Posterior stabilised total knee arthroplasty is associated with improved post-operative knee specific function, health related quality of life and greater satisfaction when compared to cruciate retaining protheses

PURPOSE

To assess whether there were differences in knee specific function, health related quality of life (HRQoL), and satisfaction between patients with a cruciate retaining (CR) or a posterior stabilised (PS) total knee arthroplasty (TKA) at 1 and 2 years postoperatively.

METHODS

A retrospective review of TKA (CR and PS) patients from a prospectively collected arthroplasty database. Patient demographics, body mass index and ASA grade, Oxford knee score (OKS) and EuroQol 5-dimension (EQ-5D) 3-level, which was used to assess HRQoL, were collected preoperatively and 1 year and 2 years postoperatively. Regression was used to adjust for confounding factors.

RESULTS

The sample included 3122 TKA, of which 1009 (32.3%) were CR and 2112 (67.7%) were PS. The PS group were more likely to be female (odd ratio (OR) 1.26, p = 0.003) and undergo resurfacing of the patella (OR 6.63, p < 0.001). There was a significantly greater improvement in the 1 year OKS in the PS group (mean difference (MD) 0.9, p = 0.016). The PS TKA was independently associated with a greater 1 year (MD 1.1, 95% CI 0.4 to 1.9, p = 0.001) and 2 years (MD 0.8, p = 0.037) post-operative improvements in OKS. PS TKA was also independently associated with a greater 1 year (MD 0.021, p = 0.024) and 2 years (MD 0.022, p = 0.025) post-operative and change in EQ-5D utility compared to the CR group. The PS group was more likely to be satisfied with their outcome at 1 year (OR 1.75, p < 0.001) and at 2 years (OR 1.38, p = 0.001) when adjusting for confounders.

CONCLUSION

PS TKA was associated with a better knee specific function and HRQoL when compared to CR, but the clinical significance of this is not clear. However, the PS group was more likely to be satisfied with their outcome compared to the CR group.

Development of in-situ electrochemical heavy metal ion sensor using integrated 1D/0D/1D hybrid by MWCNT and CQDs supported MnO2 nanomaterial

An integrated 1D/0D/1D hybrid nanomaterial was prepared from MWCNT supported carbon quantum dots @ MnO₂ nanomaterial for a sensitive and selective electrochemical heavy metal ion sensor by hydrothermal methods. The developed nanomaterials were characterized by various analytical methods such as FESEM, HRTEM, XRD, FTIR, EDX and elemental mapping study, and also its electrochemical properties of the prepared samples were investigated by cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS) analysis. Differential pulse voltammetry (DPV) analysis has been used to investigate the quantitative detection of heavy metal ions such as cadmium and chromium on modified electrodes under optimal conditions. The in-situ electrochemical sensitivity and selectivity of the samples were determined by varying various parameters, such as the concentration of heavy metal ions, different electrolytes and electrolyte pH. The observed DPV results show that prepared MWCNT (0.05 wt%) and CQD (0.1 wt%) supported MnO₂ nanoparticles show effective detection response for chromium (IV) metal ion. In particular, 0D CQD, 1D MWCNT, and MnO₂ hybrid nanostructures produced a synergistic effect among them, resulting in strong electrochemical performance of the prepared samples against the target metal ions.

1528 Pseudotumour from Corrosive Material of Total Hip Replacement: A Rare Complication with an Unusual Presentation

Total hip replacements have been performed in the UK since the 1960s, with over 280000 primary hip replacements being conducted between January 2017 – December 2019. The formation of pseudotumours is an uncommon and an unusual long-term complication of total hip replacements. Formed by galvanic corrosion of the metal prosthesis, patients can display an array of symptoms. We herein report a rare presentation of unilateral leg oedema in an elderly female, mimicking deep vein thrombosis. Despite normal metal ion levels, radiological investigations revealed an irregular cystic mass extending into the iliac fossa compressing the neurovascular bundle in the groin. The patient underwent complex revision hip surgery with dual mobility hip replacement and an Exeter stem with excision of the pseudotumour. This case highlights the importance of appropriate workup for these patients and the involvement of a multidisciplinary team.

Scheduling and adaptive listening approaches in MAC for WSN applications: A survey

False data detection, intrusion detection and coverage rate are major challenges in wireless sensor networks (WSN). Scheduling in media access control (MAC) using gateway and relay nodes solve some of the problems. In this paper, we carried out a brief survey on scheduling, delay aware MAC, cooperative communications in MAC, and adaptive listening to keep controlling the energy in sensors. In addition, multichannel MAC and various routing strategy techniques for WSN are discussed. Firefly algorithm for dynamic scheduling pipelined scheduling for linear sensor networks gives better throughput and latency. Heuristic configuration solves the overhearing problem, as node power-based MAC controls power of each node. Based on WSN applications and the performance metrics concentrated, various techniques for MAC are discussed throughout in this paper.

Corrosion resistant hydrophobic coating using modified conducting polyaniline

Almost all metals and their alloys are vulnerable to corrosion. To avoid structural damage and to avoid loss of its functionality, the most common protection method used is the application of a coating. In the present work, hydrophobic coatings using modified conducting polyaniline (PAni) were prepared and their corrosion-resistant properties were investigated. Modified PAni was prepared via two different techniques, conventional and rapid mixing method, in the presence of phenyl phosphonic acid (PPA) as dopant. The different PAni-PPA powders thus prepared were dispersed in an epoxy resin and coated on mild steel samples by drawing method. Tremendous improvement in hydrophobicity of the PAni-PPA (rapid)/epoxy was observed as compared to epoxy resin containing PAni-PPA (conventional method). The anticorrosion properties of these coatings on mild steel in 3 wt% NaCl were investigated using different electrochemical methods. Initial redox reactions and changes in conductivity of coating were reflected in the variations of open circuit potential (OCP). Both the coatings displayed stable high OCP, maintained their oxidative state, and provided corrosion protection for mild steel for more than 30 days. PAni-PPA (rapid)/epoxy gave better corrosion protection and showed higher ennoblement which may be due to the small particle size of PAni-PPA (rapid) leading to homogeneous mixing and better dispersion in the epoxy resin. Moreover, this coating is more hydrophobic in nature which is added advantage in case of corrosion-resistant coatings. The present investigation deals with preparation of highly (near super) hydrophobic coating containing conducting polymers for anticorrosion applications.

Focal segmental glomerulosclerosis in renal allografts: Is it possible to diagnose the etiology?

Recurrence of FSGS in renal allo grafts is a major cause of graft loss. In this context, we tried to diagnose and classify FSGS in renal allografts. Indications for biopsy included graft dysfunction and/or proteinuria. Three hundred and sixty-three graft biopsies were studied over a period of 2 years. We classified FSGS into recurrent FSGS, new-onset primary FSGS and FSGS secondary to chronic humoral rejection, calcineurin inhibitor toxicity, and nephron loss and hyperfiltration injury. Twenty-four cases were diagnosed as FSGS, constituting 6.6%. Secondary FSGS was the most common FSGS in grafts in our study. Incidence of recurrent FSGS may not be accurate as pretransplant biopsy is available in very few cases.

Karyomegalic interstitial nephritis with focal segmental glomerulosclerosis: A rare association

Karyomegalic interstitial nephritis (KIN) is a rare form of, progressive chronic interstitial nephritis. We present a case of KIN in a child, who was also found to have nephrotic syndrome because of focal segmental glomerulosclerosis on renal biopsy. To our knowledge, this is the first case of KIN associated with glomerulopathy.

Thrombotic microangiopathy in renal allografts

Thrombotic microangiopathy (TMA) is a serious complication of renal transplantation. It is a morphological expression of various etiological factors. In a renal allograft, TMA can occur de novo or be a recurrent disease. The aim of this study was to analyze the etiological factors and observe the changing trends of TMA with respect to emerging new etiological factors. We evaluated 131 graft biopsies over a period of 2½ years (2010-2012). All the renal biopsies were formalin fixed, paraffin embedded. Twenty serial sections were studied. Stains routinely used were Hematoxylin and Eosin, Periodic Acid Schiff, Massons Trichrome and Silver Methenamine stains. C4d by immunohistochemical method was done on all graft biopsies. Incidence of TMA in our series was 9.1%. Out of the 12 cases, five were associated with calcineurin inhibitor toxicity, three were diagnosed as acute antibody-mediated rejection, and two were recurrent haemolytic uremic syndrome. One patient developed haemolytic uremic syndrome on treatment with sirolimus and one patient was cytomegalovirus positive on treatment with ganciclovir, developed haemolytic uremic syndrome during treatment course. This study describes a spectrum of etiological factors for thrombotic mciroangiopathy ranging from common cause like calcineurin inhibitor toxicity to rare cause like ganciclovir induced TMA.

Primary marginal zone B-cell lymphoma of appendix

Primary lymphomas of appendix are extremely rare tumors. The first case of primary lymphoma of appendix was reported by Warren in the year 1898. Incidence of primary lymphoma of appendix is 0.015% of all gastrointestinal lymphomas. This is a report of primary marginal zone B-cell lymphoma of appendix which presented as appendicular mass. As some cases are incidentally discovered, this case emphasizes that histological examination of all appendicectomy specimens is mandatory.

Sustained expression of keratinase gene under PxylA and PamyL promoters in the recombinant Bacillus megaterium MS941

The ker gene encoding pre-pro keratinase of Bacillus licheniformis MKU3 was cloned with xylose inducible promoter (PxylA) or alpha-amylase promoter (PamyL) or both in Escherichia coli-Bacillus shuttle vector, pWH1520 generating recombinant plasmids pWHK3, pWAK3 and pWXAK3 respectively. Compared with Bacillius megaterium MS941 (pWXAK3) expressing ker gene with PxylA-PamyL promoters, B. megaterium MS941 (pWAK3) with PamyL displayed higher keratinase yield (168.6 U/ml) and specific activity (14.59 U/mg) after 36 h of growth in LB medium, however the keratinase yield decreased in the culture grown in LB medium supplemented with starch or xylose or both. A maximum yield of 186.3 U/ml with specific activity of 17.25 U/mg was obtained from xylose induced keratinase expression in B. megaterium MS941 (pWHK3) grown for 24h. The recombinant plasmids were stably maintained with sustained expression of keratinase for about 60 generations in B. megaterium MS941 rather than in B. megaterium 1,4945.

Cloning and expression of keratinase gene in Bacillus megaterium and optimization of fermentation conditions for the production of keratinase by recombinant strain

AIMS

Cloning and expression of keratinase gene in Bacillus megaterium and optimization of fermentation conditions for the production of keratinase by recombinant strain.

METHODS AND RESULTS

The keratinase gene with and without leader sequence from the chromosomal DNA of Bacillus licheniformis MKU3 was amplified by PCR and cloned into pET30b and transferred into Escherichia coli BL21. The ker gene without leader sequence only expressed in E. coli and the recombinant strain produced an intracellular keratinase activity of 74.3 U ml(-1). The ker gene was further subcloned into E. coli-Bacillus shuttle vector, pWH1520. Bacillus megaterium ATCC 14945 carrying the recombinant plasmid pWHK3 expressed the ker gene placed under xylA promoter and produced an extracellular keratinase activity of 95 U ml(-1). Response surface methodology (RSM) was employed to optimize the fermentation condition and to improve the level of keratinase production by the recombinant strain. A maximum keratinolytic activity of 166.2 U ml(-1) (specific activity, 33.25 U mg(-1)) was obtained in 18 h of the fermentation carried out with an initial inoculum of 0.4 OD600 nm and xylose concentration of 0.75% w/v.

CONCLUSIONS

Bacillus licheniformis keratinase was cloned and successfully expressed using T7 promoter in E. coli and xylose inducible expression system in B. megaterium. Response surface methodology was employed to optimize the process parameters, which resulted in a three-fold higher level of keratinase production by the recombinant B. megaterium (pWHK3) than the wild type strain B. licheniformis MKU3.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study suggests that B. megaterium is a suitable host for the expression of cloned genes from heterologous origin. Optimization of fermentation conditions improved the keratinase production by B. megaterium (pWHK3) and suggested that this recombinant strain could be used for the production of keratinase.

Honey as a natural preservative of milk

The anti-bacterial property and preservative nature of honey has been studied by evaluating the role of hydrogen peroxide in these properties, against bacterial strains isolated and identified from pasteurized milk samples. The antibacterial property of honey examined by agar incorporation assay and turbidometry, indicated a concentration dependent inhibition of bacterial growth in all catalase negative strains in comparison with catalase positive strains, highlighting a probable role of hydrogen peroxide. Samples of commercial milk stored at 40C in presence of honey were shown to inhibit opportunistic bacterial growth better compared to samples stored without honey. Due to the bactericidal property of hydrogen peroxide and its preservative nature, honey which is chiefly a combination of various sugars and hydrogen peroxide, can be used a preservative of milk samples.

Paratesticular malignant peripheral nerve sheath tumour: a case report

Primary malignant peripheral nerve sheath tumours (MPNST) of intrascrotal extra testicular site are extremely rare with only few cases reported in literature. These are highly malignant tumours most often associated with neurofibromatosis. The incidence in general population is 0.001%. A 35-year-old male presented with swelling of the scrotal sac of three months duration. There were no features of neurofibromatosis. The lesion was excised and was diagnosed as MPNST. The patient developed recurrence within two months.

Syndrome-related chromosome-specific radiation-induced break points of various inherited human metabolic disorders

The frequency, distribution pattern and localisation of gamma radiation-induced break points on the chromosomes of patients with various inherited metabolic disorders were studied to detect: (i) whether the break point distribution following irradiation is random and proportional to the length or the DNA content of the chromosome, or non-proportionally distributed on their length and at times clustering to form hot spots on certain region of the chromosomes; and (ii) to find whether there exists a syndrome-related chromosome-specific pattern of radiation-induced break points. Lymphocyte cultures from patients of haemophilia, ichthyosis, Duchenne muscular dystrophy, retinitis pigmentosa and alpha-thalassemia, whose defective gene loci were located by DNA probe method, were subjected to 3Gy of gamma radiation at G(0). The chromosomal break point analysis was carried out on all the 23 types of chromosomes (excluding Y chromosome) using G banding and FISH painting. The exact location of the break points on G-banded chromosomes was identified using a semi-automated microscope densitometer system (Leitz MPV2). In normal individuals in all the chromosomes except the chromosome 1, a random distribution of break points proportional to their length based on their DNA content was observed. However, in all the syndromes studied a mixture of hypersensitive chromosomes with a non-random distribution pattern of chromosomal break points invariably clustering to form hot spots, and chromosomes with random distribution of break points proportional to their length were observed. The hypersensitive chromosomes and their hot spots were syndrome-specific.

Mutation analysis of 3 genes in patients with Leber congenital amaurosis

OBJECTIVE

To assess the frequency of mutations in the CRX, GUCY2D, and RPE65 genes in patients with Leber congenital amaurosis (LCA).

PATIENTS

One hundred seventy-six probands with a clinical diagnosis of LCA were from 9 countries, with the largest subgroup being 39 probands from India.

METHODS

Samples were screened with single-strand conformation polymorphism analysis followed by DNA sequencing of 3 genes (CRX, GUCY2D, and RPE65) known to be associated with LCA.

RESULTS

Of the 176 probands, 28 (15.9%) harbored possible disease-causing mutations. The relative contribution of each gene to the total number of mutations was as follows: CRX, 2.8%; GUCY2D, 6.3%; and RPE65, 6.8%. No patients who harbored mutations in these genes had associated systemic abnormalities. Molecular diagnosis allowed definitive genetic counseling in a family affected with Best disease and LCA.

CONCLUSIONS

Molecular diagnosis may be of benefit to patients affected with LCA. The relative paucity of mutations found in this study suggests that more LCA-associated genes remain to be discovered.

CLINICAL RELEVANCE

Molecular diagnosis can confirm and clarify the diagnosis of LCA. As genotype data accumulate, clinical phenotypes associated with specific mutations will be established. This will facilitate the counseling of patients on their visual prognosis and the likelihood of associated systemic anomalies.

Sodium arsenite-induced chromosomal aberrations in the Xq arm of Chinese hamster cell lines

Non-cytotoxic concentrations (1.5, 3 and 6 microM) of sodium arsenite (SA) were used to study its cytogenetic effects with special reference to the frequency and nature of chromosomal aberrations on the X chromosome at Xq21 and at centromeric regions in CHO9, EM-C11, V79, V-H4 and CHE cell lines using Giemsa and FISH techniques. A high frequency of chromosomal breakpoints was distributed on the X chromosome localized at the secondary constriction region of the q arm (Xq21) and to a lesser degree at the centromeric region (c band-positive region), showing a high degree of fragility of these regions. This phenomenon was observed in all cell lines except for V79, where aberrations were localized only in the Xq21 region, and CHO9, where the observed breakage frequency was lowest in comparison with other cell lines and breaks were mostly located in the centromeric region rather than at Xq21. Homozygous expression of the breakpoint at Xq21 (fragile site) and in the centromeric region was also confirmed using a female Chinese hamster embryonic (CHE) cell line, which showed a similar high frequency of breakpoints at Xq21 and in the centromeric region of both X chromosomes. Further, a detailed cytogenetic study in CHO9 and its ligase-deficient mutant EM-C11 cell line showed slightly higher sensitivity to SA in a cell survival assay. No difference was found for chromosomal aberrations in Giemsa stained preparations. For SCEs a higher spontaneous frequency was evident in EMC-11. SA significantly increased the frequency of SCEs in CHO9, but no effect was found in EM-C11. Further, we observed an increased number of abnormal cells with pulverised chromosomes, decondensed chromatin, isochromosomes and hyperploidy in CHO9 and EM-C11 cell lines at all doses of SA.