RESUMEN
INTRODUCTION: Significant femoral neck narrowing following hip resurfacing arthroplasty has been observed. Several factors contributing to the physiopathology of femoral neck narrowing have been suggested. The aim of this study was to evaluate the femoral neck radiographic changes observed after hip resurfacing at a minimum follow-up period of 5 years and to determine their causes. PATIENTS AND METHODS: We conducted a prospective study of 57 hip resurfacing arthroplasties performed in 53 patients (30 men, 23 women) of mean age 49.2 years (32-65) at surgery. These patients were clinically reviewed (inguinal pain during walking, WOMAC and UCLA scores) at 2 years and radiographically examined at 1, 2 and 5 postoperative years. The accuracy of our computer-aided measurement method was 1mm. Measurement of femoral neck to implant ratio was performed to assess the amount of neck thinning at the femoral neck-implant junction (N/H) and midway between the implant and the inter-trochanteric line (N(1/2)H) on an AP radiograph. Neck-thinning greater than 10% was considered as significant. Any other radiographic morphologic change in the femoral neck was investigated. Metallic ion concentration in blood was measured. A uni- and multivariate analysis was performed to determine the correlation with radiographic changes. RESULTS: In one third of the patients, femoral neck narrowing was greater than 1mm at 2 and 5 postoperative years. Such result corresponds to a mean decrease in neck to implant ratio (N/H) of 5.9% (range, 2.3 to 9.4) at 2 years and 8.3% (range, 2.5 to 23.8) at 5 years. At 5 postoperative years, an overall neck thinning greater than 10% was reported in 3 patients (with a 10- to 17-% increase in femoral neck narrowing between the 2nd and the 5th postoperative year). In one case, neck thinning was associated with fracture of the femoral stem managed with revision surgery during which femoral neck necrosis was confirmed. Neck thinning was, in these cases, circumferential to the neck-implant junction. There was no significant negative impact on clinical scores and no relationship could be established between neck thinning and factors such as BMI or patient activity. Moreover, neck thinning greater than 10% was reported in two cases after 2 postoperative years through the appearance of a localized femoral neck notching which was absent in the postoperative period, secondary to a femoroacetabular impingement. DISCUSSION-CONCLUSION: Femoral neck narrowing used to be a common phenomenon after HR when polyethylene acetabular bearings were implanted thus inducing osteolysis secondary to PE wear debris. The incidence of such phenomenon has decreased but still occurs after HR when using a metal-on-metal bearing surface. It has an early occurence but stabilizes after 2 postoperative years. Changes in mechanical stress distribution in the neck region after hip resurfacing have been hypothesized to be a cause of neck thinning. Other aetiologies may be suggested. An overall evolutive femoral neck narrowing after 2 postoperative years should raise the suspicion of necrosis leading to a risk of loosening, fracture or implant failure. Therefore, radiographic monitoring should be conducted. The presence of femoral neck notching secondary to femoroacetabular impingement represents a differential diagnosis which conservative treatment is advocated in the absence of any associated symptoms.
Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Cuello Femoral/diagnóstico por imagen , Osteoartritis de la Cadera/cirugía , Reoperación , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/diagnóstico por imagen , Estudios Prospectivos , Radiografía , Resultado del TratamientoRESUMEN
The reference sequence for each human chromosome provides the framework for understanding genome function, variation and evolution. Here we report the finished sequence and biological annotation of human chromosome 1. Chromosome 1 is gene-dense, with 3,141 genes and 991 pseudogenes, and many coding sequences overlap. Rearrangements and mutations of chromosome 1 are prevalent in cancer and many other diseases. Patterns of sequence variation reveal signals of recent selection in specific genes that may contribute to human fitness, and also in regions where no function is evident. Fine-scale recombination occurs in hotspots of varying intensity along the sequence, and is enriched near genes. These and other studies of human biology and disease encoded within chromosome 1 are made possible with the highly accurate annotated sequence, as part of the completed set of chromosome sequences that comprise the reference human genome.
Asunto(s)
Cromosomas Humanos Par 1/genética , Secuencia de Bases , Momento de Replicación del ADN , Enfermedad , Duplicación de Gen , Genes/genética , Variación Genética/genética , Genómica , Humanos , Datos de Secuencia Molecular , Sistemas de Lectura Abierta/genética , Seudogenes/genética , Recombinación Genética/genética , Selección Genética , Análisis de Secuencia de ADNRESUMEN
Resonant nanoelectromechanical systems (NEMS) are being actively investigated as sensitive mass detectors for applications such as chemical and biological sensing. We demonstrate that highly uniform arrays of nanomechanical resonators can be used to detect the binding of individual DNA molecules through resonant frequency shifts resulting from the added mass of bound analyte. Localized binding sites created with gold nanodots create a calibrated response with sufficient sensitivity and accuracy to count small numbers of bound molecules. The amount of nonspecifically bound material from solution, a fundamental issue in any ultra-sensitive assay, was measured to be less than the mass of one DNA molecule, allowing us to detect a single 1587 bp DNA molecule.
Asunto(s)
Técnicas Biosensibles/instrumentación , ADN/análisis , ADN/química , Nanotecnología/instrumentación , Óptica y Fotónica/instrumentación , Oscilometría/instrumentación , Transductores , Técnicas Biosensibles/métodos , Diseño de Equipo , Análisis de Falla de Equipo , Mecánica , Nanotecnología/métodos , Oscilometría/métodos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
We constructed maps for eight chromosomes (1, 6, 9, 10, 13, 20, X and (previously) 22), representing one-third of the genome, by building landmark maps, isolating bacterial clones and assembling contigs. By this approach, we could establish the long-range organization of the maps early in the project, and all contig extension, gap closure and problem-solving was simplified by containment within local regions. The maps currently represent more than 94% of the euchromatic (gene-containing) regions of these chromosomes in 176 contigs, and contain 96% of the chromosome-specific markers in the human gene map. By measuring the remaining gaps, we can assess chromosome length and coverage in sequenced clones.