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Small HJ, Stentiford GD, Behringer DC, Freeman MA, Atherley NAM, Reece KS, Bateman KS, Shields JD. Characterization of microsporidian Ameson herrnkindi sp. nov. infecting Caribbean spiny lobsters Panulirus argus. Dis Aquat Organ 2019; 136:209-218. [PMID: 32129173 DOI: 10.3354/dao03406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The Caribbean spiny lobster Panulirus argus supports a large and valuable fishery in the Caribbean Sea. In 2007-2008, a rare microsporidian parasite with spore characteristics typical of the Ameson genus was detected in 2 spiny lobsters from southeast Florida (FL). However, the parasite species was not confirmed by molecular analyses. To address this deficiency, reported here are structural and molecular data on single lobsters displaying comparable 'cotton-like' abdominal muscle containing ovoid microsporidian spores found at different locations in FL in 2014 and 2018 and in Saint Kitts and Nevis Islands in 2017. In the lobster from 2014, multiple life stages consistent with an Ameson-like monokaryotic microsporidian were detected by transmission electron microscopy. A partial (1228 bp) small subunit (SSU) rRNA gene sequence showed each microsporidia to be identical and positioned it closest phylogenetically to Ameson pulvis in a highly supported clade also containing A. michaelis, A. metacarcini, A. portunus, and Nadelspora canceri. Using ecological, pathological, ultrastructural, and molecular data, the P. argus microsporidian has been assigned to a distinct species: Ameson herrnkindi.
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Affiliation(s)
- H J Small
- Virginia Institute of Marine Science, William & Mary, PO Box 1346, Gloucester Point, VA 23062, USA
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Freeman MA, Wightman AG. Did parents have it right all along? Parents, risk, and living kidney donation: Revisiting the arguments for and against parental living donation of kidneys. Pediatr Transplant 2018; 22:e13153. [PMID: 29380554 DOI: 10.1111/petr.13153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2017] [Indexed: 01/17/2023]
Abstract
Historically, living kidney donation has been justified in part by our belief that living donors face minimal risks of subsequent disease. Recent research has brought that presumption into question, particularly for younger donors including parents. In light of this finding, we re-examine many of the traditional arguments both for and against the practice of parental living kidney donation. We then propose an alternative framework in which the burden of having a child with end-stage kidney disease can be considered as an illness experienced by the potential donor parent. We believe this allows a more straightforward, as well as more accurate, assessment of the risks and benefits of donation for the potential parental donor. This assessment might then be used to best inform the decision whether or not to proceed with kidney donation using a shared decision-making model, while reflecting the appropriate ethical roles of both the potential donor and the transplantation program.
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Affiliation(s)
- M A Freeman
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - A G Wightman
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, WA, USA
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Abstract
Twenty-two patients with unilateral arthrodesis of the hip were reviewed clinically and radiologically ten years or more after operation. There was evidence of degenerative disease in 63.6% of the contralateral hips, 68.2% of the ipsilateral knees and in 59.1% of the contralateral knees. Both knees were affected in 50% of cases. All the patients had some degree of backache. The incidence of these problems in contrast with previously reported series is discussed.
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Stentiford GD, Becnel JJ, Weiss LM, Keeling PJ, Didier ES, Williams BAP, Bjornson S, Kent ML, Freeman MA, Brown MJF, Troemel ER, Roesel K, Sokolova Y, Snowden KF, Solter L. Microsporidia - Emergent Pathogens in the Global Food Chain. Trends Parasitol 2016; 32:336-348. [PMID: 26796229 PMCID: PMC4818719 DOI: 10.1016/j.pt.2015.12.004] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/26/2015] [Accepted: 12/07/2015] [Indexed: 02/07/2023]
Abstract
Intensification of food production has the potential to drive increased disease prevalence in food plants and animals. Microsporidia are diversely distributed, opportunistic, and density-dependent parasites infecting hosts from almost all known animal taxa. They are frequent in highly managed aquatic and terrestrial hosts, many of which are vulnerable to epizootics, and all of which are crucial for the stability of the animal-human food chain. Mass rearing and changes in global climate may exacerbate disease and more efficient transmission of parasites in stressed or immune-deficient hosts. Further, human microsporidiosis appears to be adventitious and primarily associated with an increasing community of immune-deficient individuals. Taken together, strong evidence exists for an increasing prevalence of microsporidiosis in animals and humans, and for sharing of pathogens across hosts and biomes.
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Affiliation(s)
- G D Stentiford
- Pathology and Molecular Systematics Team, Centre for Environment, Fisheries and Aquaculture Science (CEFAS), Barrack Road, Weymouth, Dorset DT4 8UB, UK
| | - -J J Becnel
- United States Department of Agriculture (USDA) Agricultural Research Center (ARS), Center for Medical, Agricultural, and Veterinary Entomology (CMAVE), 1600 South West 23rd Drive, Gainesville, FL, 32608, USA
| | - L M Weiss
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Forchheimer 504, Bronx, NY 10641, USA
| | - P J Keeling
- Canadian Institute for Advanced Research, Botany Department, University of British Columbia, 3529-6270 University Boulevard, Vancouver, BC, V6T 1Z4 Canada
| | - E S Didier
- Division of Microbiology, Tulane National Primate Research Center and Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA 70112, USA
| | - B-A P Williams
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Geoffrey Pope, Stocker Road, Exeter EX4 4QD, UK
| | - S Bjornson
- Department of Biology, Saint Mary's University, 923 Robie Street, Halifax, Nova Scotia, Canada
| | - M-L Kent
- Departments of Microbiology and Biomedical Sciences, 220 Nash Hall, Oregon State University, Corvallis, OR 97331, USA
| | - M A Freeman
- Ross University School of Veterinary Medicine, St. Kitts, West Indies
| | - M J F Brown
- School of Biological Sciences, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK
| | - E-R Troemel
- University of California, San Diego, 4202 Bonner Hall, 9500 Gilman Drive #0349, La Jolla, CA 92093-0349, USA
| | - K Roesel
- International Livestock Research Institute, c/o Freie Universität Berlin, Institute of Parasitology and Tropical Veterinary Medicine, Robert-von-Ostertag-Strasse 7-13, Berlin, 14163 Germany
| | - Y Sokolova
- Department of Comparative Biomedical Sciences, Louisiana State University, School of Veterinary Medicine, 1909 Skip Bertman Drive, Baton RougeLA 70803, USA
| | - K F Snowden
- Texas A&M University, College of Veterinary Medicine and Biomedical Sciences, Department of Veterinary Pathobiology, Mailstop 4467, College Station, TX 77843-4467, USA
| | - L Solter
- Illinois Natural History Survey, Prairie Research Institute at the University of Illinois at Urbana-Champaign, 1816 South Oak Street, Champaign, IL 61820, USA.
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You JJ, Cline KJ, Gu CS, Pritchard KI, Dayes IS, Gulenchyn KY, Inculet RI, Dhesy-Thind SK, Freeman MA, Chan AM, Julian JA, Levine MN. (18)F-fluorodeoxyglucose positron-emission tomography-computed tomography to diagnose recurrent cancer. Br J Cancer 2015; 112:1737-43. [PMID: 25942398 PMCID: PMC4647251 DOI: 10.1038/bjc.2015.151] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/03/2015] [Accepted: 04/13/2015] [Indexed: 11/19/2022] Open
Abstract
Background: Sometimes the diagnosis of recurrent cancer in patients with a previous malignancy can be challenging. This prospective cohort study assessed the clinical utility of 18F-fluorodeoxyglucose positron-emission tomography-computed tomography (18F-FDG PET-CT) in the diagnosis of clinically suspected recurrence of cancer. Methods: Patients were eligible if cancer recurrence (non-small-cell lung (NSCL), breast, head and neck, ovarian, oesophageal, Hodgkin's or non-Hodgkin's lymphoma) was suspected clinically, and if conventional imaging was non-diagnostic. Clinicians were asked to indicate their management plan before and after 18F-FDG PET-CT scanning. The primary outcome was change in planned management after 18F-FDG PET-CT. Results: Between April 2009 and June 2011, 101 patients (age, median 65 years; 55% female) were enroled from four cancer centres in Ontario, Canada. Distribution by primary tumour type was: NSCL (55%), breast (19%), ovarian (10%), oesophageal (6%), lymphoma (6%), and head and neck (4%). Of the 99 subjects who underwent 18F-FDG PET-CT, planned management changed after 18F-FDG PET-CT in 52 subjects (53%, 95% confidence interval (CI), 42–63%); a major change in plan from no treatment to treatment was observed in 38 subjects (38%, 95% CI, 29–49%), and was typically associated with 18F-FDG PET-CT findings that were positive for recurrent cancer (37 subjects). After 3 months, the stated post-18F-FDG PET-CT management plan was actually completed in 88 subjects (89%, 95% CI, 81–94%). Conclusion: In patients with suspected cancer recurrence and conventional imaging that is non-diagnostic, 18F-FDG PET-CT often provides new information that leads to important changes in patient management.
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Affiliation(s)
- J J You
- 1] Department of Medicine, McMaster University, 1280 Main Street West, Room HSC-2C8, Hamilton, Ontario L8S 4K1, Canada [2] Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Room HSC-2C8, Hamilton, Ontario L8S 4K1, Canada
| | - K J Cline
- Ontario Clinical Oncology Group, Department of Oncology, McMaster University, 711 Concession Street, G Wing, Hamilton, Ontario L8V 1C3, Canada
| | - C-S Gu
- Ontario Clinical Oncology Group, Department of Oncology, McMaster University, 711 Concession Street, G Wing, Hamilton, Ontario L8V 1C3, Canada
| | - K I Pritchard
- Sunnybrook Odette Cancer Centre, Department of Medicine, University of Toronto, T2-107, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - I S Dayes
- Department of Oncology, Juravinski Cancer Centre, Hamilton Health Sciences, 699 Concession Street, Hamilton, Ontario L8V 5C3, Canada
| | - K Y Gulenchyn
- Department of Nuclear Medicine & Molecular Imaging, Hamilton Health Sciences & St Joseph's Healthcare Hamilton, McMaster University, 1200 Main Street West, Room HSC-1P15, Hamilton, Ontario L8N 3Z5, Canada
| | - R I Inculet
- Department of Surgery, Division of Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, Suite E2-122, London, Ontario N6A 5W9, Canada
| | - S K Dhesy-Thind
- Department of Oncology, Juravinski Cancer Centre, Hamilton Health Sciences, 699 Concession Street, Hamilton, Ontario L8V 5C3, Canada
| | - M A Freeman
- Department of Medical Imaging, University of Toronto, University Health Network, Eaton Wing, 1-ES-416, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - A M Chan
- Department of Oncology, Thunder Bay Regional Health Sciences Centre, 980 Oliver Road, Thunder Bay, Ontario P7B 6V4, Canada
| | - J A Julian
- Ontario Clinical Oncology Group, Department of Oncology, McMaster University, 711 Concession Street, G Wing, Hamilton, Ontario L8V 1C3, Canada
| | - M N Levine
- 1] Ontario Clinical Oncology Group, Department of Oncology, McMaster University, 711 Concession Street, G Wing, Hamilton, Ontario L8V 1C3, Canada [2] Department of Oncology, Juravinski Cancer Centre, Hamilton Health Sciences, 699 Concession Street, Hamilton, Ontario L8V 5C3, Canada
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Abstract
AIM To investigate the sodium composition of maintenance intravenous fluids (mIVF) used by paediatric residents throughout the United States in common clinical scenarios of arginine vasopressin (AVP) excess. METHODS We distributed an online survey to paediatric residency programmes asking what type of mIVF (0.2%, 0.45%, 0.9% NaCl or lactated Ringer's solution) they would administer in four common clinical scenarios of AVP excess (gastroenteritis, pneumonia, meningitis and postoperative) in both a 6-month-old (mo) and a 13-year-old (yo) child. RESULTS We had 472 responses, representing 5% of the total paediatric residency population in the United States. Hypotonic mIVF were selected in 78% of children (88.2% of 6 mo and 68.5% of 13 yo). Isotonic mIVF were selected approximately twice as often for patients with meningitis as for those without (21.4% vs. 8.7% 6 mo and 42.8% vs. 27.7% 13 yo; p < 0.001). CONCLUSIONS The majority of US paediatric residents would prescribe hypotonic mIVF in disease states associated with AVP excess. However, a significant number of residents are using isotonic mIVF. Isotonic fluids are more likely to be prescribed in older children and children with meningitis.
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Affiliation(s)
- M A Freeman
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
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Freeman MA, Yokoyama H, Osada A, Yoshida T, Yamanobe A, Ogawa K. Spraguea (Microsporida: Spraguidae) infections in the nervous system of the Japanese anglerfish, Lophius litulon (Jordan), with comments on transmission routes and host pathology. J Fish Dis 2011; 34:445-452. [PMID: 21545438 DOI: 10.1111/j.1365-2761.2011.01255.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Anglerfish from the genus Lophius are a globally important commercial fishery. The microsporidian Spraguea infects the nervous system of these fish resulting in the formation of large, visible parasitic xenomas. Lophius litulon from Japan were investigated to evaluate the intensity and distribution of Spraguea xenomas throughout the nervous system and to assess pathogenicity to the host and possible transmission routes of the parasite. Spraguea infections in L. litulon had a high prevalence; all fish over 403 mm in standard length being infected, with larger fish usually more heavily infected than smaller fish. Seventy percent of all fish examined had some gross visible sign of infection. The initial site of development is the supramedullary cells on the dorsal surface of the medulla oblongata, where all infected fish have parasitic xenomas. As the disease progresses, a number of secondary sites typically become infected such as the spinal, trigeminal and vagus nerves. Fish with infection in the vagus nerve bundles often have simultaneous sites of infection, in particular the spinal nerves and along the ventral nerve towards the urinary bladder. Advanced vagus nerve infections sometimes form xenomas adjacent to kidney tissue. Spraguea DNA was amplified from the contents of the urinary bladders of two fish, suggesting that microsporidian spores may be excreted in the urine. We conclude that supramedullary cells on the hindbrain are the primary site of infection, which is probably initiated at the cutaneous mucous glands where supramedullary cells are known to extend their peripheral axons. The prevalence of Spraguea infections in L. litulon was very high, and infections often extremely heavy; however, no associated pathogenicity was observed, and heavily infected fish were otherwise normal.
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Affiliation(s)
- M A Freeman
- Institute of Ocean and Earth Science & Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia.
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Freeman MA, Eydal M, Yoshimizu M, Watanabe K, Shinn AP, Miura K, Ogawa K. Molecular identification and transmission studies of X-cell parasites from Atlantic cod Gadus morhua (Gadiformes: Gadidae) and the northern black flounder Pseudopleuronectes obscurus (Pleuronectiformes: Pleuronectidae). Parasit Vectors 2011; 4:15. [PMID: 21299903 PMCID: PMC3045979 DOI: 10.1186/1756-3305-4-15] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 02/08/2011] [Indexed: 11/10/2022] Open
Abstract
Background Epidermal pseudotumours from Hippoglossoides dubius and Acanthogobius flavimanus in Japan and gill lesions in Limanda limanda from the UK have been shown to be caused by phylogenetically related protozoan parasites, known collectively as X-cells. However, the phylogenetic position of the X-cell group is not well supported within any of the existing protozoan phyla and they are currently thought to be members of the Alveolata. Ultrastructural features of X-cells in fish pseudotumours are somewhat limited and no typical environmental stages, such as spores or flagellated cells, have been observed. The life cycles for these parasites have not been demonstrated and it remains unknown how transmission to a new host occurs. In the present study, pseudobranchial pseudotumours from Atlantic cod, Gadus morhua, in Iceland and epidermal pseudotumours from the northern black flounder, Pseudopleuronectes obscurus, in Japan were used in experimental transmission studies to establish whether direct transmission of the parasite is achievable. In addition, X-cells from Atlantic cod were sequenced to confirm whether they are phylogenetically related to other X-cells and epidermal pseudotumours from the northern black flounder were analysed to establish whether the same parasite is responsible for infecting different flatfish species in Japan. Results Phylogenetic analyses of small subunit ribosomal DNA (SSU rDNA) sequence data from Atlantic cod X-cells show that they are a related parasite that occupies a basal position to the clade containing other X-cell parasites. The X-cell parasite causing epidermal pseudotumours in P. obscurus is the same parasite that causes pseudotumours in H. dubius. Direct, fish to fish, transmission of the X-cell parasites used in this study, via oral feeding or injection, was not achieved. Non-amoeboid X-cells are contained within discrete sac-like structures that are loosely attached to epidermal pseudotumours in flatfish; these X-cells are able to tolerate exposure to seawater. A sensitive nested PCR assay was developed for the sub clinical detection of both parasites and to assist in future life cycle studies. PCR revealed that the parasite in P. obscurus was detectable in non-pseudotumourous areas of fish that had pseudotumours present in other areas of the body. Conclusions The inability to successfully transmit both parasites in this study suggests that either host detachment combined with a period of independent development or an alternate host is required to complete the life cycle for X-cell parasites. Phylogenetic analyses of SSU rDNA confirm a monophyletic grouping for all sequenced X-cell parasites, but do not robustly support their placement within any established protist phylum. Analysis of SSU rDNA from X-cells in Japanese flatfish reveals that the same parasite can infect more than one species of fish.
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Affiliation(s)
- M A Freeman
- Institute of Ocean and Earth Sciences & Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia.
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Yokoyama H, Yanagida T, Freeman MA, Katagiri T, Hosokawa A, Endo M, Hirai M, Takagi S. Molecular diagnosis of Myxobolus spirosulcatus associated with encephalomyelitis of cultured yellowtail, Seriola quinqueradiata Temminck & Schlegel. J Fish Dis 2010; 33:939-946. [PMID: 21091721 DOI: 10.1111/j.1365-2761.2010.01203.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Mass mortality of cultured yellowtail, Seriola quinqueradiata, has recently been reported from fish farms in western Japan. Previous studies revealed that diseased fish were characterized by encephalomyelitis and presporogonic stages of a myxosporean-like parasite in the spinal cord. However, the parasite has remained unidentified because of the lack of mature stages being present. Thus, in the present study, analysis of the small subunit ribosomal DNA (18S rDNA) of the parasite as well as in situ hybridization (ISH) studies using histological sections of the infected tissue was conducted. The 18S rDNA of the myxosporean had higher sequence similarities with those of bile-duct-infecting myxosporeans rather than those infecting nervous tissues and was identified as Myxobolus spirosulcatus. The ISH using specific probes demonstrated that the DNA amplified was derived from the multinuclear organisms found in histological sections. A highly sensitive and specific PCR-based assay for M. spirosulcatus was developed, which revealed a high prevalence of infection in cultured yellowtail that exhibited the clinical signs of encephalomyelitis.
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Affiliation(s)
- H Yokoyama
- Department of Aquatic Bioscience, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo, Tokyo, Japan.
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Freeman MA, Yokoyama H, Ogawa K. Description and phylogeny of Ceratomyxa anko sp. n. and Zschokkella lophii sp. n. from the Japanese anglerfish, Lophius litulon (Jordan). J Fish Dis 2008; 31:921-930. [PMID: 18803583 DOI: 10.1111/j.1365-2761.2008.00965.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Two new species of myxozoans from the Japanese anglerfish, Lophius litulon, are described using myxospore morphology and small subunit rDNA sequences. Ceratomyxa anko sp. n. is a parasite of the gall bladder and had a prevalence of 57%. Mature spores of C. anko sp. n. are arcuate to crescent shaped with valves tapering to rounded tips. A prominent sutural line runs centrally between the round adjacent polar capsules containing the polar filament coiled two to three times. Spore measurements: length 10.8 (9.7-11.9) microm, width 41.9 (36.9-47.2) microm, polar capsule diameter 4.6 (4.1-5.3) microm. Ceratomyxa anko sp. n. can be distinguished from other Ceratomyxa spp. due to its spore dimensions and shape. Zschokkella lophii sp. n. is a parasite of the urinary bladder and had a prevalence of 70%. Mature spores are ellipsoidal to semicircular with bluntly pointed ends. The sutural line is curved or sinuous and the valves have no discernable surface ornamentation. Two almost spherical polar capsules are located separately in the ends of the spore, opening in almost opposite directions and contain the polar filament with five coils. Spore measurements: length 20.1 (16.8-24.0) microm, width 14.9 (12.7-16.8) microm, polar capsule diameter 5.1 (3.6-5.8) microm. Zschokkella lophii sp. n. can be distinguished from other Zschokkella spp. due to the terminal opening of the polar capsules within the spores and the site of infection within the host fish. In the phylogenetic analyses, C. anko sp. n. grouped with other members of the same genus forming a monophyly. Zschokkella lophii sp. n. forms a discrete clade with another Zschokkella sp. that infects the urinary bladder of marine fish. This grouping forms a sister clade to one containing members of the genus Parvicapsula, all of which are parasites of the urinary system in marine fish.
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Affiliation(s)
- M A Freeman
- Institute of Aquaculture, University of Stirling, Stirling, UK.
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Abstract
The aim was to evaluate the test-retest reliability of the French translation of the Migraine Disability Assessment (MIDAS) and Headache Impact Test (HIT)-6 questionnaires as applied to episodic and chronic headaches and to assess the correlation between these two questionnaires. The MIDAS and HIT-6 questionnaires, which assess the degree of migraine-related functional disability, are widely used in headache treatment clinics. The French translation has not been checked for test-retest reliability. MIDAS involves recall, over the previous 3 months, of the number of days with functional disability with regard to work and to home and social life. HIT-6 involves a more subjective and general assessment of headache-related disability over the previous 4 weeks. We expect that there may be greater impact recall bias for chronic headaches than for episodic headaches and considered it important to be able to determine if the reliability of these questionnaires is equally good for these two patient populations. Given that both questionnaires have the same objective, that of assessing headache impact, it was thought useful to determine if their results might show a correlation and if they could thus be used interchangeably. The study was approved by an external ethics committee. The subjects were patients who regularly visit the Clinique de la Migraine de Montréal, which specializes in the treatment of headaches. The MIDAS and HIT-6 questionnaires were completed by the patients during their regular visit. Twelve days later, the same questionnaires were mailed with a prepaid return envelope. Sixty-five patients were required in both the episodic and chronic headache groups, assuming an 80± questionnaire return rate. One hundred and eighty-five patients were enrolled, and 143 completed the study, 75 with episodic headaches and 68 with chronic headaches. The questionnaire return rate was 78.9±. On average, questionnaires were completed a second time 21 days after the first, with a median of 19 days. The Shrout-Fleiss intraclass correlation coefficients for MIDAS and HIT-6 were, respectively, 0.76 and 0.77 for episodic headaches and 0.83 and 0.80 for chronic headaches. The Pearson correlation coefficient between the MIDAS and HIT-6 questionnaires was 0.48 for episodic headaches and 0.58 for chronic headaches at the first compilation and 0.42 and 0.59 at the second compilation. The test-retest intraclass correlation of the French versions for both MIDAS and HIT-6 questionnaires indicates moderate reliability for episodic headache and substantial reliability for chronic headache. The correlation between the MIDAS and HIT-6 questionnaires is weak for episodic headaches, but approaches a level of ‘good’ for chronic headaches.
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Affiliation(s)
| | - MA Freeman
- GlaxoSmithKline, Medical Affairs, Montreal, Canada
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Freeman MA, Bell AS, Sommerville C. A hyperparasitic microsporidian infecting the salmon louse, Lepeophtheirus salmonis: an rDNA-based molecular phylogenetic study. J Fish Dis 2003; 26:667-676. [PMID: 14710759 DOI: 10.1046/j.1365-2761.2003.00498.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The sea louse, Lepeophtheirus salmonis, is an obligate ectoparasitic copepod that lives on the external surface of salmonid fish. It is the most common ectoparasite of marine cage-reared salmonids, causing major economic loss to the aquaculture industry. During a sea louse monitoring programme, samples of L. salmonis were found to harbour an unreported microsporidian parasite. The microsporidian was observed in pre-adult and adult stages of both male and female copepods, with a prevalence of up to 5%. Unfixed spores were slightly pyriform in shape measuring 2.34 microm by 1.83 microm (+/- 0.01 microm) and were not observed to be enclosed by a sporophorous vesicle. The microsporidian infection was observed in all areas of the copepods' body, xenoma-like cysts forming directly under the cuticle in the epidermal tissue layer. In the present study, rDNA (530f-580r) sequence data gathered from the unidentified microsporidian parasite isolated from infected sea lice were compared with equivalents available in the databases in an attempt to identify its systematic position. The microsporidian was found to group within the phylogenetic clade containing the family Enterocytozoonidae, being most similar to members of the intranuclear genus Nucleospora. This is the first report of a hyperparasitic microsporidian infecting a caligid copepod.
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Affiliation(s)
- M A Freeman
- Institute of Aquaculture, University of Stirling, Stirling, UK.
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Freeman MA, Hennessy EV, Marzullo DM. Defensive evaluation of antismoking messages among college-age smokers: the role of possible selves. Health Psychol 2001; 20:424-33. [PMID: 11714184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
This study hypothesized that individuals respond to antismoking messages in a biased or defensive manner to the degree that smoking is a personally relevant activity for them. The authors operationalized the personal relevance of smoking variously as smoking behavior (smoking status, rate, duration, and recent attempts to quit), endorsement of the smoker stereotype, and importance of smoking behavior as an identity within the self-concept (current self and possible selves). In the experiment, smokers (n = 82) and nonsmokers (n = 105) privately viewed several antismoking video segments. Smoking status, current smoking identity, and long-term future smoking identity were significantly associated with a defensive evaluation of antismoking messages. The study concludes that the concept of possible selves (H. Markus & P. Nurius, 1986) is critical in understanding college-age smoking and in the design of effective antismoking campaigns.
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Affiliation(s)
- M A Freeman
- Department of Psychology, Drew University, Madison, New Jersey 07940, USA.
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Kulkarni SK, Freeman MA, Poal-Manresa JC, Asencio JI, Rodriguez JJ. The patello-femoral joint in total knee arthroplasty: is the design of the trochlea the critical factor? Knee Surg Sports Traumatol Arthrosc 2001; 9 Suppl 1:S8-12. [PMID: 11354868 DOI: 10.1007/s001670000155] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report the outcome after 10 years of a prospective study of two cohorts of patients undergoing total knee reconstruction treated with patellar replacement (centre A, n = 124) or without (centre B, n = 143). The same tibio-femoral components were used in all knees. The cohorts were demographically similar. The clinical outcome and the patello-femoral revision rates were the same in the two cohorts. Analgesia was required for anterior knee pain in one patient with replacement and in one without. In the replacement group patello-femoral survival on a best-case scenario was 100% at 10 years, and on a worst-case scenario 96%; one of the nonreplaced patellae had been resurfaced for pain by 10 years. In view of the satisfactory and similar outcomes with and without replacement the authors suggest that an appropriate design for the prosthetic trochlea, rather than the replacement or otherwise of the patella, is the main determinant of patello-femoral outcome in total knee reconstruction. Thus patella replacement may be optional. Desirable trochlea design features are described.
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Affiliation(s)
- S K Kulkarni
- Bone and Joint Research Unit, Royal London Hospital, 79 Albert Street, London NW1 7LX, UK
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15
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Iwaki H, Pinskerova V, Freeman MA. Tibiofemoral movement 1: the shapes and relative movements of the femur and tibia in the unloaded cadaver knee. J Bone Joint Surg Br 2000; 82:1189-95. [PMID: 11132285 DOI: 10.1302/0301-620x.82b8.10717] [Citation(s) in RCA: 294] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In six unloaded cadaver knees we used MRI to determine the shapes of the articular surfaces and their relative movements. These were confirmed by dissection. Medially, the femoral condyle in sagittal section is composed of the arcs of two circles and that of the tibia of two angled flats. The anterior facets articulate in extension. At about 20 degrees the femur 'rocks' to articulate through the posterior facets. The medial femoral condyle does not move anteroposteriorly with flexion to 110 degrees. Laterally, the femoral condyle is composed entirely, or almost entirely, of a single circular facet similar in radius and arc to the posterior medial facet. The tibia is roughly flat. The femur tends to roll backwards with flexion. The combination during flexion of no anteroposterior movement medially (i.e., sliding) and backward rolling (combined with sliding) laterally equates to internal rotation of the tibia around a medial axis with flexion. About 5 degrees of this rotation may be obligatory from 0 degrees to 10 degrees flexion; thereafter little rotation occurs to at least 45 degrees. Total rotation at 110 degrees is about 20 degrees, most if not all of which can be suppressed by applying external rotation to the tibia at 90 degrees.
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Affiliation(s)
- H Iwaki
- Charles University, Prague, Czech Republic
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16
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Nakagawa S, Kadoya Y, Todo S, Kobayashi A, Sakamoto H, Freeman MA, Yamano Y. Tibiofemoral movement 3: full flexion in the living knee studied by MRI. J Bone Joint Surg Br 2000; 82:1199-200. [PMID: 11132287 DOI: 10.1302/0301-620x.82b8.10718] [Citation(s) in RCA: 157] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We studied active flexion from 90 degrees to 133 degrees and passive flexion to 162 degrees using MRI in 20 unloaded knees in Japanese subjects. Flexion over this arc is accompanied by backward movement of the medial femoral condyle of 4.0 mm and by backward movement laterally of 15 mm, i.e., by internal rotation of the tibia. At 162 degrees the lateral femoral condyle lies posterior to the tibia.
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Affiliation(s)
- S Nakagawa
- Osaka City University and the Sakamoto Orthopaedic Clinic, Japan
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18
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Frape DL, Williams NR, Carpenter KL, Freeman MA, Palmer CR, Fletcher RJ. Insulin response and changes in composition of non-esterified fatty acids in blood plasma of middle-aged men following isoenergetic fatty and carbohydrate breakfasts. Br J Nutr 2000; 84:737-45. [PMID: 11177189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
It was previously shown that a high plasma concentration of non-esterified fatty acids (NEFA) persisted after a fatty breakfast, but not after an isoenergetic carbohydrate breakfast, adversely affecting glucose tolerance. The higher concentration after the fatty breakfast may in part have been a result of different mobilization rates of fatty acids. This factor can be investigated as NEFA mobilized from tissues are monounsaturated to a greater extent than those deposited from a typical meal. Twenty-four middle-aged healthy Caucasian men were given oral glucose tolerance tests (OGTT), and for 28 d isoenergetic breakfasts of similar fat composition but of low (L) or moderate (M) fat content. The composition of NEFA in fasting and postprandial plasma was determined on days 1 and 29. No significant treatment differences in fasting NEFA composition occurred on day 29. During the OGTT and 0-1 h following breakfast there was an increase in plasma long-chain saturated NEFA but a decrease in monounsaturated NEFA (microg/100 microg total NEFA; P<0.001). Between 1 and 3 h following breakfast treatment differences occurred for total saturated and total monounsaturated fatty acids (microg/100 microg total NEFA; P<0.05), expressed as an increase in 18 : 1 and decreases in 16 : 0 and 17 : 0 in treatment M relative to treatment L (P<0.05). Serum insulin attained 35 and 65 mU/l in treatments M and L respectively during this period. Negative correlations were found between 16 : 0 in fasting plasma and both waist:hip circumference (P=0.0009) and insulin response curve area during OGTT (within treatment M, P=0.0001). It is concluded that a normal postprandial insulin response is associated with a rapid change in plasma saturated:monounsaturated NEFA. It is proposed that this change is the result of a variable suppression of fat mobilization, which may partly account for a large difference in postprandial total plasma NEFA between fatty and carbohydrate meals.
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Affiliation(s)
- D L Frape
- NS Research, The Priory, Churchyard, Mildenhall, Suffolk IP28 7EE, UK.
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Karrholm J, Brandsson S, Freeman MA. Tibiofemoral movement 4: changes of axial tibial rotation caused by forced rotation at the weight-bearing knee studied by RSA. J Bone Joint Surg Br 2000; 82:1201-3. [PMID: 11132288 DOI: 10.1302/0301-620x.82b8.10715] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We studied the knees of 11 volunteers using RSA during a step-up exercise requiring extension while weight-bearing from 50 degrees to 0 degrees. The findings on weight-bearing flexion with and without external rotation of the tibia based on MRI were confirmed.
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Affiliation(s)
- J Karrholm
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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Hill PF, Vedi V, Williams A, Iwaki H, Pinskerova V, Freeman MA. Tibiofemoral movement 2: the loaded and unloaded living knee studied by MRI. J Bone Joint Surg Br 2000; 82:1196-8. [PMID: 11132286 DOI: 10.1302/0301-620x.82b8.10716] [Citation(s) in RCA: 187] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 13 unloaded living knees we confirmed the findings previously obtained in the unloaded cadaver knee during flexion and external rotation/internal rotation using MRI. In seven loaded living knees with the subjects squatting, the relative tibiofemoral movements were similar to those in the unloaded knee except that the medial femoral condyle tended to move about 4 mm forwards with flexion. Four of the seven loaded knees were studied during flexion in external and internal rotation. As predicted, flexion (squatting) with the tibia in external rotation suppressed the internal rotation of the tibia which had been observed during unloaded flexion.
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21
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Freeman MA. Six trends to shape the field's future. Behav Healthc Tomorrow 2000; 9:10, 48. [PMID: 11067285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Kulkarni SK, Freeman MA, Poal-Manresa JC, Asencio JI, Rodriguez JJ. The patellofemoral joint in total knee arthroplasty: is the design of the trochlea the critical factor? J Arthroplasty 2000; 15:424-9. [PMID: 10884200 DOI: 10.1054/arth.2000.4342] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The outcome at 10 years is reported of a prospective study of 2 cohorts of total knee arthroplasties treated with (center A) or without (center B) patellar replacement. The same tibiofemoral components were used in all knees. The cohorts were demographically similar. A total of 124 patellae were treated by replacement, and 143 were treated without replacement. The clinical outcome and the patellofemoral revision rates were the same in the 2 cohorts: 1 patient required analgesia for anterior knee pain after replacement, and 1 without replacement required patellar replacement for pain. In the replaced group, patellofemoral survival on a best-case scenario was 100% at 10 years; on a worst-case scenario, 96%. One of the unreplaced patellae had been resurfaced for pain by 10 years. In view of the satisfactory and similar outcomes with and without replacement, we suggest that an appropriate design for the prosthetic trochlea, rather than the replacement or otherwise of the patella, is the main determinant of patellofemoral outcome in total knee arthroplasty. Patella replacement may be optional. Desirable trochlea design features are described.
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Affiliation(s)
- S K Kulkarni
- Bone and Joint Research Unit, The Royal London Hospital, United Kingdom
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23
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Abstract
Unlike the situation at the hip, controversy continues as to the shape of the bones in the knee (for example, are the femoral condyles helical in sagittal section?) and as to the way in which the femur moves on the tibia (for example, does the femur roll-back during flexion?). Although the replaced knee is unlikely to achieve normal kinematics, it seems desirable to understand how far it departs from normal. A knowledge of the normal is also important in the management of ligament injuries. Thus it is desirable to resolve these controversies. We have studied the shape of the bones and the way in which they move in the normal cadaveric knee using MRI as a first step to developing an MRI protocol for establishing the kinematic behaviour of the knee in the clinical setting. Our results have been confirmed in normal volunteers using Open Access and Interventional MRI. The latter enables the knee to be imaged whilst the subject is weight-bearing.
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Affiliation(s)
- V Pinskerova
- Bone & Joint Research Unit, London Hospital Medical College
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Robertsson O, Scott G, Freeman MA. Ten-year survival of the cemented Freeman-Samuelson primary knee arthroplasty. Data from the Swedish Knee Arthroplasty Register and the Royal London Hospital. J Bone Joint Surg Br 2000; 82:506-7. [PMID: 10855871 DOI: 10.1302/0301-620x.82b4.10342] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a ten-year rate of survival of 96% for the cemented Freeman-Samuelson knee arthroplasty in patients from the Swedish Knee Registry and the Royal London Hospital with revision for aseptic loosening as the criterion for failure.
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Affiliation(s)
- O Robertsson
- Department of Orthopaedics, The Swedish Knee Arthroplasty Register, Lund University Hospital, Sweden
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Scott RD, Engh GA, Freeman MA, Hofmann AA, Ranawat CS, Ritter MA. Knee challenges: what would you do? Orthopedics 1999; 22:891-5. [PMID: 10507357 DOI: 10.3928/0147-7447-19990901-35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- R D Scott
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Mass, USA
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Todo S, Kadoya Y, Moilanen T, Kobayashi A, Yamano Y, Iwaki H, Freeman MA. Anteroposterior and rotational movement of femur during knee flexion. Clin Orthop Relat Res 1999:162-70. [PMID: 10335295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study was designed to analyze anteroposterior and rotational movement of femoral condyles during knee flexion from 15 degrees to 90 degrees using magnetic resonance imaging. After a pilot study, scans were made in 10 healthy male Japanese volunteers. When centers of the circular profiles of posterior femoral condyles were used as reference points, the medial and lateral femoral condyles displaced posteriorly 1.9 +/- 0.8 mm and 2.3 +/- 0.5 mm, respectively (mean +/- standard error). Duplicate examinations on two separate occasions revealed the accuracy of this procedure was in the range of 1 to 2 mm. These results have confirmed that femoral rollback occurs in the unloaded normal knee during flexion from 15 degrees to 90 degrees, but its magnitude is small (2 mm). The results obtained in this in vivo measurement of anteroposterior movement of the femoral condyles have relevance for total knee replacement design.
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Affiliation(s)
- S Todo
- Department of Orthopaedic Surgery, Osaka City University Medical School, Japan
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27
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Abstract
BACKGROUND Atrial flutter and atrial fibrillation are causes of morbidity in adults with an atrial septal defect. In this study, we attempted to identify risk factors for atrial flutter and fibrillation both before and after the surgical closure of an atrial septal defect. METHODS We searched for preoperative and postoperative atrial flutter or fibrillation in 213 adult patients (82 men and 131 women) who underwent surgical closure of atrial septal defects because of symptoms, a substantial left-to-right shunt (ratio of pulmonary to systemic blood flow, >1.5:1), or both at Toronto Hospital between 1986 and 1997. RESULTS Forty patients (19 percent) had sustained atrial flutter or fibrillation before surgery. As compared with the patients who did not have atrial flutter or fibrillation before surgery, those who did were older (59+/-11 vs. 37+/-13 years, P<0.001) and had higher mean pulmonary arterial pressures (25.0+/-9.7 vs. 19.7+/-8.2 mm Hg, P=0.001). There were no perioperative deaths. After a mean follow-up period of 3.8+/-2.5 years, 24 of the 40 patients (60 percent) continued to have atrial flutter or fibrillation. The mean age of these patients was greater than that of the 16 who converted to sinus rhythm (P=0.02). New-onset atrial flutter or atrial fibrillation was more likely to have developed at follow-up in patients who were older than 40 years at the time of surgery than in those who were 40 or younger (5 of 67 vs. 0 of 106, P=0.008). Late events (those occurring more than one month after surgery) included stroke in six patients (all but one with atrial flutter or fibrillation, one of whom died) and death from noncardiac causes in two patients. Multivariate analysis showed that older age (>40 years) at the time of surgery (P=0.001), the presence of preoperative atrial flutter or fibrillation (P<0.001), and the presence of postoperative atrial flutter or fibrillation or junctional rhythm (P=0.02) were predictive of late postoperative atrial flutter or fibrillation. CONCLUSIONS The risk of atrial flutter or atrial fibrillation in adults with atrial septal defects is related to the age at the time of surgical repair and the pulmonary arterial pressure. To reduce the morbidity associated with atrial flutter and fibrillation, the timely closure of atrial septal defects is warranted.
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Affiliation(s)
- M A Gatzoulis
- University of Toronto Congenital Cardiac Centre for Adults, Toronto Hospital, Department of Medicine, University of Toronto, ON, Canada.
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Freeman MA. The role of longitudinal tibial rotation in the replaced knee. Acta Orthop Belg 1999; 64 Suppl 2:64-9. [PMID: 9922532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Affiliation(s)
- M A Freeman
- Bone and Joint Research Unit, Royal London Hospital, England.
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Abstract
A total of 207 tibial components in total knee arthroplasty (TKA) have been reviewed at a maximum of 10 years after replacement. Twelve knees developed aseptic femoral loosening and were reviewed separately from the remaining 195. All tibial components were fixed with cement confined to the proximal surface of the implant combined with an uncemented stem. In the 195 TKAs with well-fixed femoral components and (presumably) low wear, 15% of tibiae developed early-onset, nonprogressive partial radiolucent lines (RLLs), typically in relation to preoperative sclerosis. Tibial component vertical migration was measured in 36 components: no migration was detected over the course of 5 years whether or not an RLL was present. There was no case of tibial osteolysis, no tibial component was revised for aseptic loosening, and no implant was radiologically loose. In 12 knees, the femoral component loosened with subsidence exposing peripheral bone that caused severe HDP wear. Tibial RLLs were present in 9, and osteolysis was present in 11 (although the tibial component was actually loose in only 1). This material has been used to study 1) the natural history of RLLs in cemented TKA and 2) the outcome of using cement confined to the proximal part of the tibial interface. We conclude that in low-wear prostheses RLLs are due to a failure to inject cement into sclerotic bone. Such lines are nonprogressive and do not affect fixation. In the presence of severe wear, however, they may provide a portal for the entry of debris into the interface causing progression of the RLL and lysis. Proximal cement plus an uncemented stem furnishes adequate tibial fixation, provided that the HDP wear rate is low.
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Affiliation(s)
- S Smith
- The London Hospital Medical College, Bone & Joint Research Unit, United Kingdom
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Abstract
Oxidation of LDL is now widely accepted to be involved in atherogenesis. The aim of this study was to examine the effect of BO-653, a strong radical scavenger and antioxidant, on oxidation of LDL by human macrophages in vitro. Fifty microg/ml LDL protein was incubated with macrophages in Ham's F10 medium, supplemented with additional Fe2+, for up to 48 h. Then the medium was analysed by LDL agarose gel electrophoresis, the thiobarbituric acid assay and gas chromatography. In the absence of added exogenous antioxidants, after 24h LDL oxidation produced 30.48 nmoles MDA equivalents/mg LDL protein and a relative electrophoretic mobility of 4.74. Linoleic acid (18:2), arachidonic acid (20:4) and cholesterol were depleted and 7beta-hydroxycholesterol was generated. BO-653 completely inhibited this cell-mediated oxidation of LDL in concentrations as low as 5 microM, being more effective than either alpha-tocopherol or probucol, which completely inhibited oxidation at 200 and 80 microM and only partially at 80 and 8 microM, respectively. This inhibition of cell-mediated LDL oxidation was not due to toxicity, as alpha-tocopherol, probucol and BO-653 were not toxic for the macrophages at the concentrations tested. Eighty microM alpha-tocopherol, 8 microM probucol and 5 microM BO-653 significantly reduced the toxicity to the oxidising culture caused by LDL oxidation. The results show that in this system BO-653 is a more effective antioxidant than alpha-tocopherol or probucol.
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Affiliation(s)
- K Müller
- Department of Pathology, University of Cambridge, UK.
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Revell PA, Braden M, Freeman MA. Review of the biological response to a novel bone cement containing poly(ethyl methacrylate) and n-butyl methacrylate. Biomaterials 1998; 19:1579-86. [PMID: 9830983 DOI: 10.1016/s0142-9612(97)00118-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This review describes work published independently elsewhere in which the biological reactions to poly(ethyl methacrylate) n-butyl methacrylate (PEMBMA) have been studied. This material has been compared throughout with conventional poly(methyl methacrylate) (PMMA). Butyl methacrylate monomer used in PEMBMA was slightly less toxic than methyl methacrylate monomer used in PMMA when injected intraperitoneally in mice. No differences in cardiorespiratory effects were found between n-butyl and methyl monomer infused intravenously into anaesthetized rabbits. The tissue reaction to the beaded polymers of poly(methyl methacrylate) and poly(ethyl methacrylate) implanted subcutaneously was identical. The surface appearance of the two materials differed significantly when viewed by scanning electron microscopy, showing a series of elevations resembling tightly packed spheres in the case of PMMA, but a smooth surface with only occasional smooth elevations in the case of PEMBMA. Intramuscular implantation showed more fibrous tissue and tissue damage in relation to PMMA cured in situ compared with PEMBMA and there was more bone necrosis and a thicker fibrous tissue layer adjacent to PMMA than PEMBMA when cured intraosseously.
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Affiliation(s)
- P A Revell
- Department of Histopathology, Royal Free Hospital School of Medicine, London, UK
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Ritter MA, Freeman MA, Insall JN, Ranawat CS, Rorabeck CH, Whiteside LA. Knee challenges: what would you do? Orthopedics 1998; 21:1059-63. [PMID: 9769063 DOI: 10.3928/0147-7447-19980901-47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M A Ritter
- Center for Hip and Knee Surgery, Mooresville, Ind 46158, USA
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Abstract
We have prospectively studied 63 total knee replacements (TKR) in which the femoral component was polyacetal, and 138 TKRs in which the femoral component was conventional cobalt chrome. The tibial and patellar components were of ultrahigh molecular weight polyethylene (UHMWPE). Patients were followed-up for at least 10 years. In the polyacetal group, a number of patients have died or have been revised, for reasons unrelated to the presence of polyacetal. There were no instances of femoral component fracture, nor failure by wear. One postmortem specimen, retrieved at 9 years after surgery, showed no measurable polyacetal wear and negligible HDP wear. The histology of tissue in contact with polyacetal was indistinguishable from that adjacent to polymethyl methacrylate and UHMWPE in the same knee. We believe that polyacetal could be used for the femoral component of a TKR and that a further trial should be undertaken.
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Taylor M, Tanner KE, Freeman MA. Finite element analysis of the implanted proximal tibia: a relationship between the initial cancellous bone stresses and implant migration. J Biomech 1998; 31:303-10. [PMID: 9672083 DOI: 10.1016/s0021-9290(98)00022-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The cancellous bone stresses within the implanted proximal tibia were examined using a three-dimensional anatomical finite element model. Three versions of a proximal tibial prosthesis were examined: an all polyethylene press-fit design; a metal backed, stemmed press-fit design and a (horizontally) cemented metal backed, stemmed design. All three designs had published migration and survivorship data. The objectives of the study were (i) to compare the stresses generated by each of the tibial components, (ii) examine the influence of the resected surface morphology and (iii) compare the initial cancellous bone stresses with the published migration and survivorship data. The all polyethylene prosthesis generated the highest cancellous bone stresses. Addition of a metal backing and a stem reduced the stresses, but the cemented device produced the lowest cancellous bone stresses. The surface morphology had a significant effect on the cancellous bone stresses generated by press-fit prostheses. As the bone-prosthesis contact area decreased, the peak cancellous bone stresses increased by as much as 243%. The surface morphology had no effect on the cancellous bone stresses generated by the cemented implant. Good correlation was found between the predicted cancellous bone stresses and the migration and survivorship data, with the implant generating the highest cancellous bone stresses migrating the most and having the poorest survival rates at 5 year. The results support the hypothesis that the progressive failure of cancellous bone is a mechanism of implant migration regardless of the method of fixation and the implantation site.
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Affiliation(s)
- M Taylor
- IRC in Biomedical Materials, Queen Mary and Westfield College, London, UK.
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Freeman MA, Nicholls JI, Kydd WL, Harrington GW. Leakage associated with load fatigue-induced preliminary failure of full crowns placed over three different post and core systems. J Endod 1998; 24:26-32. [PMID: 9487862 DOI: 10.1016/s0099-2399(98)80208-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Thirty-six maxillary central incisors were endodontically treated and restored with a post and core and cast crown. Three different post and core systems were evaluated. Restored teeth were fatigue-loaded until preliminary failure of the casting occurred as detected by a strain gauge bonded across the lingual margin of the cast crown. After preliminary failure, fatigue loading was continued for 100,000 load cycles with the crown margin exposed to basic fuschin dye. Teeth were then immersed in dye for 24 h, sectioned, and evaluated for leakage. There was no significant difference in the number of load cycles required to cause preliminary failure among the three post and core systems. Leakage occurred in all three groups, with no significant difference between groups. The occurrence of preliminary failure is clinically undetectable, yet it allows leakage between the restoration and tooth that may extend down the prepared post space.
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Affiliation(s)
- M A Freeman
- Department of Endodontics, University of Washington, Seattle 98195, USA
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Trabin T, Kramer T, Daniels A, Freeman MA. Cost and value of performance indicators. Results from IBH's (Institute for Behavioral Healthcare) National Leadership Council. Behav Healthc Tomorrow 1997; 6:37-9. [PMID: 10175232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Consumer Reports style report cards are becoming commonplace in our industry and will emerge as a necessary component of 21st century behavioral healthcare. As a result, health plans and providers are increasingly required to invest in and maintain an infrastructure for comparative performance measurement and reporting. Policymakers and accrediting agencies must be careful to require reporting about the most cost-effective indicators in order to minimize the extra cost burden imposed upon health plans and providers by this effort. The Institute for Behavioral Healthcare's National Leadership Council evaluated "real life" performance indicators already in use in health plans, facility-based provider settings, community mental health centers, and behavioral group practices. This study shows which performance indicators are most worth measuring and those which are not, and why. Significant implications for policy and accrediting organizations, and for the behavioral healthcare field, are discussed.
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Kobayashi A, Freeman MA, Bonfield W, Kadoya Y, Yamac T, Al-Saffar N, Scott G, Revell PA. Number of polyethylene particles and osteolysis in total joint replacements. A quantitative study using a tissue-digestion method. J Bone Joint Surg Br 1997; 79:844-8. [PMID: 9331048 DOI: 10.1302/0301-620x.79b5.7602] [Citation(s) in RCA: 124] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Our aim was to analyse the influence of the size, shape and number of particles on the pathogenesis of osteolysis. We obtained peri-implant tissues from 18 patients having revision surgery for aseptically loosened Freeman total knee replacements (10), Charnley total hip replacements (3) and Imperial College/London Hospital double-cup surface hip replacements (5). The size and shape of the polyethylene particles were characterised using SEM and their concentration was calculated. The results were analysed with reference to the presence of radiological osteolysis. The concentration of polyethylene particles in 6 areas with osteolysis was significantly higher than that in 12 areas without osteolysis. There were no significant differences between the size and shape of the particles in these two groups. We conclude that the most critical factor in the pathogenesis of osteolysis is the concentration of polyethylene particles accumulated in the tissue.
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Affiliation(s)
- A Kobayashi
- Queen Mary and Westfield College, the Royal Free Hospital School of Medicine, London, England, UK
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Dorr LD, Cuckler JM, Engh CA, Freeman MA, Ritter MA, Weber BG. Hip challenges: what would you do? Orthopedics 1997; 20:867-9. [PMID: 9306473 DOI: 10.3928/0147-7447-19970901-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Booth RE, Freeman MA, Hungerford DS, Insall JN, Stulberg SD, Whiteside LA. Knee challenges: what would you do? Orthopedics 1997; 20:875-80. [PMID: 9306474 DOI: 10.3928/0147-7447-19970901-35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- R E Booth
- Department of Orthopedics, Allegheny University Hospitals-Graduate, Philadelphia, PA 19146, USA
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Abstract
The aim of this study was to evaluate the relative contribution of polyethylene, metal, and polymethylmethacrylate (cement) particles to the overall bone loss in aseptic loosening. Twenty-four interface tissues with adjacent bone were obtained during 17 revision total joint arthroplasties (11 hips and six knees). Osteoclasts and macrophages were identified immunohistochemically on the bone surface. The length of the bone surface in contact with these cell types was measured and analyzed with reference to the particulate species present within the fibrous interface. The presence of abundant polyethylene particles significantly increased the proportion of the bone surface in contact with macrophages but did not have a significant influence on that of osteoclasts. Osteoclastic bone resorption was significantly more extensive in the presence of metal particles. In contrast, the presence of cement particles did not have a significant influence on macrophage or osteoclast coverage of the bone surface. These results highlight the significance of polyethylene particles in macrophage recruitment and subsequent osteolysis and suggest a different mechanism of bone loss related to metal, namely mediation through osteoclastic activities. The relative contribution of cement particles was negligible and needs reevaluation in light of evidence provided by others.
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Affiliation(s)
- Y Kadoya
- Department of Histopathology, Royal Free Hospital School of Medicine, London, United Kingdom
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Kobayashi A, Donnelly WJ, Scott G, Freeman MA. Early radiological observations may predict the long-term survival of femoral hip prostheses. J Bone Joint Surg Br 1997; 79:583-589. [PMID: 9250743 DOI: 10.1302/0301-620x.79b4.7210] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We reviewed a consecutive series of 527 uninfected hip replacements in patients resident in the UK which had been implanted from 1981 to 1993. All had the same basic design of femoral prosthesis, but four fixation techniques had been used: two press-fit, one HA-coated and one cemented. Review and radiography were planned prospectively. For assessment the components were retrospectively placed into two groups: those which had failed from two years onwards by aseptic femoral loosening and those in which the femoral component had survived without revision or recommendation for revision. All available radiographs in both groups were measured to determine vertical migration and examined by two observers to agree the presence of radiolucent lines (RLLs), lytic lesions, resorption of the neck, proximal osteopenia and distal intramedullary and distal subperiosteal formation of new bone. We then related the presence or absence of these features and the rate of migration at two years to the outcome with regard to aseptic loosening and determined the predictive value of each of these variables. Migration of > or = 2 mm at two years, the presence of an RLL of 2 mm occupying one-third of any one zone, and subperiosteal formation of new bone at the tip of the stem were predictors of aseptic loosening after two years. There were too few lytic lesions to assess at two years, but at five years a lytic lesion > or = 2 mm also predicted failure. We discuss the use of these variables as predictors of femoral aseptic loosening for groups of hips and for individual hips. We conclude that if a group of about 50 total hip replacements, perhaps with a new design of femoral stem, were studied in this way at two years, a mean migration of < 0.4 mm and an incidence of < 10% of RLLs of 2 mm in any one zone would predict 95% survival at ten years. For an individual prosthesis, migration of < 2 mm and the absence of an RLL of < or = 2 mm at two years predict a 6% chance of revision over approximately ten years. If either 2 mm of migration or an RLL of 2 mm is present, the chances of revision rise to 27%, and if both radiological signs are present they are 50%. If at five years a lytic lesion has developed, whatever the situation at two years, there is approximately a 50% chance of failure in the following five years. Our findings suggest that replacements using a limited number of any new design of femoral prosthesis should be screened radiologically at two years before they are generally introduced. We also suggest that radiographs of individual patients at two years and perhaps at five years should be studied to help to decide whether or not the patient should remain under close review or be discharged from specialist follow-up.
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Abstract
To obtain information about the bone scintigraphic appearance of a hydroxyapatite (HA)-coated proximal femoral implant, this examination was performed on 24 patients with a clinically and radiologically successful femoral implant in hip arthroplasty. The prosthesis had a proximal HA coating for supplementary fixation. The patients' mean age was 50.3 years (range, 28-65 years) at operation. The interval from the operation to the scintigraphy ranged from 6 months to 5.5 years (mean, 2.2 years). Scintigraphy was performed using 99mTc-medronic acid. Quantitative counts were recorded in 4 zones: 3 along the length of the implant (trochanteric region with HA coating, midprosthesis, and distal tip) and 1 below the prosthesis. The results were expressed as ratios using the nonoperated femur as a control value. The results demonstrated that the mean activities in all 4 zones were increased relative to the untreated side. The highest activity was observed in the region around the prosthetic tip, with an elevation of 46% above the control value. This activity showed a significant decline over time. The counts recorded in the trochanteric region, where the implant was coated with HA, were 20% above the control value and similar to those seen in its adjacent noncoated midprosthetic region. In the trochanteric region, however, the activity did not show a decline over the follow-up period.
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Affiliation(s)
- T Moilanen
- Tampere University Hospital, Department of Surgery, Finland
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Donnelly WJ, Kobayashi A, Freeman MA, Chin TW, Yeo H, West M, Scott G. Radiological and survival comparison of four methods of fixation of a proximal femoral stem. J Bone Joint Surg Br 1997; 79:351-60. [PMID: 9180308 DOI: 10.1302/0301-620x.79b3.7060] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We compared the radiological appearances and survival of four methods of fixation of a femoral stem in 538 hips after follow-up for five or ten years. The fixation groups were: 1) press-fit shot-blasted smooth Ti-A1-V stem; 2) press-fit shot-blasted proximally ridged stem; 3) proximal hydroxyapatite (HA) coating; and 4) cementing. Survival analysis at five to ten years showed better results in the HA-coated (100% at five to six years) and cemented stems (100% at 5 to 6 years) than in the two press-fit groups. There was a higher mean rate of migration in the smooth and ridged Ti-A1-V shot-blasted press-fit groups (0.8 mm/year and 0.6 mm/year, respectively) when compared with the HA-coated and cemented prostheses (both 0.3 mm/year). More radiolucent lines and osteolytic lesions were seen in the press-fit groups than in either the HA-coated or cemented implants, with a trend for a lower incidence of both in the HA compared with the cemented group. Proximal osteopenia increased in the press-fit and cemented prostheses with time, but did not do so in the HA group. There was a higher incidence of resorption of the femoral neck with time in the cemented group than in the other three. We conclude that the HA and the cemented interfaces both provide secure fixation with a trend in favour of HA. The cemented prosthesis meets the suggested National Institutes of Health definition of 'efficacious' at ten years.
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Freeman MA. Acetabular cup migration: prediction of aseptic loosening. J Bone Joint Surg Br 1997; 79:342-3. [PMID: 9119876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Freeman MA. Outcome of a rotating meniscal-bearing total knee replacement (TKR) prosthesis. J Arthroplasty 1997; 12:213-4. [PMID: 9139105 DOI: 10.1016/s0883-5403(97)90069-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Kobayashi A, Bonfield W, Kadoya Y, Yamac T, Freeman MA, Scott G, Revell PA. The size and shape of particulate polyethylene wear debris in total joint replacements. Proc Inst Mech Eng H 1997; 211:11-5. [PMID: 9141886 DOI: 10.1243/0954411971534638] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Osteolysis induced by wear particles has been recognized as one of the major causes of long-term failure in total joint replacements. However, little is currently known about the exact nature of particles, as the particles are too small to be characterized by light microscopy. In this study, ultra-high molecular weight polyethylene (UHMWPE) particles retrieved from ten cases (six cemented and four uncemented) for Freeman type conforming tibiofemoral total knee replacements (TKRs), three Charnley total hip replacements (THRs) and five Imperial College/London Hospital double cup surface hip replacements for aseptic loosening were extracted using a high-performance method with ultracentrifugation and characterized by scanning electron microscopy. The equivalent circle diameter (ECD) of all 18 cases ranged from 0.40 to 1.15 microns (Mean +/- SE = 0.70 +/- 0.05 micron, median = 0.67 micron). The aspect ratio was 1.50 to 2.04 (Mean +/- SE = 1.75 +/- 0.04, median = 1.73), and roundness was 1.24 to 2.34 (Mean +/- SE = 1.61 +/- 0.07, median = 1.65). The numbers of particles were 5.2 x 10(8) to 9.17 x 10(10)/g tissue (Mean +/- SE = 1.42 x 10(10) +/- 5.41 x 10(9)/g tissue, median = 7.04 x 10(9)). The number of polyethylene (PE) particles/g tissue in TKRs was significantly larger than that in THRs (1.04 x 10(10)/g tissue and 2.16 x 10(9)/g tissue respectively, median, p = 0.03, Mann-Whitney U test). Unstable fixation of the tibial PE component might account for the accumulation of a large number of PE particles in the interface tissue.
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Affiliation(s)
- A Kobayashi
- Interdisciplinary Research Centre (IRC) in Biomedical Materials, Queen Mary and Westfield College, London
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