Lower Risk of Revision With 32- and 36-Millimeter Femoral Heads Compared With 28-mm Heads in Primary Total Hip Arthroplasty: A Comparative Single-Center Study (10,104 Hips)

BACKGROUND

We aimed to compare the clinical outcomes of different head sizes (28-, 32-, and 36- millimeter) in primary total hip arthroplasty (THA) at mean 6 years follow-up (range, 1 to 17.5 years).

METHODS

This was a retrospective consecutive study of primary THA at our institution (2003 to 2019). Demographic and surgical data were collected. The primary outcome measures were all-cause revision, revision for dislocation, and all-cause revision excluding dislocation. Continuous descriptive statistics used means, median values, ranges, and 95% confidence intervals, where appropriate. Kaplan-Meier survival curves were used to estimate time to revision. Cox proportional hazard regression analyses were used to compare revision rates between the femoral head size groups. Adjustments were made for age at surgery, sex, primary diagnosis, American Society of Anesthesiologists score, articulation type, and fixation methods. There were 10,104 primary THAs included; median age was 69 years (range, 13 to 101) with 61.5% women. A posterior approach was performed in 71.6%. There were 3,295 hips with 28-mm heads (32.6%), 4,858 (48.1%) with 32-mm heads, and 1,951 (19.3%) with 36-mm heads.

RESULTS

Overall rate of revision was 1.7% with the lowest rate recorded for the 36-mm group (2.7 versus 1.3 versus 1.1%). Cox regression analyses showed a decreased risk of all-cause revision for 32 and 36-mm head sizes as compared to 28-mm; this was statistically significant for the 32-mm group (P = .01). Risk of revision for dislocation was significantly reduced in both 32-mm (P = .03) and 36-mm (P = .03) head sizes. Analysis of all cause revision excluding dislocation showed no significant differences between head sizes.

CONCLUSIONS

We found a significantly reduced risk of revision for all causes, but particularly revision for dislocation with larger head sizes. Concerns regarding increased risk of early revision for aseptic loosening, polyethylene wear, or taper corrosion with larger heads appear to be unfounded in this cohort of 10,104 patients with up to 17 years follow-up.

Satisfactory medium- to long-term outcomes of cemented rotating hinge prosthesis in revision total knee arthroplasty

Aims

The aim of this study was to evaluate medium- to long-term outcomes and complications of the Stanmore Modular Individualised Lower Extremity System (SMILES) rotating hinge implant in revision total knee arthroplasty (rTKA) at a tertiary unit. It is hypothesized that this fully cemented construct leads to satisfactory clinical outcomes.

Methods

A retrospective consecutive study of all patients who underwent a rTKA using the fully cemented SMILES rotating hinge prosthesis between 2005 to 2018. Outcome measures included aseptic loosening, reoperations, revision for any cause, complications, and survivorship. Patients and implant survivorship data were identified through both prospectively collected local hospital electronic databases and linked data from the National Joint Registry/NHS Personal Demographic Service. Kaplan-Meier survival analysis was used at ten years.

Results

Overall, 69 consecutive patients (69 knees) were included with a median age of 78 years (interquartile range 69 to 84), and there were 46 females (66.7%). Indications were septic revisions in 26 (37.7%), and aseptic aetiology in the remining 43 (62.3%). The mean follow-up was 9.7 years (4 to 18), and the overall complication was rate was 7.24%, all with patellofemoral complications. Failure rate with 'any cause revision' was 5.8%. There was one case of aseptic loosening of the femoral component. At ten years, 17/69 patients (24.63%) had died, and implant survivorship was 92.2%.

Conclusion

In our experience, the SMILES rotating hinge prosthesis achieves satisfactory long-term outcomes with ten-year implant survivorship of 92.2% and a patellofemoral complication rate of 7.24%.

The impact of a revision arthroplasty network on patient outcomes

Aims

Revision total knee arthroplasty (rTKA) and revision total hip arthroplasty (rTHA) are complex procedures with higher rates of re-revision, complications, and mortality compared to primary TKA and THA. We report the effects of the establishment of a revision arthroplasty network (the East Midlands Specialist Orthopaedic Network; EMSON) on outcomes of rTKA and rTHA.

Methods

The revision arthroplasty network was established in January 2015 and covered five hospitals in the Nottinghamshire and Lincolnshire areas of the East Midlands of England. This comprises a collaborative weekly multidisciplinary meeting where upcoming rTKA and rTHA procedures are discussed, and a plan agreed. Using the Hospital Episode Statistics database, revision procedures carried out between April 2011 and March 2018 (allowing two-year follow-up) from the five network hospitals were compared to all other hospitals in England. Age, sex, and mean Hospital Frailty Risk scores were used as covariates. The primary outcome was re-revision surgery within one year of the index revision. Secondary outcomes were re-revision surgery within two years, any complication within one and two years, and median length of hospital stay.

Results

A total of 57,621 rTHA and 33,828 rTKA procedures were performed across England, of which 1,485 (2.6%) and 1,028 (3.0%), respectively, were conducted within the network. Re-revision rates within one year for rTHA were 7.3% and 6.0%, and for rTKA were 11.6% and 7.4% pre- and postintervention, respectively, within the network. This compares to a pre-to-post change from 7.4% to 6.8% for rTHA and from 11.7% to 9.7% for rTKA for the rest of England. In comparative interrupted time-series analysis for rTKA there was a significant immediate improvement in one-year re-revision rates for the revision network compared to the rest of England (p = 0.024), but no significant change for rTHA (p = 0.504). For the secondary outcomes studied, there was a significant improvement in trend for one- and two-year complication rates for rTHA for the revision network compared to the rest of England.

Conclusion

Re-revision rates for rTKA and complication rates for rTHA improved significantly at one and two years with the introduction of a revision arthroplasty network, when compared to the rest of England. Most of the outcomes studied improved to a greater extent in the network hospitals compared to the rest of England when comparing the pre- and postintervention periods.

Allograft Extensor Mechanism Reconstruction in Salvage Revision Knee Arthroplasty: Surgical Technique

Although extensor mechanism failure remains a catastrophic complication of knee arthroplasty, there are a number of contemporary techniques with reasonable outcomes that restore function. Chronic failures require advanced reconstruction techniques. Similar complication rates have been reported for the use of autografts, allografts, or mesh reconstructions. Here, we describe our surgical technique in allograft extensor mechanism reconstruction for chronic failures in salvage revision knee arthroplasty using a complete extensor mechanism allograft with a modified proximal fixation and case demonstrations.

High ten-year implant survivorship and low patellofemoral complication rate for S-ROM rotating-hinge implants in revision total knee arthroplasty

Aims

The aim of this study was to evaluate medium-term outcomes and complications of the S-ROM NOILES Rotating Hinge Knee System (DePuy, USA) in revision total knee arthroplasty (rTKA) at a tertiary unit.

Methods

A retrospective consecutive study of all patients who underwent a rTKA using this implant from January 2005 to December 2018. Outcome measures included reoperations, revision for any cause, complications, and survivorship. Patients and implant survivorship data were identified through both local hospital electronic databases and linked data from the National Joint Registry/NHS Personal Demographic Service. Kaplan-Meier survival analysis was used at ten years.

Results

A total of 89 consecutive patients (89 knees) were included with 47 females (52.8%) and a median age of 74 years (interquartile range 66 to 79). The main indications were aseptic loosening with instability (39.4%; n = 35) and infection (37.1%; n = 33) with the majority of patients managed through two-stage approach. The mean follow-up was 7.4 years (2 to 16). The overall rate of reoperation, for any cause, was 10.1% (n = 9) with a rate of implant revision of 6.7% (n = 6). Only two cases required surgery for patellofemoral complications. Kaplan-Meier implant-survivorship analysis was 93.3% at ten years, using revision for any cause as an endpoint.

Conclusion

This implant achieved high ten-year survivorship with a low complication rate, particularly patellofemoral complications. These can be avoided by ensuring central patella tracking and appropriate tension of the patellofemoral joint in this posterior hinge design. Cite this article: Bone Jt Open 2022;3(3):205–210.

Dermatophilosis (lumpy wool) in sheep: a review of pathogenesis, aetiology, resistance and vaccines

Lumpy wool (dermatophilosis) develops following prolonged wetting of sheep when bacterial proliferation in wool and on skin induce an exudative dermatitis, causing a superficial skin lesion and damage to wool follicles and fibres. The incidence of dermatophilosis is strongly dependent on wet and warm weather and, hence, infection is sporadic. While older animals are less at risk than are lambs, it is unclear whether this reflects naturally acquired immune resistance or the maturation of skin and wool fibres. Dermatophilosis directly causes wool production losses and it also is a risk factor for blowfly strike, which has a substantial economic impact and increasing challenges associated with current control procedures. This review assessed research on the bacterial causes of lumpy wool, the characteristics of the resulting immune defence reactions in sheep, current control strategies, and limitations of previous attempts to control lumpy wool by sheep vaccination.

Control of sheep flystrike: what's been tried in the past and where to from here

Flystrike remains a serious financial and animal welfare issue for the sheep industry in Australia despite many years of research into control methods. The present paper provides an extensive review of past research on flystrike, and highlights areas that hold promise for providing long-term control options. We describe areas where the application of modern scientific advances may provide increased impetus to some novel, as well as some previously explored, control methods. We provide recommendations for research activities: insecticide resistance management, novel delivery methods for therapeutics, improved breeding indices for flystrike-related traits, mechanism of nematode-induced scouring in mature animals. We also identify areas where advances can be made in flystrike control through the greater adoption of well-recognised existing management approaches: optimal insecticide-use patterns, increased use of flystrike-related Australian Sheep Breeding Values, and management practices to prevent scouring in young sheep. We indicate that breeding efforts should be primarily focussed on the adoption and improvement of currently available breeding tools and towards the future integration of genomic selection methods. We describe factors that will impact on the ongoing availability of insecticides for flystrike control and on the feasibility of vaccination. We also describe areas where the blowfly genome may be useful in providing impetus to some flystrike control strategies, such as area-wide approaches that seek to directly suppress or eradicate sheep blowfly populations. However, we also highlight the fact that commercial and feasibility considerations will act to temper the potential for the genome to act as the basis for providing some control options.

High Survivorship of Short-Cemented Femoral Stems in Condylar Revision Total Knee Arthroplasty Without Significant Metaphyseal Bone Loss: Minimum 5-Year Follow-Up

BACKGROUND

We aimed to evaluate the outcomes of hybrid fixation technique in condylar revision total knee arthroplasty (rTKA) using cementless metaphyseal tibial sleeves and short-cemented femoral stems with a rotating platform articulation.

METHODS

Retrospective consecutive study of all condylar rTKAs with a cemented femoral stem between 2009 and 2016 was conducted. Patients were identified using a local prospective database and linkable data obtained from the National Joint Registry for rTKA. Demographic, clinical, and surgical data were collected from patients' electronic health records. The primary outcome measure was mechanical failure and implant survivorship using a nationally collected data, complications, re-operations, and "any-cause revision" were also recorded.

RESULTS

There were 72 consecutive patients (72 knees) with minimum 5-year follow-up: 33 (45.8%) females and 39 (54.2%) males with a median age of 70 years (range 47-88). The indication for revision surgery was aseptic loosening (n = 34, 47.2%), instability (n = 17, 23.6%), infection (n = 14, 19.5%) with 10 patients having 2-stage approach and 4 patients with single-stage approach, stiffness (n = 4, 5.6%), and malalignment (n = 3, 4.1%). At mean follow-up of 6.87 years (median 6.7; range 5-11.8), only 2 patients required revision for infection. Using "any-cause implant revision" as an end point, implant survivorship for this construct was 97.2% at median 6.7 years. To date, none of the femoral stems have been revised for mechanical failure.

CONCLUSION

In rTKA with good femoral condylar bone stock, we have shown excellent survivorship with a short-cemented femoral stem, in conjunction with a mobile-bearing and a tibial sleeve. This has the advantage of reducing the length of the revision construct of this complex surgery.

LEVEL OF EVIDENCE

Level IV.

Outcomes of single- and two-stage revision total knee arthroplasty for chronic periprosthetic joint infection : long-term outcomes of changing clinical practice in a specialist centre

AIMS

Single-stage revision total knee arthroplasty (rTKA) is gaining popularity in treating chronic periprosthetic joint infections (PJIs). We have introduced this approach to our clinical practice and sought to evaluate rates of reinfection and re-revision, along with predictors of failure of both single- and two-stage rTKA for chronic PJI.

METHODS

A retrospective comparative cohort study of all rTKAs for chronic PJI between 1 April 2003 and 31 December 2018 was undertaken using prospective databases. Patients with acute infections were excluded; rTKAs were classified as single-stage, stage 1, or stage 2 of two-stage revision. The primary outcome measure was failure to eradicate or recurrent infection. Variables evaluated for failure by regression analysis included age, BMI, American Society of Anesthesiologists grade, infecting organisms, and the presence of a sinus. Patient survivorship was also compared between the groups.

RESULTS

A total of 292 consecutive first-time rTKAs for chronic PJI were included: 82 single-stage (28.1%); and 210 two-stage (71.9%) revisions. The mean age was 71 years (27 to 90), with 165 females (57.4%), and a mean BMI of 30.9 kg/m² (20 to 53). Significantly more patients with a known infecting organism were in the single-stage group (93.9% vs 80.47%; p = 0.004). The infecting organism was identified preoperatively in 246 cases (84.2%). At a mean follow-up of 6.3 years (2.0 to 17.6), the failure rate was 6.1% in the single-stage, and 12% in the two-stage groups. All failures occurred within four years of treatment. The presence of a sinus was an independent risk factor for failure (odds ratio (OR) 4.97; 95% confidence interval (CI) 1.593 to 15.505; p = 0.006), as well as age > 80 years (OR 5.962; 95% CI 1.156 to 30.73; p = 0.033). The ten-year patient survivorship rate was 72% in the single-stage group compared with 70.5% in the two-stage group. This difference was not significant (p = 0.517).

CONCLUSION

Single-stage rTKA is an effective strategy with a high success rate comparable to two-stage approach in appropriately selected patients. Cite this article: Bone Joint J 2021;103-B(8):1373-1379.

Septic Revision Total Knee Arthroplasty Is Associated With Significantly Higher Mortality Than Aseptic Revisions: Long-Term Single-Center Study (1254 Patients)

BACKGROUND

The aim of this study is to examine the differences in long-term mortality rates between septic and aseptic revision total knee arthroplasty (rTKA) in a single specialist center over 17-year period.

METHODS

Retrospective consecutive study of all patients who underwent rTKA at our tertiary center between 2003 and 2019 was carried out. Revisions were classified as septic or aseptic. We identified patients' age, gender, American Society of Anesthesiologists grade, and body mass index. The primary outcome measure was all-cause mortality at 5 years, 10 years, and over the whole study period of 17 years. Death was identified through both local hospital electronic databases and linked data from the National Joint Registry/NHS Personal Demographic Service. Kaplan-Meier survival curves were used to estimate time to death.

RESULTS

In total, 1298 consecutive knee revisions were performed on 1254 patients (44 bilateral revisions) with 985 aseptic revisions in 945 patients (75.4%) and 313 septic revisions in 309 patients (24.6%). Average age was 70.6 years (range 27-95) with 720 females (57.4%). Septic revisions had higher mortality rates; patients' survivorship for septic vs aseptic revisions was 77.6% vs 89.5% at 5 years, 68.7% vs 80.2% at 10 years, and 66.1% vs 75.0% at 17 years; these differences were all statistically significant (P < .0001). The unadjusted 10-year risk ratio of death after septic revision was 1.59 (95% confidence interval 1.29-1.96) compared to aseptic revisions.

CONCLUSION

rTKA performed for infection is associated with significantly higher long-term mortality at all time points compared with aseptic revision surgery.

LEVEL OF EVIDENCE

Level IV.

Extensor mechanism failure in total knee arthroplasty

Extensor mechanism failure in total knee arthroplasty (TKA) can present as quadriceps tendon rupture, patella fracture or patella tendon rupture.Component malrotation, excessive joint line elevation and previous lateral release are some of the risk factors contributing to extensor mechanism failure in TKA.Partial quadriceps tendon rupture and undisplaced patella fracture with intact extensor mechanism function can be treated conservatively.Extensor mechanism failure in TKA with disruption of the extensor mechanism function should be treated operatively as it is associated with poor function and extensor lag.It is recommended that acute repair of patella or quadriceps tendon rupture are augmented due to the high risk of re-rupture.Chronic ruptures of the extensor mechanism must be reconstructed as repair has a high failure rate. Reconstruction can be performed using autograft, allograft or synthetic graft. Cite this article: EFORT Open Rev 2021;6:181-188. DOI: 10.1302/2058-5241.6.200119.

Distal Femoral Replacements for Acute Comminuted Periprosthetic Knee Fractures: Satisfactory Clinical Outcomes at Medium-Term Follow-up

Background

Fracture fixation techniques of comminuted periprosthetic distal femoral fractures have high risk of complications. The aim of this study was to evaluate short- to medium-term outcomes of comminuted periprosthetic distal femoral fractures treated with distal femoral replacements (DFR) at a tertiary arthroplasty unit.

Methods

Retrospective consecutive study of all patients who underwent DFR for periprosthetic fractures with minimum 2-year follow-up between 2010 and 2018. Clinical outcomes, surgical complications, revision for any cause, loosening, Knee Society Score and mortality data were collected at final follow-up.

Results

Thirty patients with average age 81 years (range, 65-90; 6 males and 24 females) were included. All had comminuted fractures (Rorabeck type-2/3). All patients had cemented DFRs. Three patients (10%) with multiple comorbidities died postoperatively. Average time from admission to being fit for discharge was 9 days (range, 3-14). Clinical outcomes and follow-up were available for 27 patients with a median follow-up duration of 4 years (2-13 years). Complication rate was 7.4% with one reoperation, change of polyethylene insert. None of the components have been revised to date. Average Knee Society Score at final follow-up was 78 (range, 57-92) with median arc of motion flexion-extension being 100° (range, 60°-125°).

Conclusions

In our experience, DFRs for comminuted periprosthetic fractures allow immediate mobilization and rehabilitation leading to satisfactory clinical outcomes with low complication rate for this challenging group of patients.

Level of evidence

level IV.

Influence of environmental factors on the detection of blood in sheep faeces using visible-near-infrared spectroscopy as a measure of Haemonchus contortus infection

BACKGROUND

Existing diagnostic methods for the parasitic gastrointestinal nematode, Haemonchus contortus, are time consuming and require specialised expertise, limiting their utility in the field. A practical, on-farm diagnostic tool could facilitate timely treatment decisions, thereby preventing losses in production and flock welfare. We previously demonstrated the ability of visible-near-infrared (Vis-NIR) spectroscopy to detect and quantify blood in sheep faeces with high accuracy. Here we report our investigation of whether variation in sheep type and environment affect the prediction accuracy of Vis-NIR spectroscopy in quantifying blood in faeces.

METHODS

Visible-NIR spectra were obtained from worm-free sheep faeces collected from different environments and sheep types in South Australia (SA) and New South Wales, Australia and spiked with various sheep blood concentrations. Spectra were analysed using principal component analysis (PCA), and calibration models were built around the haemoglobin (Hb) wavelength region (387-609 nm) using partial least squares regression. Models were used to predict Hb concentrations in spiked faeces from SA and naturally infected sheep faeces from Queensland (QLD). Samples from QLD were quantified using Hemastix® test strip and FAMACHA© diagnostic test scores.

RESULTS

Principal component analysis showed that location, class of sheep and pooled versus individual samples were factors affecting the Hb predictions. The models successfully differentiated 'healthy' SA samples from those requiring anthelmintic treatment with moderate to good prediction accuracy (sensitivity 57-94%, specificity 44-79%). The models were not predictive for blood in the naturally infected QLD samples, which may be due in part to variability of faecal background and blood chemistry between samples, or the difference in validation methods used for blood quantification. PCA of the QLD samples, however, identified a difference between samples containing high and low quantities of blood.

CONCLUSION

This study demonstrates the potential of Vis-NIR spectroscopy for estimating blood concentration in faeces from various types of sheep and environmental backgrounds. However, the calibration models developed here did not capture sufficient environmental variation to accurately predict Hb in faeces collected from environments different to those used in the calibration model. Consequently, it will be necessary to establish models that incorporate samples that are more representative of areas where H. contortus is endemic.

Metaphyseal Sleeves in Revision Total Knee Arthroplasty Provide Reliable Fixation and Excellent Medium to Long-Term Implant Survivorship

BACKGROUND

Addressing bone loss and securing implant fixation can be challenging in revision total knee arthroplasty (TKA). We present the results of a large series of revision TKAs using a metaphyseal sleeve.

METHODS

We retrospectively analyzed 319 revision TKAs with the use of a metaphyseal sleeve that had been followed up for at least 2 years, using a prospectively collected database. The mean follow-up was 91 months, and 73 patients were followed up for more than 10 years.

RESULTS

Implant survivorship was 99.1% at 3 years, 98.7% at 5 years, and 97.8% at 10 years. No metaphyseal sleeve was revised for aseptic loosening. Final radiographic review showed that there were radiolucent lines present in 2.8% of tibial sleeves and 2.7% of femoral sleeves; none of these had progressed and none were revised. About 3.7% of tibial sleeves subsided more than 1 mm compared with the immediate postoperative X-ray but all stabilized and none were revised.

CONCLUSION

Use of a metaphyseal sleeve in revision TKA is associated with excellent survivorship and radiographic outcome in the medium to long term.

A New Total Knee Arthroplasty Design Has Significantly Better Early Implant Survivorship than a Previous Gold-Standard Design-A Retrospective Analysis of 1,000 Cases

This study examined whether a new total knee arthroplasty (TKA) prosthesis improved implant survivorship and reoperation rates compared with a gold-standard, established TKA. A retrospective analysis of the first 500 consecutive new TKAs was compared with a consecutive series of the last 500 currently available TKAs performed by a single senior surgeon in one center. The primary outcome measure was revision of the femoral, tibial, or patellar component. A secondary outcome was reoperation for any reason. The new-TKA group had a significantly reduced revision rate at up to 5 years follow-up (p = 0.02). Reoperation rates for any reason were similar (p = 0.3). The new TKA design has a significantly better early revision rate compared with a currently available gold-standard TKA. This is the largest study of 1,000 cases comparing a new TKA design with a currently available design with excellent midterm results. It demonstrates very favorable early clinical results for the new TKA design, providing reassurance for patients, surgeons, and regulatory bodies.

Sagittal radius of curvature, trochlea design and ultracongruent insert in total knee arthroplasty

Multi radius (MR) total knee arthroplasty (TKA) has been associated with mid-flexion instability.

Single radius (SR) TKA may provide better anteroposterior stability through single flexion axis and biomechanical advantage for quadriceps function.

Medial pivot (MP) TKA and gradually reducing (GR) radius TKA produce better knee kinematics.

Clinical outcomes are equivalent for SR, MR and MP TKA.

Short-term studies have shown better clinical outcomes and kinematics for GR TKA.

Thinner and narrow anterior flange, deeper trochlea groove and more anatomical trochlea design reduces patellofemoral complications in TKA

Ultracongruent inserts provide comparable clinical outcomes to posterior-stabilized TKA and cruciate retaining TKA.

Cite this article: EFORT Open Rev 2019;4:519-524. DOI: 10.1302/2058-5241.4.180083

Horizontal transmission of Metarhizium anisopliae (Hypocreales: Clavicipitacea) and the effects of infection on oviposition rate in laboratory populations of Musca domestica (Diptera: Muscidae)

BACKGROUND

Effective control of house fly, Musca domestica (L.), populations currently relies on the use of chemical insecticides in most situations. Entomopathogenic fungi such as Metarhizium anisopliae (Metschn.) Sorokin may provide an alternative to chemicals and their efficacy may be enhanced by autodissemination amongst flies. This study assessed the capacity of M. anisopliae for transmission between adult M. domestica flies and the effects of infection on the fecundity of females.

RESULTS

Metarhizium anisopliae was transmitted between adult M. domestica with 91.67-100% mortality resulting across the three ratios of infected: non-infected flies tested (1:2, 1:5 and 1:10). The mean lethal time (LT₅₀ ) for female recipients mixed with infected male donor flies at the three ratios was 3.95, 4.79 and 5.65 days, respectively, whereas for male recipients mixed with infected female donors at the same ratios the LT₅₀ was 4.98, 5.98 and 7.44 days, respectively. Infection with M. anisopliae significantly reduced the reproductive capacity of female flies during the first 4 days of infection, with 25% fewer eggs oviposited by infected flies than by those that were uninfected.

CONCLUSION

Autodissemination among house flies and reduction in oviposition in the early stages of infection could contribute significantly to the effectiveness of M. anisopliae used in biocontrol programmes. © 2017 Society of Chemical Industry.

Prophylactic and therapeutic efficacy of Australian-registered insecticide formulations against Old World screwworm (Chrysomya bezziana) infestation

OBJECTIVE

To determine the prophylactic and therapeutic efficacy of Australian-registered insecticide formulations against Old World screwworm (OWS) myiases for potential use in screwworm containment and eradication programs.

METHODS

The longevity of protection provided by six insecticidal formulations (subcutaneous ivermectin, doramectin and abamectin, a topically applied aqueous formulation of spinosad, ivermectin controlled-release capsule and a dicyclanil spray-on formulation) was tested using implants of 1st-instar OWS larvae on Javanese thin-tail sheep. Therapeutic efficacy of four formulations (topical ivermectin, chlorfenvinphos/cypermethrin mixture, aerosol spinosad formulation and a formulation containing propetamphos and eucalyptus oil) was tested against 2- and 4-day-old OWS strikes.

RESULTS

Both the ivermectin capsule and dicyclanil spray-on formulation gave 100% protection against screwworm implants for the full 12 weeks of the study. Ivermectin, doramectin and abamectin administered SC all gave 100% protection at 3 days post-treatment, but at 2 weeks the protection had become incomplete. Spinosad dipping did not give complete protection at any time. All four therapeutic treatments gave complete resolution of 2-day-old strikes and topical ivermectin, spinosad and chlorfenvinphos/cypermethrin, but not the propetamphos/eucalyptus oil formulation, gave complete resolution of all 4-day-old strikes.

CONCLUSION

Dicyclanil spray-on and ivermectin capsule formulations, both registered for use in sheep, but not for cattle or other livestock species, gave much longer protection against screwworm implants than the currently recommended SC ivermectin. Pre-emptive action to facilitate rapid deployment of these formulations in the event of a screwworm incursion is urgently needed.

A comparison of lateral release rates in fixed- versus mobile-bearing total knee arthroplasty

Background

With increasing functional demands of patients undergoing total knee arthroplasty, mobile-bearing (MB) implants were developed in an attempt to increase the functional outcome of such patients. In theory, with MB implants, the self-alignment should reduce the rate of lateral release of the patella, which is usually performed to optimise patellofemoral mechanics. This study reports on the lateral release rates for the P.F.C. Sigma® MB posterior-stabilised total knee replacement (TKR) implant compared with its fixed-bearing (FB) equivalent.

Materials and methods

A total of 352 patients undergoing TKR were randomly allocated to receive either MB (176 knees) or FB (176 knees) posterior-stabilised TKR. Further sub-randomisation into patellar resurfacing or retention was performed for both designs. The need for lateral patellar release was assessed during surgery using a ‘no thumb technique’, and after releasing the tourniquet if indicated.

Results

The lateral release rate was the same for FB (10 %) and MB implants (10 %) (p = 0.9). However, patellar resurfacing resulted in lower lateral release rates when compared to patellar retention (6 vs 14 %; p = 0.0179) especially in MB implants (3 %).

Conclusions

It has been previously reported that alterations to the design of the P.F.C. system with a more anatomical trochlea in the femoral component improved patellar tracking. The addition of a rotating platform tibial component to the P.F.C. Sigma system has, on its own, had no impact on the lateral release rate in this study. Optimising patellar geometry by patellar resurfacing appears more important than tibial-bearing design. Although MB implants appear to reduce the need for lateral release in the P.F.C. Sigma Rotating Platform, this only occurs when the patellar geometry has been optimised with patellar resurfacing.

Level of evidence

Level 2.

Control of the sheep blowfly in Australia and New Zealand--are we there yet?

The last 50 years of research into infections in Australia and New Zealand caused by larvae of the sheep blowfly, Lucilia cuprina, have significantly advanced our understanding of this blowfly and its primary host, the sheep. However, apart from some highly effective drugs it could be argued that no new control methodologies have resulted. This review addresses the major areas of sheep blowfly research over this period describing the significant outcomes and analyses, and what is still required to produce new commercial control technologies. The use of drugs against this fly species has been very successful but resistance has developed to almost all current compounds. Integrated pest management is becoming basic to control, especially in the absence of mulesing, and has clearly benefited from computer-aided technologies. Biological control has more challenges but natural and perhaps transformed biopesticides offer possibilities for the future. Experimental vaccines have been developed but require further analysis of antigens and formulations to boost protection. Genetic technologies may provide potential for long-term control through more rapid indirect selection of sheep less prone to flystrike. Finally in the future, genetic analysis of the fly may allow suppression and perhaps eradication of blowfly populations or identification of new and more viable targets for drug and vaccine intervention. Clearly all these areas of research offer potential new controls but commercial development is perhaps inhibited by the success of current chemical insecticides and certainly requires a significant additional injection of resources.

A prospective randomised study comparing rotating platform and fixed bearing total knee arthroplasty in a cruciate substituting design--outcomes at two year follow-up

BACKGROUND

Fixed bearing (FB) total knee replacement is a well established technique against which new techniques must be compared. Mobile bearing (MB) prostheses, in theory, reduce polyethylene wear but the literature is yet to provide evidence that they are superior in terms of function or long-term survivorship. In addition there has been no comparison of patella resurfacing on the outcome of either design. The aims of this randomised prospective study were firstly to determine whether a mobile bearing prosthesis produced better clinical outcome and range of motion at two year follow-up and secondly to assess the effect of patella resurfacing on the outcomes of both types of bearing design.

METHODS

Three hundred fifty-two patients were randomised into receiving either a PFC Sigma© cruciate sacrificing total knee arthroplasty either with a mobile bearing or a fixed bearing, with a sub-randomisation to either patella resurfacing or patella retention. All patients participated with standard clinical outcome measures and had their range of motion measured both pre-operatively and at follow-up.

RESULTS

The mobile bearing TKR design had no impact on range of motion; Oxford Knee Score and American Knee Society knee and function scores when compared to its fixed bearing equivalent.

CONCLUSIONS

At two year follow-up there was no difference between the PFC Sigma© fixed and mobile bearing designs. With no clinical difference between the cohorts, we cannot recommend one design over the other. Long term benefits, particularly with regards to polyethylene wear, may yet be demonstrated. Level of evidence--1B.

Mechanism of resistance to synthetic pyrethroids in buffalo flies in south-east Queensland

Resistance to synthetic pyrethroids (SP) was first recorded in buffalo flies in Australia in 1980, associated with previous use of DDT and fenvalerate. By the 1990s, resistance was widespread. Resistance to SP in the related horn fly of the Americas is associated with kdr and super-kdr mutations in a gene encoding for a voltage-gated sodium channel. We describe 7-20-fold resistance to SP in buffalo flies from south-east Queensland, present evidence of flies that are heterozygous resistant at the kdr locus and show an increase in the frequency of the resistant allele 1 month after treatment of cattle with SP.

In vitro infection of sheep lice (Bovicola ovis Schrank) by Steinernematid and Heterorhabditid nematodes

Control of sheep lice with conventional pesticides can be compromised by difficulty in contacting lice in the dense water repellent fleeces of sheep, particularly when sheep have not been recently shorn. Entomopathogenic nematodes (ENs) are motile and are able to actively seek out insect hosts. They have particular advantages for the control of pests in cryptic habitats, such as the fleeces of sheep and avoid many of the problems frequently associated with chemical controls. This study investigated whether ENs were able infect and kill Bovicola ovis and compared the effectiveness of different species at different temperatures and when applied to wool. Four species of nematodes, Steinernema carpocapsae, Steinernema riobrave, Steinernema feltiae and Heterorhabditis bacteriophora were tested. All were shown to infect and kill lice in Petri dish assays at 30°C. At 35°C, the percent infection for S. carpocapsae and S. riobrave was significantly higher than for the other two species and percent infection by S. feltiae was significantly greater than for H. bacteriophora (P<0.05). At 37°C the percent mortality induced by S. riobrave was significantly greater than for S. carpocapsae (P<0.05). All species were able to locate and infect lice in wool when formulated in water with 8% Tween 80. In wool assays the percent lice infected with nematodes was significantly greater for S. riobrave than H. bacteriophora at 25°C, but there were no other differences between species (P=0.05). S. carpocapsae, S. riobrave and S. feltiae caused significantly higher lice mortality than H. bacteriophora at both 25 and 35°C in wool assays, but mortality induced by the three steinernematid species did not differ significantly (P>0.05). It is concluded that of the ENs studied S. riobrave is likely to be most effective against B. ovis when applied to live sheep because of its greater tolerance to high temperatures and 'cruiser' foraging strategy.

Issues and advances in the integrated control of sheep lice

Ongoing pressure to minimise costs of production, growing markets for low residue and organic wool and meat, resistance to chemicals in louse populations, and the deregistration of diazinon for dipping and jetting have contributed to a move away from routine annual application of lousicides to more integrated approaches to controlling lice. Advances including improved methods for monitoring and detection of lice, an expanded range of louse control products and the availability of a web-accessible suite of decision support tools for wool growers (LiceBoss™) will aid this transition. Possibilities for the future include an on-farm detection test and non-chemical control methods. The design and extension of well-constructed resistance management programs to preserve the effectiveness of recently available new product groups should be a priority.

Detection of cutaneous myiasis in sheep using an 'electronic nose'

Cutaneous myiasis (flystrike), in Australia caused primarily by Lucilia cuprina [Diptera: Calliphoridae], is a debilitating, painful and potentially lethal disease of sheep. Early detection of flystrike is difficult and continual flock surveillance is required to enable timely treatment of struck sheep. Electronic nose technology offers the potential for early and automated detection of flystrike. An electronic nose consisting of six metal oxide semiconductor sensors and temperature and humidity sensors was used to measure odours collected by dynamic headspace sampling during flystrike development in four experiments and from urine- and faeces-stained fleece in one experiment. Non-linear signal measurement techniques and linear discriminant analysis (LDA) were used to extract signal features and process those features for analysis of categorical separation of odour groups. The results from LDA indicated that the electronic nose accurately distinguished flystrike odour on days 1, 2 and 3 of development from that of dry wool in all experiments (P<0.05). The electronic nose was also able to discriminate flystrike odour on the day of larval implantation (day 0) in three of the four studies. In the experiment with urine- and faeces-stained wool, these odours were accurately distinguished from both dry wool and flystrike (P<0.05). This study provides proof-of-concept for the detection of flystrike using electronic nose technology. Practical methods for collection of odour in the field and suitable detection algorithms will be required for development to commercial application.

Strategic use of crutching and dicyclanil to protect unmulesed sheep against breech strike

OBJECTIVE

To test strategies for the application of dicyclanil and mid-season crutching to maximise protection of unmulesed sheep against breech strike.

PROCEDURE

Three hundred and eighty unmulesed Merino weaners were randomly allocated to four groups either left untreated or treated by different strategies with 50 g/L dicyclanil. Treatments included breech treatment alone and breech plus body treatment, with two application times, immediately after shearing and 6 weeks after crutching or shearing. To assess protection, larval implants with newly hatched Lucilia cuprina larvae were applied to 10 different sheep from each group at 3, 4, 5 and 6 months after crutching and shearing and assessed for the development of strike at 48 hours. The concentration of dicyclanil was measured in wool samples clipped from the breeches of the test sheep.

RESULTS

All dicyclanil treatments gave significant reduction in strike in comparison to controls up until 4 months after crutching but protection in the sheep treated immediately after shearing had waned at 5 months. Treating at 6 weeks after crutching provided significant reduction (P < 0.05) in strike for 6 months. Results for strike incidence immediately after shearing and concentration of dicyclanil in the breech wool also suggested improvements in protection by delaying treatment for 6 weeks.

CONCLUSION

In most environments it should be possible to protect unmulesed sheep against breech strike with a carefully planned integrated control program incorporating strategically timed crutching, shearing and dicyclanil application. Delaying treatment with dicyclanil to at least 6 weeks after shearing or crutching increased the protection provided in comparison to treatment immediately after shearing.

Resistance to insect growth regulator insecticides in populations of sheep lice as assessed by a moulting disruption assay

Low-volume, backline applications with the benzoylphenyl urea insecticides triflumuron and diflubenzuron represent in excess of 70% of treatments for the control of sheep lice, Bovicola ovis (Schrank) (Phthiraptera: Trichodectidae), in Australia. Reports of reduced effectiveness from 2003 and subsequent controlled treatment trials suggested the emergence of resistance to these compounds in B. ovis populations. A laboratory assay based on the measurement of moulting success in nymphs was developed and used to assess susceptibility to diflubenzuron and triflumuron in louse populations collected from sheep where a control failure had occurred. These tests confirmed the development of resistance to triflumuron and diflubenzuron in at least two instances, with estimated resistance ratios of 67-94X at LC(50).

Temporal relationship between infestation with lice (Bovicola ovis Schrank) and the development of pruritic behaviour and fleece derangement in sheep

Pruritic behaviour and deranged fleece are often used as indicators of sheep louse infestation but the exact relationship between infestation and the observation of signs of pruritus was unclear. Two studies were conducted to examine this association. In the first, 24 castrate Merino sheep were randomly assigned to six pens in groups of four and the sheep in three pens infested with 10 lice each on the right mid-side. Louse numbers were counted, fleece derangement scored and pruritic behaviour assessed periodically on each sheep until 38 weeks after infestation. In the second study a single moderately infested sheep was paddocked for 15 weeks with 32 uninfested sheep and louse numbers and fleece derangement monitored for 41 weeks. In the pen studies, differences between infested and non-infested sheep in fleece derangement and pruritic behaviour first became significant (p<0.05) at 8 and 14 weeks, respectively and at louse densities of 0.06 and 0.27 per 10 cm wool part. Some sheep showed definite signs of deranged fleece as early as 5 weeks after initial infestation. In the paddock studies, it took 37 weeks until lice were detected on all sheep in the flock. The correlation between louse numbers and fleece derangement score first became significant (r=0.44 and p<0.05) at 9 weeks after introduction of the lousy sheep, reached a maximum of r=0.79 (p<0.001) at 22 weeks when 84% of sheep had lice detected and the mean louse density was 0.29 per part, and then declined to r=0.12 (n.s.) at 41 weeks when all sheep were infested and the mean louse density was 3.04 per part. It is concluded that fleece derangement is a powerful early indicator of the presence of lice and that sheep may exhibit signs of pruritus well before lice can be readily found by direct inspection. Fleece derangement may be useful as a basis for establishing economic thresholds for the application of long wool treatments in developing louse infestations but appears to be a poor indicator of louse numbers once the infestation is advanced.

Sexually stimulated testosterone release in male mice (Mus musculus): roles of genotype and sexual arousal

In virtually every mammalian species examined, some males exhibit reflexive testosterone release upon encountering a novel female (or female-related stimulus). At the same time, not every individual male (or every published study) provides evidence for reflexive testosterone release. Four experiments using house mice (Mus musculus) examined the hypothesis that both the male's genotype and his degree of sexual arousal (as indexed by ultrasonic mating calls) are related to such variability. In Experiment 1, CF-1 males exhibited reflexive testosterone elevations 30 min after encountering female urine. CK males, on the other hand, did not exhibit testosterone elevations 20, 30, 50, 60, or 80 min after encountering female urine (Experiments 1 and 2) suggesting this strain incapable of reflexive release. In Experiment 3, we measured both mating calls and reflexive testosterone release in response to female urine in CF-1 and CK males. Most males of both strains called vigorously to female urine but not to water. But, only CF-1 males exhibited significant testosterone elevations to female urine. In Experiment 4, DBA/2J males called vigorously to females followed by testosterone elevations 30 min later. The first 3 experiments support the hypothesis that male genotype is an important variable underlying mammalian reflexive testosterone release. Statistically significant correlations between mating calls in the first minute after stimulus exposure and testosterone elevations 30 min later (Experiments 3 and 4) support the hypothesis that, in capable males, reflexive testosterone release is related to the male's initial sexual arousal.

The prevalence of lice on sheep and control practices in South Australia

OBJECTIVE

To assess the prevalence of infestations of lice in sheep flocks and to survey control practices for lice in South Australia

DESIGN

A total of 201 managers of sheep flocks, 75 chosen randomly from the high rainfall zone (HR), 76 from the cereal sheep zone (CS) and 50 from the pastoral zone (PA), were surveyed by telephone interview.

PROCEDURE

Interviews were conducted between May 19 and May 25, 1999, according to a set questionnaire. Information was collected on presence of lice at last shearing, control practices for lice, factors important for gaining good effect from chemical treatments, sources of information on control practices and property details. Survey results were analysed by agricultural region.

RESULTS

The apparent state prevalence of flocks infested with lice was 21%, with 13% infested in the HR, 21% in the CS and 25% in the PA. Ninety one percent of managers claimed to take precautions to prevent the introduction of lice and 91% routinely checked their flocks for lice. Seventy eight percent treated their sheep for lice annually and 85% had treated within the last 12 months. Of those treating in the last year, 69% had used a backline application, 16% had used a shower dip and 17% had used plunge dipping. Only 4% of producers used a long wool treatment. Synthetic pyrethroid (SP) based products were used by 50% of producers who used backline treatments in the preceding 12 months, compared to 42% and 8% for insect growth regulator and organophosphorous (OP) based products, respectively. Only 34% of managers identified SP-based products as having potential resistance problems. Of those producers who used shower or plunge dips in the last 12 months, 75% used an OP based product. Rural newspapers and magazines were by far the most commonly noted source of information for the control of lice on sheep.

Testosterone rapidly reduces anxiety in male house mice (Mus musculus)

Eight experiments supported the hypotheses that reflexive testosterone release by male mice during sexual encounters reduces male anxiety (operationally defined in terms of behavior on an elevated plus-maze) and that this anxiolysis is mediated by the conversion of testosterone to neurosteroids that interact with GABA(A) receptors. In Experiment 1, a 10-min exposure to opposite-sex conspecifics significantly reduced both male and female anxiety 20 min later (as indexed by increased open-arm time on an elevated plus-maze) compared to control mice not receiving this exposure. In contrast, locomotor activity (as indexed by enclosed-arm entries on the elevated plus-maze) was not significantly affected. The remaining experiments examined only male behavior. In Experiment 2, exposure to female urine alone was anxiolytic while locomotor activity was not significantly affected. Thus, urinary pheromones of female mice likely initiated the events leading to the male anxiolysis. In phase 1 of Experiment 3, sc injections of 500 microg of testosterone significantly reduced anxiety 30 min later while locomotor activity was not significantly affected. Thus, testosterone elevations were associated with reduced male anxiety and the time course consistent with a nongenomic, or very rapid genomic, mechanism of testosterone action. In phase 2 of Experiment 3, the anxiolytic effect of testosterone was dose dependent with a 250 microg sc injection required. Thus, testosterone levels likely must be well above baseline levels (i.e., in the range induced by pulsatile release) in order to induce anxiolysis. In Experiment 4, a high dosage of 5alpha-dihydrotestosterone was more anxiolytic than a high dosage of estradiol benzoate, suggesting that testosterone action may require 5alpha-reduction. In Experiments 5 and 6, 3alpha,5alpha-reduced neurosteroid metabolites of testosterone (androsterone and 3alpha-androstandione) were both anxiolytic at a lower dosage (100 microg/sc injection) than testosterone, supporting the notion that testosterone is converted into neurosteroid metabolites for anxiolytic activity. Experiments 7 and 8 found that either picrotoxin or bicucculine, noncompetitive and competitive antagonists of the GABA(A) receptor, respectively, blocked the anxiolytic effects of testosterone. However, conclusions from these 2 experiments must be tempered by the reduction in locomotor activity that was also seen. The possible brain locations of testosterone action as well as the possible adaptive significance of this anxiolytic response are discussed.

Testosterone rapidly affects the expression of copulatory behavior in house mice (Mus musculus)

Male mammals reflexively release an endogenous pulse of testosterone in response to either a female or her urinary pheromones. Two experiments examined the hypothesis that such pulses have quick-acting effects upon the expression of reproductive behavior in male house mice. In Experiment 1, 30 min after exposure to female urine, males exhibited significantly reduced latency to mount a receptive female (when they should have been expressing an endogenous testosterone pulse). In Experiment 2, gonadally intact males received a simulated testosterone pulse via a subcutaneous injection of 500 microg of testosterone propionate. At 60 min after injection, males mounted a receptive female significantly more quickly than if they had not received such an injection. These experiments provide evidence that elevations in testosterone titers above baseline can, under certain conditions, rapidly alter the expression of male-typical behaviors.

Variation among Merino sheep in susceptibilty to lice (Bovicola ovis) and association with susceptibility to trichostrongylid gastrointestinal parasites

Sheep of two bloodlines of Merino were artificially infested with equal numbers of lice (Bovicola ovis) and the resulting louse populations were monitored over the following 20 months. The sheep were shorn 6 and 17 months after infestation and, for analysis, the louse counts considered in 3 years separated by shearings. Nematode faecal egg counts (FECs) were assessed on faecal samples collected on five occasions, three times following natural challenge and twice after artificial challenge with 40,000 trichostrongyloid larvae (84% Trichostrongylus vitrinus). In addition, blood samples were collected and measured for B. ovis-specific immunoglobulins (predominantly IgG), B. ovis-specific IgE and serum total IgE. Bloodlines differed significantly in the size of louse populations at the end of year 2, FEC after both natural and artificial challenge and in serum levels of all three antibodies (p<0.05). There were also large variations in louse counts and FEC among sheep within bloodlines. Louse counts at inspections after louse populations had been allowed to build up were highly repeatable, both between and within years. However, correlations with counts at inspections soon after initial infestation and following shearing were lower. FEC after natural challenge was correlated with louse counts in year 2 (r=0.45, p<0.01) and year 3 (r=0.38, p<0.05), but the correlation with counts in year 1 was not significant (r=0.25, p>0.05). FEC following artificial challenge was significantly correlated with louse counts in year 3 (r=0.36, p<0.05), but not in year 2 (r=0.25, p>0.05) or year 1 (r=0.04, p>0.05). Louse counts in the 3 years were significantly correlated with anti-B. ovis antibody concentration (r=0.60, 0.48, 0.36), but not with levels of either anti-B. ovis or total serum IgE. These results suggest that sheep with greater resistance to gastrointestinal parasites also tend to be less susceptible to lice. Whether this is due to interaction of the effects of the parasites or to correlation in underlying resistance mechanisms requires clarification.

Sensitivity of two-stage sampling to detect sheep biting lice (Bovicola ovis) in infested flocks

The sampling distribution of Bovicola ovis (Schrank) on sheep was examined in two flocks, one with a light and one with a heavy infestation of lice. The derived distributions were used to calculate the sensitivity of detecting lice on individual sheep and in flocks by fleece parting regimes that varied in number of parts per animal and number of sheep per flock, different scenarios of flock sizes, proportion infested and louse density were examined. Lice were aggregated among fleece partings in the heavily infested flock and described by a negative binomial distribution with k values between 0.3 and 1.92. The distribution was indistinguishable from Poisson in the lightly infested flock. The assumed distribution had little effect on sensitivity, except when only one fleece part per animal was examined. On individual sheep where louse density was 0.5 per 10 cm part or greater, there were only marginal gains from inspecting more than 10 parts per animal. Increasing the number of sheep inspected always increased sensitivity more than increasing number of parts per sheep by an equivalent amount. This advantage was greatest in situations where a low proportion of sheep in the flock were infested with a high density of lice, and less where a low proportion of sheep were infested with a low density of lice, or a high proportion of sheep were infested with a high density of lice.

Survival away from sheep and alternative methods of transmission of sheep lice (Bovicola ovis)

Transmission of sheep lice is thought to occur mainly by sheep to sheep contact although the possibility of other sources of infestation is often suggested. This study investigated the period of survival of Bovicola ovis after removal from sheep under varying conditions and assessed the likelihood of new infestations arising from contaminated facilities, wool caught on fences and shearers' footwear. In laboratory studies with lice held away from sheep at 4, 20, 25 and 36.5 degrees C, adults and nymphs survived longest at 25 degrees C (LT90 of 11.7 and 24.1 days for adults and large nymphs, respectively). Nymphs survived longer than adults and lice provided with raw wool survived longer than lice provided with wool that had been degreased. Nymphal lice survived for up to 29 days on unscoured wool at 36.5 degrees C, but the LT50 was less than 9 days in most experiments. In shearing sheds in winter and early spring lice survived for up to 14 and 16 days, respectively. These periods of survival are considerably longer than previously indicated for B. ovis. Most lice dropped out of wool staples attached to a fence within 1 h and only two of a total of 225 lice were still present after 24 h, suggesting that sheep are unlikely to become infested from wool caught on fences. Adult and nymphal lice readily transferred to shearers' moccasins and survived there for up to 10 days, indicating that transmission of lice on the footwear of shearers or other sheep handlers may be a cause of new infestations. Microwaving each moccasin for 5 min killed all lice and may provide a simple method of reducing the likelihood of transmission of B. ovis between properties.

Modeling of cylindrically tapered cantilevers for transverse dynamic force microscopy (TDFM)

In transverse dynamic force microscopy a cylindrically tapered cantilever is mounted perpendicularly to the sample surface and set into transversal oscillation. The dynamics of the cantilever has been studied using the continuum mechanical model with discrete element analysis. A viscoelastic model has been used to describe the tip-sample interaction. In this way an in-phase and an out-of-phase component of the force has been extracted from the experimental data. Two different techniques, involving two experimental setups and two corresponding data analysis routines, have been developed to calculate the two components of the force at different tip-sample separations. In one case the change in resonant frequency and corresponding oscillation amplitude is measured whereas in the second case the usual way of recording amplitude and phase signal at a fixed driving frequency is applied. The results from these two methods are shown to be completely consistent and produce almost identical force curves.

Establishing maintenance intervals based on measurement reliability of engineering endpoints

Methods developed by the metrological community and principles used by the research community were integrated to provide a basis for a periodic maintenance interval analysis system. Engineering endpoints are used as measurement attributes on which to base two primary quality indicators: accuracy and reliability. Also key to establishing appropriate maintenance intervals is the ability to recognize two primary failure modes: random failure and time-related failure. The primary objective of the maintenance program is to avert predictable and preventable device failure, and understanding time-related failures enables service personnel to set intervals accordingly.

Aggressive aneurysmal bone cyst of the proximal humerus. A case report

The case of an 11-year-old girl with a rapidly expanding, massive lesion in the right proximal humerus is reported. After biopsy, surgical treatment of the aneurysmal bone cyst consisted of aggressive intralesional resection with autogenous tibial strut grafting for reconstruction. After followup of 17 years with no recurrence of disease, there is excellent graft incorporation and remodeling and excellent function of the shoulder.

Do sheep regulate the size of their mallophagan louse populations?

Alternatives to chemicals for controlling parasites are required to minimise problems from resistance, residues in animal products and occupational exposure. Utilisation of host response to parasites through selection of resistant types or vaccination is an appealing option. To date most studies have been with haematophagous or invasive parasites which directly contact elements of the host immune system. Sheep lice (Bovicola ovis) feed superficially on the skin of sheep ingesting lipid, scurf, bacteria and loose stratum corneum squames. Evidence is presented that despite their surface feeding habit Bovicola ovis stimulate an immune response in sheep and that this response may play a part in regulating the size of louse populations.

Spatial distribution and spread of sheep biting lice, Bovicola ovis, from point infestations

The spatial distribution of chewing lice (Bovicola ovis) on their hosts was examined in Polypay and Columbia ewes initially artificially infested on the midside or the neck. Densities of lice were determined at 69 body sites in eight body regions at approximately monthly intervals for 2 years. In the second year, half of the ewes were mated and lice were counted at 26 body sites on the resulting lambs. Polypay ewes had higher densities of lice than Columbias at most inspections but there was little effect of infestation point or mating on either numbers or the distribution of lice. During periods of high louse numbers densities were generally greatest on the sides or the back. Densities on the head were also high at times and peaked later than overall louse densities. Shearing markedly reduced density but increased the proportion of lice found on the neck, belly and lowleg sites. The distribution of lice on the lambs was similar to that on the ewes except that fewer lice were found on the head. Comparisons of lice per part with the numbers of lice extracted from clipped patches indicated that a sheep with wool bearing area of 1 m2 and a mean count of one louse per 10 cm fleece parting carried approximately 2000 lice. At most times of the year inspections for sheep lice should be concentrated on the sides and back, but in recently shorn sheep greater attention should be paid to the lower neck and ventral regions. Implications of the observed distributions of lice for the efficacy of chemical treatments are discussed.

Equipment management risk rating system based on engineering endpoints

The equipment management risk ratings system outlined here offers two significant departures from current practice: risk classifications are based on intrinsic device risks, and the risk rating system is based on engineering endpoints. Intrinsic device risks are categorized as physical, clinical and technical, and these flow from the incoming equipment assessment process. Engineering risk management is based on verification of engineering endpoints such as clinical measurements or energy delivery. This practice eliminates the ambiguity associated with ranking risk in terms of physiologic and higher-level outcome endpoints such as no significant hazards, low significance, injury, or mortality.

Serum and skin surface antibodies and their associations with sheep biting lice, Bovicola ovis, on experimentally infested sheep

The sheep biting louse (Bovicola ovis) feeds superficially on the skin of sheep but appears to stimulate an immune response. In this study we examined the association between louse infestation and serum and skin surface antibodies. Louse numbers were monitored on experimentally infested Polypay and Columbia ewes for two years and on their lambs in the second year. Serum and skin wash samples were tested for antibodies to soluble extracts of B. ovis, Stomoxys calcitrans and Musca autumnalis by enzyme linked immunosorbent assay (ELISA). In addition, the effects of skin wash extracts on B. ovis were examined in vitro. The titre of anti-B. ovis antibodies in the serum did not differ significantly between infested and naive ewes. However, there was an increase in serum antibody titre which coincided with periods of high louse density in ewes with high louse counts. Infested lambs had higher serum antibody levels than naive lambs. Substantial cross reactivity was evident among extracts of the different insects. Densities of lice on the ewes during population decline were negatively related to the titre of skin surface antibodies. Skin washings collected from sheep during B. ovis population decline reduced the number of louse progeny when incorporated into louse diet. These results indicate that B. ovis stimulates an immune response in sheep and suggest that compounds on the skin surface may play a role in the regulation of louse populations.

Médecine à la Molière

Of Moliere's thirty six plays, seven deal, to a greater or lesser extent, with medicine; the medicine as practiced in Paris during the reign of Louis XIV. In these days, Moliere satirises the recalcitrant conservatism of the Paris medical faculty. It is, however, an informed satirisation. This paper explores Moliere's motives and attempts to place Moliere's medical plays against a broad canvas of his other works. The ultimate purpose is to assess to what extent Moliere's philosophical persuasions and how he balanced them against the needs of contemporary, commercial theatre.

Pruritus and dermal response to insect antigens in sheep infested with Bovicola ovis

This study examined the relationships among louse density, pruritus and dermal response to insect antigens in sheep infested with Bovicola ovis. Polypay and Columbia ewes were allocated to two groups, infested and naive, and louse densities and pruritus were monitored for 15 months. Ten months after the initial infestation, all sheep were tested for hypersensitivity on the midside and ears by intradermal injection of soluble extracts of B. ovis, Stomoxys calcitrans and Musca autumnalis. The areas of skin reactions were measured at 20 min, 1, 3 and 24 h after injection and skin thickness was measured at 24 h. Louse densities on Polypays were approximately 10 times greater than on Columbias, and pruritus was correlated with louse numbers at most inspections. Most pruritic behaviour was directed to the sides of infested sheep. Wheal and flare reactions developed rapidly to all extracts in both infested and naive ewes. Reactions to louse extract were larger in infested than naive sheep at all four times after injection. In the infested Polypays, reactions to louse extract were greater than to the fly extracts, but in naive sheep there was little difference among extracts. Reactions in naive Columbias were larger than in naive Polypays at 20 min, 1 and 3 h, but had almost completely abated in both groups at 24 h. Reactions in infested Columbias were greater than in infested Polypays at 20 min, but at 24 h reactions in the Polypays were larger. Louse numbers and pruritus were correlated with wheal areas and skin thickness at 24 h, but there was little relationship with the size of reactions at earlier times. These findings are consistent with the development of a hypersensitive response to B. ovis and suggest that dermal reactions to lice may influence sheep susceptibility.

Seasonal dynamics and variation among sheep in densities of the sheep biting louse, Bovicola ovis

Cyclic patterns and variations among sheep in numbers of Bovicola ovis are described in Polypay and Columbia ewes that were initially infested with equal numbers of lice and penned indoors continuously for 2 years. Bovicola ovis populations were censused at 3-4-week intervals at 69 body sites on each animal. In the second year of the study, the ewes were reinfested and half were mated. Louse populations were monitored on the resulting lambs from birth until 25 weeks of age. Strong seasonal cycles in louse numbers were observed on the ewes, with peaks in spring and troughs in summer. These cycles occurred in the absence of shearing, direct solar radiation or rainfall. Populations began to decline when daily mean and maximum temperatures were 11.5 degrees C and 15 degrees C, respectively, well below temperatures thought to cause warm season decline. Louse densities on Polypay ewes were approximately 10 times higher than on Columbias at most inspections. There were also large differences among sheep within breeds and sheep counts were highly correlated among dates, both within and between years. One third of the ewes failed to become infested despite having lice applied on five separate occasions and being penned together with other infested sheep. Pregnancy and lactation did not significantly affect louse numbers on the ewes. There was a significant negative correlation between louse counts and weight gains in the lambs, and lamb counts were significantly correlated with those of their dams up until, but not after, weaning. It is suggested that sheep may exert regulatory influences on lice which contribute to cycles in B. ovis populations.