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Background: Patients are often cautioned against a high level of activity after knee arthroplasty. The purpose of this study was to report on implant survivorship and outcomes of high-activity patients compared with low-activity patients after unicondylar knee arthroplasty (UKA)., Methods: We identified 487 patients (576 knees) who underwent UKA with the Oxford mobile bearing knee (Zimmer Biomet, Warsaw, IN) with a 5-year minimum follow-up. Patients were divided into 2 groups: low activity (LA) (University of California Los Angeles ≤6) and high activity (HA) (University of California Los Angeles ≥7). Preoperative and postoperative range of motion, Knee Society scores, complications, and reoperations were evaluated., Results: Mean follow-up was 9 years (range, 4 to 13.1). The HA group had significantly more male patients, were younger, and had higher knee society clinical scores and knee society functional scores preoperatively. The HA group had significantly higher improvements in Knee Society scores and pain postoperatively. Revisions were performed in 8.4% of the LA group and 6.2% of the HA group (P = .43). At our mean of 9-year follow-up, there was 94.0% survival for the HA group and 92.1% for the LA group (P = .6085)., Conclusions: Highly active patients had no increased risk of revision after UKA with the Oxford mobile bearing knee at 5-year minimum follow-up., (Copyright © 2019 Elsevier Inc. All rights reserved.)

We thank Vorland et al [...].

Background: Treatment of isolated lateral compartment arthritic disease with partial knee arthroplasty remains underutilized in comparison to medial unicompartmental arthroplasty. This study examines the survival and outcome of lateral unicompartmental arthroplasty utilizing the first implant specifically developed for the lateral compartment., Materials and Methods: A retrospective review was performed to detect lateral unicompartmental arthroplasty procedures performed in our practice between January 2013 and May 2016. Patients indicated for surgery met specific preoperative clinical and radiographic criteria confirming lateral compartment arthritic disease with a correctable deformity, intact full-thickness medial cartilage, competent anterior cruciate ligament, and minimal disease in the patellofemoral compartment. A single implant design was used in all cases which consisted of a fixed-bearing tibial component specifically adapted to lateral compartment anatomy. Unicompartmental arthroplasty surgical technique was adjusted to attempt to recreate lateral compartment kinematics., Results: Fifty-two consecutive patients (56 knees) with lateral unicompartmental arthroplasty procedures meeting minimum two-year follow up were included in the study. Thirty-nine patients were female, and 93% of cases were performed for treatment of osteoarthritis. At a mean follow up of nearly three years, Knee Society clinical and functional scores improved postoperatively by a mean difference of 41 and 21, respectively. There were two reoperations, one medial unicompartmental arthroplasty for osteoarthritis progression and a superficial debridement for a non-healing wound. Thus, failure of lateral unicondylar knee arthroplasty (UKA) was less than 2% in this study. There were no other component revisions, radiographic evidence of loosening, or clinical failures., Conclusions: At early follow up, lateral unicompartmental arthroplasty using a modified surgical technique and an implant specifically designed for the lateral compartment is a reliable treatment for isolated lateral femorotibial arthritis when meeting defined indications.

Many studies have reported abnormal gut microbiota in individuals with Autism Spectrum Disorders (ASD), suggesting a link between gut microbiome and autism-like behaviors. Modifying the gut microbiome is a potential route to improve gastrointestinal (GI) and behavioral symptoms in children with ASD, and fecal microbiota transplant could transform the dysbiotic gut microbiome toward a healthy one by delivering a large number of commensal microbes from a healthy donor. We previously performed an open-label trial of Microbiota Transfer Therapy (MTT) that combined antibiotics, a bowel cleanse, a stomach-acid suppressant, and fecal microbiota transplant, and observed significant improvements in GI symptoms, autism-related symptoms, and gut microbiota. Here, we report on a follow-up with the same 18 participants two years after treatment was completed. Notably, most improvements in GI symptoms were maintained, and autism-related symptoms improved even more after the end of treatment. Important changes in gut microbiota at the end of treatment remained at follow-up, including significant increases in bacterial diversity and relative abundances of Bifidobacteria and Prevotella. Our observations demonstrate the long-term safety and efficacy of MTT as a potential therapy to treat children with ASD who have GI problems, and warrant a double-blind, placebo-controlled trial in the future.

Rapid urbanisation and industrial growth in South Africa increases the need for proactive allocation of freshwater resources on a regional scale. A nine-step method is described that sets long-term targets for water resource condition and future use with a focus on estuary water quantity and quality requirements. The approach specifically focuses on the environmental flow allocation to estuaries, nested within a broader, regional (multi-catchment and multi-estuary) water resource landscape. The method differs to most other approaches in that the responses of multiple estuaries to escalating future development in a region are coherently quantified (versus only considering a single estuary in a single catchment). A case study that assessed the health, biodiversity importance and resilience to current and future pressures of 64 estuaries is used to illustrate the method. Projected growth in the study area was integrated into a range of future dam development and wastewater discharge scenarios. The results showed that estuaries around the urban centres were in poor condition, but those in the more rural areas in a more natural state. As a result of their small size, most of the estuaries in the region had little resilience to changes in freshwater quantity and nutrient loading. In contrast, the larger systems, targeted for dam development, only showed sensitivity to water abstraction during low-flow periods when base-flow reduction caused mouth closure and changes in nutrient processes. Broadly, the approach aimed to find a balance between ecological requirements and socio-economic development, which meant that maintaining larger systems in relatively good condition would be at the expense of smaller systems that are already in a poor condition. The approach developed was successful in quantifying the responses of multiple estuaries to escalating future pressures on a regional scale, and could be replicated to assist in managing water resources elsewhere in data-limited environments., (Copyright © 2018 Elsevier B.V. All rights reserved.)

This paper presents an environmental flow methodology that was developed to accommodate shallow, highly dynamic micro-tidal estuaries found along the wave-dominated coast of South Arica. This method differs to most other approaches that primarily focus on larger permanently open systems having unrestricted inlets. Following an adaptive, design science research approach, the 7-step method adopted both ecohydrological and ecosystem-based concepts, encapsulating key hydrologicalhydrodynamic-biogeochemical processes, as well as biotic responses. The procedure also addresses a key challenge often encountered in applying these approaches to complex estuarine systems - the mismatch of temporal and spatial scales between abiotic processes and biotic responses. The method simplifies and aggregates abiotic processes to appropriate scales suitable for analysis of biotic responses, by introducing concepts such zoning and major physical states that characterize an estuary. The method's flexibility in data requirements lends itself to applications in countries where data is limited or where differences exist in data quality between systems. Essential in any environmental flow determination process, however, is long-term monitoring to incrementally improve confidence of the input data, but also to evaluate whether allocated flows achieve desired objectives set. Future challenges include refining the method to accommodate flow changes within much shorter timeframes and in conjunction with escalating global change pressures amongst other; pollution, living resource exploitation and physical destruction of habitat., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Coastal wetlands (mangrove, tidal marsh and seagrass) sustain the highest rates of carbon sequestration per unit area of all natural systems 1,2 , primarily because of their comparatively high productivity and preservation of organic carbon within sedimentary substrates 3 . Climate change and associated relative sea-level rise (RSLR) have been proposed to increase the rate of organic-carbon burial in coastal wetlands in the first half of the twenty-first century 4 , but these carbon-climate feedback effects have been modelled to diminish over time as wetlands are increasingly submerged and carbon stores become compromised by erosion 4,5 . Here we show that tidal marshes on coastlines that experienced rapid RSLR over the past few millennia (in the late Holocene, from about 4,200 years ago to the present) have on average 1.7 to 3.7 times higher soil carbon concentrations within 20 centimetres of the surface than those subject to a long period of sea-level stability. This disparity increases with depth, with soil carbon concentrations reduced by a factor of 4.9 to 9.1 at depths of 50 to 100 centimetres. We analyse the response of a wetland exposed to recent rapid RSLR following subsidence associated with pillar collapse in an underlying mine and demonstrate that the gain in carbon accumulation and elevation is proportional to the accommodation space (that is, the space available for mineral and organic material accumulation) created by RSLR. Our results suggest that coastal wetlands characteristic of tectonically stable coastlines have lower carbon storage owing to a lack of accommodation space and that carbon sequestration increases according to the vertical and lateral accommodation space 6 created by RSLR. Such wetlands will provide long-term mitigating feedback effects that are relevant to global climate-carbon modelling.

This study assessed the 15-year minimum outcomes of the RingLoc cup (Zimmer Biomet, Warsaw, Indiana), a second-generation cementless porous plasma-coated acetabular component. The study identified 2438 patients (2905 hips) who underwent total hip arthroplasty using the RingLoc acetabular component between 1992 and 2000. Fifteen-year minimum follow-up data were available on 431 consented patients (511 hips). Clinical outcomes included the Harris hip score. Follow-up radiographs, complications, and revisions were reviewed. Mean follow-up was 18.2 years (range, 15-24.7). Harris hip scores improved from 46.9 preoperatively to 79.3 postoperatively (p < .001). Reoperation for any reason was performed in 141 hips (27.6%). Isolated liner exchange was performed in 96 hips (18.8%) and acetabular revisions were performed in 44 hips (8.6%). Acetabular survivorship at 15 years was 93.5% for all causes and 94.3% for aseptic revision. This study demonstrated excellent acetabular survivorship of the porous plasma-sprayed RingLoc cup at a minimum 15-year follow-up. (Journal of Surgical Orthopaedic Advances 28(1):31-34, 2019).

Objective: The objective of this study was to provide an evaluation of the benefits and adverse effects (AEs) of psychiatric and seizure medications commonly used for individuals with autism spectrum disorder (ASD)., Methods: As part of the National Survey on Treatment Effectiveness for Autism, we report ratings of 26 psychiatric and seizure medications by 505 participants. Each medication was rated with a standardized scale for overall benefits, overall AEs, and specific symptoms affected. The frequency of use and net perceived benefit (overall benefit minus overall AE) are reported., Results: Most medications were rated as having a slightly greater benefit than AE. Six medications (lamotrigine, oxcarbazepine, clonidine, guanfacine, buspirone, and sertraline) had benefit ratings that were more than twice their adverse rating. Conversely, some medications had slightly negative net benefit ratings (worse AEs than benefits on average), including Adderall, Paroxetine, Quetiapine, Olanzapine, and Topiramate. However, there were wide variations in individual ratings of benefit and AEs, suggesting that clinical response to medications was highly variable, so these scores simply represent averages. A ranking of the top medications (those with the highest net perceived benefit) for each of 18 different symptoms is provided, which may provide some clinical guidance as to which medications may be most worth considering for a given symptom. A comparison of the survey results with the results of clinical trials shows generally good agreement in terms of medication benefits with some differences; in some cases the differences are because the clinical trials did not assess all of the symptoms assessed by this survey., Conclusions: It is hoped that physicians and their patients will find the survey results useful in selecting the most promising medications for a given symptom, and also for monitoring for likely benefits and AEs, especially for medications for which few or no studies have been carried out in ASD populations.

Background: Persistent pain after medial unicompartmental knee arthroplasty (UKA) is a prevailing reason for revision to total knee arthroplasty (TKA). Many of these pathologies can be addressed arthroscopically. The purpose of this study is to examine the outcomes of patients who undergo an arthroscopy for any reason after medial UKA., Methods: A query of our practice registry revealed 58 patients who had undergone medial UKA between October 2003 and June 2015 with subsequent arthroscopy. Mean interval from medial UKA to arthroscopy was 22 months (range 1-101 months). Indications for arthroscopy were acute anterior cruciate ligament tear (1), arthrofibrosis (7), synovitis (12), recurrent hemarthrosis (2), lateral compartment degeneration including isolated lateral meniscus tears (11), and loose cement fragments (25)., Results: Mean follow-up after arthroscopy was 49 months (range 1-143 months). Twelve patients have been revised from UKA to TKA. Relative risk of revision after arthroscopy for lateral compartment degeneration was 4.27 (6 of 11; 55%; P = .002) and for retrieval of loose cement fragments was 0.05 (0 of 25; 0%; P = .03). Relative risk for revision after arthroscopy for anterior cruciate ligament tear, arthrofibrosis, synovitis, or recurrent hemarthrosis did not meet clinical significance secondary to the low number of patients in these categories., Conclusion: The results of this study suggest that arthroscopic retrieval of cement fragments does not compromise UKA longevity. However, arthroscopy for lateral compartment degradation after UKA, while not the cause of revision, appears to be an ineffective treatment and predicts a high risk of revision to TKA regardless of its relative radiographic insignificance., (Copyright © 2018. Published by Elsevier Inc.)

Background: Despite improvements in polyethylene bearing surface properties, only 1 previous study has examined the results of larger thickness bearings. The purpose of this study was to determine whether polyethylene thickness influenced patient outcomes and implant survival following modular total knee arthroplasty., Methods: A retrospective review was performed of patients undergoing primary total knee arthroplasty from 2003 to 2014 in a single practice database. Patients were separated into "thin" and "thick" polyethylene groups based on manufacturer polyethylene bearing sizes of 14 mm or less compared to those greater than 14 mm, respectively. Patient clinical outcomes, need for revision surgery, and overall implant survival rates were evaluated., Results: A total of 6698 primary knee arthroplasties were included, and a thin bearing was used in 96.5% of these cases. Preoperatively, patients with a thick bearing had significantly lower Knee Society clinical scores (P < .01), a trend toward lower functional scores (P = .06), and more significant coronal plane deformity. Postoperatively, patients with thick bearings exhibited better Knee Society clinical and pain scores as well as similar functional scores and University of California at Los Angeles activity scores. The overall reoperation rate and 10-year survivorship free of revision were similar between thick and thin bearings (1.7% vs 2.3%; 98.2% vs 96.1%). Patients with thin bearings were twice as likely to require a manipulation under anesthesia postoperatively (P = .02), while there were no failures in the thick bearing group due to aseptic loosening or instability., Conclusion: Patients with thick polyethylene bearings performed similarly or better in multiple clinical outcomes and survivorship compared to those with thin bearings., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Unicompartmental knee arthroplasty (UKA) is touted as a more conservative, bone- and tissue-sparing procedure than total knee arthroplasty (TKA). Similarly, revision of UKA to TKA is generally a simpler procedure than revision of TKA to TKA and can be accomplished with primary TKA components in most cases. The purpose of this study was to review a consecutive series of patients undergoing revision of failed UKA to TKA to determine if etiology is similar to that reported in recent literature and evaluate if the results align more with primary TKA vs revision of TKA to TKA., Methods: A query of our private practice registry from 1996 to 2015 revealed 184 patients (193 knees) who underwent revisions of failed UKA with minimum 2-year follow-up. The mean age was 63.5 (37-84) years, body mass index was 32.3 (19-57) kg/m 2 , and interval after UKA was 4.8 (0-35) years. The most prevalent indications for UKA revision were aseptic loosening (42%) arthritic progression (20%), and tibial collapse (14%)., Results: At 6.1-year mean follow-up (2-20), 8 knees (4.1%) required re-revision, which is similar to what we reported at 5.5 years in a group of primary TKA patients (6 of 189; 3.2%) and much lower than what we observed at 6.0 years in a recent study of aseptic revision TKA patients (35 of 278; 12.6%). In the study group, Knee Society clinical and function scores improved from 50.8 and 52.1 preoperatively to 83.4 and 67.6 at the most recent evaluation. Re-revisions were for aseptic loosening (3), instability (2), arthrofibrosis (2), and infection (1)., Conclusions: Compared to published individual institution and national registry data, re-revision rates of failed UKA are equivalent to revision rates of primary TKA and substantially better than re-revision rates of revision TKA. These data should be used to counsel patients undergoing revision UKA to TKA., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: Short stem femoral components in primary total hip arthroplasty (THA) have increased in popularity since the advent of minimally invasive surgical techniques. The concept of a short stem is particularly compatible with tapered designs where the goal is to offload forces proximally in the femur. The purpose of this retrospective review was to review our early experience with a short, tapered titanium femoral component with updated design features., Materials and Methods: Beginning in November 2011 through February 2012, 92 consented patients (93 hips), at a single center, were treated with primary cementless THA using a short stem, tapered femoral component (Taperloc® Complete Microplasty; Zimmer Biomet, Warsaw, Indiana) and were available for review with a minimum two-year follow-up. Mean patient age at surgery was 63.2 years and body mass index (BMI) was 30.8 kg/m2. Mean stem length used was 110.3mm (range, 95-125)., Results: Mean follow-up was 4.5 years (2-6). Harris hip scores improved from 52.5 preoperatively to 84.7 at most recent. One stem was revised the same day for periprosthetic fracture. One patient with early infection was treated with single-stage exchange followed by recurrence that was treated successfully with two-stage exchange. A non-healing wound in one patient was treated with incision and debridement. Radiographic assessment demonstrated no evidence of loosening, osteolysis, distal hypertrophy, or pedestal formation in any hip, and all components appeared well fixed and in appropriate alignment., Conclusion: In this series of patients treated with primary THA using a short, tapered titanium porous plasma-sprayed femoral component with updated design features, good results were achieved with a low incidence of complications and revision. No aseptic loosening or osteolysis has occurred. Radiographic assessment was excellent for all patients.

Background: Plasma amino acid measurements have been extensively investigated in individuals with autism spectrum disorder (ASD). Results thus far have been inconclusive as studies generally disagree on which amino acids are different in individuals with ASD versus their typically developing (TD) peers, due in part to methodological limitations of several studies., Method: This paper investigates plasma amino acids in children and adults with ASD using data from Arizona State University's Comprehensive Nutritional and Dietary Intervention Study. Measurements from 64 individuals with ASD and 49 TD controls were analyzed using univariate and multivariate statistical techniques., Results: Univariate analysis indicated increased median levels of glutamate (+21%, p =0.014) and serine (+8%, p =0.043), and increased mean levels of hydroxyproline (+17%, p =0.018) for the ASD cohort, although these differences were insignificant after correcting for multiple comparisons. A multivariate approach was used to classify study participants into ASD/TD cohorts using Fisher discriminant analysis (FDA) and its nonlinear extension, kernel Fisher discriminant analysis (KFDA). Model fitting with FDA using all available measurements produced Type I and Type II errors of 27.0% and 27.8%, respectively. KFDA was most effective when using hydroxyproline, leucine, and threonine as inputs; however, leave-one-out cross-validation with this nonlinear model only resulted in 70.3% sensitivity and 77.6% specificity., Conclusions: The finding of elevated glutamate in ASD is in agreement with several other studies. Overall, however, these results suggest that plasma amino acid measurements are of limited use for purposes of ASD classification, which may explain some of the inconsistencies in results presented in the literature., Competing Interests: Conflicts of interest The authors declare that they have no conflicts of interest.

Naturally-occurring pristine estuarine ecosystems are rare in modern environments due to anthropogenic encroachment. There are more than 100 outlets around the South African coast arising from streams flowing from small catchments close to the sea. Eight near natural systems were sampled seasonally over the period of a year to acquire baseline information on water quality and chlorophyll a status across a variety of algal guilds (benthic microalgae, phytoplankton and macroalgal cover). Albeit on a much smaller-scale, these systems represent natural surrogates of larger temporarily open/closed estuaries (TOCEs). Inorganic nutrients (ammonium, total oxidized nitrogen and soluble reactive phosphate), phytoplankton and microphytobenthos chlorophyll a, as well as macroagal percentage cover, were measured using standard methods. Algae showed a seasonal trend, with blooms of both micro- and macro-algae occurring during summer, with a dieback recorded in autumn. During summer, only one system had a phytoplankton peak in chlorophyll a above 20μgL -1 , while the microphytobenthos concentrations in three of the systems were above 100mgm -2 . Summer blooms of green filamentous macroalgae occurred in all four micro-outlets and in one micro-estuary. Using a linear mixed-effects modelling approach, significant drivers for algal growth related to temperature, nutrient conditions, light availability and water residence time, all of which are known to stimulate primary production. The results show that enrichment from natural sources display similar responses from primary producers to mesotrophic and/or eutrophic water bodies, with the exception that they revert to a natural state rather than continue into a degraded state as is the case in artificially enriched systems. This importantly demonstrates how larger temporarily/open closed estuaries, most of which are anthropogenically degraded, might have functioned under a former more balanced state. Some of these larger systems now respond to nutrient enrichment by exhibiting permanent cultural eutrophication., (Copyright © 2017 Elsevier B.V. All rights reserved.)

This study involved a randomized, controlled, single-blind 12-month treatment study of a comprehensive nutritional and dietary intervention. Participants were 67 children and adults with autism spectrum disorder (ASD) ages 3-58 years from Arizona and 50 non-sibling neurotypical controls of similar age and gender. Treatment began with a special vitamin/mineral supplement, and additional treatments were added sequentially, including essential fatty acids, Epsom salt baths, carnitine, digestive enzymes, and a healthy gluten-free, casein-free, soy-free (HGCSF) diet. There was a significant improvement in nonverbal intellectual ability in the treatment group compared to the non-treatment group (+6.7 ± 11 IQ points vs. -0.6 ± 11 IQ points, p = 0.009) based on a blinded clinical assessment. Based on semi-blinded assessment, the treatment group, compared to the non-treatment group, had significantly greater improvement in autism symptoms and developmental age. The treatment group had significantly greater increases in EPA, DHA, carnitine, and vitamins A, B2, B5, B6, B12, folic acid, and Coenzyme Q10. The positive results of this study suggest that a comprehensive nutritional and dietary intervention is effective at improving nutritional status, non-verbal IQ, autism symptoms, and other symptoms in most individuals with ASD. Parents reported that the vitamin/mineral supplements, essential fatty acids, and HGCSF diet were the most beneficial., Competing Interests: J.B.A. is the president of the Autism Nutrition Research Center (ANRC), a non-profit which provides information to autism families and which produces an improved version of the vitamin/mineral supplement used in this study. He serves as an unpaid volunteer, and does not receive any royalties from the sale of the vitamin/mineral supplement. T.A. consults for Health Diagnostics, a commercial testing lab. D.W.Q. works at Doctor’s Data, a commercial testing lab. The other authors do not have any competing interests.

Biomarkers promise biomolecular explanations as well as reliable diagnostics, stratification, and treatment strategies that have the potential to help mitigate the effects of disorders. While no reliable biomarker has yet been found for autism spectrum disorder (ASD), fatty acids have been investigated as potential biomarkers because of their association with brain development and neural functions. However, the ability of fatty acids to classify individuals with ASD from age/gender-matched neurotypical (NEU) peers has largely been ignored in favor of investigating population-level differences. Contrary to existing work, this classification task between ASD and NEU cohorts is the main focus of this work. The data presented herein suggest that fatty acids do not allow for classification at the individual level., Competing Interests: The participants reported in this study were part of a 12-month nutrition/dietary treatment study known as the ASU Nutrition/Diet Treatment Study. All measurements reported in this paper are taken at baseline, prior to the initiation of treatment. Participants and/or their parents/guardians provided written informed consent and written assent was performed when applicable. This study was approved by the Institutional Review Board of Arizona State University.Not applicable.JBA is on the Scientific Advisory Board for the Autism Research Institute (ARI). All other authors declare that they have no conflict of interest.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Hydrological regimes are key in shaping the structure of phytoplankton communities in estuaries. Because anthropogenic disturbances often alter the quantity and quality of riverine inputs, this research focused on investigating phytoplankton dynamics in the St. Lucia Estuary, since being reconnected to the Mfolozi River. Due to the closed mouth state of the estuary, the input from the river resulted in oligohaline (≥5) conditions and the characteristic reverse salinity gradient to persist throughout the study (i.e. one year). Model results indicated that phytoplankton communities were structured by rainfall, light transmittance and depth, while shifts between dominant groups were driven by salinity and flow season. The persistence of chlorophytes and euglenophytes as the co-dominant functional group indicates the freshening and nutrient-enriched nature of the river. This study provides the first detailed account documenting the response of the phytoplankton community to recent restoration efforts in the St Lucia Estuary, a Ramsar Site., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Evidence supporting that gut problems are linked to ASD symptoms has been accumulating both in humans and animal models of ASD. Gut microbes and their metabolites may be linked not only to GI problems but also to ASD behavior symptoms. Despite this high interest, most previous studies have looked mainly at microbial structure, and studies on fecal metabolites are rare in the context of ASD. Thus, we aimed to detect fecal metabolites that may be present at significantly different concentrations between 21 children with ASD and 23 neurotypical children and to investigate its possible link to human gut microbiome. Using 1 H-NMR spectroscopy and 16S rRNA gene amplicon sequencing, we examined metabolite profiles and microbial compositions in fecal samples, respectively. Of the 59 metabolites detected, isopropanol concentrations were significantly higher in feces of children with ASD after multiple testing corrections. We also observed similar trends of fecal metabolites to previous studies; children with ASD have higher fecal p-cresol and possibly lower GABA concentrations. In addition, Fisher Discriminant Analysis (FDA) with leave-out-validation suggested that a group of metabolites-caprate, nicotinate, glutamine, thymine, and aspartate-may potentially function as a modest biomarker to separate ASD participants from the neurotypical group (78% sensitivity and 81% specificity). Consistent with our previous Arizona cohort study, we also confirmed lower gut microbial diversity and reduced relative abundances of phylotypes most closely related to Prevotella copri in children with ASD. After multiple testing corrections, we also learned that relative abundances of Feacalibacterium prausnitzii and Haemophilus parainfluenzae were lower in feces of children with ASD. Despite a relatively short list of fecal metabolites, the data in this study support that children with ASD have altered metabolite profiles in feces when compared with neurotypical children and warrant further investigation of metabolites in larger cohorts., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Medial unicompartmental knee arthroplasty (UKA) may have advantages over total knee arthroplasty (TKA) in the setting of obesity. There has been no direct comparison between the two cohorts. This study compares outcomes and complications of severely obese patients undergoing medial UKA versus TKA., Methods: Six hundred and fifty medial UKA and 1300 TKA were performed in patients with BMI >35kg/m 2 (mean 41kg/m 2 ) between 2007 and 2012. Pre- and postoperative ROM, Knee Society scores, perioperative factors, complications and reoperations were compared., Results: UKA patients had higher preoperative ROM, and Knee Society pain (KSP), functional (KSF), and clinical (KSC) scores (p<0.001, p=0.0008, p=0.0003, p=0.051 respectively). Mean tourniquet times, operative times, and lengths of stay were lower after UKA. Four TKA patients required transfusion. Mean follow-up was 2.3years. The frequency of manipulation under anesthesia was higher in TKA patients (p<0.001), while the rate of component revision was similar between the two groups (1.2% vs. 1.7%, p=0.328). Frequency of deep infection was lower in the UKA group (p=0.016). Postoperative KSF, change in KSF, and ROM were higher (p<0.0001) after UKA, but KSP and KSC were equivalent., Conclusions: Severely obese patients who underwent medial UKA demonstrated equal survivorship with substantially fewer reoperations, reduced deep infection, and less perioperative complications at short term follow-up. Severely obese patients had improved KSF scores and maintenance of ROM after UKA compared with TKA., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Aims: To examine incidence of complications associated with outpatient total hip arthroplasty (THA), and to see if medical comorbidities are associated with complications or extended length of stay., Patients and Methods: From June 2013 to December 2016, 1279 patients underwent 1472 outpatient THAs at our free-standing ambulatory surgery centre. Records were reviewed to determine frequency of pre-operative medical comorbidities and post-operative need for overnight stay and complications which arose., Results: In 87 procedures, the patient stayed overnight for 23-hour observation, with 39 for convenience reasons and 48 (3.3%) for medical observation, most frequently urinary retention (13), obstructive sleep apnoea (nine), emesis (four), hypoxia (four), and pain management (six). Five patients (0.3%) experienced major complications within 48 hours, including three transferred to an acute facility; there was one death. Overall complication rate requiring unplanned care was 2.2% (32/1472). One or more major comorbidities were present in 647 patients (44%), including previous coronary artery disease (CAD; 50), valvular disease (nine), arrhythmia (219), thromboembolism history (28), obstructive sleep apnoea (171), chronic obstructive pulmonary disease (COPD; 124), asthma (118), frequent urination or benign prostatic hypertrophy (BPH; 217), or mild chronic renal insufficiency (11)., Conclusion: The presence of these comorbidities was not associated with medical or surgical complications. However, presence of one or more major comorbidity was associated with an increased risk of overnight observation. Specific comorbidities associated with increased risk were CAD, COPD, and frequent urination/BPH. Outpatient THA is safe for a large proportion of patients without the need for a standardised risk assessment score. Risk of complications is not associated with presence of medical comorbidities. Cite this article: Bone Joint J 2018;100-B(1 Supple A):31-5., (©2018 The British Editorial Society of Bone and Joint Surgery.)

Introduction: The Taperloc® Complete femoral stem (Zimmer Biomet, Warsaw, Indiana) builds on the widespread clinical success of the original Taperloc design used since 1982. Enhancements to the Complete design include a lowered caput-collum-diaphyseal (CCD) angle from 138° to 133° for improved offset, optimized neck taper with polished neck flats to increase range of motion, reduced distal geometry to improve proximal canal fill, and gradual off-loading that is the goal of tapered geometry. A retrospective review was conducted to assess our early experience with the updated design., Materials and Methods: A query of our practice's arthroplasty registry revealed 97 consented patients (103 hips) who underwent primary cementless THA performed with a Taperloc® Complete femoral component between November 2010 and March 2011. A high offset option, accomplished by a constant 7.8mm medial shift of the trunnion, was utilized in 94 hips (91%). Mean age was 61.8 years and body mass index (BMI) was 31.3 kg/m2. Underlying diagnoses were osteoarthritis in 96 (93%), four avascular necrosis, two post-traumatic arthritis, and one acute fracture., Results: Mean follow-up was 5.3 years (2-7). Harris hip scores improved from 53.6 preoperatively to 87.9 at most recent. One stem was revised for periprosthetic fracture. Other reoperations were one cup revised for iliopsoas impingement, one lateral femoral cutaneous neurectomy, and one incision and debridement for a non-healing wound. Postoperative radiographs revealed satisfactory position and alignment of components with no radiolucencies observed in all patients with no evidence of osteolysis, distal hypertrophy, or pedestal formation., Conclusion: In this group, good results with a low frequency of complications and stem revision were achieved with a tapered titanium porous plasma-sprayed femoral component with updated design features. No aseptic loosening or osteolysis occurred. Radiographic findings were excellent in all hips.

Background: Total knee arthroplasty is overall a very successful surgery, but complications do occur. These complications include aseptic loosening of the tibial component, and obese patients are among the highest risk group. High-viscosity cement (HVC) has been implicated as a possible cause for aseptic loosening of the tibial component. The purpose of this study was to evaluate the incidence of aseptic loosening of the tibial component in obese patients with the use of HVC and standard tibial tray., Methods: We identified 1366 obese patients (1851 knees) with a body mass index >35 kg/m 2 and 2-year minimum follow-up who underwent primary total knee arthroplasty using HVC and a symmetrical, grit-blasted, cobalt-chrome tibial component with 40-mm stem. Preoperative and postoperative range of motion, Knee Society (KS) scores, complications, and reoperations were evaluated. Specifically, we assessed the rate of tibial aseptic loosening., Results: At a mean 5.4 years follow-up, only 1 in 1851 knees had aseptic loosening of the tibial component for an incidence of 0.054%. There was a mean increase of 3.3 degrees of knee range of motion. KS pain level decreased by 38.6 points (50 point scale). KS clinical scores improved by 52.2, Knee Society functional scores improved by 19.5, University of California, Los Angeles, activity score improved by 0.9, and Oxford Knee Score by 15.7. All these improvements were statistically significant with P < .001., Conclusion: Standard tibial components and HVC can be used in most patients, including the high-risk obese group, with low rates of tibial aseptic loosening., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Revision total knee arthroplasty (TKA) poses unique challenges compared with primary TKA such as bone loss, deformity, and ligament instability. Modular component options allow flexibility to deal with these complexities. The purpose of this study was to evaluate midterm outcomes for revision TKA using a modular revision knee system with complete interchangeability and multiple options for augmentation, offset, constraint, and stem extensions., Methods: A query of our practice registry revealed 257 consented patients (274 knees and 278 TKA) with minimum 2-year follow-up who underwent aseptic revision TKA with a modular system (Vanguard Super Stabilized Knee; Zimmer Biomet, Warsaw, IN) between 2005 and 2013. Four patients were rerevised to a second Vanguard Super Stabilized Knee within the study period. Mean age was 68 years, and mean number of previous surgeries was 2 (1-14)., Results: At mean follow-up of 6.0 years (range, 2-11 years), there have been 25 aseptic revisions involving one or more components (9.0%): 15 aseptic loosening with concomitant instability in 2, 8 others with instability, 1 with hypersensitivity, and 1 revised elsewhere for unknown cause. Ten knees were revised for infection. Range of motion improved from 100° preoperatively to 105° most recently. Knee Society clinical scores improved from 45 to 79, and function scores from 46 to 56. Radiographic evaluation revealed satisfactory position, fixation, and alignment in 97% and abnormal findings in 7 knees: 4 limited to the patella, 1 tibial radiolucency, 1 femoral and tibial radiolucency, and 1 tibial subsidence., Conclusion: The results of this modular TKA revision system at 6 years mean follow-up are promising for use in complex scenarios, with a low frequency of aseptic rerevision, good knee stability, and substantial improvements in range of motion and clinical and functional outcomes., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Introduction: Modular component options can aid in addressing complex femoral reconstructions in total hip arthroplasty (THA) by allowing for customization of version control and proximal to distal sizing. However, component breakage at the modular junction has occurred, particularly in the presence of poor bone stock. A taper roller hardening (RH) process was developed to strengthen the modular junction to reduce breakage. The purpose of this study is to review THA patients before and after taper roller hardening to compare stem survival and frequency of breakage., Materials and Methods: A query of our practice registry revealed 183 consented patients (202 THA) who underwent THA with a modular femoral revision component between January 1993 and September 2010. Forty THA were done before (non-RH) and 162 were done after taper roller hardening., Results: Mean follow-up was seven and 17 years in the RH and non-RH groups respectively. In the non-RH group, 15% were revised for component breakage versus 2% in the RH group. Overall, 35% non-RH versus 8% RH stems have been revised. Kaplan-Meier survival at 10 years with endpoint of stem revision for breakage revealed 84.2% ( ±6.0%) non-RH compared with 95.5% ( ±2.2%) RH (p=0.0033), and with endpoint of stem revision for any reason, 65.0% ( ±7.5%) non-RH compared with 80.3% ( ±3.7%) RH (p=0.0022)., Conclusions: Results indicate that the taper roller hardening process was successful in improving durability of a modular femoral revision system and reducing frequency of component breakage for patients who require treatment of the deficient femur in complex primary and revision THA.

This study compared the spatio-temporal dynamics in two agriculturally-influenced South African estuaries - Gamtoos and Sundays - to investigate how contrasting hydrological alterations influence physical, chemical and biological responses. With the Gamtoos Estuary experiencing regular high flow conditions, a key difference between the two systems is the propensity for natural flushing events to occur; a mechanism largely eliminated from the highly-regulated Sundays Catchment. Phytoplankton blooms (>20Chl-aμgl -1 ) were persistent and seasonal in the Sundays, inducing summer bottom-water hypoxia (<2mgl -1 ), whilst those in the Gamtoos were episodic and flow-dependent. Of concern in the Sundays Estuary, was the magnitude (>550μgl -1 ) and recurrent nature of two harmful algal bloom (HAB) species. This study provides the first account of HAB persistence and seasonal hypoxia in a South African estuary, demonstrating the possible consequences of shifting an ecosystem into a new stable state., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Autism spectrum disorders (ASD) are complex neurobiological disorders that impair social interactions and communication and lead to restricted, repetitive, and stereotyped patterns of behavior, interests, and activities. The causes of these disorders remain poorly understood, but gut microbiota, the 10 13 bacteria in the human intestines, have been implicated because children with ASD often suffer gastrointestinal (GI) problems that correlate with ASD severity. Several previous studies have reported abnormal gut bacteria in children with ASD. The gut microbiome-ASD connection has been tested in a mouse model of ASD, where the microbiome was mechanistically linked to abnormal metabolites and behavior. Similarly, a study of children with ASD found that oral non-absorbable antibiotic treatment improved GI and ASD symptoms, albeit temporarily. Here, a small open-label clinical trial evaluated the impact of Microbiota Transfer Therapy (MTT) on gut microbiota composition and GI and ASD symptoms of 18 ASD-diagnosed children., Results: MTT involved a 2-week antibiotic treatment, a bowel cleanse, and then an extended fecal microbiota transplant (FMT) using a high initial dose followed by daily and lower maintenance doses for 7-8 weeks. The Gastrointestinal Symptom Rating Scale revealed an approximately 80% reduction of GI symptoms at the end of treatment, including significant improvements in symptoms of constipation, diarrhea, indigestion, and abdominal pain. Improvements persisted 8 weeks after treatment. Similarly, clinical assessments showed that behavioral ASD symptoms improved significantly and remained improved 8 weeks after treatment ended. Bacterial and phagedeep sequencing analyses revealed successful partial engraftment of donor microbiota and beneficial changes in the gut environment. Specifically, overall bacterial diversity and the abundance of Bifidobacterium, Prevotella, and Desulfovibrio among other taxa increased following MTT, and these changes persisted after treatment stopped (followed for 8 weeks)., Conclusions: This exploratory, extended-duration treatment protocol thus appears to be a promising approach to alter the gut microbiome and virome and improve GI and behavioral symptoms of ASD. Improvements in GI symptoms, ASD symptoms, and the microbiome all persisted for at least 8 weeks after treatment ended, suggesting a long-term impact., Trial Registration: This trial was registered on the ClinicalTrials.gov, with the registration number  NCT02504554.

Introduction: We previously reported promising early results in patients undergoing primary total hip arthroplasty (THA) with a third-generation cementless acetabular system that has a porous plasma-sprayed coating on a titanium alloy substrate shell, a ringless barb and groove locking mechanism, and a vitamin E-infused highly crosslinked polyethylene insert. The purpose of this study was to examine the outcomes and need for revision in a subset of patients previously reviewed who now have potential for three-year follow-up., Patients and Methods: A query of our practice registry revealed 235 consented patients (241 hips) who underwent cementless primary THA performed by three surgeons with the G7® Acetabular System (Zimmer Biomet, Warsaw, Indiana) between April 2013 and September 2013. All liners were vitamin E-infused highly crosslinked polyethylene with a neutral face. Mean patient age was 65.8 years and mean BMI was 31.3 kg/m2. Heads used were 179 Biolox® delta (74%; CeramTec AG, Plochingen, Germany) and 62 cobalt-chromium (26%), with diameters of 32mm in 105 (41%) and 36mm in 136 (56%)., Results: A minimum three-year follow-up was available for 152 hips in 146 patients. Harris Hip Scores improved from 47.8 to 88.2, and UCLA activity scale from 3.9 to 5.4. One patient from this study period required cup revision secondary to failure of biological fixation at 15.1 months postoperative. There have been no dislocations or other revisions of the acetabular component. Kaplan-Meier survival with endpoint of acetabular revision was 99.5% (95% CI: 99.0% to 100%) at 3.4 years. Radiographic findings in all cases were satisfactory position and alignment with no radiolucencies observed., Conclusion: In this study, with minimum three-year follow-up, good results with 99.5% survival were achieved using a third-generation cementless acetabular system with a ringless barb and groove locking mechanism.

Introduction: The gender-specific total knee arthroplasty (TKA) debate focuses on differences in distal femoral mediolateral to anteroposterior aspect ratio between males and females. However, randomized studies have been unable to demonstrate significant differences in outcomes utilizing gender-specific implants. No studies have examined the effect of intermediate femoral component sizes on outcome. We compared outcomes before and after intermediate sizing availability., Materials and Methods: We identified 331 patients (413 knees) who underwent primary TKA between 2003 and 2004 with a single complete knee system. There were 121 males and 210 females. Three intermediate femoral sizes were added in March 2004 to the six initial options. Patients before March 2004 were assigned to group 1 (n=178), and after to group 2 (n=235)., Results: Follow-up averaged 8.5 years. Preoperative demographics and clinical scores were similar between groups. Knee Society (KS) clinical and functional scores improved in females in both groups, but there was no significant difference. Male patients in group 2 had a significant improvement in KS clinical scores compared to male patients in group 1 (group 1: 33.9, group 2: 41.1; p=0.01). Females in group 2 had significantly less need for manipulation, 1.9%, versus females in group 1, 8.7% (p=0.01). MUA rates were similar for men between groups. Overall, there were 19 revisions (4.6%) with no differences between groups or by genders. Once intermediate sizes were available, they were used in 48% of females and 13% of males. The average femoral component size for females in group 1 was 65 mm and decreased in group 2 to 62.5 mm. The average size of femoral components in males was 70 mm in both groups., Conclusions: Availability of intermediate size femoral component sizes was associated with a lower rate of manipulation in female patients. Greater KS clinical score improvement was observed in men after availability of additional femoral sizes.

Background: In past decades, polyethylene wear was a major cause of failure in total knee arthroplasty (TKA). Polyethylene for use in arthroplasty has been vastly improved in recent years, with improved materials as well as manufacturing and sterilization processes. Testing has shown that infusion of vitamin E prevents oxidative degradation of polyethylene without remelting, allowing the material to maintain mechanical properties and wear resistance over time. The purpose of this study is to review the early result of patients undergoing primary TKA with vitamin E antioxidant-infused polyethylene inserts., Materials and Methods: A query of our practice registry revealed 148 patients (163 knees) who underwent primary cemented TKA using the Vanguard® Complete Knee System and E1® Antioxidant Infused polyethylene bearings (Zimmer Biomet, Warsaw, Indiana) between May 2009 and May 2013. Indications for E1® bearings were younger, more active patients. There were 65 males (44%) and 82 females (56%). Mean age was 50.6 years and mean BMI was 37.3 kg/m2., Results: At mean follow-up of 3.2 years (range 6 weeks to 6.4 years), there have been seven revisions (4.3%): three two-staged exchanges for infection, two for arthrofibrosis (one insert only, one femoral and tibial), and two (insert only) for late instability with imbalanced tight posteromedial and loose lateral structures. No aseptic loosening has occurred. Mean range of motion improved from 108° preoperatively to 112°, Knee Society clinical scores improved from 36 to 84 and function scores from 56 to 66. Postoperative radiographs, available for 160 TKA, revealed lateral patellar tilt in one knee, and satisfactory position, alignment, and fixation in all others., Conclusion: At up to 6.4 years' follow-up, two mechanical failures of the device have occurred and no aseptic loosening. Survival was 100% with aseptic loosening as the endpoint, and 95.7% with revision for any reason as the endpoint.

Aims: An evidence-based radiographic Decision Aid for meniscal-bearing unicompartmental knee arthroplasty (UKA) has been developed and this study investigates its performance at an independent centre., Patients and Methods: Pre-operative radiographs, including stress views, from a consecutive cohort of 550 knees undergoing arthroplasty (UKA or total knee arthroplasty; TKA) by a single-surgeon were assessed. Suitability for UKA was determined using the Decision Aid, with the assessor blinded to treatment received, and compared with actual treatment received, which was determined by an experienced UKA surgeon based on history, examination, radiographic assessment including stress radiographs, and intra-operative assessment in line with the recommended indications as described in the literature., Results: The sensitivity and specificity of the Decision Aid was 92% and 88%, respectively. Excluding knees where a clear pre-operative plan was made to perform TKA, i.e. patient request, the sensitivity was 93% and specificity 96%. The false-positive rate was low (2.4%) with all affected patients readily identifiable during joint inspection at surgery. In patients meeting Decision Aid criteria and receiving UKA, the five-year survival was 99% (95% confidence intervals (CI) 97 to 100). The false negatives (3.5%), who received UKA but did not meet the criteria, had significantly worse functional outcomes (flexion p < 0.001, American Knee Society Score - Functional p < 0.001, University of California Los Angeles score p = 0.04), and lower implant survival of 93.1% (95% CI 77.6 to 100)., Conclusion: The radiographic Decision Aid safely and reliably identifies appropriate patients for meniscal-bearing UKA and achieves good results in this population. The widespread use of the Decision Aid should improve the results of UKA. Cite this article: Bone Joint J 2016;98-B(10 Suppl B):3-10., (©2016 Murray et al.)

Aims: Since redesign of the Oxford phase III mobile-bearing unicompartmental knee arthroplasty (UKA) femoral component to a twin-peg design, there has not been a direct comparison to total knee arthroplasty (TKA). Thus, we explored differences between the two cohorts., Patients and Methods: A total of 168 patients (201 knees) underwent medial UKA with the Oxford Partial Knee Twin-Peg. These patients were compared with a randomly selected group of 177 patients (189 knees) with primary Vanguard TKA. Patient demographics, Knee Society (KS) scores and range of movement (ROM) were compared between the two cohorts. Additionally, revision, re-operation and manipulation under anaesthesia rates were analysed., Results: The mean follow-up for UKA and TKA groups was 5.4 and 5.5 years, respectively. Six TKA (3.2%) versus three UKAs (1.5%) were revised which was not significant (p = 0.269). Manipulation was more frequent after TKA (16; 8.5%) versus none in the UKA group (p < 0.001). UKA patients had higher post-operative KS function scores versus TKA patients (78 versus 66, p < 0.001) with a trend toward greater improvement, but there was no difference in ROM and KS clinical improvement (p = 0.382 and 0.420, respectively)., Conclusion: We found fewer manipulations, and higher functional outcomes for patients treated with medial mobile-bearing UKA compared with TKA. TKA had twice the revision rate as UKA although this did not reach statistical significance with the numbers available. Cite this article: Bone Joint J 2016;98-B(10 Suppl B):28-33., (©2016 Berend et al.)

Background: Modular femoral components emerged because of the advantages of recreating limb length, offset, and native femoral version in total hip arthroplasty. Despite its potential benefits, the increase in modularity at the head-neck junction can lead to corrosion and subsequently failure of the implant., Methods: We present 3 case examples of patients who underwent revision surgery secondary to corrosion of their modular femoral components., Results: Issues addressed include understanding corrosion at the head-neck junction, presentations of adverse local tissue reactions, efficacy of metal ion testing and metal artifact reduction sequence magnetic resonance imaging, and approaches to revision surgery for failed modular neck stems., Conclusions: When revision surgery is indicated for failed modular neck stems, we recommend a thoughtful approach with contemporary extraction techniques and options to enhance stability. Furthermore, long-term follow-up is needed to define the growing effect of modularity in total hip arthroplasty., (Copyright © 2016 Elsevier Inc. All rights reserved.)

This manuscript reviews biological abnormalities shared by autism spectrum disorder (ASD) and epilepsy. Two neuropathological findings are shared by ASD and epilepsy: abnormalities in minicolumn architecture and γ-aminobutyric acid (GABA) neurotransmission. The peripheral neuropil, which is the region that contains the inhibition circuits of the minicolumns, has been found to be decreased in the post-mortem ASD brain. ASD and epilepsy are associated with inhibitory GABA neurotransmission abnormalities including reduced GABAA and GABAB subunit expression. These abnormalities can elevate the excitation-to-inhibition balance, resulting in hyperexcitablity of the cortex and, in turn, increase the risk of seizures. Medical abnormalities associated with both epilepsy and ASD are discussed. These include specific genetic syndromes, specific metabolic disorders including disorders of energy metabolism and GABA and glutamate neurotransmission, mineral and vitamin deficiencies, heavy metal exposures and immune dysfunction. Many of these medical abnormalities can result in an elevation of the excitatory-to-inhibitory balance. Fragile X is linked to dysfunction of the mGluR5 receptor and Fragile X, Angelman and Rett syndromes are linked to a reduction in GABAA receptor expression. Defects in energy metabolism can reduce GABA interneuron function. Both pyridoxine dependent seizures and succinic semialdehyde dehydrogenase deficiency cause GABA deficiencies while urea cycle defects and phenylketonuria cause abnormalities in glutamate neurotransmission. Mineral deficiencies can cause glutamate and GABA neurotransmission abnormalities and heavy metals can cause mitochondrial dysfunction which disrupts GABA metabolism. Thus, both ASD and epilepsy are associated with similar abnormalities that may alter the excitatory-to-inhibitory balance of the cortex. These parallels may explain the high prevalence of epilepsy in ASD and the elevated prevalence of ASD features in individuals with epilepsy.

Background: There is some suggestion that smaller diameter heads in metal-on-metal total hip arthroplasty (MoM THA) may be less prone to the adverse reactions to metal debris (ARMD) seen with large-diameter heads., Questions/purposes: We reviewed our population of patients with small head (≤ 32 mm) MoM THA to determine (1) the frequency of ARMD; (2) potential risk factors for ARMD in this population; and (3) the etiology of revision and Kaplan-Meier survivorship with revision for all causes., Methods: Small-diameter head MoM devices were used in 9% (347 of 3753) of primary THAs during the study period (January 1996 to March 2005). We generally used these implants in younger, more active, higher-demand patients. Three hundred hips (258 patients) had MoM THA using a titanium modular acetabular component with a cobalt-chromium tapered insert and were available for review with minimum 2-year followup (mean, 10 years; range, 2-19 years). Complete followup was available in 86% of hips (300 of 347). Clinical records and radiographs were reviewed to determine the frequency and etiology of revision. Kaplan-Meier survivorship analysis was performed., Results: ARMD frequency was 5% (14 of 300 hips) and represented 70% (14 of 20) of revisions performed. Using multivariate analysis, no variable tested, including height, weight, body mass index, age, cup diameter, cup angle, use of screws, stem diameter, stem type, head diameter, preoperative clinical score, diagnosis, activity level, or sex, was significant as a risk factor for revision. Twenty hips have been revised: two for infection, four for aseptic loosening, and 14 for ARMD. Kaplan-Meier analysis revealed survival free of component revision for all causes was 95% at 10 years (95% confidence interval [CI], 91%-97%), 92% at 15 years (95% CI, 87%-95%), and 72% at 19 years (95% CI, 43%-90%), and survival free of component revision for aseptic causes was 96% at 10 years (95% CI, 92%-98%), 92% at 15 years (95% CI, 88%-95%), and 73% at 19 years (95% CI, 43%-90%)., Conclusions: The late onset and devastating nature of metal-related failures is concerning with this small-diameter MoM device. Although the liner is modular, it cannot be exchanged and full acetabular revision is required. Patients with all MoM THA devices should be encouraged to return for clinical and radiographic followup, and clinicians should maintain a low threshold to perform a systematic evaluation. Symptomatic patients should undergo thorough investigation and vigilant observation for ARMD., Level of Evidence: Level IV, therapeutic study.

Previous reports have stated that MRI is less accurate than CT for patient specific guide creation in total knee arthroplasty (TKA). Twenty-three TKAs were performed with CT-based guides and 27 with MRI-based guides. A mechanical axis through the central third of the knee was achieved in 88.9% of MRI-guided TKA versus 69.6% of CT-guided TKA (p=0.07). There were nine component outliers in the CT group (39.1%) and two in the MRI group (7.4%, p=0.00768). The relative risk of having an outlier using a CT-based guide was 5.28 times that of an MRI-based guide. Superior overall alignment and fewer outliers were achieved with the use of MRI compared with CT. MRI is the best imaging modality for surgeons wishing to utilize patient specific guides for TKA., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Invasive planktonic crustaceans have become a prominent feature of aquatic communities worldwide, yet their effects on food webs are not well known. The Asian calanoid copepod, Pseudodiaptomus forbesi, introduced to the Columbia River Estuary approximately 15 years ago, now dominates the late-summer zooplankton community, but its use by native aquatic predators is unknown. We investigated whether three species of planktivorous fishes (chinook salmon, three-spined stickleback, and northern pikeminnow) and one species of mysid exhibited higher feeding rates on native copepods and cladocerans relative to P. forbesi by conducting `single-prey' feeding experiments and, additionally, examined selectivity for prey types with `two-prey' feeding experiments. In single-prey experiments individual predator species showed no difference in feeding rates on native cyclopoid copepods (Cyclopidae spp.) relative to invasive P. forbesi, though wild-collected predators exhibited higher feeding rates on cyclopoids when considered in aggregate. In two-prey experiments, chinook salmon and northern pikeminnow both strongly selected native cladocerans (Daphnia retrocurva) over P. forbesi, and moreover, northern pikeminnow selected native Cyclopidae spp. over P. forbesi. On the other hand, in two-prey experiments, chinook salmon, three-spined stickleback and mysids were non- selective with respect to feeding on native cyclopoid copepods versus P. forbesi. Our results indicate that all four native predators in the Columbia River Estuary can consume the invasive copepod, P. forbesi, but that some predators select for native zooplankton over P. forbesi, most likely due to one (or both) of two possible underlying casual mechanisms: 1) differential taxon-specific prey motility and escape responses (calanoids > cyclopoids > daphnids) or 2) the invasive status of the zooplankton prey resulting in naivety, and thus lower feeding rates, of native predators feeding on invasive prey.

A third-generation cementless acetabular system has been designed, building on the successes of a second-generation system that featured good congruity between the liner and hemispheric shell, and proven porous plasma-sprayed coating on titanium alloy substrate, by designing a ringless barb and groove locking mechanism and optimizing range of motion. These design features are amenable to modern, highly crosslinked polyethylenes. A retrospective review was performed to assess early outcomes. A query of our practice registry revealed 534 patients (576 hips) who underwent cementless total hip arthroplasty performed by three surgeons with the G7™ Acetabular System (Biomet, Warsaw, Indiana) between April 2013 and March 2014. All liners were vitamin E infused, highly crosslinked polyethylene with a neutral face. Heads used were 463 BIOLOX® delta (81%; CeramTec AG, Plochingen, Germany) and 112 cobalt-chromium (19%), with diameters of 32 mm in 238 (41%), 36 mm in 331 (58%), and 40 mm in 6. Minimum one-year follow-up was available for 400 hips. Mean follow-up was 15 months (range 10-24, SD 3.0). Harris hip scores improved from 50.7 preoperatively to 86.5 most recently. UCLA activity scale improved from 4.5 preoperatively to 5.4 most recently. Two patients required cup revision secondary to failure of biological fixation at 8.4 and 15.1 months respectively. Radiographic findings in all cases were satisfactory position and alignment with no radiolucencies observed. In this group, with very early follow-up, good results with a low rate of acetabular revision and no dislocations were achieved using a new hemispheric porous shell with ringless barb and groove locking mechanism and geometry.

There is a growing body of scientific evidence that the health of the microbiome (the trillions of microbes that inhabit the human host) plays an important role in maintaining the health of the host and that disruptions in the microbiome may play a role in certain disease processes. An increasing number of research studies have provided evidence that the composition of the gut (enteric) microbiome (GM) in at least a subset of individuals with autism spectrum disorder (ASD) deviates from what is usually observed in typically developing individuals. There are several lines of research that suggest that specific changes in the GM could be causative or highly associated with driving core and associated ASD symptoms, pathology, and comorbidities which include gastrointestinal symptoms, although it is also a possibility that these changes, in whole or in part, could be a consequence of underlying pathophysiological features associated with ASD. However, if the GM truly plays a causative role in ASD, then the manipulation of the GM could potentially be leveraged as a therapeutic approach to improve ASD symptoms and/or comorbidities, including gastrointestinal symptoms. One approach to investigating this possibility in greater detail includes a highly controlled clinical trial in which the GM is systematically manipulated to determine its significance in individuals with ASD. To outline the important issues that would be required to design such a study, a group of clinicians, research scientists, and parents of children with ASD participated in an interdisciplinary daylong workshop as an extension of the 1st International Symposium on the Microbiome in Health and Disease with a Special Focus on Autism (www.microbiome-autism.com). The group considered several aspects of designing clinical studies, including clinical trial design, treatments that could potentially be used in a clinical trial, appropriate ASD participants for the clinical trial, behavioral and cognitive assessments, important biomarkers, safety concerns, and ethical considerations. Overall, the group not only felt that this was a promising area of research for the ASD population and a promising avenue for potential treatment but also felt that further basic and translational research was needed to clarify the clinical utility of such treatments and to elucidate possible mechanisms responsible for a clinical response, so that new treatments and approaches may be discovered and/or fostered in the future.

Articulating spacers have been reported to promote greater range of motion, preserve bone, facilitate reimplantation, and enhance functional recovery, as well as provide a vehicle for local administration of antibiotics. The purpose of this study was to review patients treated at our center for deep hip and knee infection with two-staged exchange using molded, articulating antibiotic-laden cement spacers following debridement. A query of our practice registry revealed 84 patients (84 hips) and 177 patients (182 knees) diagnosed with deep infection after THA and TKA respectively, and treated with two-staged exchange using molded articulating cement spacers. Mean follow-up was three years in both groups. Second-stage reimplantation was accomplished in 81 hips, and reinfection occurred in 11 of those (14%), with three responding to a single irrigation and debridement (I&D) procedure, one undergoing two I&Ds, one chronically infected diabetic patient treated with one-stage exchange to cemented components, five patients undergoing multiple procedures including repeat two-staged exchange in four, and one patient declining further treatment. Harris hip score at most recent averaged 69. Second-stage reimplantation was accomplished in 177 knees, and reinfection occurred in 28 of those (16%). Range of motion improved from 93° preoperatively to 101° at most recent, Knee Society clinical scores improved from 46 to 76, and functional scores improved from 32 to 47. Treatment of deep infection after total joint arthroplasty using molded, articulating antibiotic-laden acrylic cement spacers was successful in eradicating infection in 83% of hips (70 of 84) and 82% of knees (149 of 182) at an average of three years after reimplantation.

In this study metal accumulating abilities of three emergent macrophytes (Phragmites australis, Typha capensis and Spartina maritima) were investigated in the urbanised Swartkops Estuary. Plants and sediment samples were collected at seven sites along the banks of the main channel and in adjacent canals. Sediments and plant organs were analysed, by means of atomic absorption spectrometry, for four elements (Cd, Cu, Pb, and Zn). Metal concentrations in the sediments of adjacent canals were found to be substantially higher than those at sites along the banks of the estuary. These differences were reflected in the plant organs for Pb and Zn, but not for Cu and Cd. All three species exhibited significantly higher concentrations of metals in their roots. These species are therefore suitable for use as indicators of the presence and level of heavy metal contaminants in estuaries., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Recent studies suggest a role for the microbiota in autism spectrum disorders (ASD), potentially arising from their role in modulating the immune system and gastrointestinal (GI) function or from gut-brain interactions dependent or independent from the immune system. GI problems such as chronic constipation and/or diarrhea are common in children with ASD, and significantly worsen their behavior and their quality of life. Here we first summarize previously published data supporting that GI dysfunction is common in individuals with ASD and the role of the microbiota in ASD. Second, by comparing with other publically available microbiome datasets, we provide some evidence that the shifted microbiota can be a result of westernization and that this shift could also be framing an altered immune system. Third, we explore the possibility that gut-brain interactions could also be a direct result of microbially produced metabolites.

The electronic structure of eight zinc-centered porphyrin macrocyclic molecules are investigated using density functional theory for ground-state properties, time-dependent density functional theory (TDDFT) for excited states, and Franck-Condon (FC) analysis for further characterization of the UV-vis spectrum. Symmetry breaking was utilized to find the lowest energy of the excited states for many states in the spectra. To confirm the theoretical modeling, the spectroscopic result from zinc phthalocyanine (ZnPc) is used to compare to the TDDFT and FC result. After confirmation of the modeling, five more planar molecules are investigated: zinc tetrabenzoporphyrin (ZnTBP), zinc tetrabenzomonoazaporphyrin (ZnTBMAP), zinc tetrabenzocisdiazaporphyrin (ZnTBcisDAP), zinc tetrabenzotransdiazaporphyrin (ZnTBtransDAP), and zinc tetrabenzotriazaporphyrin (ZnTBTrAP). The two latter molecules are then compared to their phenylated sister molecules: zinc monophenyltetrabenzotriazaporphyrin (ZnMPTBTrAP) and zinc diphenyltetrabenzotransdiazaporphyrin (ZnDPTBtransDAP). The spectroscopic results from the synthesis of ZnMPTBTrAP and ZnDPTBtransDAP are then compared to their theoretical models and non-phenylated pairs. While the Franck-Condon results were not as illuminating for every B-band, the Q-band results were successful in all eight molecules, with a considerable amount of spectral analysis in the range of interest between 300 and 750 nm. The π-π(∗) transitions are evident in the results for all of the Q bands, while satellite vibrations are also visible in the spectra. In particular, this investigation finds that, while ZnPc has a D4h symmetry at ground state, a C4v symmetry is predicted in the excited-state Q band region. The theoretical results for ZnPc found an excitation energy at the Q-band 0-0 transition of 1.88 eV in vacuum, which is in remarkable agreement with published gas-phase spectroscopy, as well as our own results of ZnPc in solution with Tetrahydrofuran that are provided in this paper.

The femoral component and proprietary instrumentation of a mobile-bearing unicompartmental knee arthroplasty (UKA) was redesigned with an additional peg for enhanced fixation, 15° of extra femoral surface for contact in deep flexion, more rounded profile, better fit into the milled surface, and redesigned intramedullary based instrumentation. To assess the benefit of these changes, we compared postoperative radiographs of 219 single-peg and 186 twin-peg UKAs done in 2008-2011. All surviving knees demonstrated satisfactory position and alignment with no radiolucencies observed. Radiographic analysis showed improved and consistent component positioning with the twin-peg design implanted with updated instrumentation compared with the single-peg. The radiographic benefits of improved implant positioning using the twin-peg component and updated instrumentation are clear and carry tremendous potential. More robust follow-up is imperative., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Sediment and Mytilus galloprovincialis samples collected from the Port Elizabeth Harbour were analysed for six indicator PCB congeners to assess their contamination status. The concentrations of total PCBs in sediments and M. galloprovincialis ranged from 0.56 to 2.35 ng/g dry weight and 14.48 to 21.37 ng/g wet weight, respectively. Congeners 138 and 153 were dominant and accounted for an average of 29% and 24% of total PCBs in M. galloprovincialis; 32% and 30% in sediments, respectively. Sediments are home to a wide variety of aquatic life. None of the sediments analysed exceeded the PCB limits recommended the Canadian interim sediment quality guideline and the South African recommended sediment guidelines (21.6 ng/g). Both humans and aquatic life are sensitive to the toxic effects of PCBs., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Although the introduction of ultraporous metals in the forms of acetabular components and augments has increased the orthopaedic surgeon's ability to reconstruct severely compromised acetabuli, there remain some that cannot be managed readily using cups, augments, or cages. In such situations, allograft-prosthetic composites or custom acetabular components may be called for. However, few studies have reported on the results of these components., Questions/purposes: The purposes of this study were to determine the (1) frequency of repeat revision, (2) complications and radiographic findings, and (3) Harris hip scores in patients who underwent complex acetabular revision surgery with custom acetabular components., Methods: Between August 2003 and February 2012, 26 patients (28 hips) have undergone acetabular reconstruction with custom triflange components. During this time, the general indications for using these implants included (1) failed prior salvage reconstruction with cage or porous metal construct augments, (2) large contained defects with possible discontinuity, (3) known pelvic discontinuity, and (4) complex multiply surgically treated hips with insufficient bone stock to reconstruct using other means. This approach was used in a cohort of patients with Paprosky Type 3B acetabular defects, which represented 3% (30 of 955) of the acetabular revisions we performed during the study period. Minimum followup was 2 years (mean, 57 months; range, 28-108 months). Seven patients (eight hips) died during the study period, and three (11%) of these patients (four hips; 14%) were lost to followup before 2 years, leaving 23 patients (24 hips) with minimum 2-year followup. Sixteen patients were women. The mean age of the patients was 67 years (range, 47-85 years) and mean BMI was 28 kg/m2 (range, 23-39 kg/m2). Revisions and complications were identified by chart review; hip scores were registered in our institution's longitudinal database. Pre- and postoperative radiographs were analyzed by the patient's surgeon to determine whether migration, fracture of fixation screws, or continued bone loss had occurred., Results: There have been four subsequent surgical interventions: two failures secondary to sepsis, and one stem revision and one open reduction internal fixation for periprosthetic femoral fracture. There were two minor complications managed nonoperatively, but all of the components were noted to be well-fixed with no obvious migration or loosening observed on the most recent radiographs. Harris hip scores improved from a mean of 42 (SD, ±16) before surgery to 65 (SD, ±18) at latest followup (p<0.001)., Conclusions: Custom acetabular triflange components represent yet another tool in the reconstructive surgeon's armamentarium. These devices can be helpful in situations of catastrophic bone loss., Level of Evidence: Level IV, therapeutic study.

Background: Cadaveric and clinical studies have suggested that, despite being touted as muscle-sparing, the direct anterior approach is still associated with muscle damage, particularly to the tensor fascia lata (TFL). Patient body mass index (BMI) and/or sex may also influence this parameter., Questions/purposes: The purposes of the study were to determine if using a shorter femoral component reduces TFL damage or if patient sex or increasing BMI increases intraoperative TFL damage in direct anterior THA., Methods: Over a 1-year period, 599 direct anterior THAs were performed by three experienced anterior hip surgeons; of those, 421 direct anterior hips had complete data (70%) and were included in the study. The amount of visible damage to the TFL was recorded before closure. Two stem types were used, a standard-length flat-wedge taper (standard) or a 3-cm shortened version of the same stem (short). Stem selection was based on timeframe of the surgery, surgeon preference, or matching a previous implant type. During the study period, the three surgeons performed an additional 225 primary THAs with other approaches such that the direct anterior approach represented 73% of the THAs performed. A member of the operating team, either a fellow or physician assistant, graded the extent of damage based on a 0 to 3 scale. On this scale, 0 represented no muscle fiber damage, 1 superficial tearing, 2 deep tearing or maceration, and 3 complete tear or severe damage. Patient sex and BMI were recorded and compared with stem type and muscle damage scores. An ordinal logistic regression model was used for statistical analysis., Results: After controlling for relevant confounding variables using logistic regression, we found that mean muscle damage was associated with male sex (0.93, SD 0.76 versus 0.70, SD 0.68; p<0.001) and increasing BMI levels (p<0.001). As BMI increased, more muscle damage also was found in men compared with women (p=0.05; odds ratio [OR], 1.029; 95% confidence interval [CI], 1.000-1.060). There was no overall difference in mean muscle damage between short and standard-length stems (0.78, SD 0.77 versus 0.85, SD 0.69, p=0.32); however, as BMI increased, less damage was seen with a short stem (p=0.04; OR, 0.968; 95% CI, 0.931-0.997)., Conclusions: Visible muscle damage occurred in most hips during anterior supine intermuscular hip arthroplasty. The clinical importance of this muscle damage requires further study, because some evidence suggests earlier restoration of gait and cessation of walking aids with direct anterior THA despite this damage; however, this was not studied here. Surgeons performing this approach can expect more difficulty and as a result possibly more damage to the TFL in patients with male sex and increased BMI. The use of a short stem can be considered for patients with increased BMI to limit damage to the TFL., Level of Evidence: Level III, therapeutic study.

Background: Use of large-diameter metal-on-metal (MoM) articulations in THA increased, at least in part, because of the possibility of achieving improved joint stability and excellent wear characteristics in vitro. However, there have been subsequent concerning reports with adverse reactions to metal debris (ARMD), pseudotumors, and systemic complications related to metal ions., Questions/purposes: The purpose of this study was to determine at a minimum of 2 years' followup (1) the proportion of patients who experienced a dislocation; (2) the short-term survivorship obtained with these implants; (3) the causes of failure and the proportion of patients who developed ARMD; and (4) whether there were any identifiable risk factors for revision., Methods: We reviewed the results of 1235 patients who underwent 1440 large-diameter MoM primary THAs at our institution using two acetabular devices from a single manufacturer with minimum 2-year followup. Large-diameter MoM devices were used in 48% (1695 of 3567) of primary THAs during the study period. We generally used these implants in younger, more active, higher-demand patients, in patients considered at higher risk of instability, and in patients with adequate bone stock to achieve stable fixation without use of screws. Clinical records and radiographs were reviewed to determine the incidence and etiology of revision. Patients whose hips were revised were compared with those not revised to identify risk factors; Kaplan-Meier survivorship analysis was performed as was multivariate analysis to account for potential confounding variables when evaluating risk factors. Minimum followup was 2 years (average, 7 years; range, 2-12 years); complete followup was available in 85% of hips (1440 of 1695)., Results: Dislocation occurred in one hip overall (<1%; one of 1440). Kaplan-Meier analysis revealed survival free of component revision was 87% at 12 years (95% confidence interval, 84%-90%). The two most common indications for revision were ARMD (48%; 47 of 108 hips revised) and loosening or failure of ingrowth (31%; 34 of 108). Risk factors for component revision were younger age at surgery (relative risk [RR] 0.98 per each increased year; p=0.02), higher cup angle of inclination (RR 1.03 per each increased degree; p=0.04), and female sex (RR 1.67; p=0.03)., Conclusions: Large-diameter MoM THAs are associated with a very low dislocation rate, but failure secondary to ARMD and loosening or lack of ingrowth occur frequently. Patients with MoM THA should be encouraged to return for clinical and radiographic followup, and clinicians should maintain a low threshold to perform a systematic evaluation. Early diagnosis and appropriate treatment are recommended to prevent the damaging effects of advanced ARMD., Level of Evidence: Level IV, Therapeutic study.

Clostridial neurotoxins (CNTs) are the deadliest toxins known and the causative agents of botulism and tetanus. Despite their structural and functional complexity, no CNT homologs are currently known outside Clostridium. Here, we report the first homologs of Clostridium CNTs within the genome of the rice fermentation organism Weissella oryzae SG25. One gene in W. oryzae S25 encodes a protein with a four-domain architecture and HExxH protease motif common to botulinum neurotoxins (BoNTs). An adjacent gene with partial similarity to CNTs is also present, and both genes seem to have been laterally transferred into the W. oryzae genome from an unknown source. Identification of mobile, CNT-related genes outside of Clostridium has implications for our understanding of the evolution of this important toxin family., (Copyright © 2015 Federation of European Biochemical Societies. Published by Elsevier B.V. All rights reserved.)

Multiple methods have been proposed to establish stable fixation to promote healing of trochanteric osteotomies or fractures in revision total hip arthroplasty (revTHA), from wiring techniques through cable-plate systems with or without supplemental locking screws. The purpose of this study is to report the clinical results of a single cable-plate system with locked screw fixation in revTHA. Between 2009 and 2012, 27 grip-plates (Supercable® System, Kinamed Inc., Camarillo, CA) were used in 26 patients in 27 revTHA procedures. Utilization was 12 1-hole (50 mm) grip-plates, 10 2-hole (135 mm) grip-plates, four 4-hole (190 mm) grip-plates, and one 6-hole (245 mm) grip-plate. There were 14 women and 12 men. Age averaged 63.2 years and BMI averaged 29.4 kg/m2. At average 2.5 year follow-up, grip-plate fixation was considered successful in 22 hips (81%) with five failures. Three failures consisted of 50 mm/short grip-plates used in one trochanteric slide, and two intraoperative trochanteric fractures during revTHA. The two additional failures were related to pre-revision trochanteric avulsion from bony necrosis of the proximal femur. An additional three grip-plates were removed electively for soft-tissue irritation and pain but with successful fixation and bony healing. Thus 70% of hips were free of reoperation related to the grip-plate. All other hips had successful fixation and the grip-plate was not symptomatic. In this study, the cable-grip system and isoelastic Supercables provided reliable fixation for adequate healing of difficult ETO and trochanteric fractures with an 81% rate of mechanical success with radiographic and clinical healing observed.