Necrotic and inflammatory changes in metal-on-metal resurfacing hip arthroplasties

Size: px
Start display at page:

Download "Necrotic and inflammatory changes in metal-on-metal resurfacing hip arthroplasties"

Transcription

1 Act Orthopedic 2009; 80 (6): Necrotic nd inflmmtory chnges in metl-on-metl resurfcing hip rthroplsties Reltion to implnt filure nd pseudotumor formtion Gyn Mhendr, Hemnt Pndit, Krolin Kliskey, Dvid Murry, Hrinderjit Singh Gill, nd Nick Athnsou Nuffield Deprtment of Orthopedic Surgery, University of Oxford, Nuffield Orthopedic Centre, Hedington, Oxford, UK Correspondence: Sumitted Accepted Bckground Necrosis nd inflmmtion in peri-implnt soft tissues hve een descried in filed second-genertion metl-onmetl (MoM) resurfcing hip rthroplsties nd in the pseudotumors ssocited with these implnts. The precise frequency nd significnce of these tissue chnges is unknown. Method We nlyzed morphologicl nd immunophenotypic chnges in the periprosthetic soft tissues nd femorl heds of 52 revised MoM rthroplsties (frcture in 21, pseudotumor in 13, component loosening in 9, nd other cuses in 9 cses). Results Sustntil necrosis ws oserved in the periprosthetic connective tissue in 28 of the cses, including ll pseudotumors, nd 5 cses of component loosening. A hevy, diffuse inflmmtory cell infiltrte composed minly of HLA-DR+/CD14+/CD68+ mcrophges nd CD3+ T cells ws seen in 45 of the cses. Perivsculr lymphoid ggregtes composed of CD3+ cells nd CD20+ B cells were noted in 27 of the cses, ut they were not seen in ll cses of component loosening or pseudotumors. Plsm cells were noted in 30 cses. Mcrophge grnuloms were noted in 6 cses of component loosening. In the one mrrow of the femorl hed, mcrophge nd T cell response ws seen in 31 of the cses; lymphoid ggregtes were noted in 19 of the cses nd discrete grnuloms in 1 cse. Interprettion Our findings indicte tht there is spectrum of necrotic nd inflmmtory chnges in response to the deposition of colt-chrome (Co-Cr) wer prticles in periprosthetic tissues. Ares of extensive cogultive necrosis nd mcrophge nd T lymphocyte response occur in implnt filure nd pseudotumors, in which there is lso grnulom formtion. The pthogenesis of these chnges is uncertin ut it my involve oth cytotoxic response nd delyed hypersensitivity (type IV) response to Co- Cr prticles. Second genertion metl-on-metl (MoM) hip resurfcing is recent development in hip rthroplsty. Although erly clinicl results of second genertion MoM hip replcement were encourging (Amstuz et l. 2004, Trecy et l. 2005, Bck et l. 2005, Pollrd et l. 2006, Hing et l. 2007), numer of complictions hve een reported including thinning of the femorl neck, vsculr necrosis, femorl neck frcture, implnt loosening, metl ion relese nd hypersensitivity, nd the formtion of inflmmtory pseudotumors (Cpello et l. 1978, Amstuz et l. 2004, Prk et l. 2005, Shimmin et l. 2005, Bordmn et l. 2006, Jcos et l. 2006, Pndit et l. 2008). The MoM ering surfce is mde from high-cron, colt-chromium-molydenum lloy. This MoM comintion produces less volumetric wer ut results in the relese of much lrger numer of very smll (nnometer-sized) prticles compred to metl-polyethylene rthroplsties. Anlysis of filed first-genertion nd second-genertion MoM resurfcing rthroplsties hs led to the identifiction of numer of histologicl chnges rising from the deposition of these tiny metl prticles in peri-implnt tissues (Doorn et l. 1996, Dvis et l. 2005, Willert et l. 2005, Korovessis et l. 2006). These include pronounced mcrophge response to wer prticles, perivsculr lymphocytic infiltrte, nd tissue necrosis. The necrotic nd inflmmtory chnges seen in periimplnt tissues in response to colt-chromium (Co-Cr) metl wer deris re thought to e due to either cytotoxicity or to delyed hypersensitivity rection (Hll et l. 2001, Willert et l. 2005, Keegn et l. 2007). The significnce of the necrosis nd inflmmtion seen in periprosthetic tissues nd one round second-genertion MoM rthroplsties hs not een fully estlished. Necrosis nd inflmmtion hve een noted not only in filed MoM hip resurfcing rthroplsties (Doorn et l. 1996) ut lso in the Open Access - This rticle is distriuted under the terms of the Cretive Commons Attriution Noncommercil License which permits ny noncommercil use, distriution, nd reproduction in ny medium, provided the source is credited. DOI /

2 654 Act Orthopedic 2009; 80 (6): Detils of revised hip resurfcings including ptient demogrphics nd durtion in situ for ech group of ptients No. of Primry implnt Men ge Sex Men time to revision hips [SD] (rnge) in months [SD] (rnge) Pseudotumor 13 8 BHR, 4 Conserve Plus, 1 Cormet 55 [13] (30 69) 13 F 34 [23] (9 79) Frcture BHR, 8 Conserve Plus 57 [11] (29 76) 8 F, 13 M 7 [11] (0.6 42) Component loosening 9 4 BHR, 3 Conserve Plus, 2 Cormet 59 [13] (30 76) 6 F, 3 M 27 [15] (1.4 45) Other 9 5 BHR, 4 Conserve Plus 60 [8] (46 66) 4 F, 3 M 30 [29] (0.1 76) recently descried pseudotumors tht develop round some MoM implnts (Bordmn et l. 2006, Pndit et l. 2008). In this study, we hve exmined the extent of necrosis nd inflmmtion in peri-implnt soft tissues nd one for lrge series of revised second-genertion MoM hip implnts in order to determine the frequency, nture, nd significnce of these chnges. Ptients nd methods Our study included 50 ptients (29 femles) with men ge of 55 (25 75) yers t the time of revision surgery, which ws crried out etween 2001 nd 2007 (Tle). The primry opertion ws hip resurfcing in ll ptients. In 2 ptients, the revision surgery ws performed on oth hips. The commonest cuse of revision surgery ws frcture (21). Other cuses included perirticulr pseudotumor formtion (13), component loosening (9), instility or recurrent disloction (3), unexplined pin (5), nd vsculr necrosis (1). The men time to revision surgery ws 20 months (rnge: 1 week to 75 months). All cses initilly underwent rthroplsty for osteorthritis; none of the cses hd microiologicl or histologicl evidence of cute infection nd cses of rheumtoid disese were excluded. In 30 cses, smples of periprosthetic soft tissue (including the pseudocpsule nd the cetulr nd femorl pseudomemrne) nd the revised femorl hed were exmined. In 14 cses only the femorl hed ws exmined nd in 8 cses only the periprosthetic tissue ws exmined. Histologicl nlysis of periprosthetic soft tissues nd one 5-µm-thick tissue sections of the pseudocpsule nd pseudomemrne were nlyzed for extent nd type of tissue necrosis, the nture nd degree of inflmmtion, nd the presence of wer deris. The degree of inflmmtion, including lymphocyte nd mcrophge infiltrtion, ws ssessed using the semiquntittive grding system of Willert nd Semlisch (1997) in which none, few, mny, undnt, nd excessive inflmmtory cell infiltrtion is scored s grde 0, 1, 2, 3, or 4. The presence of lymphoid ggregtes ws noted with regrd to their depth of loction (i.e. superficil or deep) nd whether they were perivsculr in distriution. The presence of plsm cells, grnuloms, eosinophils, nd neutrophil polymorphs within the inflmmtory infiltrte ws lso noted. The microntomicl surfce lyer of the periprosthetic tissue ws ssessed to determine whether there ws n intct cellulr lining or whether there ws disruption of the lining nd the surfce ws covered with firin (Keegn et l. 2007). The nture nd degree of inflmmtion in cncellous one ws similrly ssessed. Cncellous one ws lso exmined for the presence or sence of osteonecrosis nd the presence of wer deris. Immunohistochemicl nlysis The inflmmtory cell infiltrte in periprosthetic tissues nd one from 18 representtive cses ws nlyzed y immunohistochemistry using monoclonl ntiodies F7.2.38, NCL-L- CD4-368, C8/144B, L26, CD14-223, KPI, , M7077, nd CR3/43 directed ginst T lymphocytes (CD3, CD4, CD8), B lymphocytes (CD20), mcrophges (CD14, CD68), plsm cells, dendritic cell ntigens, nd HLA-DR, respectively. Results Histologicl nlysis of periprosthetic soft tissues following resurfcing rthroplsty Similr histologicl fetures were noted in the pseudocpsule nd the pseudomemrne of ll revised MoM rthroplsties. PMMA wer deris ws commonly seen in periprosthetic tissues. Individul metl Co-Cr prticles, eing sumicron in size, could not e visulized y light microscopy, ut scttered fine, lck prticles presumed to e ggregtes of Co- Cr prticles were seen within mcrophges nd in extrcellulr connective tissue. The surfce of the pseudocpsule or pseudomemrne ws intct nd covered y synovil lining in only 4% of cses; in the remining cses the surfce ws ulcerted, nd in 15 of these cses the surfce ws covered y firinous mteril. Connective tissue necrosis ws oserved in the superficil or deep zones of periprosthetic soft tissues in ll cses; this necrotic chnge vried considerly in mount, lthough it ws more prominent in cses where the implnt hd een in situ for more thn 12 months. Necrosis ws significnt feture (more thn 25% tissue necrosis in single histologicl section of pseudocpsule or pseudomemrne) in 28 of the cses exmined, including ll cses of pseudotumour (Figure 1). Significnt necrosis ws seen in 30 cses of component

3 Act Orthopedic 2009; 80 (6): Figure 1. Necrosis in peri-implnt soft tissues of n MoM hip resurfcing. () Necrosis of superficil firous tissue tht is covered y firin in cse of component loosening. () Cogultive necrosis in which ghost-like outlines of plump mcrophges re evident in cse of pseudotumor. loosening, ut necrosis ws less mrked in cses of frcture, with the exception of two cses where the implnts hd een in situ for 15 months nd 36 months. In ll cses of pseudotumor formtion nd foclly in 2 cses of component loosening, ghost-like outlines of mcrophges tht in mny cses ppered to lie in smll (grnulom-like) ggregtes were seen (Figure 1c). Focl res of cystic degenertion were lso noted within res of extensive necrosis in pseudotumor cses. An inflmmtory cell infiltrte composed minly of mcrophges nd lymphocytes ws noted in the pseudocpsule nd pseudomemrne of 86% revised MoM implnts. Mcrophges formed significnt component of the inflmmtory response to wer prticles in periprosthetic soft tissues. This mcrophge infiltrte (of grdes 1 3) ws composed of plump mononucler cells nd mcrophge polykryons tht expressed CD 68, HLA-DR, nd CD14 (Figure 2). Discrete grnuloms, composed of HLA-DR+/CD68+ mcrophges nd gint cells, were seen in cses of pseudotumor nd in three cses of component loosening. In cses of pseudotumor, grnulomtous response ws seen round res of necrosis (Figure 3). c Figure 2. Inflmmtion in the pseudomemrne from cse of component loosening showing () mcrophge infiltrtion nd metl prticles (rrowed); () mcrophge nd gint cell expression of CD68; nd (c) discrete grnulom formtion. A diffuse lymphocytic infiltrte in superficil nd deep firous tissue (grde 1 3) ws commonly seen in periprosthetic soft tissues in revised MoM cses (Figure 4). Scttered perivsculr lymphoid ggregtes were lso seen in 27 cses, minly in deep periprosthetic tissue. In 19 cses, 3 or more lymphoid ggregtes were noted per high-power field (HPF). Lymphoid ggregtes were seen in 41 cses of component

4 656 Act Orthopedic 2009; 80 (6): Figure 3. Mcrophge nd gint cell (rrowed) grnulomtous response round n re of cogultive necrosis (top) in cse of MoM-implnt ssocited pseudotumor. loosening nd in 30 of the pseudotumor cses. Immunohistochemistry showed tht the diffuse lymphocytic infiltrte ws composed minly of CD3+ T cells with few or no CD20+ B lymphocytes. CD4+ nd CD8+ cells were noted in equl numers. The lymphoid ggregtes contined CD3+ T lymphocytes nd CD20+ B lymphocytes. Plsm cells often scttered round lymphoid ggregtes were noted in 30 cses; more thn 10 plsm cells per HPF were seen in 14 cses. More thn 2 eosinophil polymorphs per HPF were noted in 3 cses. Histologicl nlysis of the femorl hed one following resurfcing hip rthroplsty In 31 cses where revised femorl heds were ville for nlysis, there ws chronic inflmmtory cell infiltrte in the one mrrow. This inflmmtory infiltrte ws composed minly of CD68+/CD14+/HLA-DR+ mcrophges, some of which contined metl prticles, nd lymphocytes (Figure 5 nd ). A hevy (grde 2 3) lymphocytic infiltrte composed minly of CD3+ T cells ws noted in 8 cses; lmost ll of these cses hd grde 2 3 lymphocytic infiltrte in periprosthetic soft tissues s well. CD20+ B cells were seen in 19 cses. A mcrophge nd gint cell grnulom ws noted in one cse of prosthesis frcture (Figure 5c). Osteonecrosis, mrrow firosis, remodeling chnge in one trecule, nd degenertive chnge in the mrrow were noted in lmost ll femorl heds. Discussion Our findings indicte tht spectrum of necrotic nd inflmmtory chnges cn e seen in peri-implnt tissues of MoM rthroplsties nd tht these chnges re most pronounced in cses of component loosening nd pseudotumor formtion. The pthogenesis of the necrosis nd inflmmtion tht occurs s result of the deposition of Co-Cr wer prticles in MoM c Figure 4. Pseudomemrne from cse of MoM implnt component loosening showing () numerous perivsculr lymphoid ggregtes nd diffuse lymphocyte infiltrte; () expression of CD3 y lymphocytes in the diffuse inflmmtory cell infiltrte; nd (c) CD20-expressing B lymphocytes in lymphoid ggregtes. peri-implnt tissues is not certin, ut our results suggest tht oth cytotoxicity nd hypersensitivity to metl prticles my ply role in inducing these chnges. Cogultive necrosis ws seen in periprosthetic soft tissues of ll filed MoM rthroplsties in our study. Vsculr occlusion, either due to vsculitis or toxic effect on lood vessel

5 Act Orthopedic 2009; 80 (6): c Figure 5. Femorl one mrrow from revised MoM hip resurfcing showing () collection of mcrophges contining metl prticles (rrowed); () smll lymphoid ggregte; nd (c) discrete mcrophge nd gint cell grnulom. wlls ssocited with Co-Cr metl wer prticle deposition (Evns et l. 1974, Winter 1974, Jones et l. 1975, Doorn et l. 1996, Willert nd Semlisch. 1997), hs een suggested s cuse of this tissue necrosis in long-term nd short-term firstnd second-genertion MoM hip replcements. However, Brown et l. (1977) found no correltion etween vsculr 657 occlusion nd periprosthetic tissue necrosis, nd experimentl studies hve found tht synovil tissue necrosis following injection of Co-Cr prticles into rt knee joints does not pper to correlte with vsculr occlusion or inflmmtion (Howie nd Vernon-Roerts 1988). In our series of cses, we found no morphologicl evidence to suggest n cute or chronic vsculitis, such s firinoid necrosis or destruction of the elstic lmin of smll vessels. In ddition, perivsculr lymphocytic infiltrte ws not seen in ll cses where there ws tissue necrosis. Thus, our oservtions do not point to the necrosis in periprosthetic soft tissues eing solely due to vsculitis-type process. The volumetric wer rte of MoM erings is lower thn tht of metl-on-polyethylene erings, ut the numer of prticles generted from MoM erings is much higher ecuse the metl prticles re considerly smller. These Co-Cr prticles hve high specific surfce re, promoting the dissolution of these metl ions into surrounding tissues. These ions re known to induce poptosis nd necrosis of mcrophges, the ltter eing seen prticulrly t high ion concentrtions (Huk et l. 2004). Our finding of necrosis in revised MoM periprosthetic tissues, including those cses where reltively little ssocited inflmmtion ws evident, would indicte tht cytotoxicity cnnot e discounted s possile cuse of peri-implnt tissue necrosis. Ultrstructurl studies hve shown tht metl prticles phgocytosed y mcrophges re trnsported to lysosomes; high concentrtions of metl ions would e relesed in these structures, resulting in poptosis nd cell deth with susequent relese of the phgocytosed metl (Slvti et l. 1993). The morphology of the necrotic nd vile mcrophge grnuloms seen in pseudotumors, nd in some cses of MoM component loosening, would e in keeping with this cytotoxic effect cusing vicious circle in which metl wer prticle genertion leds to mcrophge recruitment, prticle phgocytosis, poptosis, nd cell deth with resultnt relese of metl prticles leding to further mcrophge recruitment, nd repetition of this process. Surfce ulcertion of the pseudocpsule nd pseudomemrne round MoM implnts my result from similr process s the cells tht line the pseudocpsule re minly mcrophge in phenotype; exposure of rticulr synovil tissue to Co-Cr deris is sufficient to provoke surfce ulcertion nd lymphocytic infiltrte in the sence of loose prosthesis (Howie et l. 1988). A perivsculr lymphocyte nd plsm cell rection, septic lymphocyte-dominted vsculr ssocited lesion (ALVAL), hs een noted in periprosthetic soft tissues of MoM rthroplsties tht hve undergone erly filure (Dvis et l. 2005, Willert et l. 2005). It is considered to develop s result of delyed hypersensitivity response to Co-Cr metl wer deris. A diffuse mcrophge nd lymphocyte infiltrte ws commonly seen in peri-implnt MoM soft tissues nd ws grde 2 3 in degree in cses of pseudotumor nd component loosening. An ALVAL response, however, ws

6 658 Act Orthopedic 2009; 80 (6): not seen in ll revised MoM cses, including those defined s cses of implnt filure due to component loosening. We did not oserve the mcrophge inclusions reported y Willert et l. (2005), ut noted tht mcrophges nd mcrophge polykryons formed discrete grnuloms in some cses. Lymphocytes in filed surfce rthroplsties were minly CD3+ T lymphocytes, comprising mixture of CD4+ nd CD8+ cells. B lymphocytes nd plsm cells were found predominntly in lymphoid ggregtes. There ws lso vrile eosinophil polymorph nd dendritic cell infiltrte, nd some cses of component loosening contined discrete (srcoid-like) grnuloms s well s the typicl necrotic grnuloms found in pseudotumors. The presence of numerous lymphocytes, mcrophges, eosinophil polymorphs, nd ntigen presenting cells, s well s grnulom formtion, would e in keeping with hypersensitivity-induced inflmmtory response, minly type IV in nture, occurring in periprosthetic soft tissues. The presence of similr inflmmtory cell infiltrte in the one mrrow of femorl heds retrieved from revised MoM rthroplsties indictes tht similr response to wer prticles occurs in one. Osteonecrosis of the femorl hed hs lso een seen in mny of these cses, numer of which presented with frcture (Little et l. 2005). Our finding of peri-implnt tissue necrosis nd mcrophge response in ll revised MoM cses, including those with little ssocited lymphocytic infiltrte, would e in keeping with the concept of phgocytosis of cytotoxic Co-Cr prticles inducing the mcrophge poptosis nd cell deth seen in the necrotic res of pseudotumors. It is well recognised tht Co- Cr prticles cn induce ctivtion nd trnsformtion of lymphocytes (Slvti et l. 1993), nd T lymphocyte response ws seen in lmost ll revised MoM cses including cses of pseudotumor formtion, where it ws ssocited with hevy mcrophge infiltrte nd grnulom formtion. These morphologicl nd immunologicl chnges would e in keeping with delyed (type IV) hypersensitivity response to metl prticles plying role in pseudotumor formtion. A lymphocytic nd necrotic grnulomtous response cn develop in cses of contct skin hypersensitivity in response to metl components of chep jewellery, which often contin nickel or chromium; crossover hypersensitivity etween these metls is known to occur (Csper et l. 2004). It hs een suggested tht the hypersensitivity response to metl components in this jewellery my explin the high frequency of pseudotumors in femles. The hypersensitivity response to metls is proly vrile ut, when pronounced, it my e mjor contriutory fctor to the necrosis nd inflmmtion ssocited with component loosening nd pseudotumor formtion. MG: dt nlysis nd mnuscript preprtion; PH: provided clinicl expertise, co-ordinted the project, nd wrote the clinicl spects of the pper; KK: creted the dtse, dt entry nd nlysis; MD: conception nd study design, highlighted the clinicl prolem, revision of mnuscript; GHS: methodologicl expertise, revision of mnuscript; AN: conception nd study design, dt collection nd nlysis, mnuscript preprtion. The uthors cknowledge the support from Tem 2 clinicins t the Nuffield Orthopedic Centre. We thnk Ms C Lowe for help in preprtion of the mnuscript. Finncil support ws received from the NIHR Biomedicl Reserch Unit into Musculoskeletl Disese, the Nuffield Orthopedic Centre, nd the University of Oxford. Amstutz H C, Beulé P E, Dorey F J, Le Duff M J, Cmpell P A, Gruen T A. Metl-on-Metl Hyrid Surfce Arthroplsty: Two to Six-Yer Follow-up Study. J Bone Joint Surg (Am) 2004; 86: Amstutz H C, Cmpell P A, Le Duff M J. Frcture of the neck of the femur fter surfce rthroplsty of the hip. J Bone Joint Surg (Am) 2004; 86: Bck D l, Dlziel R, Young D, Shimmin A. Erly results of primry Birminghm hip resurfcings. An independent prospective study of the first 230 hips. J Bone Joint Surg (Br) 2005; 87: Bordmn D R, Middleton F R, Kvngh T G. A enign psos mss following metl-on-metl resurfcing of the hip. J Bone Joint Surg (Br) 2006; 88: Brown G C, Lockshin M D, Slvti E A, Bullough P G. Sensitivity to metl s possile cuse of sterile loosening fter colt-chromium totl hipreplcement rthroplsty. J Bone Joint Surg (Am) 1977; 59: Cpello W N, Irelnd P H, Trmmell T R, Eicher P. Conservtive totl hip rthroplsty: procedure to conserve one stock. Prt 1: nlysis of sixtysix ptients. Prt II: nlysis of filures. Clin Orthop 1978; (134): Csper C, Groth W, Hunzelmnn N. Srcoidl-type llergic contct grnuloms: rre compliction of er piercing. Am J Dermtopthol 2004; 26: Dvis A P, Willert H G, Cmpell P A, Lermonth I D, Cse C P. An unusul lymphocytic perivsculr infiltrtion in tissues round contemporry metlon-metl joint replcements. J Bone Joint Surg (Am) 2005; 87: Doorn P F, Mirr J M, Cmpell P A, Amstutz H C. Tissue rection to metl on metl totl hip prostheses. Clin Orthop (Suppl) 1996; (329): S Evns E, Freemn M A, Miller A J, Vernon-Roerts B. Metl sensitivity s cuse of one necrosis nd loosening of the prosthesis in totl joint replcement. J Bone Joint Surg 1974 (Br); 56: Hll N, Merritt K, Jcos J J. Metl sensitivity in ptients with orthopedic implnts. J one Joint Surg (Am) 2001; 83: Hing C B, Bck D L, Biley M, Young D A,Dlzier R E, Shimmin A J. The results of primry Birminghm hip resurfcings t men of five yers: An independent prospective review of the first 230 hips. J Bone Joint Surg (Br) 2007; 89: Howie D W, Vernon-Roerts B. The synovil response to intrrticulr coltchrome wer prticles. Clin Orthop 1988; (232): Huk O L, Ctels I, Mwle F Antoniou J, Zukor D J, Petit A. Induction of poptosis nd necrosis y metl ions in vitro. J Arthroplsty 2004; 19: Jcos J J, Hll N J. Loosening nd osteolysis ssocited with metl-onmetl erings. A locl effect of metl hypersensitivity? J Bone Joint Surg (Am) 2006; 88: Jones D A, Lucs H, O Driscoll M, Price C H G, Wierley B. Colt toxicity fter McKee hip rthroplsty. J Bone Joint Surg (Br) 1975; 57: Keegn G M, Lermonth I D, Cse C P. Orthopedic metls nd their potentil toxicity in the rthroplsty ptient. A review of current knowledge nd future strtegies. J Bone Joint Surg (Br) 2007; 89: Korovessis P, Petsinis G, Repnti M, Repntis T. Metllosis fter contemporry metl-on-metl totl hip rthroplsty: five to nine-yer follow-up. J Bone Joint Surg (Am) 2006; 88:

7 Act Orthopedic 2009; 80 (6): Little C P, Ruiz A L, Hrding I J, McLrdy-Smith P, Gundle R, Murry D W, Athnsou N A. Osteonecrosis in retrieved femorl heds fter filed resurfcing rthroplsty of the hip. J Bone Joint Surg (Br) 2005; 87: Pndit H, Glyn-Jones S, McLrdy-Smith P, Gundle R, Whitwell D, Gions C L, Ostlere S, Athnsou N, Gill H S, Murry D W. Pseudotumours ssocited with metl-on-metl hip resurfcings. J Bone Joint Surg (Br); 2008; 90: Prk Y S, Moon Y W, Lim S J, Yng J M, Ahn G, Choi Y L. Erly osteolysis following second-genertion metl-on-metl hip replcement. J Bone Joint Surg (Am) 2005; 87: Pollrd T C B, Bker R P, Estugh-Wring S J, Bnnister B C. Tretment of the young ctive ptient with osteorthritis of the hip; A five- to seven-yer comprison of hyrid totl hip rthroplsty nd metl-on-metl resurfcing. J Bone Joint Surg (Br) 2006; 88: Slvti E, Betts F, Doty S. Prticulte metl deris in cemented rthroplsty. Clin Orthop 1993; (293): Shimmin A J, Bck D. Femorl neck frctures following Birminghm hip resurfcing: ntionl review of 50 cses. J Bone Joint Surg (Br) 2005; 87: Trecy R B C, McBryde C W, Pynsent P B. Birminghm hip resurfcing rthroplsty. A minimum follow-up of five yers. J Bone Joint Surg (Br) 2005; 87: Willert H G, Semlisch M. Rections of the rticulr cpsule to wer products of rtificl joint prostheses. J Biomed Mter Res 1997; 11: Willert H G, Buchhorn G H, Ing D, Fyyzi A, Flury R, Windler M, Koster G, Lohmnn C H. Metl-on-metl erings nd hypersensitivity inptients with rtificil hip joints; A clinicl nd histomorphologicl study. J Bone Joint Surg (Am) 2005; 87: Winter G D. Tissue rections to metllic wer nd corrosion products in humn ptients. J Biomed Mter Res 1974; 5:11-26.

Pseudotumour Complicated by Implant Loosening One Year After revision Ceramic on Metal Total Hip Arthroplasty: A Case Report

Pseudotumour Complicated by Implant Loosening One Year After revision Ceramic on Metal Total Hip Arthroplasty: A Case Report Cse Report Journl of Orthopedic Cse Reports 2017 Jn Fe: 7(1):82 86 Pseudotumour Complicted y Implnt Loosening One Yer After revision Cermic on Metl Totl Hip Arthroplsty: A Cse Report Devendr Lkhoti 1,

More information

Check your understanding 3

Check your understanding 3 1 Wht is the difference etween pssive trnsport nd ctive trnsport? Pssive trnsport is the movement of prticles not requiring energy. Movement of prticles in ctive trnsport uses energy. 2 A gs tp in the

More information

LATE RESULTS OF TRANSFER OF THE TIBIAL TUBERCLE FOR RECURRENT DISLOCATION OF THE PATELLA1

LATE RESULTS OF TRANSFER OF THE TIBIAL TUBERCLE FOR RECURRENT DISLOCATION OF THE PATELLA1 LATE RESULTS OF TRANSFER OF THE TIBIAL TUBERCLE FOR RECURRENT DISLOCATION OF THE PATELLA1 W. G. J. HAMPSON nd P. HILL, BRISTOL, ENGLAND The uthors wished to determine the lte results of the Huser opertion,

More information

Study of Stress Distribution in the Tibia During Stance Phase Running Using the Finite Element Method

Study of Stress Distribution in the Tibia During Stance Phase Running Using the Finite Element Method Ksetsrt J. (Nt. Sci.) 48 : 729-739 (2014) Study of Stress Distriution in the Tii During Stnce Phse Running Using the Finite Element Method Thepwchr Ruchirh 1, Tumrong Puttpitukporn 1, * nd Siriporn Ssimontonkul

More information

PNEUMOVAX 23 is recommended by the CDC for all your appropriate adult patients at increased risk for pneumococcal disease 1,2 :

PNEUMOVAX 23 is recommended by the CDC for all your appropriate adult patients at increased risk for pneumococcal disease 1,2 : PNEUMOVAX 23 is recommended y the CDC for ll your pproprite dult ptients t incresed risk for pneumococcl disese 1,2 : Adults ged

More information

The Dynamics of Varicella-Zoster Virus Epithelial Keratitis in Herpes Zoster Ophthalmicus

The Dynamics of Varicella-Zoster Virus Epithelial Keratitis in Herpes Zoster Ophthalmicus Chpter 2 The Dynmics of Vricell-Zoster Virus Epithelil Kertitis in Herpes Zoster Ophthlmicus The morphology of n individul VZV lesion reflects sequence of events triggered y the virus impct on cornel epithelil

More information

General Microscopic Changes

General Microscopic Changes Generl Microscopic Chnges 2 This chpter covers collection of microscopic chnges tht lck dignostic specificity ut occur in different specific diseses, s will ecome pprent in susequent chpters. Almost ll

More information

Meat and Food Safety. B.A. Crow, M.E. Dikeman, L.C. Hollis, R.A. Phebus, A.N. Ray, T.A. Houser, and J.P. Grobbel

Meat and Food Safety. B.A. Crow, M.E. Dikeman, L.C. Hollis, R.A. Phebus, A.N. Ray, T.A. Houser, and J.P. Grobbel Met nd Food Sfety Needle-Free Injection Enhncement of Beef Strip Loins with Phosphte nd Slt Hs Potentil to Improve Yield, Tenderness, nd Juiciness ut Hrm Texture nd Flvor B.A. Crow, M.E. Dikemn, L.C. Hollis,

More information

TEMPLATE SYNTHESIS OF Cu AND Cu-Sn NANOPARTICLES USING CARBON FOAM AS A SUPPORT. Ivania MARKOVA-DENEVA, Tihomir PETROV, Ivan DENEV

TEMPLATE SYNTHESIS OF Cu AND Cu-Sn NANOPARTICLES USING CARBON FOAM AS A SUPPORT. Ivania MARKOVA-DENEVA, Tihomir PETROV, Ivan DENEV TEMPLATE SYNTHESIS OF Cu AND Cu-Sn NANOPARTICLES USING CARBON FOAM AS A SUPPORT Ivni MARKOVA-DENEVA, Tihomir PETROV, Ivn DENEV University of Chemicl Technology nd Metllurgy, 8, Kl. Ohridski lvd., Sofi,

More information

Supplementary figure 1

Supplementary figure 1 Supplementry figure 1 Dy 8 post LCMV infection Vsculr Assoc. Prenchym Dy 3 post LCMV infection 1 5 6.7.29 1 4 1 3 1 2 88.9 4.16 1 2 1 3 1 4 1 5 1 5 1.59 5.97 1 4 1 3 1 2 21.4 71 1 2 1 3 1 4 1 5 1 5.59.22

More information

Severe Gummy Smile with Class II Malocclusion Treated with LeFort I Osteotomy Combined with Horseshoe Osteotomy and Intraoral Vertical Ramus

Severe Gummy Smile with Class II Malocclusion Treated with LeFort I Osteotomy Combined with Horseshoe Osteotomy and Intraoral Vertical Ramus 2013 67 1 5560 Severe Gummy Smile with Clss II Mlocclusion Treted with LeFort I Osteotomy Comined with Horseshoe Osteotomy nd Introrl Verticl Rmus Osteotomy * 56 Shimo et l. Act Med. Okym Vol. 67, No.

More information

The effects of diversion of intestinal contents on the progress of Crohn's disease of the large bowel

The effects of diversion of intestinal contents on the progress of Crohn's disease of the large bowel Gut, 1971, 12, 11-15 The effects of diversion of intestinl contents on the progress of Crohn's disese of the lrge owel J. H. BURMAN, H. THOMPSON, W. T. COOKE, AND J. ALEXANDER WILLIAMS From the Nutritionl

More information

Invasive Pneumococcal Disease Quarterly Report July September 2018

Invasive Pneumococcal Disease Quarterly Report July September 2018 Invsive Pneumococcl Disese Qurterly Report July Septemer Introduction Since 17 Octoer 2008, invsive pneumococcl disese (IPD) hs een notifile to the locl Medicl Officer of Helth under the Helth Act 1956.

More information

SUPPLEMENTARY INFORMATION

SUPPLEMENTARY INFORMATION SUPPLEMENTARY INFORMATION doi:10.1038/nture11225 Numer of OTUs sed on 3% distnce Numer of 16s rrna-sed V2-V4 tg sequences LF MF PUFA Supplementry Figure 1. High-ft diets decrese the richness nd diversity

More information

Supplementary Figure 1

Supplementary Figure 1 Supplementry Figure 1 c d Wistr SHR Wistr AF-353 SHR AF-353 n = 6 n = 6 n = 28 n = 3 n = 12 n = 12 Supplementry Figure 1 Neurophysiologicl properties of petrosl chemoreceptive neurones in Wistr nd SH rts.

More information

SYNOPSIS Final Abbreviated Clinical Study Report for Study CA ABBREVIATED REPORT

SYNOPSIS Final Abbreviated Clinical Study Report for Study CA ABBREVIATED REPORT Finl Arevited Clinicl Study Report Nme of Sponsor/Compny: Bristol-Myers Squi Ipilimum Individul Study Tle Referring to the Dossier (For Ntionl Authority Use Only) Nme of Finished Product: Yervoy Nme of

More information

Endoprosthesis in paraplegics with periarticular ossi cation of the hip

Endoprosthesis in paraplegics with periarticular ossi cation of the hip (2003) 41, 29 ± 33 ã 2003 Interntionl Society All rights reserved 1362 ± 4393/03 $25.00 www.nture.com/sc Originl Article Endoprosthesis in prplegics with perirticulr ossi ction of the hip SWJ Becker*,1,KRoÈ

More information

EFFECTS OF AN ACUTE ENTERIC DISEASE CHALLENGE ON IGF-1 AND IGFBP-3 GENE EXPRESSION IN PORCINE SKELETAL MUSCLE

EFFECTS OF AN ACUTE ENTERIC DISEASE CHALLENGE ON IGF-1 AND IGFBP-3 GENE EXPRESSION IN PORCINE SKELETAL MUSCLE Swine Dy 22 Contents EFFECTS OF AN ACUTE ENTERIC DISEASE CHALLENGE ON IGF-1 AND IGFBP-3 GENE EXPRESSION IN PORCINE SKELETAL MUSCLE B. J. Johnson, J. P. Kyser, J. D. Dunn, A. T. Wyln, S. S. Dritz 1, J.

More information

CASE 56 Hip Pain. ? Diagnosis

CASE 56 Hip Pain. ? Diagnosis CSE 56 Hip Pain PIN IN THE HIP: 1. 50-year-old female who had undergone total hip arthroplasty [Metal on metal] of the right hip 3.4 years earlier. Shee had a tingling sensation in the trochanteric region

More information

Optimisation of diets for Atlantic cod (Gadus morhua) broodstock: effect of arachidonic acid on egg & larval quality

Optimisation of diets for Atlantic cod (Gadus morhua) broodstock: effect of arachidonic acid on egg & larval quality Optimistion of diets for Atlntic cod (Gdus morhu) roodstock: effect of rchidonic cid on egg & lrvl qulity Dr Gordon Bell, Ms. An Blnco, Dr Bill Roy, Dr Derek Roertson, Dr Jim Henderson nd Mr Richrd Prickett,

More information

THE EVALUATION OF DEHULLED CANOLA MEAL IN THE DIETS OF GROWING AND FINISHING PIGS

THE EVALUATION OF DEHULLED CANOLA MEAL IN THE DIETS OF GROWING AND FINISHING PIGS THE EVALUATION OF DEHULLED CANOLA MEAL IN THE DIETS OF GROWING AND FINISHING PIGS THE EVALUATION OF DEHULLED CANOLA MEAL IN THE DIETS OF GROWING AND FINISHING PIGS John F. Ptience nd Doug Gillis SUMMARY

More information

Heparanase promotes tumor infiltration and antitumor activity of CAR-redirected T- lymphocytes

Heparanase promotes tumor infiltration and antitumor activity of CAR-redirected T- lymphocytes Supporting Online Mteril for Heprnse promotes tumor infiltrtion nd ntitumor ctivity of -redirected T- lymphocytes IgnzioCrun, Brr Svoldo, VlentinHoyos, Gerrit Weer, Ho Liu, Eugene S. Kim, Michel M. Ittmnn,

More information

Input from external experts and manufacturer on the 2 nd draft project plan Stool DNA testing for early detection of colorectal cancer

Input from external experts and manufacturer on the 2 nd draft project plan Stool DNA testing for early detection of colorectal cancer Input externl experts nd mnufcturer on the 2 nd drft project pln Stool DNA testing for erly detection of colorectl cncer (Project ID:OTJA10) All s nd uthor s replies on the 2nd drft project pln Stool DNA

More information

PROVEN ANTICOCCIDIAL IN NEW FORMULATION

PROVEN ANTICOCCIDIAL IN NEW FORMULATION PROVEN ANTICOCCIDIAL IN NEW FORMULATION Coxidin 100 microgrnulte A coccidiosttic dditive for roilers, chickens rered for lying nd turkeys Contins 100 g of monensin sodium per kg Aville s homogenous grnules

More information

SUPPLEMENTARY INFORMATION

SUPPLEMENTARY INFORMATION Prentl doi:.8/nture57 Figure S HPMECs LM Cells Cell lines VEGF (ng/ml) Prentl 7. +/-. LM 7. +/-.99 LM 7. +/-.99 Fold COX induction 5 VEGF: - + + + Bevcizum: - - 5 (µg/ml) Reltive MMP LM mock COX MMP LM+

More information

Safety and Tolerability of Subcutaneous Sarilumab and Intravenous Tocilizumab in Patients With RA

Safety and Tolerability of Subcutaneous Sarilumab and Intravenous Tocilizumab in Patients With RA Sfety nd Tolerbility of Subcutneous Srilumb nd Intrvenous Tocilizumb in Ptients With RA Pul Emery, 1 Jun Rondon, 2 Anju Grg, 3 Hubert vn Hoogstrten, 3 Neil M.H. Grhm, 4 Ming Liu, 4 Nncy Liu, 3 Jnie Prrino,

More information

Original Research. Oral mucocutaneous lesions - Histopathological and immunofluorescence study Rameshkumar A et al

Original Research. Oral mucocutaneous lesions - Histopathological and immunofluorescence study Rameshkumar A et al Received: 18 th Septemer 2014 Accepted: 20 th Decemer 2014 Conflicts of Interest: None Source of Support: Nil Originl Reserch Orl Mucocutneous Lesions A Comprtive Clinicopthologicl nd Immunofluorescence

More information

Particle-size distribution of very low density plasma lipoproteins during fat absorption in man

Particle-size distribution of very low density plasma lipoproteins during fat absorption in man Prticle-size distriution of very low density plsm lipoproteins during ft sorption in mn EDWIN L. BIERMAN, THOMAS L. HAYES, JAMES N. HAWKINS, ALICIA M. EWING, nd FRANK T. LINDGREN Deprtment of Medicine,

More information

27 June Bmnly L. WALTER ET AL.: RESPONSE OF CERVICAL CANCERS TO IRRADIATION

27 June Bmnly L. WALTER ET AL.: RESPONSE OF CERVICAL CANCERS TO IRRADIATION 27 June 1964 Bmnly MEDICAL JOURNAL L. WALTER ET AL.: RESPONSE OF CERVICAL CANCERS TO IRRADIATION x 1,638.) FIG. 2.-Foci of sme tumour s in Fig. 1 contining vible tumour cells with scnty cytoplsm, reltively

More information

Fundamentals of Spine MRI and Essential Protocols

Fundamentals of Spine MRI and Essential Protocols Fundmentls of Spine MRI nd Essentil Protocols A. C. Dougls-Akinwnde, MD Octoer 13, 2009 Fundmentls of Spine MRI Lerning Ojectives: 1. List the essentil sequences for Spine MRI exmintion 2. Discuss the

More information

Bioactive milk components to secure growth and gut development in preterm pigs ESTER ARÉVALO SUREDA PIGUTNET FA1401 STSM

Bioactive milk components to secure growth and gut development in preterm pigs ESTER ARÉVALO SUREDA PIGUTNET FA1401 STSM Bioctive milk components to secure growth nd gut development in preterm pigs ESTER ARÉVALO SUREDA PIGUTNET FA1401 STSM STSM Pigutnet FA1401 STSM 03/Septemer 30/Novemer/2017 (3 months) Host: Home: Thoms

More information

Supplementary Figure 1

Supplementary Figure 1 doi: 1.138/nture6188 SUPPLEMENTARY INFORMATION Supplementry Figure 1 c CFU-F colonies per 1 5 stroml cells 14 12 1 8 6 4 2 Mtrigel plug Neg. MCF7/Rs MDA-MB-231 * * MCF7/Rs-Lung MDA-MB-231-Lung MCF7/Rs-Kidney

More information

Using Paclobutrazol to Suppress Inflorescence Height of Potted Phalaenopsis Orchids

Using Paclobutrazol to Suppress Inflorescence Height of Potted Phalaenopsis Orchids Using Pcloutrzol to Suppress Inflorescence Height of Potted Phlenopsis Orchids A REPORT SUBMITTED TO FINE AMERICAS Linsey Newton nd Erik Runkle Deprtment of Horticulture Spring 28 Using Pcloutrzol to Suppress

More information

Invasive Pneumococcal Disease Quarterly Report. July September 2017

Invasive Pneumococcal Disease Quarterly Report. July September 2017 Invsive Pneumococcl Disese Qurterly Report July September 2017 Prepred s prt of Ministry of Helth contrct for scientific services by Rebekh Roos Helen Heffernn October 2017 Acknowledgements This report

More information

Agilent G6825AA MassHunter Pathways to PCDL Software Quick Start Guide

Agilent G6825AA MassHunter Pathways to PCDL Software Quick Start Guide Agilent G6825AA MssHunter Pthwys to PCDL Softwre Quick Strt Guide Wht is Agilent Pthwys to PCDL? Fetures of Pthwys to PCDL Agilent MssHunter Pthwys to PCDL converter is stnd-lone softwre designed to fcilitte

More information

Hallux valgus and cartilage degeneration in the first metatarsophalangeal joint

Hallux valgus and cartilage degeneration in the first metatarsophalangeal joint Hllux vlgus nd crtilge degenertion in the first mettrsophlngel joint P. Bock, K.-H. Kristen, A. Kröner, A. Engel From the Dnue Hospitl, Vienn, Austri This study reltes the extent of crtilge lesions within

More information

Characteristics of hip involvement in patients with ankylosing spondylitis in Korea

Characteristics of hip involvement in patients with ankylosing spondylitis in Korea ORIGINAL ARTICLE Koren J Intern Med 2017;32:158-164 Chrcteristics of hip involvement in ptients with nkylosing spondylitis in Kore Hyemin Jeong, Yeong Hee Eun, In Young Kim, Hyungjin Kim, Jejoon Lee, Eun-Mi

More information

Factor XIII Deficiency (Fibrin Stabilizing Factor Deficiency)

Factor XIII Deficiency (Fibrin Stabilizing Factor Deficiency) Helthline VOLUME 18 Corm s Continuing Eduction Progrm Fctor XIII Deficiency (Firin Stilizing Fctor Deficiency) Fctor XIII (FXIII) is protein mde y the ody tht stilizes the formtion of lood clot. When FXIII

More information

Bright Futures Medical Screening Reference Table 2 to 5 Day (First Week) Visit

Bright Futures Medical Screening Reference Table 2 to 5 Day (First Week) Visit Bright Futures Medicl Reference Tle 2 to 5 Dy (First Week) Visit Universl Action Metolic nd Verify documenttion of neworn metolic screening results, pproprite rescreening, nd needed follow-up. Document

More information

Supplementary information for: Low bone mass and changes in the osteocyte network in mice lacking autophagy in the osteoblast lineage

Supplementary information for: Low bone mass and changes in the osteocyte network in mice lacking autophagy in the osteoblast lineage Supplementry informtion for: Low one mss nd chnges in the osteocyte network in mice lcking utophgy in the osteolst linege Mrilin Piemontese, Meld Onl, Jinhu Xiong, Li Hn, Jeff D. Thostenson, Mri Almeid,

More information

XII. HIV/AIDS. Knowledge about HIV Transmission and Misconceptions about HIV

XII. HIV/AIDS. Knowledge about HIV Transmission and Misconceptions about HIV XII. HIV/AIDS Knowledge bout HIV Trnsmission nd Misconceptions bout HIV One of the most importnt prerequisites for reducing the rte of HIV infection is ccurte knowledge of how HIV is trnsmitted nd strtegies

More information

Effects of physical exercise on working memory and prefrontal cortex function in post-stroke patients

Effects of physical exercise on working memory and prefrontal cortex function in post-stroke patients Effects of physicl exercise on working memory nd prefrontl cortex function in post-stroke ptients M Moriy, C Aoki, K Sktni Grdute School of Helth Sciences Reserch, Mjor of Physicl Therpy, TeikyoHeisei

More information

Scientific research on the biological value of olive oil

Scientific research on the biological value of olive oil Scientific reserch on the biologicl vlue olive oil Cov F.G. Ally M. (ed.). L' économie de l' olivier Pr : CIHEAM Options Méditerrnéennes : Série Etudes; n. 1988-V 1988 pges 149-152 Article vilble on le

More information

Symptomatic Remote Cyst after BCNU Wafer Implantation for Malignant Glioma

Symptomatic Remote Cyst after BCNU Wafer Implantation for Malignant Glioma Cse Report doi: 10.2176/nmc.cr.2017-0218 Neurol Med Chir (Tokyo) 58, 270 276, 2018 Symptomtic Remote Cyst fter BCNU Wfer Implnttion for Mlignnt Gliom Online My 21, 2018 Hideki MATSUMURA, 1 Eiichi ISHIKAWA,

More information

Background Pears (Pyrus L.) are one of the leading cultivated fruit trees in China following apples and oranges in planting area and fruit yield.

Background Pears (Pyrus L.) are one of the leading cultivated fruit trees in China following apples and oranges in planting area and fruit yield. Nnjing Agriculturl University Potssium enhnces the sugr ssimiltion in leves nd fruit y regulting the expression of key genes involved in sugr metolism of Asin pers Cixi Dong, Chngwei Shen, Yngchun Xu College

More information

SUPPLEMENTARY INFORMATION

SUPPLEMENTARY INFORMATION TM TM tip link horizontl top connectors 1 leucine-rich (21 %) otoncorin-like 1809 ntigenic peptides B D signl peptide hydrophoic segment proline/threonine-rich (79 %) Supplementry Figure 1. () The outer

More information

Optimizing Metam Sodium Fumigation in Fine-Textured Soils

Optimizing Metam Sodium Fumigation in Fine-Textured Soils Optimizing Metm Sodium Fumigtion in Fine-Textured Soils Neil C Gudmestd University Distinguished Professor & Endowed Chir of Potto Pthology Deprtment of Plnt Pthology North Dkot Stte University Erly Dying

More information

Effect of fungicide timing and wheat varietal resistance on Mycosphaerella graminicola and its sterol 14 α-demethylation-inhibitorresistant

Effect of fungicide timing and wheat varietal resistance on Mycosphaerella graminicola and its sterol 14 α-demethylation-inhibitorresistant Effect of fungicide timing nd whet vrietl resistnce on Mycospherell grminicol nd its sterol 14 α-demethyltion-inhiitorresistnt genotypes Didierlurent L., Roisin-Fichter C., Snssené J., Selim S. Pltform

More information

CheckMate 153: Randomized Results of Continuous vs 1-Year Fixed-Duration Nivolumab in Patients With Advanced Non-Small Cell Lung Cancer

CheckMate 153: Randomized Results of Continuous vs 1-Year Fixed-Duration Nivolumab in Patients With Advanced Non-Small Cell Lung Cancer CheckMte 53: Rndomized Results of Continuous vs -Yer Fixed-Durtion Nivolumb in Ptients With Advnced Non-Smll Cell Lung Cncer Abstrct 297O Spigel DR, McCleod M, Hussein MA, Wterhouse DM, Einhorn L, Horn

More information

Health-Related Quality of Life and Symptoms of Depression in Extremely Obese Persons Seeking Bariatric Surgery

Health-Related Quality of Life and Symptoms of Depression in Extremely Obese Persons Seeking Bariatric Surgery Oesity Surgery, 15, 3-39 Helth-Relted Qulity of Life nd Symptoms of Depression in Extremely Oese Persons Seeking Britric Surgery Anthony N. Frictore, PhD; Thoms A. Wdden, PhD; Dvid B. Srwer, PhD; Myles

More information

A FACTORIAL STUDY ON THE EFFECTS OF β CYCLODEXTRIN AND POLOXAMER 407 ON THE SOLUBILITY AND DISSOLUTION RATE OF PIROXICAM

A FACTORIAL STUDY ON THE EFFECTS OF β CYCLODEXTRIN AND POLOXAMER 407 ON THE SOLUBILITY AND DISSOLUTION RATE OF PIROXICAM IJRPC 20, (3) Chowdry et l. ISSN: 223 278 INTERNATIONAL JOURNAL OF RESEARCH IN PHARMACY AND CHEMISTRY Aville online t www.ijrpc.com Reserch Article A FACTORIAL STUDY ON THE EFFECTS OF β CYCLODEXTRIN AND

More information

Sterolsland the Production of Oospores by Phytophthova cactovum

Sterolsland the Production of Oospores by Phytophthova cactovum Journl of Generl Microiology (I972), 72, 321-327 Printed in Gret Britin 321 Sterolslnd the Production of Oospores y Phytophthov cctovum By C. G. ELLIOTT Deprtment of Botny, The University of Glsgow, Glsgow,

More information

Single-Molecule Studies of Unlabelled Full-Length p53 Protein Binding to DNA

Single-Molecule Studies of Unlabelled Full-Length p53 Protein Binding to DNA Single-Molecule Studies of Unlbelled Full-Length p53 Protein Binding to DNA Philipp Nuttll, 1 Kidn Lee, 2 Pietro Ciccrell, 3 Mrco Crminti, 3 Giorgio Ferrri, 3 Ki- Bum Kim, 2 Tim Albrecht 1* 1 Imperil College

More information

Multidrug resistance gene and its relationship to ulcerative colitis and immune status of ulcerative colitis

Multidrug resistance gene and its relationship to ulcerative colitis and immune status of ulcerative colitis Multidrug resistnce gene nd its reltionship to ulcertive colitis nd immune sttus of ulcertive colitis Y.J. Zhng 1, J.J. Xu 1, P. Wng 2 nd J.L. Wng 1 1 Deprtment of Gstroenterology, The First Affilited

More information

BENIGN ulceration along the greater curvature of the pars media of the

BENIGN ulceration along the greater curvature of the pars media of the BENIGN ULCERS OF THE GREATER CURVATURE OF THE STOMACH Report of Two Cses CHARLES H. BROWN, M.D. Deprtment of Gstroenterology nd ANTHONY D. INTRIERE, M.D.* BENIGN ulcertion long the greter curvture of the

More information

/v x

/v x POLSKI PRZEGLĄD CHIRURGICZNY 2011, 83, 9, 518 522 10.2478/v10035-011-0081-x Reconstruction of the distl rdio-ulnr joint with prosthesis of the distl uln in the tretment of recurrent gint cell tumour Dniel

More information

PDGF-BB secreted by preosteoclasts induces angiogenesis during coupling with osteogenesis

PDGF-BB secreted by preosteoclasts induces angiogenesis during coupling with osteogenesis Supplementry Informtion PDGF-BB secreted y preosteoclsts induces ngiogenesis during coupling with osteogenesis Hui Xie, Zhung Cui, Long Wng, Zhuying Xi, Yin Hu, Lingling Xin, Chngjun Li, Ling Xie, Jnet

More information

Relationship between bronchial anthracofibrosis and endobronchial tuberculosis

Relationship between bronchial anthracofibrosis and endobronchial tuberculosis ORIGINAL ARTICLE Koren J Intern Med 2013;28:330-338 Reltionship between bronchil nthrcofibrosis nd endobronchil tuberculosis Hyun Ji Kim, Sng Dong Kim, Dong Woo Shin, Soo Hyun Be, Ah Lim Kim, Ji N Kim,

More information

Not for Citation or Publication Without Consent of the Author

Not for Citation or Publication Without Consent of the Author Not for Cittion or Puliction Without Consent of the Author AN AUTOMATED SEX PHEROMONE TRAP FOR MONITORING ADULT CM AND OFM AND THE INFLUENCE OF TRAP COLOR ON MOTH AND NON-TARGET CAPTURES Brin L. Lehmn

More information

SUPPLEMENTARY INFORMATION

SUPPLEMENTARY INFORMATION SUPPEMENTARY INFORMATION DOI: 1.138/ncb956 Norml CIS Invsive crcinom 4 months months b Bldder #1 Bldder # Bldder #3 6 months (Invsive crcinom) Supplementry Figure 1 Mouse model of bldder cncer. () Schemtic

More information

Assessment of Depression in Multiple Sclerosis. Validity of Including Somatic Items on the Beck Depression Inventory II

Assessment of Depression in Multiple Sclerosis. Validity of Including Somatic Items on the Beck Depression Inventory II Assessment of Depression in Multiple Sclerosis Vlidity of Including Somtic Items on the Beck Depression Inventory II Peggy Crwford, PhD; Noh J. Webster, MA Signs nd symptoms of multiple sclerosis (MS)

More information

The potential future of targeted radionuclide therapy: implications for occupational exposure? P. Covens

The potential future of targeted radionuclide therapy: implications for occupational exposure? P. Covens The potentil future of trgeted rdionuclide therpy: implictions for occuptionl exposure? Introduction: Trgeted Rdionuclide Therpy (TRT) Systemic tretment Molecule lbelled with rdionuclide delivers toxic

More information

Identical twins with borderline lepromatous leprosy mimicking extensive alopecia areata: A rare presentation

Identical twins with borderline lepromatous leprosy mimicking extensive alopecia areata: A rare presentation Lepr Rev (2018) 89, 301 305 CASE REPORT Identicl twins with orderline lepromtous leprosy mimicking extensive lopeci ret: A rre presenttion RUBINA JASSI*, KRISHNA DEB BURMAN**, BHAVYA SWARNKAR** & RADHIKA

More information

Supplementary Online Content

Supplementary Online Content Supplementry Online Content Rieckmnn N, Kronish IM, Shpiro PA, Whng W, Dvidson KW. Serotonin reuptke inhibitor use, depression, nd long-term outcomes fter n cute coronry : prospective cohort study. JAMA

More information

INFLUENCE OF DIFFERENT STRAINS AND WAYS OF INOCULATION ON THE RABBIT S RESPONSE TO EXPERIMENTAL INFECTION WITH PASTEURELLA MULTOCIDA

INFLUENCE OF DIFFERENT STRAINS AND WAYS OF INOCULATION ON THE RABBIT S RESPONSE TO EXPERIMENTAL INFECTION WITH PASTEURELLA MULTOCIDA Pthology nd Hygiene INFLUENCE OF DIFFERENT STRAINS AND WAYS OF INOCULATION ON THE RABBIT S RESPONSE TO EXPERIMENTAL INFECTION WITH PASTEURELLA MULTOCIDA Kulcsár G. 1, Fáián K. 1 *, Brn T. 1, Virág Gy.

More information

Copy Number ID2 MYCN ID2 MYCN. Copy Number MYCN DDX1 ID2 KIDINS220 MBOAT2 ID2

Copy Number ID2 MYCN ID2 MYCN. Copy Number MYCN DDX1 ID2 KIDINS220 MBOAT2 ID2 Copy Numer Copy Numer Copy Numer Copy Numer DIPG38 DIPG49 ID2 MYCN ID2 MYCN c DIPG01 d DIPG29 ID2 MYCN ID2 MYCN e STNG2 f MYCN DIPG01 Chr. 2 DIPG29 Chr. 1 MYCN DDX1 Chr. 2 ID2 KIDINS220 MBOAT2 ID2 Supplementry

More information

Dose-dependent effect of daptomycin on the artificial prolongation of prothrombin time in coagulation abnormalities: in vitro verification

Dose-dependent effect of daptomycin on the artificial prolongation of prothrombin time in coagulation abnormalities: in vitro verification Hshimoto et l. BMC Phrmcology nd Toxicology (2017) 18:74 DOI 10.1186/s40360-017-0180-3 RESEARCH ARTICLE Open Access Dose-dependent effect of dptomycin on the rtificil prolongtion of prothrombin time in

More information

Implications for Human Leukocyte Antigen Antibodies After Lung Transplantation. A 10-Year Experience in 441 Patients

Implications for Human Leukocyte Antigen Antibodies After Lung Transplantation. A 10-Year Experience in 441 Patients CHEST Originl Reserch TRANSPLANTATION Implictions for Humn Leukocyte Antigen Antibodies After Lung Trnsplnttion A 10-Yer Experience in 441 Ptients Lurie D. Snyder, MD, MHS ; Ziwei Wng, BS ; Dong-Feng Chen,

More information

THE EFFECT OF DIFFERENT STIMULI ON MEAGRE (Argyrosomus regius) FEEDING BEHAVIOUR.

THE EFFECT OF DIFFERENT STIMULI ON MEAGRE (Argyrosomus regius) FEEDING BEHAVIOUR. THE EFFECT OF DIFFERENT STIMULI ON MEGRE (rgyrosomus regius) FEEDING EHVIOUR. Ionnis E. Ppdkis, Nikos Ppndroulkis, lkioni Sfendourki, Veronic Cmporesi 3, Mnolis Vsilkis, Constntinos C. Mylons Institute

More information

Associations of Psoriatic Arthritis and Cardiovascular Conditions in a Large Population

Associations of Psoriatic Arthritis and Cardiovascular Conditions in a Large Population ville online: www.kp.org/permnentejournl Originl rticle Associtions of Psoritic Arthritis nd Crdiovsculr Conditions in Lrge Popultion Svetln Kondrtiouk, DO Ntli Udltsov, PhD Arthur L Kltsky, MD Astrct

More information

Emerging Options for Thromboprophylaxis After Orthopedic Surgery: A Review of Clinical Data

Emerging Options for Thromboprophylaxis After Orthopedic Surgery: A Review of Clinical Data Emerging Options for Thromboprophylxis After Orthopedic Surgery: A Review of Clinicl Dt Bob L. Lobo, Phrm.D. In four rndomized, controlled studies of ptients undergoing orthopedic surgery, the ntithrombotic

More information

Lipase and Pancreatic Amylase Activities in Tissues and in Patients with Hyperamylasemia

Lipase and Pancreatic Amylase Activities in Tissues and in Patients with Hyperamylasemia CLINICAL CHEMISTRY Originl Article Lipse nd Pncretic Amylse Activities in Tissues nd in Ptients with Hypermylsemi FRED APPLE, PH.D, PETER BENSON, M.D., LYNNE PREESE, MT, M.B.A., STEVEN EASTEP, M.D., LAURA

More information

thalassaemia major, treated with long term subcutaneous desferrioxamine

thalassaemia major, treated with long term subcutaneous desferrioxamine Iron stte nd heptic disese in ptients with thlssemi mjor, treted with long term subcutneous desferrioxmine J Clin Pthol 1987;4:1353-1359 BEATRIX WONKE,t A V HOFFBRAND,* D M FLYNN,$ M A ALDOURI,* MARTINE

More information

Summary: American Red Cross-Northeast Region, Dedham, MA; 11 Department of Pathology, University of New Mexico, Albuquerque, NM; 12

Summary: American Red Cross-Northeast Region, Dedham, MA; 11 Department of Pathology, University of New Mexico, Albuquerque, NM; 12 (2000) 25, 385 393 2000 Mcmilln Pulishers Ltd All rights reserved 0268 3369/00 $15.00 www.nture.com/mt The extent of HLA clss II llele level disprity in unrelted one mrrow trnsplnttion: nlysis of 1259

More information

Flexion Contracture Following Primary Total Knee Arthroplasty: Risk Factors and Outcomes

Flexion Contracture Following Primary Total Knee Arthroplasty: Risk Factors and Outcomes Feture Article Flexion Contrcture Following Primry Totl Knee Arthroplsty: Risk Fctors nd Outcomes STUART T. GOUDIE, MBCHB; ANGELA H. DEAKIN, PHD; AFTAB AHMAD, FRCS; ROHIT MAHESHWARI, MS, FRCS; FREDERIC

More information

IL-18 induction of IgE: dependence on CD4 + T cells, IL-4 and STAT6

IL-18 induction of IgE: dependence on CD4 + T cells, IL-4 and STAT6 ARTICLES IL-18 induction of IgE: dependence on CD4 + T cells, IL-4 nd STAT6 Tomohiro Yoshimoto 1,2,7, Hitoshi Mizutni 3, Hiroko Tsutsui 1, Nncy Noen-Truth 6, Kei-ichi Ymnk 3, Minoru Tnk 4, Shinzo Izumi

More information

WSU Tree Fruit Research and Extension Center, Wenatchee (509) ext. 265;

WSU Tree Fruit Research and Extension Center, Wenatchee (509) ext. 265; FINAL REPORT WTFRC Project # AH-1-5 WSU Project # 13C-355-3 Project title: PI: Orgniztion: Coopertors: of Sunburn in Apples with RAYNOX Lrry Schrder, Horticulturist WSU Tree Fruit Reserch nd Extension

More information

Arthroscopic Anatomy of Shoulder

Arthroscopic Anatomy of Shoulder Arthroscopic Antomy of Shoulder Murt Bozkurt, Mehmet Emin Simsek, nd Hlil İrhim Açr 2 2.1 Introduction In the lst 30 yers, shoulder rthroscopy hs ecome of greter importnce in the dignosis nd tretment of

More information

Bacterial contamination upon the opening of injection needles

Bacterial contamination upon the opening of injection needles Ae et l. JA Clinicl Reports (2018) 4:61 https://doi.org/10.1186/s40981-018-0197-7 CLINICAL RESEARCH ARTICLE Open Access Bcteril contmintion upon the opening of injection needles Shintro Ae 1, Iso Hrg 2*,

More information

% Inhibition of MERS pseudovirus infection. 0 h 0.5 h 1 h 2 h 4 h 6 h Time after virus addition

% Inhibition of MERS pseudovirus infection. 0 h 0.5 h 1 h 2 h 4 h 6 h Time after virus addition % Inhiition of MERS pseudovirus infection 1 8 h.5 h 1 h 2 h 4 h 6 h Time fter virus ddition Supplementry Figure S1. Inhiition of on MERS pseudovirus infection t the different intervls postinfection. A

More information

C reactive protein: an aid to assessment and

C reactive protein: an aid to assessment and C rective protein: n id to ssessment nd monitoring of cute pncretitis J Clin Pthol 1984;37:27-211 AD MAYR,* MJ McMAHON,* MARGART BOWN,t H COOPRt From the *University Deprtment ofsurgery, Generl Infrmry,

More information

Review article. Key words non specific low back pain, exercise therapy, stretching, motor control. Grade D

Review article. Key words non specific low back pain, exercise therapy, stretching, motor control. Grade D Spinl Surgery 31 2 140 144 2017 総説 Review rticle Astrct Exercise therpy is useful for low ck pin. Exercise therpy ims to improve posturl lignment, muscle strength, nd endurnce, nd lso contriutes to pin

More information

Significance of Expression of TGF- in Pulmonary Metastasis in Non-small Cell Lung Cancer Tissues

Significance of Expression of TGF- in Pulmonary Metastasis in Non-small Cell Lung Cancer Tissues Originl Article Significnce of Expression of in Pulmonry Metstsis in Non-smll Cell Lung Cncer Tissues Hisshi Sji, Hruhiko Nkmur, Idiris Awut, Norihito Kwski, Msru Hgiwr, Akihiko Ogt, Mkoto Hosk, Tkmoto

More information

(Received for publication February 17, 1944) Since, as has been demonstrated by Enders (3),

(Received for publication February 17, 1944) Since, as has been demonstrated by Enders (3), CHEMICAL, CLINICAL, AND IMMUNOLOGICAL STUDIES ON THE PRODUCTS OF HUMAN PLASMA FRACTIONATION. XII. THE USE OF CONCENTRATED NORMAL HUMAN SERUM GAMMA GLOBULIN (HUMAN IMMUNE SERUM GLOBULIN) IN THE PREVENTION

More information

SUPPLEMENTARY INFORMATION

SUPPLEMENTARY INFORMATION DOI: 1.138/nc286 Figure S1 e f Medium DMSO AktVIII PP242 Rp S6K1-I Gr1 + + + + + + Strvtion + + + + + IB: Akt-pT38 IB: Akt K-pT389 K IB: Rptor Gr1 shs6k1-a shs6k1-b shs6k1-c shrictor shrptor Gr1 c IB:

More information

Effect of supplemental fat from dried distillers grains with solubles or corn oil on cow performance, IGF-1, GH, and NEFA concentrations 1

Effect of supplemental fat from dried distillers grains with solubles or corn oil on cow performance, IGF-1, GH, and NEFA concentrations 1 Effect of supplementl ft from dried distillers grins with solules or corn oil on cow performnce, IGF-1, GH, nd NEFA concentrtions 1 Aigil Brtosh 2, Cody Wright 3, Aimee Wertz-Lutz 4, nd George Perry 5

More information

distraction cleaning Peaks cages specifications

distraction cleaning Peaks cages specifications Peks cges specifictions We thnk for choosing Qulgenix Peks lumbr cges. 0Pwith α 8 00D8S Mteril 9 0D9S 9 be po Peks 0 - -8 0 0D0S resection with introduce remer 0DM remer 007RM Acute or chronic 0DM remer

More information

Expression of Three Cell Cycle Inhibitors during Development of Adipose Tissue

Expression of Three Cell Cycle Inhibitors during Development of Adipose Tissue Expression of Three Cell Cycle Inhiitors during Development of Adipose Tissue Jiin Zhng Deprtment of Animl Sciences Advisor: Michel E. Dvis Co-dvisor: Kichoon Lee Development of niml dipose tissue Hypertrophy

More information

SUPPLEMENTARY INFORMATION

SUPPLEMENTARY INFORMATION doi: 10.1038/nture07679 Emryonic Stem (ES) cell Hemngiolst Flk1 + Blst Colony 3 to 3.5 Dys 3-4 Dys ES differentition Sort of Flk1 + cells Supplementry Figure 1. Chrcteristion of lst colony development.

More information

Modulatory role of regulatory T cells in a murine model of severe equine asthma

Modulatory role of regulatory T cells in a murine model of severe equine asthma Henríquez et l. BMC Veterinry Reserch (2017) 13:117 DOI 10.1186/s12917-017-1037-0 RESEARCH ARTICLE Open Access Modultory role of regultory T cells in murine model of severe equine sthm Cludio Henríquez

More information

Introduction. These patients benefit less from conventional chemotherapy than patients identified as MMR proficient or microsatellite stable 3-5

Introduction. These patients benefit less from conventional chemotherapy than patients identified as MMR proficient or microsatellite stable 3-5 Nivolumb + Ipilimumb Combintion in Ptients With DNA Mismtch Repir-Deficient/Microstellite Instbility-High Metsttic Colorectl Cncer: First Report of the Full Cohort From CheckMte-142 Abstrct 553 André T,

More information

Geographical influence on digit ratio (2D:4D): a case study of Andoni and Ikwerre ethnic groups in Niger delta, Nigeria.

Geographical influence on digit ratio (2D:4D): a case study of Andoni and Ikwerre ethnic groups in Niger delta, Nigeria. Journl of Applied Biosciences 27: 1736-1741 ISSN 1997 5902 Geogrphicl influence on digit rtio (2D:4D): cse study of Andoni nd Ikwerre ethnic groups in Niger delt, Nigeri. Gwunirem, Isrel U 1 nd Ihemelndu,

More information

Supplementary Materials. Viral delivery of mir-196a ameliorates the SBMA phenotype via the silencing of CELF2

Supplementary Materials. Viral delivery of mir-196a ameliorates the SBMA phenotype via the silencing of CELF2 Supplementry Mterils Virl delivery of mir-96 meliortes the SBMA phenotype vi the silencing of CELF2 Yu Miyzki, Hiroki Adchi, Mshis Ktsuno, Mkoto Minmiym, Yue-Mei Jing, Zhe Hung, Hideki Doi, Shinjiro Mtsumoto,

More information

Supplementary Online Content

Supplementary Online Content Supplementry Online Content Zulmn DM, Pl Chee C, Ezeji-Okoye SC, et l. Effect of n intensive outptient progrm to ugment primry cre for high-need Veterns Affirs ptients: rndomized clinicl tril. JAMA Intern

More information

manage excessive exudate, thereby protecting peri-wound skin and facilitating wound healing.

manage excessive exudate, thereby protecting peri-wound skin and facilitating wound healing. A clinicl cse-series evlution of supersorent dressing on exuding wounds l Ojective: To evlute the cpcity of supersorent dressing (DryMx Extr; Asorest AB) to mnge excessive exudte, therey protecting peri-wound

More information

SUPPLEMENTARY INFORMATION

SUPPLEMENTARY INFORMATION doi:.3/nture93 d 5 Rttlesnke DRG (reds) Rttlesnke TG (reds) c 3 TRPV1 other TRPs 1 1 3 Non-pit snke TG (reds) SFig. 1 5 5 3 other TRPs TRPV1 1 1 3 Non-pit snke DRG (reds) 5 Antomy of the pit orgn nd comprison

More information

Chapter 02 Crime-Scene Investigation and Evidence Collection

Chapter 02 Crime-Scene Investigation and Evidence Collection Nme: Clss: Dte: Chpter 02 Crime-Scene Investigtion nd Evidence Collection 1. The terms grid, liner, qudrnt, zone, nd spirl re typiclly used to descrie dtum points... Flse Flse 2. An evidence log nd chin

More information

Prosthetic Valve Dysfunction 35 Years after Mitral Valve Replacement with a Starr-Edwards Caged-disc Valve

Prosthetic Valve Dysfunction 35 Years after Mitral Valve Replacement with a Starr-Edwards Caged-disc Valve CASE REPORT Prosthetic Vlve Dysfunction 35 Yers fter Mitrl Vlve Replcement with Strr-Edwrds Cged-disc Vlve Tetsuro Yokokw 1, Tkhiro Ohr 1, Seiji Tkshio 1, Mri Skmoto 1,YukoWd 1, Kenji Nkmur 1, Hiroyuki

More information

Temporal Target Integration Underlies Performance at Lag 1 in the Attentional Blink

Temporal Target Integration Underlies Performance at Lag 1 in the Attentional Blink Journl of Experimentl Psychology: Humn Perception nd Performnce 212, Vol. 38, No. 6, 1448 1464 212 Americn Psychologicl Assocition 96-1523/12/$12. DOI: 1.137/2761 Temporl Trget Integrtion Underlies Performnce

More information

ENERGY CONTENT OF BARLEY

ENERGY CONTENT OF BARLEY ENERGY CONTENT OF BARLEY VARIATION IN THE DIETARY ENERGY CONTENT OF BARLEY Shwn Firbirn, John Ptience, Hnk Clssen nd Ruurd Zijlstr SUMMARY Formultion of commercil pig diets requires n incresing degree

More information