Are patients with hypermobile Ehlers-Danlos syndrome or hypermobility spectrum disorder so different?

Diagnosing hypermobile Ehlers-Danlos syndrome (hEDS) remains challenging, despite new 2017 criteria. Patients not fulfilling these criteria are considered to have hypermobile spectrum disorder (HSD). Our first aim was to evaluate whether patients hEDS were more severely affected and had higher prevalence of extra-articular manifestations than HSD. Second aim was to compare their outcome after coordinated physical therapy. Patients fulfilling hEDS/HSD criteria were included in this real-life prospective cohort (November 2017/April 2019). They completed a 16-item Clinical Severity Score (CSS-16). We recorded bone involvement, neuropathic pain (DN4) and symptoms of mast cell disorders (MCAS) as extra-articular manifestations. After a standardized initial evaluation (T0), all patients were offered the same coordinated physical therapy, were followed-up at 6 months (T1) and at least 1 year later (T2), and were asked whether or not their condition had subjectively improved at T2. We included 97 patients (61 hEDS, 36 HSD). Median age was 40 (range 18-73); 92.7% were females. Three items from CSS-16 (pain, motricity problems, and bleeding) were significantly more severe with hEDS than HSD. Bone fragility, neuropathic pain and MCAS were equally prevalent. At T2 (20 months [range 18-26]) 54% of patients reported improvement (no difference between groups). On multivariable analysis, only family history of hypermobility predicted (favorable) outcome (p = 0.01). hEDS and HDS patients showed similar disease severity score except for pain, motricity problems and bleeding, and similar spectrum of extra-articular manifestations. Long-term improvement was observed in > 50% of patients in both groups. These results add weight to a clinical pragmatic proposition to consider hEDS/HSD as a single entity that requires the same treatments

Increased tolerance of sunflower mutant seedlings to Cd and Zn in hydroponic culture

Cadmium and zinc show similarities in their chemistry, geochemistry and environmental properties. Whereas Cd is a phytotoxic non-essential element, Zn is an essential trace element for plant growth and development. Zinc plays a fundamental role in several key cellular functions, such as protein metabolism, gene expression, chromatin structure, photosynthetic carbon metabolism and indole acetic acid metabolism (Vallee and Falchuk, 1993; Marschner, 1995; Bonnet et al., 2000; Cakmak and Braun, 2001). Zinc is also an important component of many enzymes and proteins (Broadley et al., 2007). Cadmium can readily inhibit most of the Zn-dependent processes by binding to the membrane and to enzyme active sites, thus inactivating their functions (Aravind and Prasad, 2005). However, increasing Zn concentrations can replace such wrongly bound Cd (Van Assche and Clijsters, 1990; Shaw et al., 2004). Cadmium has been shown to cause many morphological, physiological, biochemical and structural changes in plants, such as growth inhibition, reduction in photosynthesis, transpiration or water imbalance (Sanità di Toppi and Gabbrielli, 1999; Schützendübel et al., 2001; Benavides et al., 2005; Mishra et al., 2006). Cadmium and high zinc concentration affect plant growth and metabolism, but the intensity of their toxic effects depends on plant species and the way and duration of metal exposure. Plants called hyperaccumulators are able to tolerate and accumulate extraordinary levels of trace elements in their above-ground tissue without developing any toxicity symptoms (Baker and Brooks, 1989; Reeves and Baker, 2000). Their high metal accumulation capability makes them interesting for the decontamination technique called phytoextraction, which uses plants for environmental clean-up (Salt et al., 1998). However, their low biomass production strongly limits the real application of this soil decontamination strategy. The ideal plant for phytoextraction should provide both a high biomass and a high tolerance and metal accumulation (Schwitzguébel et al., 2002). High biomass producing plants with improved tolerance to trace elements and with an enhanced metal accumulation capacity should be good candidates for metal removal from contaminated area. Previous studies have shown enhanced tolerance and metal accumulation properties in transgenic tobacco plants (Pomponi et al., 2006; Gorinova et al., 2007; Wojas et al., 2008). However, the main disadvantage of genetic engineering is still public acceptance and free-land application. In vitro breeding techniques have also been successfully used to obtain tobacco lines with a considerably enhanced Cd, Zn and Cu tolerance and metal accumulation (Herzig et al., 1997; Guadagnini et al., 1999; Herzig et al., 2003). In addition, the chemical mutagen ethyl methane sulphonate has been used to develop new sunflower lines with a significantly enhanced biomass and metal uptake on a metal contaminated field (Nehnevajova et al., 2007, 2009). Although these field experiments have revealed the potential of sunflower mutants for metal phytoextraction, their tolerance to trace elements and the effect of Cd and Zn on growth and photosynthetic pigments were not studied within previous free-land experimentation. The aim of the present work was thus to assess the tolerance to Cd and excess Zn of selected sunflower mutant lines with improved biomass and metal uptake capacity, by measuring different physiological parameters. For such a purpose, sunflower seedlings of eight selected mutant lines were cultivated under hydroponic conditions in the presence and in the absence of Cd and Zn to study the effect of these trace elements on (1) growth parameters, such as root elongation, root and shoot dry mass; (2) chlorophyll content; (3) carotenoid content; (4) Cd and Zn accumulation capacity of sunflower mutants; and (5) a possible correlation between Cd and Zn accumulation in sunflower shoots and roots

Glenoid loosening and migration in reverse shoulder arthroplasty

AIMS The aim of this study was to report the outcomes of different treatment options for glenoid loosening following reverse shoulder arthroplasty (RSA) at a minimum follow-up of two years. PATIENTS AND METHODS We retrospectively studied the records of 79 patients (19 men, 60 women; 84 shoulders) aged 70.4 years (21 to 87) treated for aseptic loosening of the glenosphere following RSA. Clinical evaluation included pre- and post-treatment active anterior elevation (AAE), external rotation, and Constant score. RESULTS From the original cohort, 29 shoulders (35%) were treated conservatively, 27 shoulders (32%) were revised by revision of the glenosphere, and 28 shoulders (33%) were converted to hemiarthroplasty. At last follow-up, conservative treatment and glenoid revision significantly improved AAE, total Constant score, and pain, while hemiarthroplasty did not improve range of movement or clinical scores. Multivariable analysis confirmed that conservative treatment and glenoid revision achieved similar improvements in pain (glenoid revision vs conservative, beta 0.44; p = 0.834) but that outcomes were significantly worse following hemiarthroplasty (beta -5.00; p = 0.029). CONCLUSION When possible, glenoid loosening after RSA should first be treated conservatively, then by glenosphere revision if necessary, and last by salvage hemiarthroplasty Cite this article: Bone Joint J 2019;101-B:461-469