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Background: Patella resurfacing is commonly performed during total knee arthroplasty; however, determining the appropriate patellar thickness remains a challenge. The purpose of this study was to evaluate the role of post-TKA patellar thickness on knee extensor strength and biomechanical joint loading forces during walking and stair negotiation., Methods: Fifteen patients (21 knees) underwent gait analysis prior to TKA and post-TKA at six weeks, three months, six months, and one year. Knee extensor strength and biomechanics were collected during level walking and stair negotiation and analyzed using Pearson correlation coefficients., Results: Knee extensor strength was positively correlated to patellar thickness at three months and one year post-TKA (p ≤ .05). During walking, no significant correlations were present. During stair ascent, there was a positive correlation between patellar thickness and peak knee flexion angle one year post-TKA (p ≤ .05). During stair descent, there was a positive correlation between patellar thickness and maximum vertical ground reaction forces at one year post-TKA (p ≤ .01)., Conclusions: The loss of patellar thickness when compared to measured pre-resurfacing thickness was correlated with a decrease in knee extensor strength; however, changes in patellar thickness were not significantly correlated to biomechanical loading forces during walking. Increases in demand of activity increase the torque to the knee joint, which elicit increases in compensatory motions, likely reducing the extent to which differences in joint loading during stair negotiation may be attributable to changes in patellar thickness. Therefore, the effect of post-patellar thickness on patient function in primary TKA is limited., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Tibial osseous defects can present a serious challenge in primary total knee arthroplasty. We describe a technique of using porous tantalum cones along with primary arthroplasty implants to address large tibial osseous defects in primary total knee arthroplasty and present the short-term results., Methods: We present 17 cases (15 patients) in which primary total knee implants and porous tantalum cones were used to address large tibial bony defects. Clinical results were evaluated using Knee Society Scores, pre- and postoperative knee range of motion, and serial radiographs., Results: At an average of 3.5 years of follow-up, all 17 knees had functioning implants with stable metaphyseal cones demonstrating radiographic evidence of osteointegration. At a minimum follow-up of two years, no patient had signs of osteolysis, instability, infection, or systemic complications. All 15 patients had excellent results with an average post-operative Knee Society Score of 94.6. Knee flexion improved by an average of 12.0° and knee extension improved to neutral in all patients., Conclusion: Primary total knee arthroplasty with porous tantalum cone augmentation produced excellent short-term results and should be considered an effective method for addressing large tibial osseous defects in primary total knee arthroplasty., (Copyright © 2018 Elsevier B.V. All rights reserved.)

To characterize pulmonary vein (PV) anatomy and the relative position of the PV ostia to the adjacent thoracic vertebral bodies, two readers reviewed 176 computed tomography pulmonary venous studies. PV ostial dimensions were measured and PV ovality assessed. Anatomical variations in PV drainage were noted. The position of the PV ostium relative to the nearest vertebral body edge was recorded. Right PV ostia were significantly more circular than the left (p<.001). Anatomical variability was greater for right PVs: 82% of patients had 2 ostia, 17% had 3 ostia, 0.5% had 4 ostia and 0.5% a common ostium. For left PVs, 91% of patients had 2 ostia, 8.5% a common ostium and 0.5% 3 ostia. Mean ostial distances from vertebral margin were: right PVs 3.62±7.48 mm; left PVs 3.84±8.46 mm (p=.72). 65% of right upper PV, 60.5% of right lower PV, 51% of left upper PV and 57% of left lower PV ostia were positioned lateral to vertebral bodies. Right PV ostia are rounder than left-sided and right PV drainage is more variable. As a significant proportion of PV ostia overlap the vertebral bodies, prior anatomical evaluation by CT can assist catheter ablation procedures for atrial fibrillation (AF), especially when performed under fluoroscopy., (Copyright © 2011 Elsevier Inc. All rights reserved.)

A simple, rapid, and sensitive spectrofluorimetric technique for the microdetermination of epinephrine in human serum is described. The investigation shows that trace amounts of epinephrine, antidepressant of clinical importance, can be determined without the conventional derivatization or use of fluorophores by diazotization. The method is based on the optimization of experimental parameters, such as pH, temperature, careful selection of excitation and emission wavelengths and on the use of anionic surfactant, sodium dodecyl sulfate (SDS), to enhance sensitivity. The measurement was carried out at 360 nm with excitation at 286 nm. Under the optimum conditions, a linear relationship was obtained between the fluorescence intensity and epinephrine concentration in the range of 0.10 and 1.0 microg/mL; the correlation coefficient and detection limit are 0.9953 and 0.05 microg/mL, respectively. Recovery tests indicated an efficiency of 95.5-98.7% by using known amounts of epinephrine spiked with human serum.

Background: To compare patterns of coronary artery disease in British South Asian and White European men., Methods: 41 South Asian and 42 European men (mean age 64+/-9 years) with coronary artery disease were studied. All had similar symptoms. Vessel reference diameter and degree of stenosis were calculated using quantitative coronary angiography. Extent of atherosclerotic disease in the LAD was assessed using calcification scores (CAC) measured by multislice Computed Tomography. Fasting bloods and blood pressure were measured. The LAD was subdivided into four 2.5 cm segments for analysis., Results: Most atherosclerosis occurred in the proximal LAD segment, South Asian men had more proximal LAD stenosis than European men (50% vs. 37%, p=0.036), but CAC scores were similar. South Asians with CAC scores in the lowest tertile (0-22 HU), had significantly narrower LAD diameters than Europeans (2.8 mm vs. 3.8 mm, p=0.004, adjusted for body surface area and age). This ethnic difference was not explained by measured risk factors, including diabetes. In contrast, ethnic differences in LAD diameter were abolished in the upper tertiles of CAC scores (23-2416 HU) (South Asians: 3.0 mm, Europeans: 3.1 mm, p=0.6). Calcification scores were negatively correlated with LAD diameter in Europeans (rho=-0.38, p=0.016) but not in South Asians (rho=-0.06, p=0.72)., Conclusions: Increased LAD stenosis, despite equivalent levels of calcified disease, in South Asians is attributable to narrower arteries. Reduced LAD diameter is associated with advanced disease in Europeans but not in South Asians, indicative of ethnic differences in vascular remodelling.

Background: Increased platelet activation occurs in ischemic heart disease (IHD), but increased platelet activation is also seen in cerebrovascular atherosclerosis and peripheral artery disease. It is not clear therefore whether platelet activation is an indicator of IHD or a marker of generalized atherosclerosis and inflammation. South Asian subjects are at high risk of IHD, but little is known regarding differences in platelet and leukocyte function between European and South Asian subjects., Methods: Fifty-four male subjects (age 49-79 years) had coronary artery calcification measured by multislice computed tomography (CT), aortic atherosclerosis assessed by measurement of carotid-femoral pulse wave velocity (aortic PWV), and femoral and carotid atherosclerosis measured by B-mode ultrasound. Platelet and leukocyte activation was assessed by flow cytometry of platelet-monocyte complexes (PMC), platelet expression of PAC-1 binding site and CD62P, and expression of L-selectin on leukocytes., Results: Elevated circulating PMC correlated significantly with elevated aortic PWV and PMC were higher in subjects with femoral plaques. In contrast PMC did not differ by increasing coronary artery calcification category or presence of carotid plaques. Higher numbers of PMC were independently related to elevated levels of C-reactive protein (CRP), higher aortic PWV, hypertension and smoking in a multivariate model. Markers of platelet and leukocyte activation did not differ significantly by ethnicity., Conclusions: Increased PMC are related to the extent of aortic and femoral atherosclerosis rather than coronary or carotid atherosclerosis. The association between elevated CRP and increased PMC suggests that inflammation in relation to generalized atherosclerosis may play an important role in PMC activation.

Objectives: Indian Asians have high rates of heart disease and stroke, but risks of peripheral arterial disease appear to be low. This paradox, and reasons for it, have not been explored. We compared ethnic differences in peripheral arterial disease for a given level of coronary disease., Methods: We studied 83 European and 84 Indian Asian men with a range of coronary disease. Extent of coronary atheroma was quantified by coronary artery calcification score on multislice CT. Femoral intima-media thickness (IMT) was measured by ultrasound., Results: Femoral IMT was 1.58, 2.06, 2.12, and 2.69 mm in Europeans, and 0.61, 1.41, 1.81 and 2.29 in Indian Asians by increasing categories of coronary atheroma (p=0.003 for ethnic difference, adjusted for age and lumen diameter). Adjustment for smoking and systolic blood pressure, the only risk factors adversely distributed in Europeans, only partly accounted for this ethnic difference (p=0.05). Other risk factors, including lipids, obesity, insulin and glycaemic status, more adversely distributed in Indian Asians, could not account for ethnic differences. Prevalence of abnormal ankle brachial index and lower limb atherosclerotic plaque was also greater in Europeans., Conclusions: For a given level of coronary disease, Indian Asians have less lower limb atherosclerosis than Europeans, unexplained by established risk factors. Further study of these populations would help tease out relative contributions of risk factors to atherosclerosis in different vessel beds.

Background: The aim of this study was to use a biopsychosocial perspective to characterize patients who were identified as being at high risk, or HR, of progressing from acute to chronic jaw-related pain., Methods: The authors classified 74 subjects as being at HR or low risk, or LR, according to the predictive algorithm. They used a variety of functional and biopsychosocial measures to evaluate subjects., Results: The HR group had significantly higher levels of self-reported pain as measured by the Characteristic Pain Inventory and significantly higher levels of depression as measured by the Beck Depression Inventory-II. They were 11 times more likely to have a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or DSM-IV, Axis I clinical diagnosis, and more than three times as likely to have a DSM-IV Axis II personality disorder. Logistic regression analyses identified variables that differentiated, with 77 percent accuracy, the HR and LR patients., Conclusions: Overall, the HR subjects had more psychopathology than did the LR subjects, used poorer coping styles and had greater self-reported pain. Six psychosocial factors alone enabled the authors to correctly classify 77 percent of the subjects as being in the HR group., Clinical Implications: Future research, in conjunction with the above findings, may enable the authors to determine, with greater certainty, if patients who are more anxious are at greater risk of developing chronic pain. If so, this provides further evidence of the need for early detection of patients at risk of developing chronic pain and the need to refer them for adjunctive care, such as cognitive-behavioral intervention.

Hailey-Hailey disease (HHD) is a rare autosomal dominant genodermatosis characterized by disturbed keratinocyte adhesion. The disease has recently been mapped to a 14 cM region on chromosome 3q. We have further refined the location of the HHD gene by linkage analysis in six HHD families from Germany and Italy using 11 polymorphic microsatellite markers and found no evidence for genetic heterogeneity. We observed complete cosegregation between HHD and marker D3S1587, with a maximal lod score of 4.54. Detailed haplotype analyses allowed us to narrow the interval containing the HHD locus to 5 cM, flanked by D3S1589 and D3S1290.

Darier's disease (DD) is an autosomal dominant genodermatosis characterized by epidermal acantholysis and dyskeratosis. We have performed genetic linkage studies in 10 families with DD (34 affected) by analyzing 14 polymorphic microsatellite markers. Our results confirm recent reports mapping the DD gene to chromosome 12q23-q24.1. Haplotype analysis of recombinant chromosomes in our families, along with previously reported data, narrow the location of the DD gene to a 5 cM interval flanked by the loci D12S354 and D12S84/D12S105. This localization allowed exclusion of two known genes, PLA2A and PAH, as candidate loci for DD. Three other gene loci (PPP1C, PMCH, PMCA1), mapping in 12q21-q24, remain potential candidates.

Four cases of Poland's syndrome were investigated with thoracic computed tomography (CT) to determine the precise extent of the upper limb girdle abnormalities. CT confirmed in all cases the absence of the sternocostal head of pectoralis major and clearly showed associated abnormalities of pectoralis minor, serratus anterior and latissimus dorsi as well as bony structures. In view of the importance of latissimus dorsi in reconstructive surgery, we believe that a limited thoracic CT scan provides useful information in patients with Poland's syndrome requesting anterior axillary reconstruction and breast mound formation.