The effect of new oral anticoagulants and extended thromboprophylaxis policy on hip and knee arthroplasty outcomes: observational study

The efficacy and safety of the new oral anticoagulants (NOAC) and the benefits of extended duration thromboprophylaxis following hip and knee replacements remain uncertain. This observational study describes the relations between thromboprophylaxis policies following hip and knee replacements across England's NHS and patient outcomes between January 2008 and December 2011. From the national administrative database, we analyzed mortality, thromboembolic complications, emergency readmission, and bleeding rates for 201,418 hip and 230,282 knee replacements. There were no differences in outcomes for either LMWH or NOAC. We found no advantage in favor of any single anticoagulation policy or in changing policy. This study supports the American Academy of Orthopaedic Surgeons' recommendation that the choice and duration of thromboprophylaxis prophylaxis be decided by the treating surgeon

Biology and conservation of the unique and diverse halophilic macroinvertebrates of Australian salt lakes

This study synthesises information on the biology of the unique and diverse halophilic macroinvertebrates of Australian salt lakes, focusing on gastropods and crustaceans. This information is needed to evaluate and manage the threats posed to these invertebrates by increased periods of drought and secondary salinisation. Most of these species are endemic to Australian salt lakes, and some have adapted to extreme conditions (e.g. salinities >100 g L–1 and pH <5). This study identifies key general findings regarding the taxonomy, ecology and life histories of these invertebrates, such as that many ‘new’ species have been uncovered in the past 20 years, with more likely to come. The study also identifies critical knowledge gaps, such as the need to elucidate the abiotic and biological drivers of the field distributions of species, including why some species are widespread and common whereas other congeneric species are rare or have narrow distributions. Those species that are either restricted to low salinity environments or survive dry periods as aestivating adults (as opposed to desiccation-resistant eggs) are probably the most vulnerable to increasing salinisation and drought. Future work should prioritise the development of a sound taxonomy for all groups, because this is needed to underpin all other biological research

Updated recommendations for HER2 testing in the UK

This paper serves to update previously published guidance on rationale and methodology for HER2 laboratory testing following the recommendation for the use of HER2 targeted treatment in the management of advanced breast cancer in the UK. Emphasis is placed on the standardisation of methodology and assessment and strategies to achieve high quality performance. A two phase testing algorithm based on first line immunocytochemistry evaluation and second line fluorescence in situ hybridisation assessment of borderline cases is recommended. To ensure maintenance of expertise, an annual caseload volume of at least 250 cases is recommended for laboratories providing a testing service

A novel technique for the detailed size characterization of wear debris

The accurate and detailed characterization of artificial joint wear debris is important in determining both the wear rate of prostheses and understanding the role that the debris plays in the development and progression of aseptic loosening. The novel application of low angle laser light scattering (LALLS) to the particle size characterization of ultra high molecular weight polyethylene (UHMWPE) wear debris is described. The results demonstrate that both ex vivo and in vitro origin wear debris samples, at concentrations typical of those produced via an alkali-digestion retrieval route, can be reproducibly analyzed via LALLS. Because the LALLS route enables particle size analysis of the entire debris sample to be acquired non-destructively and whilst in suspension, artefacts associated with filtering, drying and agglomeration of debris are avoided, in contrast to currently used techniques such as filtration and scanning electron microscopy (SEM) observation