Arms A/B/C was 39%/36%/27%. CONCLUSION: Motesanib treatment was associated with increased gallbladder volume, decreased ejection fraction, biliary sludge, gallstone formation, and infrequent cholecystitis. Trial registration: ClinicalTrials.gov NCT00448786Lee S. Rosen, Lara Lipton, Timothy J. Price, Neil D. Belman, Ralph V. Boccia, Herbert I. Hurwitz, Joe J. Stephenson Jr., Lori J. Wirth, Sheryl McCoy, Yong-jiang Hei, Cheng-Pang Hsu and Niall C. Tebbut

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Does Conservative Rehabilitation Program Lead to Long-Term Stiffness after Arthroscopic Rotator Cuff Repair?

Background: Evidence on the ideal rehabilitation program for arthroscopic rotator cuff repair is lacking. Most data and results are conflicting with no consensus made. This study aims to compare between an early aggressive program with immediate postoperative range-of-motion (ROM) exercises and a more conservative program with early restriction of motion in Hong Kong Chinese population. Materials and methods: We retrospectively evaluated 37 arthroscopic rotator cuff repair cases who underwent a standardized delayed rehabilitation protocol of immobilization for 4 weeks to 6 weeks before formal passive ROM exercises. Patients were evaluated at 3 months, 6 months, and 12 months after the surgery, for which they would be tested on passive forward flexion (FF). They were categorized as “stiff” if FF was less than 100°. Constant score, Disability of Arm, Shoulder and Hand (DASH) score, Visual Analog Scale (VAS) score, and isometric abduction power deficit percentage were parameters to assess the functional outcome, and they were obtained in all of the patients' last follow-up assessments. Results: Two cases (5.4%) are considered “stiff” 6 months after the surgery. At 1 year, the stiffness in both cases resolved, resulting in 0% rate of stiffness. The mean FF at 1 year was 153.33 ± 20.15, which is comparable to the literature. Two cases (5.4%) of clinical retear occurred. Mean Constant score at the latest follow-up was 62.4 ± 13.2. Mean VAS score was 1.1 ± 1.8 at rest and 2.8 ± 2.0 on exertion. Mean DASH score was 25.3 ± 21.9. Mean isometric abduction power deficit was 42.7% ± 0.2%. Discussion: Historically, due to concerns on long-term stiffness, an early aggressive postoperative rehabilitation protocol was used. We found that an early restriction of ROM with 4 weeks to 6 weeks of immobilization did not lead to long-term stiffness and functional disadvantage. This includes patients with stiffness even before the operations. Conclusions: Immobilization for 4 weeks to 6 weeks after arthroscopic rotator cuff repair does not result in long-term stiffness and may even be beneficial to cuff tendon healing. 中 文 摘 要: 背景: 關於關節鏡修復肩袖的理想康復方案缺乏證據，大多數數據和結果是矛盾而沒有達成共識。本研究目的是以香港中國人，以積極方案即時術後可動範圍運動和較保守的早期運動限制方案作比較. 材料與方法: 我們回顧性評估了關節鏡修復肩袖37例，採用標準化的延遲康復方案，避免術後4至6周內的可動範圍被動活動。手術後3個月、6 個月、12 個月對患者進行評估，並測試向前屈曲，若向前屈曲 少於100度，就被歸類為僵硬。評估能力結果的參數是Constant 評分、上臂肩手功能殘疾 (DASH) 評分、视覺模擬量表 (VAS) 和等距外展力量不足百分比，都在所有患者的最後隨訪中獲得. 結果: 手術6 個月後，2例 (5.4%) 被認為“僵硬”。1年時，2例僵硬均可解決，僵硬的比率為0%。1年時，平均向前屈曲為153.33°+/-20.5°，與文獻類同。2例 (5.4%) 出現臨床再撕裂。最後隨訪中，平均Constant評分為62.4+/-13.2。平均视覺模擬量表在休息時為1.1+/-1.8，運動時為2.8+/-2.0。平均上臂肩手功能殘疾 (DASH) 評分為25.3+/-21.9。 平均等距外展力量不足百分比是42.7%+/-0.2%. 討論: 從歷史上看，由於對長期僵硬的擔憂，使用了早期積極術後康復方案。我們發現在4至6周早期限制可動範圍運動並不會導致長期僵硬和功能缺陷。這包括了即使在手術前有僵硬的患者.結論: 關節鏡修復肩袖後4至6周的不動不會導致長期僵硬，甚或有利於肩袖筋腱癒合. Keywords: arthroscopic rotator cuff repair, cuff tendon healing, range-of-motion exercises, rehabilitation program, stiffnes

Revision Total Hip Arthroplasty Complicated by Metastatic Malignant Gastrointestinal Stromal Tumour

Periprosthetic malignancy causing failure of total hip arthroplasty is a rare entity. Metastasis of malignant tumour to the proximity of orthopaedic implants is even more uncommon. We present a case of a 74-year-old female with an infected Austin Moore prosthesis, requiring a two-stage revision total hip arthroplasty. Within 2 years postoperatively, erosion of the lesser trochanter was noted. Further revision surgery was performed with the insertion of a cement spacer. Despite the expectation of an infected prosthesis, intraoperative frozen section showed sarcoma and the final pathology was metastasis of a recurrent gastrointestinal stromal tumour (GIST). Metastatic GIST to total hip prosthesis had not been reported previously and this case illustrates how intraoperative frozen section can aid diagnosis and management. We also highlighted some diagnostic clues, differentiating this rare diagnosis from septic loosening and osteolysis. Malignant infiltration should be considered as a differential diagnosis in failed total hip arthroplasty, especially in patients with a previous history of malignancy

Scarf Osteotomy in Treating Hallux Valgus: Clinical and Radiographical Outcome and Technical Notes

Introduction: Scarf osteotomy can be a technically demanding procedure and early reports have shown high complication rates. Proponents, however, suggest that this type of osteotomy is versatile and allows for both translation and angulation correction of the hallux valgus (HV) deformity. The purpose of this study was to evaluate the clinical and radiological results of the scarf osteotomy procedure performed in our hospital. Materials and methods: We retrospectively reviewed 31 feet in 25 patients with an average follow-up duration of 16 months (range: 6–30 months). Results: On the latest follow up, 77% of the patients were satisfied with the result, with an average postoperative American Orthopaedic Foot and Ankle Society score of 88. The average improvement of HV angle was from 37.9° to 10.0°. The intermetatarsal angle improved from 16.0° to 8.0°. The average first metatarsal shortening was 0.3 mm. Neither delayed union nor osteonecrosis was observed. Conclusion: Scarf osteotomy is a reliable procedure to achieve correction of HV deformity with good patient satisfaction

Microglia activation in the offspring of prenatal Poly I: C exposed rats: a PET imaging and immunohistochemistry study

Background The well-known ‘pyrotherapy’ of Julius Wagner-Jauregg might be the beginning of the study on the immunological concepts of schizophrenia. As the primary immune effector cells in the brain, microglia play a pivotal role in neuroinflammatory processes. Maternal viral infection during pregnancy is associated with an increased risk for psychiatric disorders with presumed neurodevelopmental origin, including autism spectrum disorders and schizophrenia. The present study was to quantify microglia activation in vivo in the mature offspring of rats exposed to polyriboinosinic–polyribocytidilicacid (Poly I:C) during pregnancy using 11C-PK11195 positron emission tomography (PET) and immunohistochemistry. Objective The study aimed to quantify microglia activation in vivo in the prefrontal cortex and hippocampus in mature offspring of prenatal Poly I:C exposed rats. Methods Offspring of Poly I:C-treated dams were the model group, offspring of saline-treated dams were the control group. Behavioural test for two groups was taken by spontaneous activity, prepulse inhibition (PPI) and latent inhibition (LI) test (including active avoidance conditioning task and passive avoidance conditioning task). Randomly selected successful model rats were assessed by behavioural test in the model group and control group rats. 11C-PK11195 micro-PET/CT and immunohistochemistry were performed on the selected rats to measure microglia activation. Results The treatment group showed hyperlocomotion and deficits in PPI and LI compared with the control group. The treatment group also showed an increased 11C-PK11195 uptake ratio in the prefrontal cortex (t=−3.990, p=0.003) and hippocampus (t=−4.462, p=0.001). The number of activated microglia cells was significantly higher in the treatment group than in the control group (hippocampus: t=8.204, p Conclusions The present study demonstrated microglia activation in vivo in the prefrontal cortex and hippocampus in mature offspring of prenatal Poly I:C exposed rats. This study suggests that microglia activation may play a possible or potential role in the pathogenesis of schizophrenia

Treatment of Mycobacterium fortuitum Infection of Total Knee Arthroplasty: A Case Report

Mycobacterium fortuitum is a rapidly growing bacterium that can cause infection at different sites in humans. Prosthetic infection caused by this bacterium has historically been a challenge, with reimplantation being unsuccessful in all but one case. M. fortuitum is resistant to almost all conventional antituberculous medications. There is no standardised treatment due to its rarity of occurrence. Here, we report a case of successful reimplantation with initial debridement surgery and 6 weeks of antibiotics