Pre-surgical radiologic identification of peri-prosthetic osteolytic lesions around TKRs: a pre-clinical investigation of diagnostic accuracy

Background: Emerging longitudinal data appear to demonstrate an alarming trend towards an increasing prevalence of osteolysis-induced mechanical failure, following total knee replacement (TKR). Even with high-quality multi-plane X-rays, accurate pre-surgical evaluation of osteolytic lesions is often difficult. This is likely to have an impact on surgical management and provides reasonable indication for the development of a model allowing more reliable lesion assessment. The aim of this study, using a simulated cadaver model, was to explore the accuracy of rapid spiral computed tomography (CT) examination in the non-invasive evaluation of peri-prosthetic osteolytic lesions, secondary to TKR, and to compare this to conventional X-ray standards. Methods: A series of nine volume-occupying defects, simulating osteolytic lesions, were introduced into three human cadaveric knees, adjacent to the TKR implant components. With implants in situ, each knee was imaged using a two-stage conventional plain X-ray series and rapid-acquisition spiral CT. A beam-hardening artefact removal algorithm was employed to improve CT image quality. After random image sorting, 12 radiologists were independently shown the series of plain X-ray images and asked to note the presence, anatomic location and 'size' of osteolytic lesions observed. The same process was repeated separately for review of the CT images. The corresponding X-ray and CT responses were directly compared to elicit any difference in the ability to demonstrate the presence and size of osteolytic lesions. Results: Access to CT images significantly improved the accuracy of recognition of peri-prosthetic osteolytic lesions when compared to AP and lateral projections alone (P = 0.008) and with the addition of bi-planar oblique X-rays (P = 0.03). No advantage was obtained in accuracy of identification of such lesions through the introduction of the oblique images when compared with the AP and lateral projections alone (P = 0.13) Conclusion: The findings of this study suggest that peri-prosthetic osteolytic lesions can be reliably described non-invasively using a simple, rapid-acquisition CT-based imaging approach. The low sensitivity of conventional X-ray, even with provision of supplementary bi-planar 45° oblique views, suggests a limited role for use in situ for TKR implant screening where peri-prosthetic osteolytic lesions are clinically suspected. In contrast, the accuracy of CT evaluation, linked to its procedural ease and widespread availability, may provide a more accurate way of evaluating osteolysis around TKRs, at routine orthopaedic follow up. These findings have direct clinical relevance, as accurate early recognition and classification of such lesions influences the timing and aggressiveness of surgical and non-operative management strategies, and also the nature and appropriateness of planned implant revision or joint-salvaging osteotomy procedures.Timothy P. Kurmis, Andrew P. Kurmis, David G. Campbell and John P. Slavotine

The endothelial glycocalyx: composition, functions, and visualization

This review aims at presenting state-of-the-art knowledge on the composition and functions of the endothelial glycocalyx. The endothelial glycocalyx is a network of membrane-bound proteoglycans and glycoproteins, covering the endothelium luminally. Both endothelium- and plasma-derived soluble molecules integrate into this mesh. Over the past decade, insight has been gained into the role of the glycocalyx in vascular physiology and pathology, including mechanotransduction, hemostasis, signaling, and blood cell–vessel wall interactions. The contribution of the glycocalyx to diabetes, ischemia/reperfusion, and atherosclerosis is also reviewed. Experimental data from the micro- and macrocirculation alludes at a vasculoprotective role for the glycocalyx. Assessing this possible role of the endothelial glycocalyx requires reliable visualization of this delicate layer, which is a great challenge. An overview is given of the various ways in which the endothelial glycocalyx has been visualized up to now, including first data from two-photon microscopic imaging

The preference and actual use of different types of rural recreation areas by urban dwellers--the Hamburg case study.

In the wake of urbanisation processes and the constitution of metropolitan regions, the role of the city's rural surroundings is receiving more attention from researchers and planners as rural areas offer various (cultural) ecosystem services for the urban population. Urban dwellers increasingly desire recreation and landscape experience. Although this need for recreation is generally recognized, few studies have focused on the question of people's preferences for certain types and characteristics of outdoor recreation areas in relation to the frequency of use. In order to acquire baseline data on this subject, the main objectives of this study were to explore recreation preferences of urban dwellers and the relation between actual use and perceived value of recreation areas in a case study in the Hamburg Metropolitan Region (Germany). In a social survey, Hamburg residents (n = 400) were asked about their preferences and use of four important regional recreation areas with different landscape characteristics in face-to-face interviews in different locations in the city. We found that both outdoor recreation within and outside of the city were fairly or very important for more than 70% of the questioned urban dwellers. Interestingly, the preference for a recreation area outside of the city did not depend on the frequency of use, which indicates that certain recreation areas had a symbolic value besides their use value. When people were questioned on the characteristics of recreation areas, perceived naturalness was found to be strongly related to preference. Respondents considered the diversity, uniqueness, and naturalness of the landscape to be far more important than the accessibility of the recreation areas and the provision of service facilities

Mineralisation and mechanical strength of the glenoid cavity subchondral bone plate

PURPOSE: Failures in total shoulder replacements are often due to aseptic loosening of the glenoid component; the subchondral bone plate is an important factor governing primary fixation of implant materials. Therefore, we investigated characteristic mineralisation patterns of the subchondral bone plate, which demonstrate long-term stress on articular surfaces, age-related changes, postsurgical biomechanical situations and regions of fixation. Using computed tomography osteo-absorptiometry (CT-OAM), these distribution patterns can be demonstrated in vivo. The aim of this study was to investigate the relationship between subchondral bone-plate mineralisation measured with CT-OAM and the mechanical strength measured by indentation. METHODS: A total of 32 cadaverous glenoid cavities were evaluated by CT-OAM and indentation testing. Linear regression was used to compare mineralisation and strength of the subchondral bone plate. RESULTS: Results showed two patterns of mineralisation distribution. Twenty-eight cavities were related to bicentric distribution pattern and four showed a single maximum. The correlation coefficient between CT-OAM density and subchondral bone-plate strength was determined to be between 0.62 and 0.96 (P > 0.02). CONCLUSIONS: Long-term stress affects not only the subchondral but also the underlying cancellous bone. It therefore can be assumed that mineralisation patterns of the subchondral bone plate continue in cancellous bone. Areas of high density could serve as anchoring locations for orthopaedic implants in resurfacing the glenoid cavity

Catalyst selection based on intermediate stability measured by mass spectrometry

The power of natural selection through survival of the fittest is nature’s ultimate tool for the improvement and advancement of species. To apply this concept in catalyst development is attractive and may lead to more rapid discoveries of new catalysts for the synthesis of relevant targets, such as pharmaceuticals. Recent advances in ligand synthesis using combinatorial methods have allowed the generation of a great diversity of catalysts. However, selection methods are few in number. We introduce a new selection method that focuses on the stability of catalytic intermediates measured by mass spectrometry. The stability of the intermediate relates inversely to the reactivity of the catalyst, which forms the basis of a catalyst-screening protocol in which less-abundant species represent the most-active catalysts, ‘the survival of the weakest’. We demonstrate this concept in the palladium-catalysed allylic alkylation reaction using diphosphine and IndolPhos ligands and support our results with high-level density functional theory calculations