159 The Need Of Six Monthly Follow Up X-Rays Post Total Knee Replacement(TKR)

Background

There is a longstanding culture of repeat x-rays after total knee replacement (TKR) as part of follow up, often combined with a clinic review. This is to check that the prosthesis is in a satisfactory position. There are inherently a number of issues with this historic approach including exposure of patients to further radiation who may be asymptomatic, time delays in busy clinics or x-ray departments and costs.

Objectives

The aim of this audit was to assess whether follow up plain films after TKR are methodically undertaken and of benefit to confirm satisfactory appearance if immediate post -operative x-rays were unremarkable. The findings of a six month follow up x-ray was specifically evaluated. The secondary aim was to establish the timing of further follow up x-rays within the department.

Method

200 patients were included within the analysis, they all received a TKR at a major trauma centre, over a one-year period between December 2017 and December 2018.

Results

It was found that 100% of those patients having a post-operative film had a satisfactory appearance. 78% of patients had at least one further follow op x-ray of which 99.4% were satisfactory. Up to five follow up x-rays were taken with 53.5% of patients having a follow up x-ray at 6 months.

Conclusions

From the above results there is minimal, if any, evidence within the data set to support routine, additional follow up imaging if initial post-operative films are satisfactory, and the patient is asymptomatic.

502 Benefits of Rivaroxaban over Enoxaparin in Trauma and Orthopaedics

Aim

Our Aim was to show what the benefits of Rivaroxaban over Enoxaparin post-operatively in trauma and orthopaedics. Doing a meta-analysis of previous studies and comparing post-op thrombotic risk in both rivaroxaban and Enoxaparin. To compare costs of using Enoxaparin vs Rivaroxaban in the major trauma centre.

Method

Meta-analysis of four studies conducted;Lassen 2008, Turpie 2005, Turpie 2009, Xie 2017 and Zou 2014. Gathered data from the British national formulary about Rivaroxaban cost and enoxaparin cost.

Results

This illustrated that rivaroxaban after TKA(Total knee Arthroplasty) had a significantly lower rate of symptomatic VTE, symptomatic DVT, asymptomatic DVT, distal DVT, and proximal DVT (shown in figure 1). The study shows that rivaroxaban after TKA is more effective than enoxaparin and did not increase major bleeding or cause increased mortality Major venous thromboembolism occurred in 9 of 908 patients (1.0%) given rivaroxaban and 24 of 925 (2.6%) given enoxaparin in a study done by Lassen et al Rivaroxaban requires less training for the patient, enoxaparin requires the patient to be taught proper administration. Rivaroxaban is considerably cheaper compared to enoxaparin. Enoxaparin provided by both Inhixa and Clexane cost £30.27 for a batch of 10 pre-filled disposable injections of 40mg, whilst rivaroxaban costs £18 for 10 tablets of the dose 10mg.

Conclusions

Rivaroxaban is cheaper to use for post-op anticoagulation, less resource intensive as patient is not required to be taught optimal administration method. Rivaroxaban has significantly reduced occurrence of thrombus compared to that of enoxaparin (based of the meta-analysis).

Co-expression of Hsp70 Protein and Autophagy Marker Protein LC3 in A549 Cells and THP1 Cells Exposed to Nanoparticles of Air Pollution

The ability of air particulate matter (PM) to cause reactive oxygen species-driven protein damage is associated with both COPD and lung cancer, but the mechanisms are unsettled. In this study, we investigated the co-expression of Hsp70 and the autophagy marker protein LC3 in A549 cells (alveolar epithelial cell line) and THP-1 cells (monocyte/macrophage cells) grown in media supplemented with 100 μg/mL of four types of PM: carbon black (CB), urban dust (UD), nanoparticulate CB (NPCB), and nanoparticulate CB coated with benzo(a)pyrene (NPCB-BaP). Fluorescent monoclonal antibodies and flow cytometry were used to assess the expression and co-expression of HSP70 and LC3 proteins. Hsp70 expression was significantly increased by all PM, while LC3 was decreased by CB in A549 cells, unchanged by CB and UD in THP-1 cells and increased by NPCB and NPCB-BaP in both cell types. All PMs increased the Hsp70/LC3 ratio in binary scatterplots; the relationship was positive and linear, which may reflect chaperone-dependent autophagy. The UD was the only PM type that affected the slopes of the spatial trend lines and altered binary patterns of Hsp70/LC3 distribution in THP1 cells. These findings provide an insight into the molecular mechanisms regulating proteostasis in PM-exposed cells through the chaperone-autophagy system in the cytoplasm.

Cigarette Smoke-Induced Oxidative Stress and Autophagy in Human Alveolar Epithelial Cell Line (A549 Cells)

Chronic exposure to cigarette smoke (CS) causes structural and functional changes in the respiratory tract. It is a major risk factor for cardiovascular and systemic pulmonary diseases. The aim of this study was to investigate the effect of acute CS exposure (2 h) on oxidative stress, heat shock protein 70 (HSP70) expression, autophagy (LC3 expression), and oxidative stress (DCF fluorescence) in human alveolar epithelial cell line A549. Cell culture medium was conditioned with CS using commercial cigarettes, and A549 cells were grown in modified media for 2 h. In some experiments, A549 cells were pretreated with 100 μM of L-buthionine-sulfoximine (BSO) for 24 h to induce glutathione (GSH) depletion. In the cells grown in CS-conditioned medium, GSH was depleted by more than 30%, and reactive oxygen species were increased. Moreover, there was a considerable overexpression of HSP70 and a substantial accumulation of LC3. Similar changes were found when the cells were pretreated with BSO. We conclude that the short-term exposure of epithelial cells to CS increases oxidative stress that entails enhanced autophagy activity.

An efficient system for conditional gene expression in embryonic stem cells and in their in vitro and in vivo differentiated derivatives

We have developed a universally applicable system for conditional gene expression in embryonic stem (ES) cells that relies on tamoxifen-dependent Cre recombinase-loxP site-mediated recombination and bicistronic gene-trap expression vectors that allow transgene expression from endogenous cellular promoters. Two vectors were introduced into the genome of recipient ES cells, successively: (i) a bicistronic gene-trap vector encoding the beta-galactosidase/neo(R) fusion protein and the Cre-ER(T2) (Cre recombinase fused to a mutated ligand-binding domain of the human estrogen receptor) and (ii) a bicistronic gene-trap vector encoding the hygro(R) protein and the human alkaline phosphatase (hAP), the expression of which is prevented by tandemly repeated stop-of-transcription sequences flanked by loxP sites. In selected clones, hAP expression was shown to be regulated accurately by 4'hydroxy-tamoxifen. Strict hormone-dependent expression of hAP was achieved (i) in vitro in undifferentiated ES cells and embryoid bodies, (ii) in vivo in virtually all the tissues of the 10-day-old chimeric fetus (after injection of 4'hydroxy-tamoxifen to foster mothers), and (iii) ex vivo in primary embryonic fibroblasts isolated from chimeric fetuses. Therefore, this approach can be applied to drive conditional expression of virtually any transgene in a large variety of cell types, both in vitro and in vivo.

[The comparison of concentration of endogenous ethanol blood serum in alcoholics and in non-alcoholics at different stages of abstinence]

In this report the concentration of endogenous ethanol in blood serum in alcoholics at different stages of abstinence and in non-alcoholics was studied. 36 people--26 alcoholics and 10 non-alcoholics were examined and gas chromatography was used. It was revealed that the longer the period of abstinence in alcoholics, the lower the concentration of endogenous ethanol in blood serum. Moreover, the alcoholics showed a higher concentration of endogenous ethanol in blood serum as compared to non-alcoholics.

[HSG--usefulness in diagnosing infertility]

HSG examination was performed on 363 female patients diagnosed because of infertility. In 258 (71.8%) women primary infertility was recognized and in 105 (28.9%) secondary infertility. Normal anatomical state of Fallopian tube was observed in 65 (77.4%) patients with primary infertility and only in 19 (22.6%) with secondary infertility. Abnormal results of examination were discovered in altogether 279 (76.9%) diagnosed patients. Taking into consideration Fallopian tube factor in secondary infertility, it was discovered in as many as 81.9% of cases.