Delayed dislocation following metal-on-polyethylene hip replacement due to “silent” trunnion corrosion

AimsWe present a case series of ten metal-on-polyethylene total hip arthroplasties (MoP THAs) with delayed dislocation associated with unrecognised adverse local tissue reaction due to corrosion at the trunnion and pseudotumour formation.MethodsThe diagnosis was not suspected in nine of the ten patients (six female/four male; mean age 66 years), despite treatment in a specialist unit (mean time from index surgery to revision was 58 months, 36 to 84). It was identified at revision surgery and subsequently confirmed by histological examination of resected tissue. Pre-operative assessment and culture results ruled out infection. A variety of treatment strategies were used, including resection of the pseudotumour and efforts to avoid recurrent dislocation.ResultsThe rate of complications was high and included three deep infections, two patients with recurrent dislocation, and one recurrent pseudotumour.ConclusionThis series (mean follow-up of 76 months following index procedure and 19 months following revision THA) demonstrates that pseudotumour is an infrequent but important contributor to delayed instability following MoP THA. It is easy to overlook in the differential diagnosis, especially if the alignment of the components is less than optimal, leading to an assumption that malalignment is the cause of the dislocation. The instability is likely to be multifactorial and the revision surgery is complex. Take home message: Due to the high complication rate associated with revision in this cohort, the diagnosis should be borne in mind when counselling patients regarding the risks of revision surgery. Cite this article: Bone Joint J 2016;98-B:187–93.</jats:sec

Medicine and improvement in the Scots Magazine; and Edinburgh Literary Miscellany, 1804-17

Megan Coyer’s chapter engages with periodical print as a vehicle for an improving medical culture in Scotland, concentrating on the second series of the Scots Magazine. Coyer demonstrates how the Scottish press often complemented improving civic initiatives like the Edinburgh Lunatic Asylum campaign. She focuses attention on the distinctive national dynamics associated with medical improvement efforts in early nineteenth-century Scotland, with the Scots Magazine ‘providing a public forum for the expression of a national medical identity’. This identity, as Coyer shows, had an ideology of improvement at its core. This work recovers the cultural significance of the Scots Magazine as ‘the third major player in popular periodical culture in Romantic-era Scotland’; a status overshadowed by the recent critical attention devoted to the second Edinburgh Review and Blackwood’s in Scottish Romantic studies. Coyer also shows how the efforts of public health reformers highlight the complexity of improvement as both a material and moral process. She argues that print efforts dedicated to improving public health represent a ‘discursive strand in the magazine identifying a lack of cleanliness … as a moral and material blight on an otherwise improving Scottish society’. This bringing together of moral and practical aspects of improvement in the Scots also finds expression in the magazine’s series of Scottish medical biographies, whose narratives, Coyer notes, provide ‘ideal exemplars of lives dedicated to a culture of improvement’

Revision for adverse local tissue reaction following metal-on-polyethylene total hip arthroplasty is associated with a high risk of early major complications

AimsFretting and corrosion at the modular head/neck junction, known as trunnionosis, in total hip arthroplasty (THA) is a cause of adverse reaction to metal debris (ARMD). We describe the outcome of revision of metal-on-polyethylene (MoP) THA for ARMD due to trunnionosis with emphasis on the risk of major complications.Patients and MethodsA total of 36 patients with a MoP THA who underwent revision for ARMD due to trunnionosis were identified. Three were excluded as their revision had been to another metal head. The remaining 33 were revised to a ceramic head with a titanium sleeve. We describe the presentation, revision findings, and risk of complications in these patients.ResultsThe patients presented with pain, swelling, stiffness, or instability and an inflammatory mass was confirmed radiologically. Macroscopic material deposition on the trunnion was seen in all patients, associated with ARMD. Following revision, six (18.2%) dislocated, requiring further revision in four. Three (9.1%) developed a deep infection and six (18.2%) had significant persistent pain without an obvious cause. One developed a femoral artery thrombosis after excision of an iliofemoral pseudotumor, requiring a thrombectomy.ConclusionThe risk of serious complications following revision MoP THA for ARMD associated with trunnionosis is high. In the presence of extensive tissue damage, a constrained liner or dual mobility construct is recommended in these patients. Cite this article: Bone Joint J 2018;100-B:720–4.</jats:sec

RANGING THE KHABAROVSK KRAY TERRITORIES BY THE LEVELS OF DYSENTERY EPIDEMIC MANIFESTATIONS

Aim: to reveal the Khabarovsk region territories that are under high risk of spread of dysentery in the period of large-scale flood fallout liquidation. Materials and methods. There was the analysis conducted of dysentery incidence during the period of 2003-2012 including distribution of annual and long-term annual average indicators per 100 000 inhabitants throughout administrative entities of Khabarovsk territory. We used methods that reveal tendencies and evaluated dynamic rates of dysentery epidemic process in time. Results and discussion. Khabarovsk region shows uneven levels of manifestations of epidemic process of dysentery not only during evaluation of annual incidence but also among certain administrative territories. During ten years preceding the flood in the Amur River region, long-term annual average level of incidence equaled to 42.7 ± 1.740/0000 The epidemic process was most intense in the Nanayi region, in other six administrative regions long-term annual average levels of incidence were exceeding similar averaged levels in Khabarovsk region. An intense epidemiologic situation on dysentery in several territories of the region was associated with registration of foci of clustered incidence caused by dysentery Sonne of alimentary and water-borne origin including atypical variants of Shigella Sonne. Conclusion. A year before the flood the elevation of dysentery incidence was registered in most of the territories of Khabarovsk Kray, and there was the evidence of outlined tendency of activation of epidemic process. This served as a basis for required adequate emergency measures for prophylaxis of dysentery

АНАЛИЗ ПУБЛИКАЦИЙ ОБ АВАРИИ НА АЭС «ФУКУСИМА» В СРЕДСТВАХ МАССОВОЙ ИНФОРМАЦИИ

The analysis of informing the public about radiation and radiation risks is made on the basiс of publications on the Fukushima nuclear accident after the earthquake and tsunami of March 11, 2011, by five newspapers and the official internet sites of the Federal Service for Surveillance on Consumer Rights Protection and Human Well-being and the Federal Service for Hydrometeorology and Environmental Monitoring. The analysis of the data suggests that the population is satisfied with its request in timely, clear, and reliable information on the radiation situation, protective measures and forecast of the situation development in the future. The possibility to learn about different viewpoints positively affects the mood of readers and reduces their anxiety. However, it should be recognized that, if the information have been provided by a single media only, the population would not have adequate understanding of the situation related to the accident at the Fukushima nuclear power plant.Информирование населения о радиации и радиационном риске выполнено на основе анализа газетных публикаций об аварии на АЭС «Фукусима» после землетрясения и цунами 11 марта 2011 г. в пяти газетах и на официальных Интернет-сайтах Роспотребнадзора и Росгидромета. Анализ информации позволяет считать, что удовлетворен запрос населения на своевременную, ясную, правдивую информацию о радиационной ситуации, о защитных мерах и о прогнозе развития ситуации в будущем. Возможность ознакомиться с разными открыто выраженными мнениями положительно влияет на настроения читателей, снижая уровень их обеспокоенности. Следует признать, однако, что если бы информирование осуществлялось только одним изданием, население не могло бы иметь адекватного ситуации представления об аварии на АЭС «Фукусима»

Total hip replacement in young adults with hip dysplasia: Age at diagnosis, previous treatment, quality of life, and validation of diagnoses reported to the Norwegian Arthroplasty Register between 1987 and 2007

Background and purpose: Dysplasia of the hip increases the risk of secondary degenerative change and subsequent total hip replacement. Here we report on age at diagnosis of dysplasia, previous treatment, and quality of life for patients born after 1967 and registered with a total hip replacement due to dysplasia in the Norwegian Arthroplasty Register. We also used the medical records to validate the diagnosis reported by the orthopedic surgeon to the register. Methods: Subjects born after January 1, 1967 and registered with a primary total hip replacement in the Norwegian Arthroplasty Register during the period 1987–2007 (n = 713) were included in the study. Data on hip symptoms and quality of life (EQ-5D) were collected through questionnaires. Elaborating information was retrieved from the medical records. Results: 540 of 713 patients (76%) (corresponding to 634 hips) returned the questionnaires and consented for additional information to be retrieved from their medical records. Hip dysplasia accounted for 163 of 634 hip replacements (26%), 134 of which were in females (82%). Median age at time of diagnosis was 7.8 (0–39) years: 4.4 years for females and 22 years for males. After reviewing accessible medical records, the diagnosis of hip dysplasia was confirmed in 132 of 150 hips (88%). Interpretation: One quarter of hip replacements performed in patients aged 40 or younger were due to an underlying hip dysplasia, which, in most cases, was diagnosed during late childhood. The dysplasia diagnosis reported to the register was correct for 88% of the hips

Therapeutic effect of exogenous Hsp70 in mouse models of Alzheimer's disease

Brain deterioration resulting from "protein folding" diseases, such as the Alzheimer's disease (AD), is one of the leading causes of morbidity and mortality in the aging human population. Heat shock proteins (Hsps) constitute the major cellular quality control system for proteins that mitigates the pathological burden of neurotoxic protein fibrils and aggregates. However, the therapeutic effect of Hsps has not been tested in a relevant setting. Here we report the dramatic neuroprotective effect of recombinant human Hsp70 in the bilateral olfactory bulbectomy model (OBX mice) and 5XFAD mouse models of neurodegeneration. We show that intranasally-administered Hsp70 rapidly enters the afflicted brain regions and mitigates multiple AD-like morphological and cognitive abnormalities observed in model animals. In particular, in both cases it normalizes the density of neurons in the hippocampus and cortex which correlates with the diminished accumulation of amyloid-β (Aβ) peptide and, in the case of 5XFAD mice, reduces Aβ plaque formation. Consistently, Hsp70 treatment also protects spatial memory in OBX and 5XFAD mice. These studies demonstrate that exogenous Hsp70 may be a practical therapeutic agent for treatment of neurodegenerative diseases associated with abnormal protein biogenesis and cognitive disturbances, such as AD, for which neuroprotective therapy is urgently needed

Analysis of Epidemiological Situation on Hemorrhagic Fever with Renal Syndrome in the Khabarovsk Territory and the Jewish Autonomous Region, and Prognosis of Its Development for the Past-Flood Period in 2013-2014

Complex analysis of the data concerning epidemiological situation on HFRS in the Khabarovsk Territory and the Jewish Autonomous Region for the past decade (2003-2012) previous to high water in 2013 and results of operative epidemiological inspection of the flooding area and the adjoining territory where a high index of laboratory evidences of the virus presence in the main carriers was revealed, outlines high probability of the epidemiological condition complications in view of the infection in the post-flooding period in 2013-2014 in the both entities. Therewith on the basis of the unfavorable prognosis for the epidemiological situation development a Plan of organizational, preventive and anti-epidemic measures directed to minimization of risks related to aggravation of epidemiological situation on hemorrhagic fever with renal syndrome has been developed and is being implemented

Sanitary-Hygienic and Microbiological Monitoring over the Water Supply Sources and Surface Water Reservoirs during Natural Disaster in the Amur-River Territory

Emergency situation in summer 2013 due to flooding of extensive areas of the Russian Amur-River territories (including residential areas with different level of development of public services and amenities, agricultural land, sites of cattle grazing and stock-keeping) resulted in the increased microbiological, virologic and physical-chemical load upon water reservoir ecosystems. The results of monitoring over water supply sources, quality of drinking water and surface reservoir waters in the devastated territories were analyzed by the specialists from Rospotrebnadzor and specialized anti-epidemic teams No. 1 and 2. Complex approach presuming increase in extent and frequency of the examinations, performance of operative epidemiological analysis along with daily adequation of preventive and anti-epidemic measures allowed for taking control over the situation and to avoid epidemic complications as regards acute water-borne intestinal infections