Digit ratio (2D:4D) and its relationship to foetal and maternal sex steroids: A mini-review

The challenges of terrestrial existence may mean that the early development of tetrapod limb traits is linked to the development of the urogenital system and sex steroids. One such limb trait is the sex-dependent ratio of the lengths of the 2nd and 4th digits (2D:4D). Direct evidence for the association between early sex steroids and offspring 2D:4D can be obtained by manipulating foetal sex hormones. However, this is not ethically permissible in humans. It is widely accepted that 2D:4D is a biomarker for early foetal sex hormones in tetrapods but the link in humans remains controversial. Here we review the evidence that (i) manipulation of sex steroids in early development leads to sex-dependent changes in 2D:4D throughout the tetrapods, and (ii) maternal sex steroids cross the placenta and thus are associated with offspring 2D:4D in both non-human and human animals. We suggest a research focus on associations between human maternal sex steroids and offspring 2D:4D to clarify the link between 2D:4D and early sex steroids. A protocol is proposed to examine the correlation between 1st-trimester maternal sex steroids and offspring 2D:4D. Such an association may explain the existence and medium effect size of the human sex difference in 2D:4D.

Mentalisierungsfähigkeit und Empathie in der Psychiatrie – eine Sozialisationsfrage?

Berufliche Sozialisation entwickelt sich im Kontext der Persönlichkeitsentwicklung und vorhandener Bedingungen unterschiedlich. Das Aufrechterhalten der Mentalisierungsfähigkeit im beruflichen Alltag und vor allem in herausfordernden Situationen ist keine Selbstverständlichkeit, sondern abhängig von Umgebungsbedingungen. Die Übernahme von Verantwortung für die gewählte berufliche Tätigkeit erfordert eine Auseinandersetzung mit dem jeweils spezifischen Anforderungsprofil; es stellen sich Lern- und Entwicklungsaufgaben. Die Integration der beruflichen Identität im Rahmen förderlicher Umgebungsbedingungen bedeutet, sich als Teil dieser Gruppe(n) zu erleben. Aus gruppenpsychoanalytischer Sicht stellt die Identifikation mit einer Gruppe eine Verinnerlichung eines „guten Objekts“ dar, einer Gruppenrepräsentanz, welche in herausfordernden Situationen zugänglich ist. Dies kann die Mentalisierungsfähigkeit verbessern.

Three-step technique for implantation of rotating hinge knee prostheses : Demonstration using the Enduro prosthesis

OBJECTIVE

Implantation of an axis-guided knee prosthesis with consideration of the joint line and balanced flexion and extension gap to reduce the mechanical load on the prosthesis axis and to improve the movement of the prosthesis.

INDICATIONS

Distinct unilateral instability due to ligament insufficiency in association with knee prostheses. Primary implantation of axis-guided knee prostheses with pronounced axial malalignment (>20-25° valgus or varus malalignment) or/and severe flexion contracture > 40°. Replacement of prosthesis with nonsignificant imbalance between flexion and extension gap.

CONTRAINDICATIONS

Clearly unstable flexion gap such that the extension gap cannot be adjusted appropriately. Significant femoral bone defects requiring distal femoral replacement prostheses.

SURGICAL TECHNIQUE

Reconstruction of the tibial platform with the trial prosthesis with regard to height in relation to the tip of the fibula. Determination of the femoral prosthesis size. Adjustment of the anteroposterior (AP) cutting block of the selected size, referenced anteriorly and in correct rotation. Determination of the flexion gap with spacers using the stable side of the collateral ligaments. Positioning the distal cutting block and determination of the height of the extension gap. Moving the distal cutting block until the same height of spacer as used in the flexion gap fits into the extension gap, taking into account the stable side of the collateral ligaments. The extent of the displacement D1 is noted. Reverse displacement of the distal cutting block by the distance D2 until a satisfactory bony contact surface for the femoral component in the distal femur can be created. The thickness of the required distal augments on the following chamfer-cutting guide (4-in‑1 cutting block) and thus on the femoral prosthetic component is the sum of D1 + D2. The chamfer-cutting guide (4-in‑1 block) with distal augments of the calculated height (D = D1 + D2) is placed in position. Definition and preparation of the posterior contact surface with positioning of any necessary posterior augments. Completion of the femoral preparation taking into account the distal and posterior augments. Assembly of the trial prostheses with a trial inlay having the height of the spacers used. Implantation of the selected prosthesis components.

POSTOPERATIVE MANAGEMENT

Thrombosis prophylaxis, physiotherapy under full weight-bearing and mobility exercises.

RESULTS

After implantation of 104 axis-guided Enduro™ knee prostheses (Aesculap AG, Tuttlingen, Germany) (73 knee prosthesis revisions and 31 primary implantations), the Knee Society Score increased from 42.8 ± 18.8 preoperatively to 84.8 ± 13.9 after 24 months. Complications comprised one deep vein thrombosis and one periprosthetic infection.

Improving the improvisational pelvic circumferential compression technique for open-book pelvic fractures using a simulation model and a sphygmomanometer

BACKGROUND

Open-book pelvic fractures are associated with significant mortality. Emergency management may require a commercial pelvic circumferential compression device to reduce the fracture and compress haemorrhaging pelvic vasculature. Standard, commercial, twin-sized bedsheets are acceptable should commercial devices be unavailable. However, obese victims or personnel with insufficient body strength may impede successful reduction.

OBJECTIVE

To demonstrate the value of an improvisational windlass (intravenous pole) in improving the ability to reduce an open-book pelvic fracture.

METHODS

The Institutional Review Board-approved study involved 28 diverse healthcare students and emergency medicine residents. Each participant's demographic information and physical characteristics were recorded. A METIman was prepared with knee and ankle binding and a sphygmomanometer set at 40 mm Hg placed over the symphysis pubis. Two-person teams were randomly selected to place a bedsheet at greater trochanter level and atop the sphygmomanometer. The bedsheet was secured with maximum effort by the pairs and the pressure recorded. Following this, the pairs inserted an intravenous pole in the knot and torqued the pole to maximum effort and a repeat pressure recorded.

RESULTS

The mean increase in pressure using only the bedsheet was 106.43 mm Hg per team. With bedsheet and intravenous pole, the mean pressure increase was 351.79 mm Hg per team. The difference was statistically significant (independent samples t-test: t = 17.177, p < 0.001, 95% CI (216.65 to 274.07 mm Hg). There was no correlation between pressure increases and the individual physical characteristics of the subjects (r = - 0.183, p = 0.352).

CONCLUSIONS

Regardless of personnel's physical attributes, the addition of an improvisational windlass to a pelvic circumferential compression bedsheet can improve the ability to reduce an open-book fracture, especially in obese victims.

The effect of skin surface topography and skin colouration cues on perception of male facial age, health and attractiveness

OBJECTIVE

Previous studies investigating the effects of skin surface topography and colouration cues on the perception of female faces reported a differential weighting for the perception of skin topography and colour evenness, where topography was a stronger visual cue for the perception of age, whereas skin colour evenness was a stronger visual cue for the perception of health. We extend these findings in a study of the effect of skin surface topography and colour evenness cues on the perceptions of facial age, health and attractiveness in males.

METHODS

Facial images of six men (aged 40 to 70 years), selected for co-expression of lines/wrinkles and discolouration, were manipulated digitally to create eight stimuli, namely, separate removal of these two features (a) on the forehead, (b) in the periorbital area, (c) on the cheeks and (d) across the entire face. Omnibus (within-face) pairwise combinations, including the original (unmodified) face, were presented to a total of 240 male and female judges, who selected the face they considered younger, healthier and more attractive.

RESULTS

Significant effects were detected for facial image choice, in response to skin feature manipulation. The combined removal of skin surface topography resulted in younger age perception compared with that seen with the removal of skin colouration cues, whereas the opposite pattern was found for health preference. No difference was detected for the perception of attractiveness. These perceptual effects were seen particularly on the forehead and cheeks. Removing skin topography cues (but not discolouration) in the periorbital area resulted in higher preferences for all three attributes.

CONCLUSION

Skin surface topography and colouration cues affect the perception of age, health and attractiveness in men's faces. The combined removal of these features on the forehead, cheeks and in the periorbital area results in the most positive assessments.

Hip revision arthroplasty for failed osteosynthesis in periprosthetic Vancouver type B1 fractures using a cementless, modular, tapered revision stem

Aims

To evaluate the hypothesis that failed osteosynthesis of periprosthetic Vancouver type B1 fractures can be treated successfully with stem revision using a transfemoral approach and a cementless, modular, tapered revision stem with reproducible rates of fracture healing, stability of the revision stem, and clinically good results.

Patients and Methods

A total of 14 patients (11 women, three men) with a mean age of 72.4 years (65 to 90) undergoing revision hip arthroplasty after failed osteosynthesis of periprosthetic fractures of Vancouver type B1 were treated using a transfemoral approach to remove the well-fixed stem before insertion of a modular, fluted titanium stem which obtained distal fixation. These patients were clinically and radiologically followed up for a mean 52.2 months (24 to 144).

Results

After a mean of 15.5 weeks (standard deviation (sd) 5.7) all fractures had healed. No stems subsided and bony-ingrowth fixation had occurred according to the classification of Engh et al. The mean Harris Hip Score increased from a pre-operative score of 22.2 points (sd 9.7) to 81.5 points (sd 16.8) 24 months post-operatively. All hips had obtained an excellent result according to the classification of Beals and Tower.

Conclusions

The technique described here for stem revision provides reproducibly good results in the treatment of failed osteosynthesis for Vancouver types B1 periprosthetic fractures of the hip. Cite this article: Bone Joint J 2017;99-B(4 Supple B):11–16.

[Diagnostic Algorithm for Failure Analysis of Painful Total Hip Arthroplasties]

Background: Total hip arthroplasty (THA) is one of the most common and successful surgical procedures in orthopedic surgery and clinical success can be characterized by the revision rate and improvement of function, as well as the patient's satisfaction and pain. Despite the clinical success of primary THA with 10-year survival rates as high as 96 % (Swedish Hip Arthroplasty Register, 2011), the prevalence of groin pain after conventional total hip replacement ranges from 0.4 to 18.3 % and activity-limiting thigh pain is still an existing problem linked to the femoral component of uncemented hip replacement in up to 1.9 to 40.9 % of cases in some series. Obvious causes of failure might be identified with clinical examinations and standard radiographs only, whereas the unexplained painful THA still remains a challenge for the surgeon. They can be classified into extra- and intraarticular disorders, the latter being divided into biological and mechanical origins. The onset of the pain after the operation and the differentiation between pain in motion and at rest are helpful to distinguish between mechanical and non-mechanical problems. An infection should be the first diagnosis to be ruled out in a painful THA. It is generally accepted that a clear understanding of the failure mechanism in each case is required prior considering revision surgery. Method: In this review a practical diagnostic algorithm is described for failure analysis in more detail. The evaluation of a painful THA includes a detailed history with an extended analysis of the type of pain, thorough clinical examination including the spine and knee joints, radiographic and laboratory analysis, as well as invasive examinations like joint aspiration and biopsies. Conclusion: This diagnostic algorithm offers an important tool for a sufficient failure analysis in almost all patients with painful THA.

[Tripolar cups]

Tripolar cups can be separated into constrained and unconstrained dual-mobility cups. The latter show better survival and revision rates. The main problem is the polyethylene wear. Therefore modern types of polyethylene are used in these cups. The indications for dual-mobility cups are recurrent dislocation and situations where the risk of dislocation is increased.

Mid term results with the curved modular tapered, fluted titanium Revitan stem in revision hip replacement

We report our experience of revision total hip replacement (THR) using the Revitan curved modular titanium fluted revision stem in patients with a full spectrum of proximal femoral defects. A total of 112 patients (116 revisions) with a mean age of 73.4 years (39 to 90) were included in the study. The mean follow-up was 7.5 years (5.3 to 9.1). A total of 12 patients (12 hips) died but their data were included in the survival analysis, and four patients (4 hips) were lost to follow-up. The clinical outcome, proximal bone regeneration and subsidence were assessed for 101 hips. The mean Harris Hip Score was 88.2 (45.8 to 100) after five years and there was an increase of the mean Barnett and Nordin-Score, a measure of the proximal bone regeneration, of 20.8 (-3.1 to 52.7). Five stems had to be revised (4.3%), three (2.9%) showed subsidence, five (4.3%) a dislocation and two of 85 aseptic revisions (2.3%) a periprosthetic infection. At the latest follow-up, the survival with revision of the stem as the endpoint was 95.7% (95% confidence interval 91.9% to 99.4%) and with aseptic loosening as the endpoint, was 100%. Peri-prosthetic fractures were not observed. We report excellent results with respect to subsidence, the risk of fracture, and loosening after femoral revision using a modular curved revision stem with distal cone-in-cone fixation. A successful outcome depends on careful pre-operative planning and the use of a transfemoral approach when the anatomy is distorted or a fracture is imminent, or residual cement or a partially-secured existing stem cannot be removed. The shortest appropriate stem should, in our opinion, be used and secured with > 3 cm fixation at the femoral isthmus, and distal interlocking screws should be used for additional stability when this goal cannot be realised.

[Arthroplasty of the Femoropatellar Joint - What Data are Available?]

BACKGROUND

Osteoarthritis of the knee joints is rarely seen only in the femoropatellar joint. In isolated severe osteoarthritis of the femoropatellar joint an isolated prosthetic joint replacement of this joint is indicated. To achieve good results, correct patient selection with no arthritis in the femorotibial joint and absence of maltracking and instability of the patella are crucial. Modern prostheses with a femoral onlay component and a proper surgical technique with correct alignment of the prosthetic component and prevention of an overstuffing of the patella are essential.

PATIENTS AND METHODS

Fifty-three Vanguard Prostheses (Biomet GmbH, Warsaw, IL) were examined after a follow-up of 3.7 ± 2.8 (1-8) years.

RESULTS

The Knee Society score increased from 117.3 points preoperative to 181.2 points at the follow-up. One knee was revised because of neuropathic pain. Two patients suffered from periprosthetic patellar fractures after falling.

CONCLUSION

In well indicated cases with isolated osteoarthritis of the femoropatellar joint, good clinical results with a femoropatellar prosthesis can be expected.

Peri-conceptional obesogenic exposure induces sex-specific programming of disease susceptibilities in adult mouse offspring

Vulnerability of the fetus upon maternal obesity can potentially occur during all developmental phases. We aimed at elaborating longer-term health outcomes of fetal overnutrition during the earliest stages of development. We utilized Naval Medical Research Institute (NMRI) mice to induce pre-conceptional and gestational obesity and followed offspring outcomes in the absence of any postnatal obesogenic influences. Male adult offspring developed overweight, insulin resistance, hyperleptinemia, hyperuricemia and hepatic steatosis; all these features were not observed in females. Instead, they showed impaired fasting glucose and a reduced fat mass and adipocyte size. Influences of the interaction of maternal diet∗sex concerned offspring genes involved in fatty liver disease, lipid droplet size regulation and fat mass expansion. These data suggest that a peri-conceptional obesogenic exposure is sufficient to shape offspring gene expression patterns and health outcomes in a sex- and organ-specific manner, indicating varying developmental vulnerabilities between sexes towards metabolic disease in response to maternal overnutrition.

Peri-conceptional obesogenic exposure induces sex-specific programming of disease susceptibilities in adult mouse offspring

Vulnerability of the fetus upon maternal obesity can potentially occur during all developmental phases. We aimed at elaborating longer-term health outcomes of fetal overnutrition during the earliest stages of development. We utilized Naval Medical Research Institute (NMRI) mice to induce pre-conceptional and gestational obesity and followed offspring outcomes in the absence of any postnatal obesogenic influences. Male adult offspring developed overweight, insulin resistance, hyperleptinemia, hyperuricemia and hepatic steatosis; all these features were not observed in females. Instead, they showed impaired fasting glucose and a reduced fat mass and adipocyte size. Influences of the interaction of maternal diet∗sex concerned offspring genes involved in fatty liver disease, lipid droplet size regulation and fat mass expansion. These data suggest that a peri-conceptional obesogenic exposure is sufficient to shape offspring gene expression patterns and health outcomes in a sex- and organ-specific manner, indicating varying developmental vulnerabilities between sexes towards metabolic disease in response to maternal overnutrition.

[Extended approach in hip revision and preservation of the muscles. Is that possible?]

For revision of hip prostheses several standard and extended approaches can be used. The goal of these approaches is a good visualisation with minimal trauma of the bone and its vascularisation as well as of the muscles. Of the extended approaches we prefer the transfemoral approach in a modified technique. This approach is indicated when the stem of the endoprosthesis is broken, when the femoral axis has shifted because of stem loosening, or when the bone has become noticeably thin, which by itself or in combination would greatly increase the risk of an intraoperative fracture or perforation. Similarly, it is indicated in cases in which the cement mantle was stable, when a periprosthetic fracture of Vancouver B2 or B3 type is present or when a loose cementless stem with a coarsely porous surface cannot be removed in an endofemoral manner. In a published study of 68 patients with hip revisions using this modified transfemoral approach, we could see a continuous increase of the Harris hip score from 41.4 points preoperatively to 85.9 points 24 months postoperatively. Healing of the bony flap was seen in 98.5 % of the cases. Two postoperative non-dislocated trochanter fractures could be treated conservatively. The transfemoral approach is an extended approach with sparing of the gluteal muscles and the vasto-gluteal sling. Reproducible good clinical results can be achieved.

[Repair of chronic ruptures of the gluteus medius muscle using a nonresorbable patch]

OBJECTIVE

Repair of a chronic rupture with a defect of the gluteus medius muscle with or without a total hip replacement. Improvement of gait and limping by functional stabilization of the pelvis. Reduction of pain in the region of the greater trochanter.

INDICATIONS

Chronic rupture with a defect of the gluteus medius.

CONTRAINDICATIONS

Complete bony defect and absence of the greater trochanter and hip infection.

OPERATIVE TECHNIQUE

Lateral positioning of the patient. Longitudinal incision of 12-15 cm over the greater trochanter. Preparation to the fascia and longitudinal incision slightly dorsal to the greater trochanter. Preparation and mobilization of the ruptured parts of the gluteal muscles. Smoothening of the insertion of the gluteal muscle. Transosseus fixation of the ventral part of the ruptured gluteal muscles using fiber wires (Arthrex, Munich, Germany) with a Mason-Allen technique. Suturing of the mobilized posterior part of the ruptured gluteal muscle on the resutured ventral gluteal part. Securing of the readaptation by suturing a nonresorbable collagen patch (Zimmer, Winterthur, Switzerland) in a rhomboid direction with nonresorbable sutures (Ethibond, Ethicon, Norderstedt, Germany). Wound closure. POSTOPERATIVE TREATMENT: Prophylaxis of deep venous thrombosis. Early functional mobilization. Continuous increase of weight bearing over a period of 6 weeks and 6 weeks no adduction or active abduction.

RESULTS

Ten patients (9 women, 1 man; age 73.4 ± 12.3 years) showed significant improvement of their symptoms after 1 year. All were pain free and did not need crutches anymore. Four could walk without any limping and in 6 slight limping was observed. The Harris Hip Score increased from 47.5 ± 9.5 points preoperative to 85.2 ± 7.6 points 1 year postoperative. Complications were not observed.

Visible skin colouration predicts perception of male facial age, health and attractiveness

Although there is evidence that perception of facial age, health and attractiveness is informed by shape characteristics as well as by visible skin condition, studies on the latter have focused almost exclusively on female skin. Recent research, however, suggests that a decrease in skin colour homogeneity leads to older, less healthy and less attractive ratings of facial skin in both women and men. Here, we elaborate on the significance of the homogeneity of visible skin colouration in men by testing the hypothesis that perception of age, health and attractiveness of (non-contextual) digitally isolated fields of cheek skin only can predict that of whole facial images. Facial digital images of 160 British men (all Caucasian) aged between 10 and 70 were blind-rated for age, health and attractiveness by a total of 147 men and 154 women (mean age = 22.95, SD = 4.26), and these ratings were related to those of corresponding images of cheek skin reported by Fink et al. (J. Eur. Acad. Dermatol. Venereol. in press). Linear regression analysis showed that age, health and attractiveness perception of men's faces could be predicted by the ratings of cheek skin only, such that older men were viewed as older, less healthy and less attractive. This result underlines once again the potent signalling role of skin in its own right, independent of shape or other factors and suggests strongly that visible skin condition, and skin colour homogeneity in particular, plays a significant role in the perception of men's faces.

[Minimally invasive posterior approach for total hip arthroplasty]

The mini-posterior approach for total hip arthroplasty (THA) belongs to the mini-incision approaches. In comparison to standard approaches, less muscle trauma resulting in less pain, less blood loss and faster rehabilitation in the early postoperative period are attributed to this approach, as known for all other minimally invasive approaches. In a prospective study of 100 cases of THA it could be shown that this is true when comparing the mini-posterior approach with the posterolateral approach. Lower levels of muscle enzymes as a parameter for muscle trauma, could not be seen.

[Logistic requirements and biopsy of periprosthetic infections: what should be taken into consideration?]

Preoperative diagnosis of periprosthetic infections is particularly important before revision of knee and hip arthroplasties because of the therapeutic consequences. Therefore, periprosthetic infections should be ruled out before any revision surgery is performed. Of the different diagnostic methods direct techniques which allow the direct detection of microorganisms with testing of antibiotic sensitivity are recommended. This allows microorganism-specific systemic and local antibiotic therapies and helps to reduce the risk of development of resistance. In our studies it could be shown that the time for incubation to detect microorganisms should be 14 days and that biopsy of periprosthetic tissues is superior to aspiration alone because it combines several diagnostic methods (microbiological and histological). It is preferable to repeating an aspiration when data are unclear, i.e. in cases of potentially false positives or negatives results of aspiration.

Colour homogeneity and visual perception of age, health and attractiveness of male facial skin

BACKGROUND

Visible facial skin condition in females is known to affect perception of age, health and attractiveness. Skin colour distribution in shape- and topography-standardized female faces, driven by localized melanin and haemoglobin, can account for up to twenty years of apparent age perception. Although this is corroborated by an ability to discern female age even in isolated, non-contextual skin images, a similar effect in the perception of male skin is yet to be demonstrated.

OBJECTIVES

To investigate the effect of skin colour homogeneity and chromophore distribution on the visual perception of age, health and attractiveness of male facial skin.

METHODS

Cropped images from the cheeks of facial images of 160 Caucasian British men aged 10-70 years were blind-rated for age, health and attractiveness by a total of 308 participants. In addition, the homogeneity of skin images and corresponding eumelanin/oxyhaemoglobin concentration maps were analysed objectively using Haralick's image segmentation algorithm.

RESULTS

Isolated skin images taken from the cheeks of younger males were judged as healthier and more attractive. Perception of age, health and attractiveness was strongly related to melanin and haemoglobin distribution, whereby more even distributions led to perception of younger age and greater health and attractiveness. The evenness of melanized features was a stronger cue for age perception, whereas haemoglobin distribution was associated more strongly with health and attractiveness perception.

CONCLUSIONS

Male skin colour homogeneity, driven by melanin and haemoglobin distribution, influences perception of age, health and attractiveness.

The biology of facial beauty

It was once widely believed that standards of beauty were arbitrarily variable. Recent research suggests, however, that people's views of facial attractiveness are remarkably consistent, regardless of race, nationality or age. Facial characteristics are known to influence human attractiveness judgements and evolutionary psychologists suggest that these characteristics all pertain to health, leading to the conclusion that humans have evolved to view certain bodily features as attractive because the features were displayed by healthy others. Here we review some of the fundamental principles of sexual selection theory that apply to human beauty and summarize the major findings of human beauty perception.

Visible skin condition and perception of human facial appearance

Evolutionary psychology suggests that certain human beauty standards have evolved to provide reliable cues of fertility and health. Hence, preferences for some physical characteristics of the face and body are thought to reflect adaptations for the promotion of mate choice. Studies that have investigated facial attractiveness have concentrated mainly on features such as symmetry, averageness and sex-typical traits, which are developed under the influence of sex steroids. Few studies, however, have addressed the effect of human skin condition on perception of facial appearance in this context, and possible implications for sexual selection. There is now accumulating evidence that skin pigmentation and skin surface topography cues, particularly in women, have a significant influence on attractiveness judgements, as they seem primarily to signal aspects of age and health. This article (i) reviews briefly some of the main determinants of visible skin condition, (ii) presents recent evidence on its signalling value in face perception and (iii) suggests areas for future research with reference to an evolutionary psychology framework.

Second to fourth digit ratio, body mass index, waist-to-hip ratio, and waist-to-chest ratio: their relationships in heterosexual men and women

BACKGROUND

Prenatal sex steroids have been broadly discussed in terms of their possible effect on brain differentiation, whereas pubertal/adult sex hormones are thought to be the main regulators of sexually dimorphic physical features in males and females. Assessing prenatal steroid exposure has previously been difficult but evidence now suggests that finger length ratio may provide a 'window' into prenatal hormone exposure. The length of the second digit (the index finger) relative to the length of the fourth digit (the ring finger) is sexually dimorphic as males have a lower second to fourth digit ratio (2D:4D). The sexual dimorphism is determined as early as the 14th week of fetal life, and remains unchanged at puberty. There is evidence that sex differences in 2D:4D arise from in utero concentrations of sex steroids, with a low 2D:4D (male typical ratio) being positively related to prenatal testosterone, while a high 2D:4D (female typical ratio) is positively associated with prenatal oestrogen.

AIM

The studied aimed to determine whether, and to what extent, adult sexually dimorphic physical traits, which are largely determined at puberty, relate to traits that are largely determined in utero. This work examined the relationship between three sexually dimorphic traits--body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-chest ratio (WCR)--and digit ratio.

PARTICIPANTS AND METHODS

BMI, WHR and WCR were assessed in 30 heterosexual male and 50 heterosexual female participants by recording their body height, weight, and measuring their waist, hip and chest circumference. Digit lengths of the second and fourth fingers were measured from photocopies of the ventral surface of the hand and by actual finger measurements.

RESULTS

Digit ratio was found to be significantly lower in men than in women. Significant negative correlations were found between female's left and right hand 2D:4D, waist and hip circumference, and WCR. In males, BMI was found to be positively related to digit ratio but remained significant only for left hand 2D:4D. Generally, the relationships were stronger for females than for males. Although not all relationships were found to be significant, they were in accord with our predictions.

CONCLUSION

In addition to an activational effect of sex hormones at puberty, the present data suggest an early organizational effect of sex hormones through the association between indices of female body shape, male BMI, and human finger length patterns.

The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements

We analysed the serum C-reactive protein level, synovial fluid obtained by joint aspiration and five synovial biopsies from 145 knee replacements prior to revision to assess the value of these parameters in diagnosing late peri-prosthetic infection. Five further synovial biopsies were used for histological analysis. Samples were also obtained during the revision and incubated and analysed in an identical manner for 14 days. A total of 40 total knee replacements were found to be infected (prevalence 27.6%). The aspiration technique had a sensitivity of 72.5% (95% confidence interval (CI) 58.7 to 86.3), a specificity of 95.2% (95% CI 91.2 to 99.2), a positive predictive value of 85.3% (95% CI 73.4 to 100), a negative predictive value of 90.1% (95% CI 84.5 to 95.7) and an accuracy of 89%. The biopsy technique had a sensitivity of 100%, a specificity of 98.1% (95% CI 95.5 to 100), a positive predictive value of 95.2% (95% CI 88.8 to 100), a negative predictive value of 100% and an accuracy of 98.6%. C-reactive protein with a cut-off-point of 13.5 mg/l had a sensitivity of 72.5% (95% CI 58.7 to 86.3), a specificity of 80.9% (95% CI 73.4 to 88.4), a positive predictive value of 59.2% (95% CI 45.4 to 73.0), a negative predictive value of 88.5% (95% 81.0 to 96.0 CI) and an accuracy of 78.1%. We found that biopsy was superior to joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements.

Disease severity and family history in keratoconus

BACKGROUND/AIMS

To determine if disease severity is associated with a family history of keratoconus.

METHODS

Markers of disease severity in the CLEK Study cohort were assessed to determine if they could discriminate individuals with and without family history. Logistic regression was used to examine association between corneal scarring, average corneal power, flat and steep keratometry readings, and higher-order root mean square (RMS) wavefront error with family history.

RESULTS

In univariate analyses, none of the severity indices had any significant associations with family history; however, contact lens use, gender, and Caucasian race were found to be significant predictors. After controlling for these confounders, there were no significant associations between any severity indices and family history.

CONCLUSIONS

Presence or absence of family history is not associated with more severe clinical disease, at least when each marker for severity is considered independently. The results of this analysis are important for genetic studies of keratoconus in that it will allow recruitment of keratoconus patients across all stages of disease severity because it does not influence familial aggregation.

The effects of skin colour distribution and topography cues on the perception of female facial age and health

According to evolutionary psychology, the preference for some facial characteristics reflects adaptations for mate choice because they signal aspects of mate quality. Although morphological features such as facial symmetry and sexually dimorphic traits have been studied extensively in recent years, little is known about skin condition in this context. The preferences for young and healthy looking skin could offer an explanation as to why women place such an importance on the condition of their skin and its refinement through e.g., cosmetic products. Recent research showed that facial skin colour distribution significantly influences the perception of age and attractiveness of female faces, independent of skin surface topography cues. However, the relative effect of skin colour distribution and topography cues on age and health perception remains to be investigated. We present data showing that both skin colour distribution and skin surface topography cues not only significantly influence the perception of female facial age and health but also convey differential information with regard to the strength of these effects. Our data indicate that skin surface topography cues account for a large proportion of variation in facial age perception, whereas skin colour distribution seems to be a stronger health cue.

Moderne 3-Komponenten-Sprunggelenkprothesen

Luxation and excessive wear of the mobile bearing in modern three-piece total ankle replacement (TAR) is reported. We conducted a systematic review of studies to explore and discuss the rate and causes of these complications.A systematic review of studies since 2000 showed 26 studies with altogether 1,318 followed up TARs which we analyzed. Of these 1,318 TARs, 188 (14.3%) were revised and 56 (4.2%) complications with the mobile bearing were reported. A total of 39 cases (3%), i.e., 20.7% of all revisions, were revised due to failure of the mobile bearing, including 17 cases with subluxation (1.3%), 15 with asymmetric load of the bearing (1.1%), 10 with fracture of the polyethylene (PE) inlay (0.76%), 7 with massive PE wear (0.53%), and 7 with luxation of the meniscal bearing (0.53%).Complications due to the meniscal mobile bearing in TARs such as luxation, subluxation, massive wear, and fracture of the PE inlay are rare complications. The cause of these complications is regularly not found in the design of this three-piece total ankle replacement. Causes of failure of the mobile bearing are mostly found in incorrect indication, incorrect soft tissue balancing, incorrect positioning of components, implantation in ankles with hindfoot malalignment and ankle instability.

[Principles of fixation of the cementless modular revision stem Revitan]

AIM AND METHOD

To analyse the femoral fixation of a modular cementless revision endoprosthesis, eight prosthetic combinations of the Revitan-System (Centerpulse, Winterthur, Switzerland) were implanted in four cadavers. On three cadavers a curved revision Revitan stem was implanted by an endofemoral approach on one side and by a transfemoral approach on the contralateral side. On the fourth cadaver a straight Revitan stem was implanted on one side and a curved Revitan stem on the contralateral side using a transfemoral approach. Transversal slides of 7-8 mm thickness were performed at the fixation areas of each implant and the implant-bone contact was analysed macroscopically and using contact radiography.

RESULTS

The straight stem implanted by a transfemoral approach showed a double-conical press-fit fixation with cutting of the eight longitudinal fins into the cortical bone. The curved revision stems implanted by the same approach had a circular surface fixation similar to the press-fit fixation of the straight stem. In contrast, the curved stems implanted by the endofemoral approach (without a window) showed a three-surface fixation. Hereby the two distal fixation areas led to the primary implant stability by three of the four double edges of the octagonal cross-sectional area cutting into the cortical bone. At the proximal fixation zone the implant only had contact of two implant double edges to the cortical bone.

CONCLUSION

Different approaches for implantation lead to different fixation techniques of a curved revision stem. This should be considered by analysing postoperative sintering rates of cementless revision stems.

The 2nd–4th digit ratio (2D:4D) and neck circumference: implications for risk factors in coronary heart disease

BACKGROUND

The ratio of the lengths of the 2nd and 4th digit (2D:4D) is negatively related to prenatal and adult concentrations of testosterone (T). Testosterone appears to be a protective against myocardial infarction (MI) in men as men with low 2D:4D are older at first MI than men with high 2D:4D, and men with coronary artery disease have lower T levels than men with normal angiograms. Neck circumference (NC), a simple and time-saving screening measure to identify obesity is reported to be positively correlated with the factors of the metabolic syndrome, a complex breakdown of normal physiology characterized by obesity, insulin resistance, hyperlipidemia, and hypertension, and is therefore likely to increase the risk of coronary heart disease (CHD).

OBJECTIVE

To investigate possible associations between 2D:4D ratios and NC in men and women.

RESEARCH METHODS AND PROCEDURES

2D:4D ratios, NC, along with measures of waist and hip circumferences, body mass index (BMI), and waist-to-hip ratio was recorded from 127 men and 117 women.

RESULTS

A significant positive correlation between 2D:4D and NC and was found for men but not for women after controlling for body mass index (BMI); the higher the ratio the higher the NC.

DISCUSSION

This finding supports the suggestion of NC to serve as a predictor for increased risk for CHD as previously suggested. In addition, the present association suggests a predisposition for men towards CHD via 2D:4D as proxy to early sex-steroid exposure.

Rheumatoid arthritis and pigmented villonodular synovitis: comparative analysis of cell polyploidy, cell cycle phases and expression of macrophage and fibroblast markers in proliferating synovial cells

AIMS

Rheumatoid arthritis (RA) and pigmented villonodular synovitis (PVNS) are aggressive diseases with progressive joint destruction. The present study aims to define cell cycle phases, polyploidy and the immunophenotype of proliferating synovial cells in both diseases.

METHODS AND RESULTS

Synovial tissues from patients with proliferative-active RA, localized and diffuse PVNS were analysed by DNA flow cytometry, immunohistochemistry and double immunofluorescence with confocal laser scan microscopy. Expression of macrophage markers (CD68/CD163), fibroblast markers (h4Ph/CD55) and Ki67 antigen was examined. Synovial cells positive for either macrophage or fibroblast markers as well as double-labelled cells were found in both RA and PVNS. In RA, CD68/CD163+ synoviocytes were preferentially located in the vicinity of the synovial lining layer, while they were more randomly distributed in PVNS. Of cases with diffuse PVNS, 20% showed an aneuploid cell pattern. All samples of localized PVNS and RA were diploid. Proliferative activity was significantly higher in aneuploid PVNS.

CONCLUSIONS

In spite of their histologically homogeneous appearance, proliferating synovial cells display a heterogeneous immunophenotype in both RA and PVNS, indicating functional properties of both macrophages and fibroblasts. Aneuploidy seems to be a special feature of diffuse PVNS.

Die Wertigkeit von präoperativer Punktion und arthroskopischer Synovialisprobenentnahme bei Knietotalendoprothesenwechsel

AIM

The accurate preoperative diagnosis of occult sepsis in endoprosthetic loosening of total knee arthroplasty is the key to successful management of revision total knee arthroplasties. The aim of this study was to evaluate the results of preoperative aspiration in comparison with preoperative arthroscopic biopsy of the synovial tissue.

METHOD

From 2000 to 2004 eighty-six revision total knee arthroplasties in 86 patients were performed. 60 patients had only a knee aspiration, 15 an arthroscopic biopsy and an aspiration, 11 only arthroscopic biopsy. The results of both methods were compared with the intraoperative cultures during revision surgery.

RESULTS

69 aseptic and 17 septic knee exchange arthroplasties were performed. The preoperative aspiration of the prosthetic knee joint had a sensitivity of 68.8 %, specificity of 96.6 %, positive predictive value of 84.5 % and a negative predictive value of 92.2 %. The preoperative arthroscopic biopsy had a sensitivity of 100 %, specificity of 94.7 %, positive predictive value of 87.4 % and a negative predictive value of 100 %.

CONCLUSION

Preoperative aspiration of the knee is a very helpful study for the diagnosis or exclusion of infection in a prosthetic knee joint and should be a standard procedure in the diagnosis of prosthetic loosening. If after aspiration a suspicion of infection remains, then the biopsy is an accurate procedure to diagnose or exclude periprosthetic sepsis.

The significance of subacromial arthrography to verify partial bursal-side rotator cuff ruptures

BACKGROUND

The purpose of this study was to verify a partial bursa-side rupture of the rotator cuff (RC) using different imaging techniques with special emphasis on the validity of a specific method of subacromial arthrography (SAA).

METHODS

Patients (n=92, mean age 53.8 years) with a subacromial impingement syndrome underwent sonography, magnetic resonance imaging (MRI), and SAA. All diagnostic results were checked by subsequent arthroscopic surgery.

RESULTS

Of 31 surgically verified ruptures, 17 showed a partial rupture located towards the bursa. These had been detected by MRI and ultrasound with a sensitivity of 64% and 41%, respectively, while SAA as a diagnostic tool yielded a sensitivity of 82%. In 14 cases of complete RC ruptures, all imaging techniques had a similar sensitivity of 86-93%.

CONCLUSION

It appears that SAA is an adequate and valid diagnostic tool for the detection of partial bursa-sided RC ruptures. Ultrasound and MRI showed a comparably lower sensitivity. It is therefore concluded that SAA has clear advantages in the diagnosis of this defect with the consequence that open surgical techniques can be avoided.

Homosexual orientation in males: evolutionary and ethological aspects

Evolutionary theory proposes that adaptive traits are reproduced more successfully than maladaptive traits. Accordingly, natural selection should favor heterosexuality as it facilitates reproduction and the propagation of genes. However, the question becomes, what has maintained homosexuality in a small but consistent percentage of the human population? Research into the evolutionary and hormonal factors associated with a homosexual orientation have yielded provocative but inconsistent results. It also suggests that human sexual orientation, and in particular homosexual orientation, is too complex to be described by one simple model or a single research discipline. The current paper treads a new path and emphasizes an integrative approach for the understanding of homosexuality. The authors examine the combined effects of evolutionary factors and neurohormonal processes on the development of a homosexual orientation. It is suggested that research into the topic could benefit from an examination of and change in some of the assumptions upon which much past research has been based.

Human pheromones: integrating neuroendocrinology and ethology

The effect of sensory input on hormones is essential to any explanation of mammalian behavior, including aspects of physical attraction. The chemical signals we send have direct and developmental effects on hormone levels in other people. Since we don t know either if, or how, visual cues might have direct and developmental effects on hormone levels in other people, the biological basis for the development of visually perceived human physical attraction is currently somewhat questionable. In contrast, the biological basis for the development of physical attraction based on chemical signals is well detailed.

The effect of high-dose pentaerythritol tetranitrate on the development of nitrate tolerance in rabbits

Experimental studies with therapeutic doses of pentaerythritol tetranitrate (PETN) have shown unexpected actions such as a lack of nitrate tolerance and vasoprotective effects in atherosclerosis. We investigated the effect of a 3-week treatment with low- (6 mg kg(-1) day(-1), n=10) and high-dose (100 mg kg(-1) day(-1), n=10) oral PETN given twice daily on the development of nitrate tolerance in rabbits. We measured aortic relaxation in response to acetylcholine, S-nitroso-N-acetyl-D,L-penicillamine and PETN, constriction in response to phenylephrine and production of reactive oxygen species (ROS). Mean aortic pressure (AOPmean) and heart rate were measured after a single oral dose of PETN (50 mg kg(-1), n=6) and after increasing doses of pentaerythritol dinitrate (PEDN, n=5) and pentaerythritol mononitrate (PEMN, n=5) in anaesthetized rabbits. Oral PETN, even at high dosage, was not associated with nitrate tolerance. None of the aortic ring studies showed a difference in the responses to the vasodilators, while the vasoconstriction to phenylephrine was slightly reduced in both PETN groups. The production of vascular ROS was also not different. Oral PETN reduced AOPmean transiently (-19.3+/-4.4%, P<0.01 vs. controls) and i.v. administration of both PEMN and PEDN reduced AOPmean dose dependently (P<0.05, ANOVA). These results suggest that oral PETN elicits minor nitrate tolerance. This unique feature might be due to the slow onset of vasodilator activity of the predominantly active metabolites PEDN and PEMN and might contribute to the vasoprotective activity of PETN in atherosclerosis.

Potentiation of sildenafil-induced hypotension is minimal with nitrates generating a radical intermediate

Recently the new specific phosphodiesterase-5 inhibitor sildenafil was introduced into therapy for erectile dysfunction. Because of the phosphodiesterase-5 inhibitor-induced increases of cyclic GMP in the vasculature, vasodilation in various vascular beds is induced, which in combination with various nitrovasodilators (e.g., when used simultaneously for the treatment of coronary artery disease), may lead to excessive hypotension. Thus nitrovasodilators are contraindicated when sildenafil may be used and reports of a number of accidents have recently been published. We therefore studied the acute interactions of glyceryl trinitrate (GTN), pentaerythritol tetranitrate (PETN), and isosorbide dinitrate (ISDN) with sildenafil in six chronically instrumented conscious dogs for each nitrate to assess the magnitude of blood pressure drops (and compensatory increases in heart rate) during a 24-h nitrate administration (infusion into the pulmonary artery). Sildenafil (3 mg/kg) was given orally (after a 24-h fast) 30 min after start of nitrate infusion. GTN, PETN, or ISDN (which follow different steps of metabolic conversion to nitric oxide) were applied at submaximal dosages leading to 90% of maximal coronary artery dilation at 1.5 microg/kg per min, 0.75 microg/kg per min, or 6 microg/kg per min, respectively. During GTN infusion sildenafil caused a maximum drop in mean blood pressure of 21 +/- 3 mm Hg (rise in heart rate from 117.0 +/- 7.2 to 126.0 +/- 6 .0/min) and during ISDN infusion of 18 +/- 3 mm Hg (rise in heart rate from 115.0 +/- 7.0 to 125 +/- 6/min), which was significantly less (p < 0.01) during PETN (only 6 +/- 1 mm Hg with a rise in heart rate from 107.0 +/- 5.0 to 122.0 +/- 7.0/min). When sildenafil is used during exposure to nitrates (e.g., in coronary artery disease), the PETN-induced drop in blood pressure at equi-effective dosages (with regard to coronary dilation) is substantially smaller compared with that of GTN or ISDN, which is probably because of lesser potentiation of phosphodiesterase-5 inhibitor-induced effects in the arteriolar bed, thus minimizing critical drops in blood pressure.