Conventional versus highly cross-linked polyethylene in primary total knee replacement : a comparison of revision rates using data from the National Joint Registry for England, Wales, and Northern Ireland

There is evidence to support the use of highly cross-linked polyethylene (HXLPE) in patients undergoing total hip arthroplasty. However, the benefits for those undergoing total knee arthroplasty are uncertain, with conflicting reports based on previous cohort analyses. The purpose of the present study was to compare the revision rates following primary total knee arthroplasty with use of HXLPE as compared with conventional polyethylene (CPE) using data from the National Joint Registry (NJR) for England, Wales and Northern Ireland. We performed a retrospective analysis of primary total knee arthroplasties recorded in the NJR from 2003 to 2014. Cobalt-chromium (CoCr)-CPE and CoCr-HXLPE bearing surfaces were compared using all-cause revision, aseptic revision, and septic revision as end points. Survival analyses were conducted using rates per 100 years observed, Kaplan-Meier survival estimates, and Cox regression hazard ratios (HRs) adjusted for age, sex, American Society of Anesthesiologists (ASA) classification, body mass index (BMI), lead surgeon grade, and implant constraint. Secondary analyses compared the most commonly used HXLPEs (Zimmer Prolong, DePuy XLK, and Stryker X3) against CPE for the 3 most common total knee arthroplasty systems (NexGen, PFC Sigma, and Triathlon). In the present study of 550,658 total knee arthroplasties, the unadjusted aseptic revision rates were significantly lower following procedures performed with CPE (n = 513,744) as compared with those performed with HXLPE total knee replacements (n = 36,914) (0.29 [95% confidence interval (CI), 0.28 to 0.30] compared to 0.38 [95% CI, 0.35 to 0.42], p 35 kg/m, the "second-generation" Stryker X3 HXLPE demonstrated significantly better survival than its respective CPE, with CPE having an HR of 2.6 (95% CI, 1.2 to 5.9) (p = 0.02). Alternative bearings are marketed as having improved wear properties over traditional CoCr-CPE. This registry-based analysis demonstrated no overall survival benefit of HXLPE after a maximum duration of follow-up of 12 years. Because of their increased cost, the routine use of HXLPE bearings may not be justified. However, they may have a role in specific "higher demand" groups such as patients 35 kg/m. Therapeutic Level III. See Instructions for Authors for a complete list of levels of evidence

The effect of diffuse background on the spatially-resolved Schmidt relation in nearby spiral galaxies

The global Schmidt law of star formation provides a power-law relation between the surface densities of star-formation rate (SFR) and gas, and successfully explains plausible scenarios of galaxy formation and evolution. However, star formation being a multi-scale process, requires spatially-resolved analysis for a better understanding of the physics of star formation. It has been shown that the removal of a diffuse background from SFR tracers, such as H$\alpha$, far-ultraviolet (FUV), infrared, leads to an increase in the slope of the sub-galactic Schmidt relation. We reinvestigate the local Schmidt relations in nine nearby spiral galaxies taking into account the effect of inclusion and removal of diffuse background in SFR tracers as well as in the atomic gas.We used multiwavelength data obtained as part of the surveys such as SINGS, KINGFISH, THINGS, and HERACLES. Making use of a novel split of the overall light distribution as a function of spatial scale, we subtracted the diffuse background in the SFR tracers as well as the atomic gas. Using aperture photometry, we study the Schmidt relations on background subtracted and unsubtracted data at physical scales varying between 0.5--2 kpc. The fraction of diffuse background varies from galaxy to galaxy and accounts to $\sim$34 % in H$\alpha$, $\sim$43 % in FUV, $\sim$37 % in 24 $\mu$m, and $\sim$75\% in H I on average. We find that the inclusion of diffuse background in SFR tracers leads to a linear molecular gas Schmidt relation and a bimodal total gas Schmidt relation. However, the removal of diffuse background in SFR tracers leads to a super-linear molecular gas Schmidt relation. A further removal of the diffuse background from atomic gas results in a slope $\sim$1.4 $\pm$ 0.1, which agrees with dynamical models of star formation accounting for flaring effects in the outer regions of galaxies.Comment: 33 pages, 25 figures, 6 tables, accepted for publication in A&

Modifying monolayer behaviour by incorporating subphase additives and improving Langmuir–Blodgett thin film deposition on optical fibres

Experiments showing the possibility of modifying the behaviour of calix[4]resorcinarene monolayers at the air–water interface and optimising the deposition of multilayer coatings onto optical fibres are presented. The nature of the subphase is fundamental to the behaviour of monolayers and their utility in coating and sensing applications. Here we show initial studies exploring the modification of the calix[4]resorcinarene monolayer–water interaction through the introduction of dipole altering alcohol additives to the aqueous subphase. We explored the effect of this modification for three small alcohols. The resulting isotherms of the materials showed a reduction in the surface pressure and area per molecule required in order for the monolayer to reach its point of collapse. Incorporation of alcohols shifted the point of collapse, leading to the application of ethanol being successful in improving the transfer of material via Langmuir–Blodgett coating onto optical fibres at lower pressures. This method may prove useful in allowing greater control over future sensor surface coatings

Ariel - Volume 2 Number 2

Editors Delvyn C. Case, Jr. Paul M. Fernhoff News Editors Richard Bonanno Daniel B. Gould Ronald A. Hoffman Lay-Out Editor Carol Dolinskas Sports Editor James J. Nocon Contributing Editors MichaeI J. Blecker Lin Sey Edwards Jack Guralnik W. Cherry Light Features Editor Donald A. Bergman Stephen P. Flynn Business Manager Nick Grego Public Relations Robin A. Edward

Incidence and severity of respiratory syncytial virus pneumonia in rural Kenyan children identified through hospital surveillance

Background.Although necessary for developing a rationale for vaccination, the burden of severe respiratory syncytial virus (RSV) disease in children in resource‐poor settings remains poorly defined. Methods.We conducted prospective surveillance of severe and very severe pneumonia in children aged <5 years admitted from 2002 through 2007 to Kilifi district hospital in coastal Kenya. Nasal specimens were screened for RSV antigen by immunofluorescence. Incidence rates were estimated for the well‐defined population. Results.Of 25,149 hospital admissions, 7359 patients (29%) had severe or very severe pneumonia, of whom 6026 (82%) were enrolled. RSV prevalence was 15% (20% among infants) and 27% during epidemics (32% among infants). The proportion of case patients aged 3 months was 65%, and the proportion aged 6 months was 43%. Average annual hospitalization rates were 293 hospitalizations per 100,000 children aged <5 years (95% confidence interval, 271–371 hospitalizations per 100,000 children aged <5 years) and 1107 hospitalizations per 100,000 infants (95% confidence interval, 1012–1211 hospitalizations per 100,000 infants). Hospital admission rates were double in the region close to the hospital. Few patients with RSV infection had life‐threatening clinical features or concurrent serious illnesses, and the associated mortality was 2.2%. Conclusions.In this low‐income setting, rates of hospital admission with RSV‐associated pneumonia are substantial; they are comparable to estimates from the United States but considerably underestimate the burden in the full community. An effective vaccine for children aged >2 months (outside the age group of poor responders) could prevent a large portion of RSV disease. Severity data suggest that the justification for RSV vaccination will be based on the prevention of morbidity, not mortality