Same-Day Discharge vs. Inpatient Total Shoulder Arthroplasty: An Age Stratified Comparison of Postoperative Outcomes and Hospital Charges

BACKGROUND

As the number of total shoulder arthroplasty (TSA) procedures increases, there is a growing interest in improving patient outcomes, limiting costs, and optimizing efficiency. One approach has been to transition these surgeries to an outpatient setting. Therefore, the purpose of this study was to conduct an age-stratified analysis comparing the 90-day postoperative outcomes of primary TSA in the same-day discharge (SDD) and inpatient (IP) settings with a specific focus on the super-elderly.

METHODS

This retrospective study included all patients who underwent primary anatomic or reverse TSA between January 2018 and December 2021 in ambulatory and inpatient settings. The outcome measures included LOS, complications, hospital charges, ED utilization, readmissions, and reoperations within 90-days following TSA. Patients with LOS ≤8 hours were considered as SDD, and those with LOS >8 hours were considered as IP. P <0.05 was considered statistically significant.

RESULTS

There were 121 and 174 procedures performed in SDD and IP settings, respectively. There were no differences in comorbidity indices between the SDD and IP groups (ASA score P=0.12, ECI P=0.067). The SDD cohort was younger than the IP group (SDD 67.0 years vs. 73.0 IP years, P<0.001), and the SDD group higher rate of intraoperative tranexamic acid use (P=0.015) and lower estimated blood loss (P=0.009). There were no differences in 90-day overall minor (P=0.20) and major complications (P=1.00), ED utilization (P=0.63), readmission (P=0.25) or reoperation (P =0.51) between the SDD and IP groups. When stratified by age, there were no differences in overall major (P=0.80) and minor (P=0.36) complications among the groups. However, the LOS was directly correlated with increasing age (LOS=8.4 hours in ≥65 to < 75-year cohort vs. LOS=25.9 hours in ≥80-year cohort; P<0.001). There were no differences in hospital charges between SDD and IP primary TSA in all 3 age groups (P=0.82).

CONCLUSION

SDD TSA has a shorter LOS without increasing postoperative major and minor complications, ED encounters, readmissions, or reoperations. Older age was not associated with an increase in the complication profile or hospital charges even in the SDD setting, although it was associated with increased LOS in the IP group. These results suggest that TSA can be safely performed expeditiously in an outpatient setting.

LEVEL OF EVIDENCE

Level III; Retrospective Comparative Study.

Risk Factors of Emergency Department Utilization After Outpatient Surgery for Sports-Related Injuries

INTRODUCTION

The purpose of this study was to identify the most common reasons for and risk factors associated with postoperative emergency department (ED) utilization after orthopaedic procedures for sports-related injuries.

METHODS

Using the 2014 to 2016 New York and Florida State Databases from the Healthcare Cost and Utilization Project, outpatient procedures for sports-related injuries were identified. Patient records were tracked across care settings within each state to determine the rate and reasons of postoperative ED utilization within 90 days after the index surgery. Multiple logistic regression models were used to identify risk factors associated with ED visits at 0 to 7 days, 8 to 30 days, 31 to 90 days postoperatively.

RESULTS

A total of 28,192 surgery visits for sports-related injuries were identified, with knee arthroscopy with partial meniscectomy (18.48%) and arthroscopic anterior cruciate ligament reconstruction (17.04%) as the two most common procedures treating sports injuries. The overall postoperative ED utilization rates were 1.6% (0 to 7 days postoperative), 1.3% (8 to 30 days) and 2.1% (31 to 90 days). The main cause of ED visits was markedly different during each postoperative period: mainly musculoskeletal pain (36.3%) during 0 to 7 days, either musculoskeletal pain (17%) or injury (16.6%) during 8 to 30 days, and injury (24.2%) during 31 to 90 days. Sports with the highest ED utilization in descending order were basketball, football, ice/snow sports, walking/running, cycling, and soccer. Relative to open procedures, arthroscopic procedures were 0.71 times as likely to result in a postoperative ED visit. Independent predictors of ED utilization up to 90 days postoperatively included renal failure, chronic pulmonary disease, psychosis, diabetes, and alcohol abuse.

DISCUSSION

Rate of ED utilization after outpatient surgery for sports-related injuries is low (<2.2%), with postoperative musculoskeletal pain and reinjury as the two most common causes, highlighting the importance of postoperative pain management and injury prevention. Arthroscopic procedures showed markedly lower ED utilization compared with open surgery, although not indicative of overall superiority.

LEVEL OF EVIDENCE

III, Retrospective Cohort Study.

Effects of Opioid-Limiting Legislation in the State of Ohio on Opioid Prescriptions After Shoulder Arthroscopy

Background

Recent studies have shown that legislation regulating opioid prescriptions in the United States has been successful in reducing the morphine milligram equivalent (MME) prescribed after certain orthopaedic procedures.

Purpose

To (1) determine the effect of Ohio's legislation limiting opioid prescriptions after shoulder arthroscopy and (2) identify risk factors associated with prolonged opioid use and increased postoperative opioid dosing.

Study Design

Cohort study; Level of evidence, 3.

Methods

We reviewed the data of patients who underwent shoulder arthroscopy between January 1, 2016, and March 31, 2020. Patients were classified according to the date of legislation passage (August 31, 2017) as before legislation (PRE) or on/after legislation (POST). Patients were also classified based on the number of opioid prescriptions filled within 30 days of surgery as opioid-tolerant (at least 1 prescription) or opioid-naïve (zero prescriptions). We recorded patient characteristics, medical comorbidities, and surgical details, as well as the number of opioid prescriptions, MME per prescription from 30 days preoperatively to 90 days postoperatively, and the number of gamma-aminobutyric acid (GABA) analogues and benzodiazepine prescriptions from 30 days preoperatively to the date of surgery. Differences between cohorts were compared with the Fisher exact test and Wilcoxon test. A covariate-adjusted regression analysis was used to evaluate risk factors associated with increased postoperative opioid dosing.

Results

Overall, 279 patients (n = 97 PRE; n = 182 POST; n = 42 opioid-tolerant; n = 237 opioid-naïve) were included in the final analysis. There was a significant reduction in the cumulative MME prescribed in the immediate (0-7 days) postoperative period (PRE, 450 MME vs POST, 315 MME), the first 30 postoperative days (PRE, 590 MME vs POST, 375 MME), and the first 90 postoperative days (PRE, 600 MME vs POST, 420 MME) (P < .001 for all). The opioid-tolerant cohort had higher MME at every time point in the postoperative period (P < .001). Consumption of preoperative opioid (β = 1682.5; P < .001), benzodiazepine (β = 468.09; P < .001), and GABA analogue (β = 251.37; P = .04) was associated with an increase in the cumulative MME prescribed.

Conclusion

Opioid prescription-limiting legislation in Ohio significantly reduced the cumulative MME prescribed in the first 30 days postoperatively for both opioid-naïve and opioid-tolerant patients after shoulder arthroscopy. Consumption of opioids, benzodiazepines, and GABA analogues preoperatively was associated with increased postoperative opioid dosage.

Scaling up numbers and competency of graduating medical and dental students in Nigeria: Need to improve medical trainers' competency in teaching

Background

With the increasing medical brain drain in Nigeria, there is a need to train and graduate more doctors to fill in the gaps created to mitigate the effects. To meet this goal, the trainers need to evolve and have the competency to deliver quality training for many more enrollees in medical schools.

Aim

This study aimed to gather information about the perception of medical teachers' need to obtain certification in medical education and what this will achieve in scaling up the competency and number of graduating medical doctors.

Subjects and Methods

Medical teachers in Nigeria participated in this mixed (quantitative and qualitative) study. Four hundred medical consultants and teachers were randomly selected and sent a semi-structured pre-validated questionnaire; also, a panel discussion was conducted with six medical teachers with other special assignments in universities and postgraduate colleges. Quantitative data were analyzed using Statistical Package for the Social Sciences (SPSS) 24, differences in proportions were calculated using the Chi-square test, and P values <0.05 were considered significant.

Results

Two hundred and thirty-eight (59.5%) participants completed the form, 63 (26.5%) had practiced for <5 years, and 114 (47.9%) had >10 years of practice experience. A majority of 168 (70.6%) were physician lecturers in federal or state universities, and 15.5% had obtained certifications of any kind in medical education. Over 80% perceived that medical education training should not be a prerequisite to teach, but a similar percentage believed that faculty medical education training can help scale up the training competency and the number of graduating medical doctors.

Conclusion

To scale up the number and competency of graduating medical doctors, medical teachers need to acquire core teaching competency. The respondents and discussants believe that when these core teaching competencies have been fully developed, it will be easier to increase the number of medical students' enrollees, teach them their curriculum through innovations, and graduate them with improved competencies.

Emphysematous Osteomyelitis of the Pubis Associated With Necrotizing Soft Tissue Infection of the Thigh

Emphysematous osteomyelitis (EO) is a rare condition identified through the presence of intraosseous gas. It is frequently fatal even with prompt recognition and management. We report a case of EO presenting with a necrotizing soft tissue infection of the thigh in the setting of prior pelvic radiation. The purpose of this study was to highlight the unusual association between EO and necrotizing soft tissue infection.

Effects of Opioid-Limiting Legislation and Increased Provider Awareness on Postoperative Opioid Use and Complications After Hip Arthroscopy

Background

On August 31, 2017, Ohio passed legislation that regulates how opioids can be prescribed postoperatively. Studies have shown that such legislation is successful in reducing the morphine milligram equivalents (MMEs) prescribed after certain orthopaedic procedures.

Purpose

(1) To determine if the opioid prescription-limiting legislation in Ohio reduced the cumulative MMEs prescribed after hip arthroscopy without significantly affecting the rates of emergency department (ED) visits, hospital readmissions, and reoperations within 90 days postoperatively, and (2) to assess risk factors associated with increased postoperative opioid dosing.

Study Design

Cohort study; Level of evidence, 3.

Methods

This study included patients who underwent primary and revision hip arthroscopy at a single institution over a 4-year period. The prelegislation (PRE) and postlegislation (POST) groups were defined as patients who underwent surgery before August 31, 2017, and on/after this date, respectively. The Ohio Automated Rx Reporting System was queried for controlled-substance prescriptions from 30 days preoperatively to 90 days postoperatively, and patient medical records were reviewed to collect demographic, medical, surgical, and readmission data. Inverse probability weighting-adjusted mean treatment effect regression models were used to measure the difference in mean outcomes between the PRE and POST cohorts.

Results

A total of 546 patients (228 PRE, 318 POST) were identified. There was a 25% reduction in the cumulative MMEs prescribed to the POST group as compared with the PRE group during the first 90 days postoperatively (840 vs 1125 MME, respectively; P < .01). The legislation was associated with a significant decrease in the cumulative MMEs prescribed in the first 90 postoperative days (mean treatment effect = -280.6; P < .01), and there were no significant between-group differences in the frequency of ED encounters (8.8% PRE, 11.6% POST; P = .32), hospital readmissions (1.3% PRE, 0.9% POST; P = .70), or reoperations (0.9% PRE, 0.6% POST; P ≥ .99) during this period. Preoperative opioid use was a significant independent risk factor for increased cumulative MMEs in the first 90 days postoperatively (β = 275; P < .01).

Conclusion

Opioid prescription-limiting legislation in Ohio was associated with significant reductions in opioid MMEs dosing in the 90-day period following hip arthroscopy. This legislation had no significant effect on ED utilization, hospital readmissions, or reoperations within the same period. Preoperative opioid use was a significant risk factor for increased MME dosing after hip arthroscopy.

Patients who have undergone total shoulder arthroplasty prefer greater surgeon involvement in shared decision making

BACKGROUND

There has been a shift in medical decision making from a paternalist model to a shared decision-making (SDM) approach, described as a patient-physician relationship where both parties collaborate to arrive on an evidence-based treatment regimen that best suits the patient's needs and values. However, there is a scarcity in evidence regarding SDM in shoulder arthroplasty. The purpose of this study was to evaluate overall patient preference for SDM and determine demographic and socioeconomic factors related to SDM preference in those undergoing shoulder arthroplasty.

METHODS

Patients aged 40-89 years who had undergone a total shoulder arthroplasty were enrolled. Two-part questionnaires were administered collecting patient demographic information and SDM subscale scores postoperatively. Bivariate and multivariate regression models were used to determine factors associated with SDM Total and subscale scores.

RESULTS

A total of 125 patients (53 male; mean age, 69.5 ± 10.4 years) who had undergone primary total shoulder arthroplasty were included. The mean Total SDM score was -2.24 ± 1.9 and the Preoperative, Operative, and Postoperative SDM subscale scores were -1.54 ± 2.0, -2.59 ± 2.2, and -2.48 ± 2.1, respectively, indicating a preference for SDM in the Preoperative subscale and surgeon-driven decision making in the total score and other 2 subscales. Multivariate regression models demonstrated a preference for surgeon decision making at both the 4-12-week postoperative period for the Preoperative subscale (odds ratio [OR] -1.03, 95% CI -2.0, -0.1, P = .039) and the 2-4-week postoperative period for the Operative subscale (OR -1.74, 95% CI -3.4, -0.1, P = .038) when compared to patients at the 2-week postoperative period. No other variables were significantly associated with any of the SDM subscale scores or Total SDM score.

CONCLUSION

Patients reported a more passive role in the decision-making process with an overall preference for a surgeon-led approach in primary total shoulder arthroplasty. Patients preferred a shared decision-making approach in regard to preoperative considerations but indicated a significant preference for surgeon-led decision making regarding day of surgery decisions. There were no correlations between SDM scores and age, sex, race, income, education level, insurance type, or treating surgeon. Overall, patients demonstrated a predilection for an SDM approach for preoperative considerations, contrary to those decisions associated with the day of surgery and postoperative care.

Patients With Anterior Cruciate Ligament Rupture and Ipsilateral Segond Fractures Have High Rates of Concurrent Knee Pathology

Purpose

The purpose of this study was to determine the rates of concomitant knee pathology in patients with ACL injuries and Segond fractures.

Methods

A retrospective study is undertaken with patients identified via query of CPT codes for ACL reconstruction from 2014 to 2020. All patients with preoperative radiographs were reviewed for the presence of Segond fractures. Operative reports were analyzed for the presence of concurrent pathology, including meniscus, cartilage, and other ligamentous injuries at the time of arthroscopic ACL reconstruction.

Results

A total of 1,058 patients were included in the study. Segond fractures were identified in 50 (4.7%) patients. Ipsilateral concomitant knee pathology was identified in 84% of Segond patients. Thirty-eight (76%) patients had meniscal pathology with a total 49 meniscal injuries, of which 43 were treated operatively. Multiligamentous injuries were present in 16 patients (32%), with 8 patients undergoing further ligament repair/reconstruction at the time of surgery. Chondral injuries were identified in 13 patients (26%).

Conclusions

A high prevalence of concomitant meniscal, chondral, and ligamentous injuries was found in patients with Segond fractures. These additional injuries may require further operative management and may place patients at increased risk for future instability or degenerative changes. Patients with Segond fractures should be counseled preoperatively on the nature of their injuries and risk of associated pathologies.

Level of Evidence

Level IV, prognostic case series.

Ipsilateral ACL injured patients with Segond fractures demonstrate increased posterior tibial slope

BACKGROUND

The anterolateral complex has been demonstrated to assist with rotational stability and prevention of anterior tibial translation during the pivot shift. In this study the Segond fracture is used as a surrogate for an anterolateral complex injury to determine if there is an association between Segond fracture and increased posterior tibial slope.

METHODS

Patients' charts and radiographs were analyzed retrospectively for the presence of Segond fractures on injury radiographs. These patients, the Segond cohort, were then age and gender matched to a control cohort. Demographic as well MRI measurements of medial and lateral posterior tibial slope and lateral-to-medial slope asymmetry were collected for each cohort. Secondary outcome of anterior cruciate ligament reconstruction failure data was also collected.

RESULTS

The Segond group demonstrated a statistically significantly greater lateral posterior tibial slope (8.42° versus 6.55°, P = 0.003) as well as medial posterior tibial slope (6.57° versus 5.34° degrees, P = 0.045). There was no significant differences between lateral-to-medial asymmetry (2.18°versus 1.83°, P = 0.246).

CONCLUSION

Patients with Segond fractures at the time of anterior cruciate ligament injury have increased medial and lateral posterior tibial slope. This may relate to increased rotational and translational instability associated with anterolateral complex injuries. Surgeons treating these patient may use this information to counsel their patients on the risks of associated pathology at the time of arthroscopy such as lateral meniscal posterior root tears.

Radiographic Templating for Calcaneus Operative Fixation: How Similar Is Side-to-Side Comparison?

OBJECTIVES

Calcaneal fractures often require contralateral, uninjured calcaneus radiographs as a template. The purpose of this study was to establish mean values for calcaneal radiographic parameters in an uninjured urban American population and perform side-by-side comparison with respect to age, sex, laterality, and radiograph obliquity (XRO).

DESIGN

Retrospective analysis of consecutive patients.

SETTING

Fourteen hospitals including Level 1 trauma center.

PATIENTS/PARTICIPANTS

Retrospective review of >800 uninjured patients with bilateral foot and calcaneus radiographs obtained between June and December 2019 was performed. Inclusion criteria were the following: age 18-89 years without fracture; previous foot surgical procedures; radiographic evidence of arthrosis in ankle, hindfoot, or midfoot; osteomyelitis; tumor; or foot deformities.

INTERVENTION

The lateral radiographs were independently reviewed by 3 observers, measuring Böhler angle (BA), crucial angle of Gissane (CAG), calcaneal length (CL), calcaneal height (CH), calcaneotalar ratio (CTR), and XRO.

MAIN OUTCOME MEASUREMENTS

The mean values of BA, CAG, CL, CH, and CTR were established. Side-by-side comparisons were completed with respect to age, sex, laterality, and XRO.

RESULTS

There were no statistically significant differences in side-by-side measurements of the BA, CAG, CL, or CH. XRO had significant effects on the measurements of BA, CAG, CH, and CTR. Side-by-side comparisons showed greater intersubject variability than within-subject differences.

CONCLUSIONS

We did not observe any differences in commonly measured calcaneal radiographic parameters. CAG is not a reliable parameter for diagnostic and operative planning purposes. We conclude that the use of contralateral calcaneus radiographs as templates for calcaneus fractures is a valid technique.

Effects of opioid-limiting legislation on postoperative opioid use in shoulder arthroplasty in an epidemic epicenter

BACKGROUND

The current opioid epidemic in the United States has become a public health crisis with an estimated 150 daily deaths and nearly 47,000 opioid-related deaths in the United States in 2017 alone. Sensible prescriber practice changes have been a focus of policymakers to decrease the total number of narcotic pain medications in circulation. In the state of Ohio, opioid prescription limits for acute pain were enacted in August 2017. However, given the association of acute opioid exposure with long-term use and lack of assessment of these policies, there is an unmet need to evaluate the effects of similar legislation in Ohio on postoperative opioid dosing after shoulder arthroplasty. This study evaluates the effects of opioid prescription-limiting legislation in Ohio on postoperative opioid dosing in shoulder arthroplasty and assesses risk factors related to long-term opioid use.

METHODS

All patients undergoing primary and revision shoulder arthroplasty over a 5-year period performed by a single surgeon were included. The pre-legislation (PRE) and post-legislation (POST) groups were defined as patients undergoing shoulder arthroplasty before August 31, 2017 and on or after August 31, 2017, respectively. The Ohio Automated Rx Reporting System was queried for controlled-substance prescriptions from 30 days preoperatively to 90 days postoperatively. Patients were designated as opioid tolerant if they had filled an opioid prescription within 30 days of surgery. A binary logistic regression analysis was applied to assess factors related to long-term opioid use.

RESULTS

A total of 334 patients were categorized into 2 cohorts: PRE (n = 99) and POST (n = 235). Accounting for legislative effects, we observed significant reductions in cumulative morphine milligram equivalent (MME) dosing in the opioid-naive patients in the 7-day and 30-day postoperative periods (450.0 MMEs in PRE group vs. 210.0 MMEs in POST group, P < .001) and in the opioid-tolerant patients in the 7-day postoperative period (450.0 MMEs in PRE group vs. 250.0 MMEs in POST group, P = .001). Among the opioid-naive patients, the POST group had a significant MME reduction in the 90-day postoperative period relative to the PRE cohort (P < .001). Preoperative opioid tolerance and benzodiazepine tolerance were independent risk factors for increased MME dosing at 90 days postoperatively (P < .001 and P = .02, respectively).

CONCLUSION

Opioid prescription-limiting legislation for acute pain in the state of Ohio is associated with a notable reduction in opioid MME dosing in the 90-day postoperative period after shoulder arthroplasty, particularly in opioid-naive patients in the first 30 days postoperatively. Preoperative opioid tolerance is correlated with significantly higher MME dosing postoperatively after shoulder arthroplasty.

The Role of Imaging in Femoroacetabular Impingement: History, Current Practices, and Future Applications

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Femoroacetabular impingement (FAI) is one of the most common causes of early hip articular cartilage wear and labral damage, and subsequently leads to the onset of hip osteoarthritis.

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Cam-type FAI impingement lesions can be best identified with a 90° Dunn lateral radiograph and a cross-table lateral radiograph with 15° of internal rotation; the alpha angle and the femoral head-neck offset are the most used predictive radiographic markers.

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FAI lesions with pincer impingement are associated with acetabular retroversion and are more difficult to identify on traditional radiographic imaging; however, the presence of a crossover sign, an ischial spine sign, and/or a posterior wall sign can be useful radiographic markers.

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Advanced imaging modalities such as magnetic resonance imaging (MRI) and/or magnetic resonance arthrography (MRA) can also be beneficial in the evaluation of FAI and labral pathology; MRA is more sensitive than MRI in detecting intra-articular pathology.

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Computer-assisted navigation for preoperative planning and intraoperative surgical assistance are promising technologies; however, additional studies are needed before they can be utilized safely and effectively.

Opioid-prescribing patterns among shoulder and elbow surgeons: considerations for future prescription guidelines

BACKGROUND

Although the achievement of adequate analgesia is critical to patient comfort and recovery following orthopedic procedures, no standard protocol exists to dictate the appropriate duration and quantity of narcotic prescription in the postoperative period. Therefore, the purpose of this survey was to determine patterns of opioid prescribing among orthopedic shoulder and elbow providers.

METHODS

In March 2020, a survey was distributed through a LISTSERV to 989 members of the American Shoulder and Elbow Surgeons orthopedic society. Survey recipients were asked to describe their personal and practice characteristics. Additionally, they were asked to list their 3 most commonly performed procedures and, for each operation, to list which narcotic pain medication they most commonly prescribe postoperatively, along with the corresponding number of tablets typically given. Similarly, respondents were asked to record frequently recommended alternative strategies for postoperative pain control, factors influencing the respondents' prescribing practices, and methods of patient counseling regarding opioid use and disposal.

RESULTS

A total of 177 providers responded to the survey. Across all selected procedures, Percocet (5 mg of oxycodone hydrochloride and 325 mg of acetaminophen) was the most commonly prescribed drug, with 21-30 tablets being the most commonly prescribed amount. The majority of surgeons (82%) indicated that previous opioid prescriptions influence their decision to prescribe opioids. Respondents most frequently reported patient age (48%) and duration of the patient's symptoms (32%) as additional influential factors. Most surgeons (93%) reported counseling their patients regarding the use of opioid medications. However, only 30% of surgeons reported providing information regarding how to dispose of unused opioids. In lieu of opioids, nearly all investigators reported the use of ice as a pain-relief strategy, with rest and the use of nonsteroidal anti-inflammatory drugs reported as other commonly recommended alternatives. Of 137 respondents who were aware of prescription guidelines, 21% reported using recommendations from the American Academy of Orthopaedic Surgeons, 21% used institutional policies, and 20% used personal guidelines, whereas the remaining respondents used other literature findings in their prescription decisions. Of particular concern, 21% of overall respondents were unaware of any type of guidelines.

DISCUSSION

To prevent both misuse and abuse of opioid prescribing, this analysis serves as a starting point for the establishment of more consistent, evidence-based opioid prescription guidelines for surgical procedures on the shoulder and elbow. In addition to recommending safe, procedure-specific opioid dosages and standardizing pain management strategies, these guidelines should include effective methods of educating both providers and patients regarding the use of opioid medication.

Protective role of Allium cepa Linn (onion) juice on maternal dexamethasone induced alterations in reproductive functions of female offspring of Wistar rats

Maternal treatment with dexamethasone induces oxidative stress in the reproductive structures of offspring. Consumption of Allium cepa Linn improves antioxidant status. This study was designed to evaluate the protective role of Allium cepa Linn juice on maternal dexamethasone induced alterations in reproductive functions of the female offspring of Wistar rats. Twenty lactating dams (180-200 ​g) were randomly assigned into four groups (n ​= ​5) on the day of parturition and treated as follows during lactation for 21 days: Control (5 ​ml/kg BW distilled water); Dexamethasone (60 ​μg/kg BW); Allium cepa (5 ​ml/kg BW); Dexamethasone ​+ ​Allium cepa (60 ​μg/kg BW ​+ ​5 ​ml/kg BW). The female offspring were separated at birth. Days of vaginal opening and first oestrus cycle, length and frequency of estrous cycle as well as serum hormonal profiles were assessed as measure of reproductive functions. Ovarian superoxide dismutase (SOD) activity, catalase activity and malondialdehyde (MDA) level were measured as indices of oxidative stress. Oestrous cycle length, frequencies of diestrus as well as the Ovarian MDA were significantly increased (p ​< ​0.05) in dexamethasone (DEX) group relative to control group. Serum 17β-oestradiol and corticosterone level in addition to SOD and catalase activities were significantly reduced (p ​< ​0.05) in DEX group relative to control. Co-administration of Dex with Allium cepa Linn juice reduced the oestrous length, frequency of diestrous as well as ovarian MDA. There was also a significant increase in serum 17β-oestradiol, ovarian SOD and catalase activity. The results suggest that Allium cepa could protect against alterations in reproductive functions of offspring induced by maternal treatment with dexamethasone during lactation in Wistar rats. The flavonoid constituent of onion may also help in reducing oxidative stress in the offspring.

Endoscopic Treatment of Calcific Tendinitis of the Gluteus Maximus: A Case Report

CASE

Calcific tendinitis of the gluteus maximus is a rare condition with poorly described operative treatment options. We present a 51-year-old man with chronic left posterolateral hip pain because of gluteus maximus calcific tendinitis that was refractory to conservative treatment. Endoscopy was pursued given the severity and chronicity of his symptoms. The patient remains asymptomatic without recurrence.

CONCLUSION

This is the first description of endoscopic management of calcific tendinitis of the gluteus maximus. This is a minimally invasive, efficacious option for management of this pathology.

Allium cepa Linn juice protect against alterations in reproductive functions induced by maternal dexamethsone treatment during lactation in male offspring of Wistar rats

Treatment with dams with dexamethasone during lactation has been reported to induce oxidative stress in the testis of the offspring. Allium cepa L (Red Onion) is known to be a potent free radical scavenger. The protective role of Allium cepa against oxidative stress induced in testis following treatment with dexamehasone during lactation in Wistar rats was assessed. Twenty female rats were assigned into four groups (n = 5) during lactation and they were treated as follows: Group 1 serve as Control (distilled water), Group 2, 3, and four were admistered dexamethasone (60 μg/kg), Allium cepa (5 ml/kg) and dexamethasone + Allium cepa respectively. Testicular descent, pubertal age, sperm quality indices, and serum hormonal profile were assessed as indices of reproductive function. Testicular malondialdehyde (MDA) reduced glutathione (GSH) as well as superoxide dismutase (SOD) and catalase activities were assessed as measures of oxidative stress. Results obtained showed that dexamethasone caused significant (P < 0.05) reduction in testes weights, indices of sperm quality, serum testosterone, FSH, LH levels and testicular antioxidant enzyme activities. There was significant delay (P < 0.05) in days of testes descent, preputial separation and increase in testicular MDA. However, maternal treatment with Allium cepa Linn juice significantly (P < 0.05) improved both indices of reproductive function and testicular antioxidant enzymes. These findings suggest that Allium cepa Linn has a protective effect against testicular oxidative stress and reproductive dysfunction following treatment of dams with dexamethasone during lactation.

Coconut Water Prevents Renal and Hepatic Changes in Offspring of Monosodium Glutamate-Treated Wistar Rat Dams

Monosodium glutamate (MSG) is a widely-consumed taste enhancer which has been implicated in the aetiology of renal and hepatic dysfunction in adults and their offspring. There is increasing evidence on the therapeutic properties of Coconut Water (CW) in kidney and liver disorders. This study investigated the effects of CW on renal and hepatic functions in offspring of MSG-fed dams. Twelve female Wistar rats (120 - 140 g) were grouped into four as follows; Control (10 ml/Kg distilled water), MSG (0.08 mg/Kg), CW (10 ml/Kg) and MSG+CW. Treatments were given orally daily commencing two weeks prior to mating, throughout mating and gestation until parturition. All dams received standard rodent diet and drinking water ad libitum throughout the study. After weaning on Post-Natal Day (PND) 28, serum was obtained from offspring for assay of liver and renal function. Histological analysis of the livers and kidneys were performed on both dams and offspring. There was no significant difference in liver enzymes, urea, creatinine and albumin levels amongst the offspring on PND 28. However, liver and kidney sections from MSG dams and their offspring showed early degenerative changes which were not evident in renal and hepatic tissues from CW and MSG+CW dams and offspring. These observations suggest that coconut water protects against monosodium glutamate-induced renal and hepatic dysfunction in dams and offspring.

Ectopic thyroid: The great mimicker

Ectopic thyroid tissue is very rare, but its prevalence increases in those with thyroid pathology. It typically occurs due to aberrant development of the thyroid gland during its migration to the pretracheal region. In this report, there are two cases of mediastinal ectopic thyroid tissue discussed, which were initially considered to be malignancies. The hospital course, diagnostic workup, including the use of computed tomography and positron emission tomography scans, and the characteristic features of the tissue are examined here. Due to the imaging characteristics, it is important to consider ectopic thyroid tissue as a differential diagnosis for mediastinal masses as encountered in these cases. Asymptomatic ectopic thyroid tissue is usually treated medically; however, patients in both of our cases opted for surgical resection of the masses even after confirmation of the origin of the tissues.

Outpatient thyroidectomy is safe in the elderly and super-elderly

OBJECTIVES

1) Determine the safety of outpatient thyroidectomy in the geriatric patient population. 2) Analyze the risk of postoperative complications from thyroid surgery in patients aged over 65 years (elderly) and aged over 80 years (super-elderly) undergoing ambulatory thyroidectomy compared to patients aged 21 through 40 years.

STUDY DESIGN

A retrospective analysis of consecutive patients undergoing thyroidectomy between January 2008 and July 2015 at a tertiary academic institution.

METHOD

Patients were stratified by age, and three subsets within this population were considered and analyzed further: youthful/control (aged 21-40 years), elderly (aged 65-79 years), and super-elderly (≥ 80 years). Patient demographics, surgical and pathological data, admission status, complication, and readmission rates were recorded.

RESULTS

A total of 1,429 thyroidectomies were accomplished; of these, 1,207 (84.5%) were outpatient operations. Among the outpatients, 85.2% were female, 14.1% were male, and the mean age was 50.3 ± 15.2 years. The control (youthful) group was comprised of 328 patients with a mean age of 33.3 years; the elderly group of 201 patients had a mean age of 70.3 years; and 16 patients in the super-elderly group had a mean age 82.7 years. The complication rates (5.2%, 5.0%, and 6.3%, respectively; P = 0.98) and re-admission rates (1.5%, 1.5%, and 0.0%, respectively; P = 0.89) were not different among these groups.

CONCLUSION

Outpatient thyroid surgery is as safe in appropriately selected elderly and super-elderly patients as it is in a control group of youthful patients. Therefore, age should not be a contraindication to conducting thyroidectomy on an ambulatory basis.

LEVEL OF EVIDENCE

4. Laryngoscope, 128:290-294, 2018.

Phase-Contrast Micro-Computed Tomography Measurements of the Intraocular Pressure-Induced Deformation of the Porcine Lamina Cribrosa

The lamina cribrosa (LC) is a complex mesh-like tissue in the posterior eye. Its biomechanical environment is thought to play a major role in glaucoma, the second most common cause of blindness. Due to its small size and relative inaccessibility, high-resolution measurements of LC deformation, important in characterizing LC biomechanics, are challenging. Here we present a novel noninvasive imaging method, which enables measurement of the three-dimensional deformation of the LC caused by acute elevation of intraocular pressure (IOP). Posterior segments of porcine eyes were imaged using synchrotron radiation phase contrast micro-computed tomography (PC μCT) at IOPs between 6 and 37 mmHg. The complex trabecular architecture of the LC was reconstructed with an isotropic spatial resolution of 3.2 μm. Scans acquired at different IOPs were analyzed with digital volume correlation (DVC) to compute full-field deformation within the LC. IOP elevation caused substantial tensile, shearing and compressive devformation within the LC, with maximum tensile strains at 30 mmHg averaging 5.5%, and compressive strains reaching 20%. We conclude that PC μCT provides a novel high-resolution method for imaging the LC, and when combined with DVC, allows for full-field 3D measurement of ex vivo LC biomechanics at high spatial resolution.

Ethical and legal issues in renal transplantation in Nigeria

With the increasing number of patients being offered kidney transplantation by many centers in the developing world, it is not unexpected that there would be attendant ethical and legal issues even when the selection process for transplantation seems medically justified. Because of the inadequate infrastructure for hemodialysis and peritoneal dialysis, coupled with the challenges of logistics for maintenance dialysis, transplantation would seem to be the best option for patients with end-stage renal failure, even in developed economies where these can easily be tackled. The main issues here revolve around incentives for donors, organ trade and trafficking and the economics of eliminating the waiting list and the criminal activities of organ trans-plantation. In the developing world, with the current level of corruption and poverty, there is a need to redouble efforts to monitor transplant activities. Professional bodies should take the lead in this regard. Furthermore, there is a need for governments to engage in public consultation and community awareness concerning organ donation in living and deceased persons.

Maternal treatment with dexamethasone during lactation delays male puberty and disrupts reproductive functions via hypothalamic-pituitary-gonadal axis alterations

The effects of maternal treatment with dexamethasone during lactation on pubertal timing, serum hormonal profile and sperm indices in the male offspring were assessed. Twenty lactating dams were divided into 4 groups (n=5). Group 1 was administered subcutaneously 0.02ml/100g/day normal saline at lactation days 1-21. Groups 2-4 were administered subcutaneously 100μg/kg/day dexamethasone (Dex) at lactation days 1-7, 1-14, and 1-21 respectively. Results showed that there was significant reduction in serum testosterone in the DexLD 1-7 (p<0.05), DexLD 1-14 (p<0.01) and DexLD 1-21 (p<0.001) relative to control. In addition there was a significant reduction in serum FSH and LH in the DexLD 1-7 (p<0.01), DexLD 1-14 (p<0.001) and DexLD 1-21 (p<0.001) when compared with the control. Treatment with dexamethasone during lactation significantly increased the days of preputial separation in the DexLD 1-7 (p<0.05), DexLD 1-14 (p<0.05) and DexLD 1-21 (p<0.001) relative to control. Maternal treatment with dexamethasone throughout lactation period also significantly reduced sperm counts (p<0.001), motility (p<0.01) and increased percentage abnormal sperm (p<0.001) in the offspring when compared with the control. In conclusion, maternal treatment with dexamethasone during lactation may induce delayed puberty and disrupt reproductive functions by altering activities at hypothalamic-pituitary-gonadal axis in the male offspring.

Effects of Oral Maternal Administration of Caffeine on Reproductive Functions of Male Offspring of Wistar Rats

Caffeine was investigated for its possible fetal programming effects on reproductive function of male offspring. Sixty-five pregnant Wistar rats were grouped into four. Group 1 was control and received distilled water. Groups 2, 3 and 4 were treated orally with 1.14, 3.42 and 5.70 mg/kg body weight of caffeine respectively. Each group was subdivided into four based on gestation days (GD) 1-7, 8-14, 15-21 and 1-21. The day of parturition was taken as postnatal day zero (0). Male offspring were sacrificed on postnatal day 70. Parameters determined were: weight at birth, body weight at postnatal day 21 and 70, anogenital distance (AGD) index, sperm parameters, reproductive organ weight, histology and hormonal profile (testosterone, FSH and LH). Data were analyzed using Analysis of Variance. Level of significance was taken at P<0.05. Male offspring belonging to caffeine treated dams showed dose dependent significant decreases in birth weight. Male offspring from dams treated with caffeine during GD 1-7 and GD 1-21 had a significant increase in their AGD index. Also, male offspring from dams treated with 1.14 and 5.70 mg/kg body weight of caffeine during GD 8-14 had a significant increase in AGD index. Dams treated with 3.42 mg/kg body weight of caffeine during GD 15-21, had a significant increase in the AGD index of their male offspring. The sperm motility of offspring from dams treated with 5.70 mg/kg body weight of caffeine during GD 1-7 and GD 1-21 were significantly increased. Offspring of GD 8-14 and GD 15-21 dams treated with 3.42 and 5.70 mg/kg body weight of caffeine respectively, showed significantly reduced serum testosterone level. There was a significant decrease in the weight of testes of offspring from dams treated with caffeine during GD 8-14. Histological sections of testes of offspring from caffeine treated dams showed interstitial congestions, edema, reduced germinal epithelial height and detached basal membrane. Maternal caffeine exposure during different gestational periods adversely affected birth weight and some reproductive indices in male offspring of Wistar rats.

Effects of methotrexate on serum testosterone level in sleep deprived male Wistar rats

BACKGROUND

Sleep deprivation has been reported to decrease testosterone levels but the mechanism remains unclear. Studies have shown that sleep deprivation increases interleukin 1 beta (IL-1β), a pro-inflammatory cytokine and that increased IL-1β levels cause reductions in Leydig cell production of testosterone. This study was therefore designed to determine the effects of methotrexate, an IL-1β blocker on serum testosterone levels in sleep deprived male Wistar rats.

METHODS

Twenty male Wistar rats were randomly assigned into four groups (n = 5); group I (Control) received the vehicle (1% tween 80 solution); group II (methotrexate) received 0.5 mg/kg body weight methotrexate; group III (SD) was sleep deprived and received the vehicle; group IV (SD+Methotrexate) was sleep deprived and received 0.5 mg/kg body weight methotrexate. Sleep deprivation was induced using the modified multiple platform technique for 14 days. Treatments were administered twice weekly by oral gavage for 14 days. Blood was collected on day 14 and serum was obtained for analyses of testosterone, LH and FSH levels. IL-1β level and histology of the testis were also determined. Data were expressed as Mean ± SEM and analysed using ANOVA. p < 0.05 was considered significant.

RESULTS

Serum testosterone levels were significantly decreased while testicular IL-1β was increased in SD and SD+Methotrexate compared with Control. FSH and LH levels were not significantly different among the groups.

CONCLUSION

Results of this study suggest that reduction in serum testosterone level in sleep deprived rats is not dependent on increased level of IL-1β.

Coconut water alters maternal high fat diet induced changes in hormones and pup morphometry of Wistar rats

BACKGROUND

Maternal high fat diet (HFD) during gestation adversely programmes foetal metabolism and cardiovascular function for the development of obesity and its related cardiovascular diseases in adult life. The hypolipidemic actions of coconut water (CW) in the presence of HFD have been reported. This study examined the effects of oral administration of CW on lipid panel, hormone profile, pup and placental morphometry of dams fed HFD during gestation.

METHODS

Twenty-four pregnant Wistar rats were assigned to four groups (n = 6) and treated daily from gestation day (GD) 1 to 21 as follows; Group 1: 1 ml/100g b.wt. distilled water; Group 2: 1ml/100g b.wt. CW; Group 3: HFD (70% standard rat feed plus 30% butter); Group 4: HFD + 1 ml/100g b.wt. CW. Animals were sacrificed on GD 21. Random blood glucose was measured using tail blood. Caesarean section was performed to remove the pups and their placentas which were immediately measured. Oxidative stress status of the placentas; serum lipid and hormone profiles of dams were assessed.

RESULTS

HFD+CW resulted in significant (P < 0.05) reductions in pup weight and morphometric indices when compared with pups from HFD. These changes were accompanied by significant improvements in maternal serum lipid profile, alterations in hormone levels and higher placental lipid peroxidation.

CONCLUSION

These results suggest that coconut water is protective against maternal high fat diet-induced changes. Further studies are on-going to determine the actions of coconut water of maternal high fat diet induced foetal programming of adult health.

N (G)-nitro-L-arginine Methyl Ester Protects Against Hormonal Imbalances Associated with Nicotine Administration in Male Rats

Background:

The administration of nicotine is associated with altered hormonal imbalances and increased serum and testicular nitric oxide (NO) level.

Aim:

This study sought to investigate the effects of NO inhibition with N^G-nitro-L-arginine methyl ester (L-NAME) on altered hormonal imbalance in adult male albinorats.

Materials and Methods:

Rats were administered with 0.5 mg/kg body weight (BW) and 1.0 mg/kg BW nicotine and were treated with L-NAME in the drinking water or drinking water alone for 30 days. Serum was analyzed for testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH), and prolactin using radioimmunoassay.

Results:

Nicotine administration significantly decreased (P < 0.05) testosterone in the low and high dose treated groups and FSH in the high dose treated group when compared with the control group. There was a significant increase (P < 0.05) in mean LH and prolactin level in the high dose treated group when compared with the control. Concomitant treatment with nicotine and L-NAME produced significant increases in testosterone and FSH, and a decrease in prolactin in 1.0 mg/kg BW. L-NAME alone did not lead to a significant increase in testosterone when compared with control.

Conclusion:

These data demonstrate that the suppressive effects of nicotine on testosterone level of the adult male rat can be prevented by NOS blockade with L-NAME. It appears that these beneficial effects are mediated primarily within the gonad; however, the involvement of the pituitary cannot be totally ruled out.

Effects of vitamin E and melatonin on serum testosterone level in sleep deprived Wistar rats

BACKGROUND

Sleep deprivation affects a significant proportion of the global population. It has been reported to induce oxidative stress in the testes and reduce serum testosterone levels. Exogenous anti-oxidants have been known to prevent damages and diseases associated with oxidative stress but there is dearth of knowledge on their effectiveness during sleep deprivation.

AIM

This study was designed to investigate the effects of two anti-oxidants; melatonin and vitamin E on serum testosterone concentration in sleep deprived male Wistar rats.

METHODS

Thirty (30) male Wistar rats were used for this study. Animals were divided into six (6) groups (n = 5). Group 1 was the control, group 2 rats were sleep deprived, group 3 received vitamin E (200 mg/ kg bwt) only, group 4 rats received vitamin E and were sleep deprived, group 5 received melatonin only (10 mg/kg bwt), and group 6 rats received melatonin (10 mg/kg bwt) and were sleep deprived. Sleep deprivation was induced using the modified multiple platform technique. Body weights were taken on days 7, 14 and 21. Blood was collected at sacrifice and serum was obtained for analyses of testosterone, corticosterone and melatonin. Testicular malondialdehyde, superoxide dismutase and catalase levels were determined by the methods of Adam-Vizi and Seregi (1982), Misra and Fridovich (1972), and Sinha, (1972) respectively. Data obtained were analyzed using one way ANOVA and p < 0.05 was considered significant.

RESULTS

Serum testosterone (nmol/l) of the sleep deprived animals (0.6 ± 0.3) reduced significantly (p < 0.05) compared with control group (3.3 ± 0.04), sleep deprived+vitamin E group (2.8 ± 0.5) and sleep deprived+melatonin group (2.0 ± 0.3). Also, melatonin+sleep deprived group had reduced testosterone compared with control. There were no significant changes in the serum corticosterone (nmol/l) and melatonin levels in all the groups compared with the sleep deprived group. However, corticosterone was increased in the sleep deprived+Vitamin E group (51.6 ± 20.5) compared with control (6.3 ± 0.6) Sleep deprived group had increased testicular malondialdehyde (MDA) (1.6 ± 0.1 unit/mg), superoxide dismutase (SOD) (3.2 ± 0.2 unit/mg), and catalasel evels (44.3 ± 1.1 unit/ mg) compared with control (0.9 ± 0.0 μmg). MDA, and catalase were significantly reduced in sleep deprived+vitamin E (1.1 ± 0.2, 2.4 ± 0.3, 39 ± 1.0 unit/ mg) compared with sleep deprived while melatonin alone had increased MDA. level (1.7 ± 0.2unit/mg) compared with control. SOD in the sleep deprived+melatonin group (2.7 ± 0.2 μ/mg) as compared with control increased (p < 0.05) while MDA and catalase levels as compared with control and sleep deprived groups showed no difference. Histological findings showed that the pathology in the testes of sleep deprived rats was ameliorated by vitamin E.

CONCLUSION

Vitamin E had a more potent effect than melatonin in maintaining testosterone level in sleep deprived Wistar rat.

Cocos nucifera L. water improves reproductive indices in Wistar Rats

BACKGROUND

This study explored the effects of Cocos nucifera L. water (CW) on the hypothalamo-pituitary-gonadal axis (HPG) and fertility in Wistar rats.

METHODS

Adult male and female Wistar rats were treated orally as follows; Study 1: Group 1: control (distilled water), group 2: 20 ml/kg corn oil (danazol vehicle), group 3: 20 ml/kg CW, group 4: 40 ml/kg CW, group 5: danazol, group 6: danazol + 20 ml/kg CW and group 7: danazol + 40 ml/kg CW. 200 mg/ kg danazol was administered. Serum levels of LH, FSH, estradiol and testosterone; gonadal weights and sperm indices were assessed. Study 2: Group 1: control (distilled water), group 2: 20 ml/kg CW, group 3: 40 ml/kg CW for 6 and 2 weeks prior to mating in male and female rats respectively.

RESULTS

Significant (p < 0.05) increases in estradiol concentration were observed in groups 3, 4, 6 and 7. Significant reductions in LH, FSH, estradiol and testosterone levels were observed in group 5 which were ameliorated in groups 6 and 7. Males showed significant increases in sperm count and motility in groups 3, 4, 6 and 7, and reductions in these variables along with viability in group 5. CW pre-treatment increased fecundity index and proportion of female pups from dams, while the pups from sires showed higher birth weights.

CONCLUSIONS

CW acts on the HPG to positively influence reproductive function in both males and females and may aid in maternal preconception sex selection of female offspring.

Antioxidant profile changes in reproductive tissues of rats treated with nicotine

OBJECTIVES:

Nicotine intake has been associated with reduced fertility, although the mechanisms responsible are still unclear. However, oxidative stress has been repeatedly implicated as the leading cause of male infertility. This study was therefore designed to investigate the effects of nicotine administration on testicular oxidant and antioxidant system in male albino rats.

MATERIALS AND METHODS:

Forty male rats weighing between 150 and 180 g were divided into five groups and treated orally for 30 days. Group I, which served as the control received 0.2 ml/kg normal saline, Groups II and III received 0.5 mg/kg and 1.0 mg/kg body weight (BW) of nicotine respectively. The fourth and fifth groups were administered with 0.5 mg/kg and 1.0 mg/kg BW of nicotine, but were left untreated for another 30 days. Homogenate of testis and epididymis were assayed for lipid peroxidation and anti-oxidant enzyme.

RESULTS:

The results show a significant decrease (P < 0.05) in testicular glutathione peroxidase, glutathione reductase, catalase and superoxide dismutase while a significant increase (P < 0.05) was observed in testicular lipid peroxidation and nitric oxide level in both groups when compared with the control.

CONCLUSION:

This experiment established that nicotine administration is associated with decreased testicular antioxidant and increase testicular lipid peroxidation, which might be a mechanism by which nicotine induce infertility.

Particulated Juvenile Articular Cartilage Implantation in the Knee: A 3-Year EPIC-µCT and Histological Examination

OBJECTIVE

The goal of this report is to describe the outcome of sequential particulated cartilage allograft and autologous osteochondral transfer treatments for an osteochondral lesion of the medial femoral condyle.

METHODS

A 44-year-old woman was treated with a particulated juvenile articular cartilage allograft (DeNovo NT) for a chondral lesion of the knee. As a result of continued pain, she had 2 further surgeries, including an autologous osteochondral transfer system procedure and finally a unicondylar knee arthroplasty. At the final procedure, the areas of the allograft and autograft tissue were biopsied for histological evaluation. The quality of the residual cartilage tissue was assessed first by equilibrium partitioning of an ionic contrast agent via micro-computed tomography (EPIC-µCT), and then by hematoxylin and eosin, Safranin O staining, and polarized light microscopy.

RESULTS

Despite showing good healing at 7 months postsurgery by MRI, at 28 months post DeNovo NT tissue implantation the excised cartilage tissue was heterogeneous, with some regions of hyaline-like cartilage and some regions of fibrocartilage. The later mosaicplasty may have helped maintain hyaline-like cartilage of the DeNovo NT tissue in its vicinity.

CONCLUSION

This case report describes the cartilage repair tissue produced by DeNovo NT implantation and compares it with autologous osteochondral plug tissue.

Intra-articular injection of micronized dehydrated human amnion/chorion membrane attenuates osteoarthritis development

INTRODUCTION

Micronized dehydrated human amnion/chorion membrane (μ-dHACM) is derived from donated human placentae and has anti-inflammatory, low immunogenic and anti-fibrotic properties. The objective of this study was to quantitatively assess the efficacy of μ-dHACM as a disease modifying intervention in a rat model of osteoarthritis (OA). It was hypothesized that intra-articular injection of μ-dHACM would attenuate OA progression.

METHODS

Lewis rats underwent medial meniscal transection (MMT) surgery to induce OA. Twenty four hours post-surgery, μ-dHACM or saline was injected intra-articularly into the rat joint. Naïve rats also received μ-dHACM injections. Microstructural changes in the tibial articular cartilage were assessed using equilibrium partitioning of an ionic contrast agent (EPIC-μCT) at 21 days post-surgery. The joint was also evaluated histologically and synovial fluid was analyzed for inflammatory markers at 3 and 21 days post-surgery.

RESULTS

There was no measured baseline effect of μ-dHACM on cartilage in naïve animals. Histological staining of treated joints showed presence of μ-dHACM in the synovium along with local hypercellularity at 3 and 21 days post-surgery. In MMT animals, development of cartilage lesions at 21 days was prevented and number of partial erosions was significantly reduced by treatment with μ-dHACM. EPIC-μCT analysis quantitatively showed that μ-dHACM reduced proteoglycan loss in MMT animals.

CONCLUSIONS

μ-dHACM is rapidly sequestered in the synovial membrane following intra-articular injection and attenuates cartilage degradation in a rat OA model. These data suggest that intra-articular delivery of μ-dHACM may have a therapeutic effect on OA development.

Localized 3D analysis of cartilage composition and morphology in small animal models of joint degeneration

OBJECTIVE

Current histological scoring methods to evaluate efficacy of potential therapeutics for slowing or preventing joint degeneration are time-consuming and semi-quantitative in nature. Hence, there is a need to develop and standardize quantitative outcome measures to define sensitive metrics for studying potential therapeutics. The objectives of this study were to use equilibrium partitioning of an ionic contrast agent via Equilibrium Partitioning of an Ionic Contrast-Microcomputed tomography (EPIC-μCT) to quantitatively characterize morphological and compositional changes in the tibial articular cartilage in two distinct models of joint degeneration and define localized regions of interest to detect degenerative cartilage changes.

MATERIALS AND METHODS

The monosodium iodoacetate (MIA) and medial meniscal transection (MMT) rat models were used in this study. Three weeks post-surgery, tibiae were analyzed using EPIC-μCT and histology. EPIC-μCT allowed measurement of 3D morphological changes in cartilage thickness, volume and composition.

RESULTS

Extensive cartilage degeneration was observed throughout the joint in the MIA model after 3 weeks. In contrast, the MMT model showed more localized degeneration with regional thickening of the medial tibial plateau and a decrease in attenuation consistent with proteoglycan (PG) depletion. Focal lesions were also observed and 3D volume calculated as an additional outcome metric.

CONCLUSIONS

EPIC-μCT was used to quantitatively assess joint degeneration in two distinct preclinical models. The MMT model showed similar features to human Osteoarthritis (OA), including localized lesion formation and PG loss, while the MIA model displayed extensive cartilage degeneration throughout the joint. EPIC-μCT imaging provides a rapid and quantitative screening tool for preclinical evaluation of OA therapeutics.

Preliminary study on the effects of Buchholzia coriacea seed extract on male reproductive parameters in rats

The effects of methanol extract of Buchholzia coriacea seed was studied on male reproductive system of albino rats. Administration of 200mg/kg b.w.(p.o.) of the extract for 6 weeks resulted in significant reduction (P˂0.05) in the weight of the epididymis and seminal vesicle, but not the testes and prostate gland. Also the weight of the visceral organs- lungs, liver, heart and kidney were unaffected. A marked decrease (P<0.05) in sperm motility and volume was also observed in sperm collected from the caudal epididymis of the treated animals. Sperm count and morphology were not significantly affected (P<0.05). Total tissue protein of the epididymis and testes of the treated rats was significantly increased (P<0.05) and fertility was zero in the treated rats. Histological section showed that the epididymal ducts were mostly empty, though the epithelial lining appeared normal. There were fewer spermatozoa and late stage spermatids in the testes, with normal testicular epithelium. The results suggest that the extract of Buchholzia coriacea may have antifertility effects in male rats, the site of action most probably the epididymis.

Influence of prolonged exposure to Nigerian Bonny light crude oil on fertility indices in rats

The effect of Bony Light Crude Oil (BLCO) on some sperm functions during short term exposure has been reported. The present study investigated the effect of long term ingestion of BLCO on fertility indices in male and female albino rats. Adult male rats in groups of five were exposed daily to 0, 200, 400 and 800 mg/kg BLCO (orally, p.o) dissolved in olive oil which served as the control, for six weeks. The male rats were cohabited with untreated adult female rats (for mating) during the last 6th week of treatment. Similarly, adult female rats in groups of five were exposed daily to 0, 200, 400 and 800 mg/kg BLCO (p.o) for 6 weeks. The rats were mated with untreated male rats during the last 6th week of treatment. Body weights of the treated rats remain unaffected. However, a significant decrease in the weight of the testis, epididymis, cauda epididymal sperm count, motility, viability and normal morphology of the spermatozoa was observed. There was 100% mating success as all untreated female rats with a significant decrease in number, birth weight and survival rate of offspring delivered. BLCO treated female rats had irregular oestrous cycle with increased frequency of oestrous and metestrous phases and a decrease in the diestrous phase. A dose-dependent reduction in fertility success, number and birth weight of offspring of the BLCO treated females mated with normal males was recorded. Histological study of the epididymis and testis showed BLCO treatment-related lesions. The results suggest that, Bonny light crude oil reduced fertility indices of male and female rats.

Gastro-protective effect of methanol extract of Ficus asperifolia bark on indomethacin-induced gastric ulcer in rats

The gastro-protective and antioxidant effects of methanol extract of Ficus asperifolia bark on indomethacin induced gastric ulcer were investigated in male rats. Thirty two male rats divided into 4 equal groups and were treated as follows: group1 (control), 0.5ml of 5% tween 80 (vehicle for the extract), groups 2 and 3, 100 and 500mg/kg of Ficus asperifolia extract respectively and group 4, cimetidine (100mg/kg). After two weeks of daily oral administration of vehicle, extract or cimetidine, gastric ulcer was induced in all rats with indomethacin (40 mg/kg, p.o). Gastric juice pH, gastric acid concentration, gastric ulcer score, percentage gastric ulcer inhibition, activity levels of superoxide dismutase (SOD), catalase and malondiadehyde (MDA) were determined. Ficus asperifolia extract significantly increased gastric pH (p<0.05) but decreased (p<0.01) gastric acid secretion in dose dependent manner when compared with the control. Inhibition of gastric ulcer in extract and cimetidine treated rats was similar. Activities of SOD and catalase were significantly increased (p<0.05) while MDA was significantly decreased (p< 0.05) in extract treated rats when compared with the control. The results suggest that Ficus asperifolia possesses gastro-protective and antioxidant properties against gastric ulcer induced by indomethacin.

Quinolizidine alkaloids: the bioactive principles in Cnestis ferruginea (de Candolle) with male antifertility activities

OBJECTIVES

The reproductive activities of purified fractions from the root extract of Cnestis ferruginea was evaluated in rats. Phytochemical screening of the extract revealed the presence of alkaloids, tannins and anthraquinones.

MATERIALS AND METHODS

Column chromatography produced 20 fractions which were reduced to 6 by thin layer chromatography. Nuclear magnetic resonance spectroscopy revealed quinolizidine alkaloids (fractions 3 and 4) as the active principles in the extract of Cnestis ferruginea. Each fraction of Cnestis ferruginea (0.1, 1 and 2 mgkg(-1)bw) was administered to rats by gavages for 60 days.

RESULTS

All fractions caused significant reduction (p<0.05) in sperm counts, motility, viability, morphology and plasma levels of testosterone, luteinizing hormone and follicle stimulating hormone. Fractions 3 and 4 caused the highest reduction (p<0.001) in fertility, FSH and LH levels comparable to those of quinine sulphate. There was recovery after 60 days of withdrawal from the extracts.

CONCLUSION

The results suggest that Cnestis ferruginea possesses reversible male antifertility effects. The active principles with these activities appear to be quinolizidine alkaloids.

Effects of oral administration of nicotine on organ weight, serum testosterone level and testicular histology in adult male rats

This study investigated the effects of oral administration of nicotine on body and reproductive organ weight, serum testosterone level and testicular histology in adult male rats. Forty male rats divided into five groups and treated for a period of 30 days with 0.5mg/kg (low dose) and 1.0 mg/kg (high dose) body weight of nicotine while the control rats received 0.2 ml/kg normal saline. The fourth and fifth groups were gavaged with 0.5mg/kg and 1.0mg/kg body weight of nicotine but were left untreated for another 30 days. These groups served as the recovery groups.&nbsp; At the end of each experimental period, the animals were scarified and their reproductive organs were removed and weighed immediately. There was no significant change in the body weight. There was a significant decrease (p <0.05) in the testicular and epididymal weight of rats for both treatments while the decrease in the seminal vesicle weight for both treatment groups was not significant. The prostate weight was not significantly increased in both groups. The recovery groups showed appreciable recovery in their organ weight. Serum level of testosterone of both groups was significantly decreased in a dose dependent manner when compared with those of the control rats. The histological section showed testicular degeneration and disorganization in the cytoarchitecture, as the observed changes were pronounced in the high dose group than the low dose group. However, there were both regeneration of the germinal epithelium and restructuring of the interstitum towards normal in the recovery groups. No lesion was observed in the epididymis of the rats. The results suggest that nicotine has deleterious effect on the male reproductive organ of albino rats ameliorated by nicotine cessation.

Implication of reproductive endocrine malfunction in male antifertility efficacy of Azadirachta indica extract in rats

The effects of the ethanol extract of Azadirachta indica stem bark on body and organ weights, sperm morphology, counts and viability, serum levels of testosterone, luteinizing hormone (LH), and follicle stimulating hormone (FSH) were studied in albino rats. Intraperitoneal administration (i.p) of the extract for ten weeks caused significant dose-dependent decreases in weights of the testis, epididymis and seminal vesicles but an increase in that of the adrenal gland. Sperm counts, morphology and viability were adversely affected in the extract treated rats. Rats that received 150 mgkg(-1) b.w. Azadirachta extract were unable to impregnate female rats throughout the duration of the study. However, these female rats conceived and sired physically normal litters about four weeks after cohabitation with untreated male rats. Azadirachta indica produced dose-dependent reduction in serum testosterone and LH but no change in FSH levels. Most of the changes produced in this study were restored in recovery experiments.

A comparative study of students' performance in preclinical physiology assessed by multiple choice and short essay questions

This study was designed to compare the performance of medical students in physiology when assessed by multiple choice questions (MCQs) and short essay questions (SEQs). The study also examined the influence of factors such as age, sex, O/level grades and JAMB scores on performance in the MCQs and SEQs. A structured questionnaire was administered to 264 medical students' four months before the Part I MBBS examination. Apart from personal data of each student, the questionnaire sought information on the JAMB scores and GCE O' Level grades of each student in English Language, Biology, Chemistry, Physics and Mathematics. The physiology syllabus was divided into five parts and the students were administered separate examinations (tests) on each part. Each test consisted of MCQs and SEQs. The performance in MCQs and SEQs were compared. Also, the effects of JAMB scores and GCE O/level grades on the performance in both the MCQs and SEQs were assessed. The results showed that the students performed better in all MCQ tests than in the SEQs. JAMB scores and O' level English Language grade had no significant effect on students' performance in MCQs and SEQs. However O' level grades in Biology, Chemistry, Physics and Mathematics had significant effects on performance in MCQs and SEQs. Inadequate knowledge of physiology and inability to present information in a logical sequence are believed to be major factors contributing to the poorer performance in the SEQs compared with MCQs. In view of the finding of significant association between performance in MCQs and SEQs and GCE O/level grades in science subjects and mathematics, it was recommended that both JAMB results and the GCE results in the four O/level subjects above may be considered when selecting candidates for admission into the medical schools.

Antiulcerogenic effects of Tylophora conspicua in male rats

Studies were undertaken on the effect of a crude (TC) and an alkaloid fraction (TA) of the leaf extracts of Tylophora conspicua on indomethacin-induced gastric ulceration and gastric acid secretion in male albino rats. Both the TC and TA produced a dose-dependent inhibition of gastric ulceration. At a dose level of 40 mg/kg TC and TA were more effective (TA being more potent) than propranolol in inhibiting gastric ulceration. The highest dose of the extracts used (80 mg/kg) completely inhibited gastric ulceration. Intravenous administration of the TC and TA significantly decreased acid output at low dose (20 mg/kg), medium dose (40 mg/kg) and high dose (80 mg/kg) from the peak basal of 0.54 +/- 0.02 mEq/L/min to 0. 49 +/- 0.02 mEq/L/min, 0.35 +/- 0.01 mEq/L/min and 0.21 +/- 0.02 Meq/L/min respectively. 80 mg/kg of TC and TA significantly reduced the histamine (1 mg/kg) induced gastric acid secretion. The results suggest that the antiulcer activity of Tylophora conspicua might be produced by gastric acid inhibition.