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Purpose: Since Kellgren and Lawrence (KL) originally classified knee osteoarthritis, several authors have reported varying levels of reliability and a lack of uniformity in the use of this classification system. We propose several modifications to the KL classification including the use of a compartment-specific approach that we hypothesize will lead to a better understanding of knee OA while maintaining an adequate interobserver and intraobserver reliability., Methods: We propose the addition of the lateral and skyline-view radiographs to the standard anteroposterior (AP) and lateral projections in the evaluation. Also suggest a more precise definition of the evaluated parameters; the addition of the subchondral cancellous bone as parameter of evaluation; and the assessment of medial tibiofemoral compartment (MTFC), lateral tibiofemoral compartment (LTFC) and patellofemoral compartment (PFC) separately resulting in a compartment-specific KL staging score rather than a single overall KL score. Six evaluators (two knee surgeons, two radiologists and two knee fellows) used the modified KL classification to classify 230 randomly selected knees on two separate occasions. Reliabilities were assessed by calculating Krippendorff's ⍺ coefficients., Results: Two hundred and ten knees were included for final evaluation and analyses (53% left knees; 65% females; mean age 56 years old). Average interobserver reliability was moderate for all compartments (0.51 for the MTFC; 0.51 for the LTFC; and 0.56 for the PFC). Average intraobserver reliability was substantial for all compartments (0.63 for the MTFC; 0.65 for the LTFC; and 0.7 for the PFC). Experienced evaluators showed a higher intraobserver reliability than less-experienced evaluators., Conclusions: A modified compartment-specific KL classification enables a practical and detailed description of knee OA involvement and demonstrates acceptable interobserver and intraobserver reliability. Level of Evidence: Level III., Competing Interests: Each author certifies that he has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article., (© 2024 The Author(s). Journal of Experimental Orthopaedics published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

SARS-CoV-2 infection often results in a more severe COVID-19 disease course in multiple myeloma (MM) patients compared to immunocompetent individuals. The aim of this report is to summarize the clinical features of the MM patients with COVID-19 and the impact of MM treatment on outcomes to guide risk stratification and ensure the appropriate management of the patients. Serological responses in MM patients post-infection or -vaccination are also reviewed to better understand the strategy of prevention. Along with reports from the literature, we presented findings from a retrospective analysis of the clinical characteristics and outcomes of COVID-19 infection in MM patients in our institution. Study population includes 34 MM patients with a median age of 61 (range: 35-82 years) who tested positive for SARS-CoV-2 between 1 March 2020-15 August 2021. We examined the effect of chemotherapy, the benefit of neutralizing monoclonal antibody (Bamlanivimab) and the impact of anti-CD38 antibody (daratumumab) on the hospitalization and mortality of the patients, as well as the efficacy of native antibody production. Our results showed that MM patients have increased hospitalization and mortality rates from COVID-19 compared with that of general population, especially those on active chemotherapy. Advanced age, high-risk myeloma, renal disease, and suboptimal disease control are independent predictors of adverse outcomes. The use of daratumumab does not increase the disease severity/hospitalization or the post-infection/vaccination seropositivity of SARS-CoV-2. The neutralizing antibody decreases overall mortality. Evidence from the current study and previous publications suggest that testing of neutralizing antibody post-SARS-CoV-2 vaccination in MM patients may be needed in reducing COVID-19 risk.

Background: One of the most critical points in the planning of hip replacement surgeries is the selection of the implant, since its survival significantly impacts the patients health. However, the ideal survival time that an implant must prove to be selected has not been defined. The objective of this consensus is to define minimum performance standards for the selection of conventional primary hip replacement prosthesis., Material and Methods: The consensus was carried out using the methodology of nominal group. This included: 1. A review of the available evidence and the issues to be evaluated, 2. Meeting for the vote and discussion, 3. Quantitative statistical analysis with median (M) and interquartile range (IQR) and qualitative one with proportions of the results to generate recommendations., Results: The primary source of information for prosthesis selection (M: 8; IQR: 7-9), choice in the event of conflicting evidence (M: 8; IQR: 7-9), or limited evidence in the literature (M: 7; IQR: 4.75-825) should be national registries. The minimum acceptable follow-up is 10 years (M: 9; IQR: 8-9) and the minimum acceptable survival is 90% at 10 years (M: 8; IQR: 5-8.5)., Discussion: According to these results, the consensus of experts proposed that the selection of the implant for conventional primary hip replacement must be based on the information published in the national registries and that the prosthesis must have a minimum follow-up of 10 years and show a minimum survival of 90%.

Introduction: Identifying risk factors and strategies for the prevention of deep venous thromboembolism in major orthopedic surgery has allowed the development of Clinical Practice Guidelines (CPGs). Currently, there is a gap between clinical practice and the implementation of the recommendations of CPGs. The purpose of this paper is to report the impact of the implementation of improvement strategies on adherence to venous thromboembolism (VTE) prophylaxis guidelines., Materials and Methods: We defined 3 quality indicators to assess the adequate use of thromboprophylaxis according to CPGs. We obtained a baseline measurement and identified several barriers for adherence. Six improvement strategies to promote adherence to CPGs were designed and applied. A systematic monitoring of these indicators was performed in real time and a description of the data was completed for patients undergoing primary joint replacement of the hip, knee and shoulder, during February 2012 and August 2014., Results: Data from 773 patients were obtained. In the first trimester, the average of adherence was: 98.3% for medical order in the post-operative note, 60.3% for opportune administration and 67% for adherence to therapy at home. In the trimester, the rates of adherence were 100%, 95.7% and 100% respectively., Conclusions: Combined strategies for improvement of adherence to VTE prophylaxis is associated with higher compliance with clinical practice guidelines., (Copyright © 2015. Published by Elsevier Ltd.)

Behaviour of Mg and Ca content in the blood serum of 28 cattle with grass tetany and hypocalcaemia was evaluated at short time intervals after infusion of 500 ml of a solution A (containing 12 g Mg-adipat and 5 g Ca-gluconate/100 ml aqua dest.) and a solution B (containing 12 g Mg-adipate and 12 g Ca-gluconate/100 ml) respectively. After treatment with the last-named solutions there was evident a considerable increase of Mg-values in the blood serum for a longer period (up to 6 h), also in the case of distinct hypomagnesaemia while Ca-values of the circulating blood declined more quickly. Efficacy of treatment was the better the earlier infusion was performed after occurence of clinical signs. Application of solution B for treatment of grass tetany and paresis with tetany like symptoms is recommended for several reasons. Necessity of assurance the Mg and Ca supply after infusion is emphasized.

Three high-performance cows in lactation were tested each for the effects of two kinds of infusion each, 500 ml of Tetamag-2 solution (60 g of calcium gluconate and 60 g of magnesium adipate) and 500 ml of Calcimag (100 g of calcium gluconate and 20 g of magnesium adipate), upon the levels of calcium, magnesium, Pa, potassium, and sodium as well as upon the activities of aspartate-aminotransferase, leucine-aminopeptidase, and alkaline phosphatase in blood serum and upon glucose levels in blood plasma. Migration of calcium out of blood plasma was found to take place at much higher rate than that of magnesium. Infusion of Pa and glucose was followed soon by some temporary drop of values. No directional effects were recordable from potassium and sodium. Aspartate-aminotransferase activity did not change in response to transfusion. Intravenous infusion of Tetamag-2 solution caused strong temporary rise in magnesium concentration and, consequently, activation of leucine-aminopeptidase.

The pharmacokinetic properties of sulphamerazine, following oral application of granulated Mebacid to cattle, calf, and sheep, were compared with results obtained from the use of Mebacid tablets. Elimination half-life was higher in cattle, calf, and sheep, following oral application of Mebacid tablets. Different pharmacokinetic properties of sulphamerazine were found to exist between the two modes of preparation. Sulphonamide was eliminated more rapidly by cattle, calf, and sheep, when granulated Mebacid was used. When granulate is used, higher sulphamerazine doses have to be applied to calf and sheep to obtain the sulphonamide levels required for effective therapy. No intolerance was recorded from the above species, following oral application of granulated Mebacid.

Pharmacokinetic data of sulphamerazine were recorded from eight heads each of calf, adult cattle, horse, and sheep, following intravenous application of Mebacid 200, and mathematical implications were discussed. Exponential excretion was recorded from all species, according to the following equation: c = B x e-k2 x t The most favourable pharmacokinetic parameters were recorded from calf.

The use of organophosphorus preparations in the treatment of ectoparasites and endoparasites of pigs is discussed. Treatment of 43 store pigs with preparations produced in the German Democratic Republic by washing and by the pour-on method resulted in considerable inactivation of acetylcholinesterase, which implies good systemic action. Overdosage increased this effect, but without producing signs of toxicity. The oral dosages for pigs cited in the literature were confirmed. Repeated treatment was recommended for the best results, as pigs rapidly break down the preparations. It is necessary to take into account adverse effects of oral administration on palatability of the ration and on weight gain. Addition of a preparation to a batch of food for a group of pigs is likely to be less successful than individual dosing, which is the best method for sows.

Acetylation and protein fixation were established for the purpose of elucidating the chemotherapeutically effective part of sulphamerazine when applied to cattle, swine, horse, sheep, dog, and cat. The highest degree of acetylation and lowest protein fixation in all species tested, were recorded from swine. A reciprocal correlation was found to exist between the two above parameters, and it was statistically secured, except for horse. A mathematical description of the functional relationship between sulphamerazine fixed to serum protein and free sulphamerazine was possible by means of the Freundlich isothermia which had been recommended by SCHOLTAN (1962) in the following form: cgeb = K+ . cfreim The problem of minimum inhibitory concentration is discussed and explained in greater detail by computational examples with Escherichia coli.

Two antigenic extracts, prepared by different methods, were tried on 317 serum samples in the microscope-slide agglutination, sedimentation and tube agglutination tests. In comparison with the haematological findings, both antigens and all the tests gave a proportion of non-specific positive results, which made it impossible to obtain specific results. Various ways of reducing the proportion of non-specific reactions were tried, without success.

The use of organophosphorus preparations for the control of ectoparasites and endoparasites of sheep, particularly systemic application, is discussed. Experiments on 13 groups of sheep with five preparations produced in the German Democratic Republic in various formulations and concentrations showed that external application had good contact activity, but little was absorbed. Acetylcholinesterase activity was not inhibited, except by pour-on application of doses several times the normal dose. The preparations were arranged in order of cholinesterase inhibition. In contrast to cattle, diminished cholinesterase activity was unreliable as in indicator of systemic toxicity of organophosphorus preparations in sheep.

The mathematical foundations underlying pharmacokinetic testing and acceptance of medicaments for domestic mammals are expounded and discussed, with reference being made to examples of intramuscular, subcutaneous, and oral application of Mebacid 200 and Mebacid tablets. Elimination of sulphamerazine may be mathematically described by means of the following bi-exponential function: c = B x e-k2 x t -- A x e-k1 x t The concepts of the mono-compartmental model "Extravasal Application" can be claimed as being of basic validity. Blood levels established after intramuscular and subcutaneous application of sulphamerazine-sodium (Mebacid 200) were lower than those recorded after oral application of Mebacid tablets. The half-lives of elimination, following oral application to big animals of Mebacid tablets, were longer than those following intravenous application of comparable injection solution.

An optimal magnesium supply of dairy cows during pasture period is still a pressing problem in our farms and husbandry. Experiences are described concerning the application of different magnesium concentrated preparations in cases of grass tetany in 1970 to 1975 in the district of Potsdam. In 224 cows with magnesium concentrations values in the serum below 1.8 mg/100 ml a 25% MgSO4-solution, Parevert and Vers. A, a test solution of VEB Tierarzneimittelwerk Leipzig are used as a metaphylactic treatment. Losses by grass tetany could be reduced after application of the named preparations. Also in cases of low dosage a further, at least temporary drop of magnesium values in the serum could be prevented. Metaphylactic measures are recommended for andangered herds.

Four anticoagulants in current use were compared in blood samples used to prepare dried specimens. The most suitable was a mixture of one part of heparin solution (5000 IU strength) and four parts of distilled water. Blood samples treated in this way must be process at the laboratory within 16 hours. Specimens dried in tubes could be stored for a long time, and this was the best way of dealing with samples from individual or export cattle.

The formula proposed by RITSCHEL (1973) for calculation of rates of resorption is explained and modified for use of the monocompartment model. Resorption rates were calculated for cattle, calf, horse, and sheep, with reference being made to the example of Mebacid tablets. The most favourable rate of resorption was established for calf.

The problem of no residues is elucidated and discussed under pharmacokinetic aspects. An equation with due consideration confidence by which to calculate the absence of residues in drugs is given under the assumption that elimination of such residues should follow the concepts of the monocompartment model. The time is calculated by which all residues of sulphamerazine have disappeared, following application of Mebacid 200 and Mebacid tablets to farm animals.

The anticoagulant Chelaplex III in aqueous solution with two new stabilizers (methenamine and tannin) was tested for the preservation of blood samples, together with another combination composed of oxalic acid and methenamine solution. The eventual aim was to test their suitability for use with blood specimens dried in the tube, but this was not done in the present experiments. It was shown that a combination of 5% oxalic acid with 36% methenamine was at least as good as the conventional Chelaplex III-formaldehyde combination for inhibiting coagulation, and it was relatively cheap.

The levels of various compounds in blood serum and blood plasma were tested in 14 heads of cattle with hypomagnesiaemia (x = 0.76 +/- 0.29 mg/100 ml), prior to and following infusion of 500 ml of a calcium-magnesium solution (containing 60 g of magnesium adipate and 60 g of calcium gluconate). Concomitant hypocalcaemia (6.1 mg/100 ml) was recordable only from one animal. Most of the potassium as well as all Pa and protein values in blood serum were physiologically normal, while sodium ws somewhat reduced. The glucose level in blood plasma was increased in the animal with concomitant hypocalcaemia and in one animal with poor recovery potential. The drops in magnesium and calcium levels in blood serum, following infusion, in cattle with hypomagnesiaemia was very similar to that in clinically intact cattle. Aspartate-aminotransferase and creatinine-phosphokinase activities of the serum were increased in all cattle, but leucine-aminopeptidase activity in only some of them. The activity of alkaline phosphatase of the blood serum was physiologically normal.

The highly variegated complex of aspects relating to dosage calculation for veterinary drugs is explained and discussed by examples of Mebacid 200 and Mebacid tablets. For domestic mammals, a dosage interval of 24 hours is desirable for reasons of economy. Therefore, due allowance must be made, by means of unilateral confidence, of the most unfavourable case of high protein fixation, low half-life for elimination, and high coefficient of distribution. The following equation, proposed by DETTLI and SPRING (1966) was used for dosage calculation: AD = c . delta' . ek2 . t or ED = c . delta' . (ek2 . t -1) The dosage will now be in a twelve-hour rhythm, because of the low half-life for elimination of sulphamerazine-Na. A pharmacokinetically founded dosage interval of 24 hours will be feasible only by oral application of Mebacid tablets. The difference between the calculated initial and maintenance doses was found to be negligible.