No clinically relevant difference in patient-reported outcomes between the direct superior approach and the posterolateral or anterior approach for primary total hip arthroplasty:analysis of 37,976 primary hip arthroplas-ties in the Dutch Arthroplasty Registry

Background and purpose — The direct superior approach (DSA) is a modification of the posterolateral approach (PLA) for total hip arthroplasty (THA). Patient-reported outcome measures (PROMs) of the DSA have not been investigated previously using nationwide data. Our aim was to assess PROMs after THA using the DSA compared with the PLA and, secondarily, with the anterior approach (DAA). Patients and methods — In this population-based cohort study we included 37,976 primary THAs performed between 2014 and 2020 (PLA: n = 22,616; DAA: n = 15,017; DSA: n = 343) using Dutch Arthroplasty Registry data. PROMs (NRS pain, EQ-5D, HOOS-PS, and OHS) were mea-sured preoperatively, and at 3 and 12 months postoperatively. Repeated measurements were analyzed using mixed-effects models, adjusted for confounders, to investigate the associa-tion between surgical approach and PROMs over time. Results — From baseline to 3 and 12 months, improve-ments for NRS pain scores, EQ-5D, and OHS were com-parable for the DSA compared with the PLA or DAA. No difference was found in HOOS-PS improvement 3 months postoperatively between DSA and PLA (–0.2, 95% confidence interval [CI] –2.4 to 1.9) and between DSA and DAA (–1.7, CI –3.9 to 0.5). At 12 months postoperatively, patients in the DSA group had improved –2.8 points (CI –4.9 to –0.6) more in HOOS-PS compared with the DAA, but not with the PLA group (–1.0, CI –3.2 to 1.1). Conclusion — Our study showed no clinically meaning-ful differences between the DSA and either PLA or DAA.</p

TCR Gene Transfer: MAGE-C2/HLA-A2 and MAGE-A3/HLA-DP4 Epitopes as Melanoma-Specific Immune Targets

Adoptive therapy with TCR gene-engineered T cells provides an attractive and feasible treatment option for cancer patients. Further development of TCR gene therapy requires the implementation of T-cell target epitopes that prevent “on-target” reactivity towards healthy tissues and at the same time direct a clinically effective response towards tumor tissues. Candidate epitopes that meet these criteria are MAGE-C2336-344/HLA-A2 (MC2/A2) and MAGE-A3243-258/HLA-DP4 (MA3/DP4). We molecularly characterized TCRαβ genes of an MC2/A2-specific CD8 and MA3/DP4-specific CD4 T-cell clone derived from melanoma patients who responded clinically to MAGE vaccination. We identified MC2/A2 and MA3/DP4-specific TCR-Vα3/Vβ28 and TCR-Vα38/Vβ2 chains and validated these TCRs in vitro upon gene transfer into primary human T cells. The MC2 and MA3 TCR were surface-expressed and mediated CD8 T-cell functions towards melanoma cell lines and CD4 T-cell functions towards dendritic cells, respectively. We intend to start testing these MAGE-specific TCRs in phase I clinical trial

Estimation of acute and chronic Q fever incidence in children during a three-year outbreak in the Netherlands and a comparison with international literature

Background:  In the Dutch 2007-2009 Q fever outbreak Coxiella burnetii was transmitted aerogenically from dairy goat farms to those living in the surrounding areas. Relatively few children were reported. The true number of pediatric infections is unknown. In this study, we estimate the expected number of acute and chronic childhood infections. Methods:  As Coxiella was transmitted aerogenic to those living near infected dairy goat farms, we could use adult seroprevalence data to estimate infection risk for inhabitants, children and adults alike. Using Statistics Netherlands data we estimated the number of children at (high) risk for developing chronic Q fever. Literature was reviewed for childhood (0-15 years) Q fever reports and disease rates. We compared this with Dutch reported and our estimated data for 2007-2009. Results:  In The Netherlands epidemic, 44 children were reported (1.2 % of total notifications). The childhood incidence was 0.15 compared to 2.6 per 10,000 inhabitants for adults. No complications were reported. Based on the expected similarity in childhood and adult exposure we assume that 9.8 % of children in the high-risk area had Q fever infection, resulting in 1562 acute infections during the Q fever epidemic interval. Based on the prevalence of congenital heart disease, at least 13 children are at high risk for developing chronic Q fever. In medical literature, 42 case reports described 140 childhood Q fever cases with a serious outcome (four deaths). In chronic Q fever, cardiac infections were predominant. Four outbreaks were reported involving children, describing 11 childhood cases. 36 National and/or regional studies reported seroprevalences varying between 0 and 70 %. Conclusion:  In the 3-year Dutch epidemic, few childhood cases were reported, with pulmonary symptoms leading, and none with a serious presentation. With an estimated 13 high-risk children for chronic infection in the high exposure area, and probably forty in the whole country, we may expect several chronic Q fever complications in the coming years in paediatric practice

Man on the throne of God? The societal implications ofthe bio-medical revolution

The article deals with the possible influences on society of developments in the bio-medical field and especially cloning, ‘the book of life’ and eugenics. It is argued that the present resistance against these developments may diminish under the influence of biologism which is on the rise. The author investigates these societal influences in four fields: the welfare state (will the notion of collective solidarity disappear?), citizenship, meritocracy (can we expect new class divisions?) and democratic politics (the rise of new political cleavages).L’articolo tratta delle possibili influenze sulla società degli sviluppi nel campo bio-medico e particolarmente nella clonazione, “il libro della vita” e dell’eugenetica. Si considera che la presente resistenza a questi sviluppi possa diminuire sotto l’influenza del biologismo in crescita. L’autore analizza queste influenze societarie in quattro campi: il welfare state (scomparirà la nozione della solidarietà collettiva?), la cittadinanza, la meritocrazia (si possono avere nuove divisioni di classe?), e la politica democratica (il sorgere di nuove divisioni politiche)

Vers une culture mondialisée : rêve ou cauchemar ?

Die Globalisierung kann als Drohung oder als Herausforderung empfunden werden. In der aktuellen Debatte über die Frage der Globalisierung der Kultur beschäftigt man sich vor allem mit dem Aspekt der Drohung. Dieser Presseartikel gibt eine Übersicht einer gewissen Anzahl von Alptraum-Hypothesen über die Zukunft der globalisierten Kultur und beweist, dass trotz der herrschenden Sorge über die "schleichende Amerikanisierung" und den "Zivilisationenaufprall" keines dieser Szenarios glaubwürdig ist und auch nicht von der empirischen Realität bestätigt wird.Globalization can be seen as a threat or as a challenge. The discussion on cultural globalization which dominates the recent discourse emphasizes the first aspect. In this article a number of nigthmare-hypothesis with regard to the future of a global culture are discussed. It appears that despite the prevailing anxiety about "creeping Americanization" and a "clash of civilizations ”, none of these scenarios is tenable nor supported by the empirical reality.La mondialisation peut être perçue comme une menace ou comme un challenge. Dans le débat actuel sur la question de la mondialisation de la culture, le discours porte surtout la menace induite. Cet article passe en revue un certain nombre d’hypothèses-cauchemar sur l’avenir de la culture mondialisée et démontre qu’en dépit de l’inquiétude ambiante à propos de "l’américanisation rampante" et du " choc des civilisations", aucun de ces scénarios n’est crédible, ni conforté par la réalité empirique.Se puede percibir la globalización como una amenaza o como un reto. En este debate actual acerca de la globalización de la cultura, el discurso apunta sobre todo al aspecto de amenaza. Este artículo pasa revista a varias hipótesis pesadillas en cuanto al porvenir de la cultura globalizada y muestra que, a pesar de la inquietud latente acerca de la "americanización rampante" y del "choque de las civilizaciones", ninguno de estos esquemas es creíble, ni tampoco se ve corroborado por la realidad empírica.van Steenbergen Bart, Santagati Grazia. Vers une culture mondialisée : rêve ou cauchemar ?. In: Agora débats/jeunesses, 19, 2000. Les jeunes et la mondialisation. pp. 71-80

Femoral Neck Design Does Not Impact Revision Risk After Primary Total Hip Arthroplasty Using a Dual Mobility Cup

Background: The use of dual mobility (DM) cups has increased quickly. It is hypothesized that femoral neck taper geometry may be involved in the risk of prosthetic impingement and DM cup revision. We aim to (1) explore the reasons for revision of DM cups or head/liners and (2) explore whether certain femoral neck characteristics are associated with a higher risk of revision of DM cups. Methods: Primary total hip arthroplasties with a DM cup registered in the Dutch Arthroplasty Register between 2007 and 2021 were identified (n = 7603). Competing risk survival analyses were performed, with acetabular component and head/liner revision as the primary endpoint. Reasons for revision were categorized in cup-/liner-related revisions (dislocation, liner wear, acetabular loosening). Femoral neck characteristics were studied to assess whether there is an association between femoral neck design and the risk of DM cup/liner revision. Multivariable Cox proportional hazard analyses were performed. Results: The 5- and 10-year crude cumulative incidence of DM cup or head/liner revision for dislocation, wear, and acetabular loosening was 0.5% (CI 0.4-0.8) and 1.9% (CI 1.3-2.8), respectively. After adjusting for confounders, we found no association between the examined femoral neck characteristics (alloy used, neck geometry, CCD angle, and surface roughness) and the risk for revision for dislocation, wear, and acetabular loosening. Conclusions: The risk of DM cup or head/liner revision for dislocation, wear, and acetabular loosening was low. We found no evidence that there is an association between femoral neck design and the risk of cup or head/liner revision.</p

Femoral Neck Design Does Not Impact Revision Risk After Primary Total Hip Arthroplasty Using a Dual Mobility Cup

Background: The use of dual mobility (DM) cups has increased quickly. It is hypothesized that femoral neck taper geometry may be involved in the risk of prosthetic impingement and DM cup revision. We aim to (1) explore the reasons for revision of DM cups or head/liners and (2) explore whether certain femoral neck characteristics are associated with a higher risk of revision of DM cups. Methods: Primary total hip arthroplasties with a DM cup registered in the Dutch Arthroplasty Register between 2007 and 2021 were identified (n = 7603). Competing risk survival analyses were performed, with acetabular component and head/liner revision as the primary endpoint. Reasons for revision were categorized in cup-/liner-related revisions (dislocation, liner wear, acetabular loosening). Femoral neck characteristics were studied to assess whether there is an association between femoral neck design and the risk of DM cup/liner revision. Multivariable Cox proportional hazard analyses were performed. Results: The 5- and 10-year crude cumulative incidence of DM cup or head/liner revision for dislocation, wear, and acetabular loosening was 0.5% (CI 0.4-0.8) and 1.9% (CI 1.3-2.8), respectively. After adjusting for confounders, we found no association between the examined femoral neck characteristics (alloy used, neck geometry, CCD angle, and surface roughness) and the risk for revision for dislocation, wear, and acetabular loosening. Conclusions: The risk of DM cup or head/liner revision for dislocation, wear, and acetabular loosening was low. We found no evidence that there is an association between femoral neck design and the risk of cup or head/liner revision.</p

Dual mobility cups in primary total hip arthroplasties: trend over time in use, patient characteristics, and mid-term revision in 3,038 cases in the Dutch Arthroplasty Register (2007–2016)

Background and purpose — We noticed an increased use of dual mobility cups (DMC) in primary total hip arthroplasty (THA) despite limited knowledge of implant longevity. Therefore, we determined the trend over time and mid-term cup revision rates of DMC compared with unipolar cups (UC) in primary THA. Patients and methods — All primary THA registered in the Dutch Arthroplasty Register (LROI) during 2007–2016 were included (n = 215,953) and divided into 2 groups — DMC THA (n = 3,038) and UC THA (n = 212,915). Crude competing risk and multivariable Cox regression analyses were performed with cup revision for any reason as primary endpoint. Adjustments were made for sex, age, diagnosis at primary THA, previous operation, ASA score, type of fixation, surgical approach, and femoral head size. Results — The proportion of primary DMC THA increased from 0.8% (n = 184) in 2010 to 2.6% (n = 740) in 2016. Patients who underwent DMC THA more often had a previous operation on the affected hip, a higher ASA score, and the diagnosis acute fracture or late posttraumatic status compared with the UC THA group. Overall 5-year cup revision rate was 1.5% (95% CI 1.0–2.3) for DMC and 1.4% (CI 1.3–1.4) for UC THA. Stratified analyses for patient characteristics showed no differences in cup revision rates between the 2 groups. Multivariable regression analyses showed no statistically significantly increased risk for revision for DMC THA (HR 0.9 [0.6–1.2]). Interpretation — The use of primary DMC THA increased with differences in patient characteristics. The 5-year cup revision rates for DMC THA and UC THA were comparable