Femoral deficiency reconstruction using a hydroxyapatite-coated locked modular stem. A series of 43 total hip revisions

SummaryIntroductionWe report a continuous prospective series of patients operated on for total hip prosthesis femoral component loosening involving a bone defect. Reconstruction was performed using a hydroxyapatite-coated locked modular stem. The study's objective was to assess medium term clinical and X-ray results obtained with this original concept.Materials and methodsThe patients included received a REEF® (DePuy) femoral implant for aseptic loosening or loosening associated with a periprosthetic fracture. Implantation was systematically accompanied by an extended trochanteric osteotomy (ETO). Patients were followed up prospectively by clinical and X-ray examination. Their loosening was graded at inclusion according to Vives’ classification as revised by SOFCOT in 1999. Analysis focused on actuarial implant survivorship, dislocation and the bone/implant interface.ResultsForty-three hips were included: mean follow-up was 58.2 months (12–92) and mean age at surgery was 72.4 years (37–94). The main indications were severe bone loss rated grade III (n=15) or IV (n=16) according to the SOFCOT classification. There was one long-term failure, involving implant fracture secondary to nonunion of the femoral shaft. Mean Postel and Merle d’Aubigné (PMA) clinical assessment score increased from six preoperatively to 14.5 at end of follow-up. X-ray analysis found no stem migration by end of follow-up. There was consistent consolidation of the ETO around the stem, except in one case of stem fracture which evolved into tight nonunion. In terms of metaphyseal integration, five patients showed radiolucency without evolution over follow-up, and eight had severe calcar cortical atrophy at end of follow-up. Mean 5-year actuarial survivorship was 97.7±2.3%, with a 2% incidence of dislocation.DiscussionThe complications rate was low, and results were comparable with those reported in the literature. The study confirmed the interest of the extended trochanteric osteotomy exposure and the effectiveness of the hydroxyapatite-coated interlocked modular stem concept in the treatment of hip prosthesis loosening with femoral bone loss (involving or not the cortex). On analysis, the one case of failure does not proscribe the surgical technique employed. Implant osseointegration was difficult to analyze. The extent of the surgical approach and of its corresponding sequels, combined with the complexity of adjusting the implant, however, restrict this surgical option indications to level III and IV cases of femoral loosening.Level of evidence: level IV; therapeutic study

Dual mobility cup reduces dislocation rate after arthroplasty for femoral neck fracture

<p>Abstract</p> <p>Background</p> <p>Hip dislocation after arthroplasty for femoral neck fractures remains a serious complication. The aim of our study was to investigate the dislocation rate in acute femoral neck fracture patients operated with a posterior approach with cemented conventional or dual articulation acetabular components.</p> <p>Methods</p> <p>We compared the dislocation rate in 56 consecutive patients operated with conventional (single mobility) cemented acetabular components to that in 42 consecutive patients operated with dual articulation acetabular components. All the patients were operated via posterior approach and were followed up to one year postoperatively.</p> <p>Results</p> <p>There were 8 dislocations in the 56 patients having conventional components as compared to no dislocations in those 42 having dual articulation components (p = 0.01). The groups were similar with respect to age and gender distribution.</p> <p>Conclusions</p> <p>We conclude that the use of a cemented dual articulation acetabular component significantly reduces the dislocation rates in femoral neck fracture patients operated via posterior approach.</p

Compared to conventional, ecological intensive management promotes beneficial proteolytic soil microbial communities for agro-ecosystem functioning under climate change-induced rain regimes

Projected climate change and rainfall variability will affect soil microbial communities, biogeochemical cycling and agriculture. Nitrogen (N) is the most limiting nutrient in agroecosystems and its cycling and availability is highly dependent on microbial driven processes. In agroecosystems, hydrolysis of organic nitrogen (N) is an important step in controlling soil N availability. We analyzed the effect of management (ecological intensive vs. conventional intensive) on N-cycling processes and involved microbial communities under climate change-induced rain regimes. Terrestrial model ecosystems originating from agroecosystems across Europe were subjected to four different rain regimes for 263 days. Using structural equation modelling we identified direct impacts of rain regimes on N-cycling processes, whereas N-related microbial communities were more resistant. In addition to rain regimes, management indirectly affected N-cycling processes via modifications of N-related microbial community composition. Ecological intensive management promoted a beneficial N-related microbial community composition involved in N-cycling processes under climate change-induced rain regimes. Exploratory analyses identified phosphorus-associated litter properties as possible drivers for the observed management effects on N-related microbial community composition. This work provides novel insights into mechanisms controlling agro-ecosystem functioning under climate change

Metabolic flexibility as a major predictor of spatial distribution in microbial communities

A better understand the ecology of microbes and their role in the global ecosystem could be achieved if traditional ecological theories can be applied to microbes. In ecology organisms are defined as specialists or generalists according to the breadth of their niche. Spatial distribution is often used as a proxy measure of niche breadth; generalists have broad niches and a wide spatial distribution and specialists a narrow niche and spatial distribution. Previous studies suggest that microbial distribution patterns are contrary to this idea; a microbial generalist genus (Desulfobulbus) has a limited spatial distribution while a specialist genus (Methanosaeta) has a cosmopolitan distribution. Therefore, we hypothesise that this counter-intuitive distribution within generalist and specialist microbial genera is a common microbial characteristic. Using molecular fingerprinting the distribution of four microbial genera, two generalists, Desulfobulbus and the methanogenic archaea Methanosarcina, and two specialists, Methanosaeta and the sulfate-reducing bacteria Desulfobacter were analysed in sediment samples from along a UK estuary. Detected genotypes of both generalist genera showed a distinct spatial distribution, significantly correlated with geographic distance between sites. Genotypes of both specialist genera showed no significant differential spatial distribution. These data support the hypothesis that the spatial distribution of specialist and generalist microbes does not match that seen with specialist and generalist large organisms. It may be that generalist microbes, while having a wider potential niche, are constrained, possibly by intrageneric competition, to exploit only a small part of that potential niche while specialists, with far fewer constraints to their niche, are more capable of filling their potential niche more effectively, perhaps by avoiding intrageneric competition. We suggest that these counter-intuitive distribution patterns may be a common feature of microbes in general and represent a distinct microbial principle in ecology, which is a real challenge if we are to develop a truly inclusive ecology

Anisotropic Panglial Coupling Reflects Tonotopic Organization in the Inferior Colliculus

Astrocytes and oligodendrocytes in different brain regions form panglial networks and the topography of such networks can correlate with neuronal topography and function. Astrocyte-oligodendrocyte networks in the lateral superior olive (LSO)—an auditory brainstem nucleus—were found to be anisotropic with a preferred orientation orthogonally to the tonotopic axis. We hypothesized that such a specialization might be present in other tonotopically organized brainstem nuclei, too. Thus, we analyzed gap junctional coupling in the center of the inferior colliculus (IC)—another nucleus of the auditory brainstem that exhibits tonotopic organization. In acute brainstem slices obtained from mice, IC networks were traced employing whole-cell patch-clamp recordings of single sulforhodamine (SR) 101-identified astrocytes and concomitant intracellular loading of the gap junction-permeable tracer neurobiotin. The majority of dye-coupled networks exhibited an oval topography, which was preferentially oriented orthogonal to the tonotopic axis. Astrocyte processes showed preferentially the same orientation indicating a correlation between astrocyte and network topography. In addition to SR101-positive astrocytes, IC networks contained oligodendrocytes. Using Na+ imaging, we analyzed the capability of IC networks to redistribute small ions. Na+ bi-directionally diffused between SR101-positive astrocytes and SR101-negative cells—presumably oligodendrocytes—showing the functionality of IC networks. Taken together, our results demonstrate that IC astrocytes and IC oligodendrocytes form functional anisotropic panglial networks that are preferentially oriented orthogonal to the tonotopic axis. Thus, our data indicate that the topographic specialization of glial networks seen in IC and LSO might be a general feature of tonotopically organized auditory brainstem nuclei

On the role of goal relevance in emotional attention: Disgust evokes early attention to cleanliness

Prior evidence has shown that aversive emotional states are characterised by an attentional bias towards aversive events. The present study investigated whether aversive emotions also bias attention towards stimuli that represent means by which the emotion can be alleviated. We induced disgust by having participants touch fake disgusting objects. Participants in the control condition touched nondisgusting objects. The results of a subsequent dot-probe task revealed that attention was oriented to disgusting pictures irrespective of condition. However, participants in the disgust condition also oriented towards pictures representing cleanliness. These findings suggest that the deployment of attention in aversive emotional states is not purely stimulus driven but is also guided by the goal to alleviate this emotional state

Is tibial tuberosity-trochlear groove distance an appropriate measure for the identification of knees with patellar instability?

PURPOSE - Tibial tuberosity-trochlear groove distance (TT-TG) has been regarded as a useful tool for establishing therapeutic choices for patellar instability. Recently, it has been shown that TT-TG negatively correlated with the quadriceps angle, suggesting that if used individually, neither provide a valid measure of instability. This study aimed to compare TT-TG distance between both knees in patients with unilateral instability to assess whether this measurement is a decisive element in the management decisions for patellar instability. METHODS - Sixty-two patients (18 male and 44 female), reporting to a specialist patella clinic for recurrent unilateral patellar instability, were included in the study. Patients underwent bilateral long leg computed tomography scan to determine TT-TG distance in both knees. Tibial TT-TG in symptomatic and asymptomatic knees in the same individual was compared statistically. RESULTS - Mean TT-TG distance in the symptomatic knee was 16.9 (±4.9) mm, compared to 15.6 (±5.6) mm in the asymptomatic knee. Tibial TT-TG was not significantly different between stable and unstable knees (n.s.). CONCLUSIONS - The lack of difference in TT-TG distance between stable and unstable knees suggests that TT-TG distance alone may not be a decisive element in establishing therapeutic choices for patellar instability. It should, therefore, be interpreted with caution during clinical evaluations. LEVEL OF EVIDENCE: II

Is tibial tuberosity-trochlear groove distance an appropriate measure for the identification of knees with patellar instability?

PURPOSE - Tibial tuberosity-trochlear groove distance (TT-TG) has been regarded as a useful tool for establishing therapeutic choices for patellar instability. Recently, it has been shown that TT-TG negatively correlated with the quadriceps angle, suggesting that if used individually, neither provide a valid measure of instability. This study aimed to compare TT-TG distance between both knees in patients with unilateral instability to assess whether this measurement is a decisive element in the management decisions for patellar instability. METHODS - Sixty-two patients (18 male and 44 female), reporting to a specialist patella clinic for recurrent unilateral patellar instability, were included in the study. Patients underwent bilateral long leg computed tomography scan to determine TT-TG distance in both knees. Tibial TT-TG in symptomatic and asymptomatic knees in the same individual was compared statistically. RESULTS - Mean TT-TG distance in the symptomatic knee was 16.9 (±4.9) mm, compared to 15.6 (±5.6) mm in the asymptomatic knee. Tibial TT-TG was not significantly different between stable and unstable knees (n.s.). CONCLUSIONS - The lack of difference in TT-TG distance between stable and unstable knees suggests that TT-TG distance alone may not be a decisive element in establishing therapeutic choices for patellar instability. It should, therefore, be interpreted with caution during clinical evaluations. LEVEL OF EVIDENCE: II

Learning to collaborate: Can young children develop better communication strategies through collaboration with a more popular peer

Unpopular children are known to have poor communication skills and experience difficulty in collaborative situations. This study investigated whether pairing unpopular, 5 to 6 year-old, children with a more popular peer would promote more effective collaboration. The study also investigated differences in popular and unpopular children's verbal and non-verbal communication. Thirty-six girls and 36 boys were placed in one of 12 popular, 12 unpopular or 12 mixed pairs. There were no mixed gender pairs. Children were filmed playing a collaborative game. Collaboration in popular pairs was more successful and less disputational than in unpopular pairs. Boys in unpopular pairs broke the rules of the game more often, argued more and did not monitoring their partners' facial expressions effectively. With popular partners they argued less, were more likely to elaborate disagreements, looked at their partner for longer, smiled more and were more likely to offer him a small toy. Unpopular girls' interactions were not markedly disruptive but they clearly benefited from being paired with a child with good communication skills. Popular girls modified their behaviour to take into account an unpopular partner's need for support. These findings suggest that pairing popular and unpopular children may be a useful classroom organisation strategy