Protective effects of protocatechuic acid against cisplatin-induced renal damage in rats

The protective effects of an extract from bitter melon (. Momordica charantia, Cucurbitaceae) against oxidative stress was previously reported and found that protocatechuic acid (PCA) was one of the major phenolic constituents in the extract. The renoprotective effect of PCA from bitter melon was investigated in the present study. In the LLC-PK1 cellular model, the decline in cells viabilities induced by oxidative stress, such as that induced by sodium nitroprusside, pyrogallol, and SIN-1, was significantly and dose-dependently inhibited by PCA. In the in vivo model, the cisplatin-treated rats showed increased plasma levels of creatinine, decreased creatinine clearance, and increased urine protein levels. However, these parameters related to renal dysfunction were markedly attenuated by PCA treatment. Administration of PCA resulted in remarkable improvement in the histological appearance and reduction in tubular cell damage in the cisplatin-treated rat kidneys. Moreover, the elevated levels of pro-caspase-3 induced by cisplatin in rat kidneys were down-regulated by PCA co-treatment. These results suggest that PCA has protective activity against anticancer drug-induced oxidative nephrotoxicity

Neuroprotective Effect of Gallocatechin Gallate on Glutamate-Induced Oxidative Stress in Hippocampal HT22 Cells

Oxidative stress leads to protein degeneration or mitochondrial dysfunction, causing neuronal cell death. Glutamate is a neurotransmitter that nerve cells use to send signals. However, the excess accumulation of glutamate can cause excitotoxicity in the central nervous system. In this study, we deciphered the molecular mechanism of catechin-mediated neuroprotective effect on glutamate-induced oxidative stress in mouse hippocampal neuronal HT22 cells. Cellular antioxidant activity was determined using the 1,1-diphenyl-picryl hydrazyl (DPPH) assay and 2′,7′-dichlorodihydrofluorescein diacetate (DCFDA) staining. Furthermore, the levels of intracellular calcium (Ca2+) as well as nuclear condensation and protein expression related to neuronal damage were assessed. All five catechins (epigallocatechin gallate, gallocatechin gallate (GCG), gallocatechin, epicatechin gallate, and epicatechin) showed strong antioxidant effects. Among them, GCG exhibited the highest neuroprotective effect against glutamate excitotoxicity and was used for further mechanistic studies. The glutamate-induced increase in intracellular Ca2+ was reduced after GCG treatment. Moreover, GCG reduced nuclear condensation and the phosphorylation of extracellular signal-regulated kinase (ERK) and c-Jun N-terminal kinases (JNK) involved in cell death. The neuroprotective effect of GCG against glutamate-induced oxidative stress in HT22 cells was attributed to the reduction in intracellular free radicals and Ca2+ influx and also the inhibition of phosphorylation of ERK and JNK. Furthermore, the antioxidant effect of GCG was found to be likely due to the inhibition of phosphorylation of ERK and JNK that led to the effective suppression of neurocytotoxicity caused by glutamate in HT22 cells

Temporal patterns of commonly used clinical outcome scales during a 5-year period after total knee arthroplasty

Abstract Background It is not established beyond doubt whether improvements in functional outcome after total knee arthroplasty (TKA) are maintained in the long term. We therefore investigated the temporal patterns of functional outcome [using range of motion (ROM), American Knee Society (AKS) score, Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, and 36-Item Short Form Health Survey (SF-36) score] over a 5-year period after uncomplicated TKA, and whether these patterns differed by implant type and patient age. Materials and methods This prospective study evaluated 138 patients who underwent unilateral TKA with either a mobile-bearing (MB) or fixed-bearing (FB) posterior-stabilized prosthesis. An independent investigator evaluated the functional outcome at five time points: preoperatively and at 6-month, 1-year, 2-year, and 5-year follow-up. Differences in functional outcomes between adjacent time points were evaluated by mixed-effect model repeat measurement (MMRM). Results The different functional outcome scores showed improvement till 6 months–2 years, followed by a variable decline. In patients aged ≥ 68 years with an MB implant, most of the functional outcome scores declined between 2 and 5 years after variable initial improvement till 6 months–2 years, whereas the parameters plateaued after 2 years in those aged < 68 years and in older patients with an FB implant. Conclusions A decline in function and pain relief occurs 2 years after TKA. This decline is more evident in older patients with an MB prosthesis. Based on these findings, we believe that use of MB implants in older patients (≥ 68 years) requires further investigation. Level of evidence Level 3

Influence of Posterior Condylar Offset on Maximal Flexion and Outcome Scales Following TKA in Asian Patients

Background: Infection complicates traditional joint reconstruction prostheses in up to 7% of cases, witBackground: Alteration in femoral posterior condylar offset (PCO) after total knee arthroplasty (TKA) has been reported to influence maximal flexion angle after TKA. However, there are contradictory reports about its influence on clinical outcome, and the effects of PCO alterations may vary with implant type. Question / purposes: The purpose of this study was to determine whether PCO alterations affect maximal flexion after TKA and other functional outcomes, and whether the effects of PCO alterations differ by implant type. Patients and Methods: Fifty consecutive cases of TKAs in each of four implant types, namely, fixed bearing (FB) cruciate retaining (CR) or posterior stabilized (PS), mobile bearing (MB) CR or PS were included in the study. Patients were evaluated for maximal flexion and clinical outcome scales. The PCO alteration was measured using pre- and postoperative true lateral knee radiographs. Correlations between PCO alterations and functional outcomes including maximal flexion were compared among the four implant types. Results: No significant correlation was found between PCO alterations and maximal flexion achieved in any of the four implant groups (Correlation Coefficient [CC]=-0.03, 0.14, -0.14, 0.04; p> 0.05). The mean maximal postoperative flexion was greater in PS implants than in CR implants (p <0.05). In MB-CR implanted knees, a greater PCO alteration was correlated with worse anterior knee pain score as measured by the PF scoring system (CC=-0.44, p=0.003) and worse WOMAC pain score (CC=-0.41, p=0.007). Conclusions: Our findings indicate that PCO alterations have no effect on maximal postoperative flexion after TKA regardless of the implant type. Whether the implant is of PS or CR type is a better predictor of the final flexion achieved. However, increased PCO is correlated with worse pain score in MB-CR implants

Causes and predictors of patient's dissatisfaction after uncomplicated total knee arthroplasty

We aimed to identify the causes and predictors of patient's dissatisfaction after total knee arthroplasty (TKA). Patient's satisfaction was evaluated in 438 TKAs. Causes of patient dissatisfaction were identified using patient interview, physical examinations, laboratory and radiographic tests, and relevant medical consultations. Investigation of 33 dissatisfied knees identified knee-related symptoms in 16 knees (48.5%) and the symptoms unrelated to the replaced knee in 17 knees (51.5%). Multivariate logistic regression analysis revealed that worse preoperative Western Ontario McMaster University Osteoarthritis Index scale pain score and postoperative decrease in range of motion were significantly associated with postoperative dissatisfaction (odds ratio, 7.6 and 2.1, respectively). This study demonstrates that residual symptoms or dysfunctions not directly associated with the replaced knee could be a frequent cause of postoperative dissatisfaction after TKA in osteoarthritic patients

Interpretations of the Clinical Outcomes of the Nonresponders to Mail Surveys in Patients After Total Knee Arthroplasty

This study examined whether or not nonresponders to mail survey have poorer clinical outcomes than responders. A postal questionnaire, which was designed to evaluate the functional disability and patient's satisfaction, was mailed to 387 patients whose 1-year clinical outcomes were available. Of the 270 patients (69.8%) who responded, 247 (91.4%) reported that they were satisfied with their replaced knees. The knees of the nonresponders showed significantly poorer results in terms of the function-related scales (American Knee Society score function, Western Ontario McMaster University Osteoarthritis Index scale function, Short-Form 36 physical and functional scores) than the knees of the responders, whereas there were no significant differences in the pain-related scales. The clinical results of the nonresponders were poorer in most of the clinical outcome scales than those of the satisfied subgroup of responders but better than those of the dissatisfied subgroup. The results of the pain-related scales were similar to the satisfied subgroup but the function-related scales were similar to the dissatisfied subgroup

Interpretations of the Clinical Outcomes of the Nonresponders to Mail Surveys in Patients After Total Knee Arthroplasty

This study examined whether or not nonresponders to mail survey have poorer clinical outcomes than responders. A postal questionnaire, which was designed to evaluate the functional disability and patient`s satisfaction, was mailed to 387 patients whose 1-year clinical outcomes were available. Of the 270 patients (69.8%) who responded, 247 (91.4%) reported that they were satisfied with their replaced knees. The knees of the nonresponders showed significantly poorer results in terms of the function-related scales (American Knee Society score function, Western Ontario McMaster University Osteoarthritis Index scale function, Short-Form 36 physical and functional scores) than the knees of the responders, whereas there were no significant differences in the pain-related scales. The clinical results of the nonresponders were poorer in most of the clinical outcome scales than those of the satisfied subgroup of responders but better than those of the dissatisfied subgroup. The results of the pain-related scales were similar to the satisfied subgroup but the function-related scales were similar to the dissatisfied subgroup.Marx RG, 2005, J BONE JOINT SURG AM, V87A, P1999, DOI 10.2106/JBJS.D.02286Kim J, 2004, J BONE JOINT SURG AM, V86A, P15Ludemann R, 2003, AM J SURG, V186, P143, DOI 10.1016/S002-9610(03)00175-2Joshi AB, 2003, J ARTHROPLASTY, V18, P149, DOI 10.1054/arth.2003.50061Edwards P, 2002, BRIT MED J, V324, P1183Fowler FJ, 2002, MED CARE, V40, P190Robertsson O, 2001, J ARTHROPLASTY, V16, P476Dunbar MJ, 2001, J BONE JOINT SURG BR, V83B, P339Norquist BM, 2000, J BONE JOINT SURG AM, V82A, P838Sethuraman V, 2000, J ARTHROPLASTY, V15, P183Asch DA, 1997, J CLIN EPIDEMIOL, V50, P1129MCHORNEY CA, 1994, MED CARE, V32, P551WARE JE, 1992, MED CARE, V30, P473INSALL JN, 1989, CLIN ORTHOP RELAT R, P13BELLAMY N, 1988, J RHEUMATOL, V15, P1833

Differences between Sagittal Femoral Mechanical and Distal Reference Axes Should Be Considered in Navigated TKA

In computer-assisted TKA, surgeons determine positioning of the femoral component in the sagittal plane based on the sagittal mechanical axis identified by the navigation system. We hypothesized mechanical and distal femoral axes may differ on lateral views and these variations are influenced by anteroposterior bowing and length of the femur. We measured angles between the mechanical axis and distal femoral axis on 200 true lateral radiographs of the whole femur from 100 adults. We used multivariate linear regression to identify predictors of differences between the axes. Depending on the method used to define the two axes, the mean angular difference between the axes was as much as 3.8° and as little as 0.0°, with standard differences ranging from 1.7° to 1.9°. Variation between the two axes increased with increased femoral bowing and increased femoral length. Surgeons should consider differences between the mechanical axes and distal femoral axes when they set the sagittal plane position of a femoral component in navigated cases. Our findings also may be relevant when measuring rotation of the femoral component in the sagittal plane from postoperative radiographs or when interpreting femoral component sagittal rotation results reported in other studies