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The aim of this study is to compare the performance of antitissue transglutaminase (atTG) chemiluminescence immunoassay (CLIA) with the standard enzyme-linked immunosorbent assay (ELISA) methods in monitoring celiac children after the start of gluten-free diet (GFD). Celiac children diagnosed between 2005 and 2016 at our centre were classified into 2 groups based on serum assay (ELISA vs CLIA) used for atTG monitoring, and were compared on percentage of decrease and time to normalization of atTG on GFD. Among 260 included children, the rate of normalization of atTG levels at 30 months’ follow-up was 86% and 70% in ELISA and CLIA group, respectively (P< 0.01). Median time to normalization was 11.7 and 14.7 months in ELISA and CLIA group respectively (P= 0.003). Marsh score at diagnosis was not associated with time to atTG normalization (P= 0.770), whereas older age at diagnosis and higher baseline atTG predicted longer time to atTG normalization (P= 0.01, P< 0.01). The percentage and the time of the atTG normalization in celiac children on GFD should be interpreted according to the utilized assay: at 30 months’ follow-up children tested by CLIA are less likely to normalize atTG levels compared to those tested by ELISA. Younger age at diagnosis and lower baseline atTG are predictors of earlier atTG normalization, regardless of the adopted assay.

Introduction Ceramic-on-ceramic (CoC) couplings are alternative bearings surfaces that have been reported to reduce osteolysis, wear debris and aseptic loosening compared to the use of polyethylene. Early experiences with ceramics had poor results, but they have led to many improvements in the manufacture and design of subsequent implants.Methods We analysed medical files of 300 CoC total hip arthroplasty (THA) with a modular neck performed during period 1995-2000 by a single surgeon for a minimum follow-up of 13 years, evaluating clinical and radiological outcome.Results The mean clinical Merle d'Aubigne and Postel hip score at the final follow-up is 17.4, against a pre-operative value of 11.4. Overall survivorship with an endpoint of revision is 93.2% (95% CI, 89.0%-97.3%) at 15 years, while considering only prosthesis failures related to aseptic loosening and ceramic breakage, survival rate at 15 years is 97.2% (95% CI, 94.8%-100%). We observed complications that led to revision surgery in 11 patients (4%) (periprosthetic fractures, liner ruptures, septic loosening of the implant, aseptic loosening of the cup, aseptic loosening of the stem). The occurrence of squeaking is low (1.6%, 4 cases) and we analysed the characteristics of these patients.Discussion Our study shows an excellent long term survivorship of third generation alumina CoC THA. We reiterate the importance to have a stable implant to maximise the advantage of ceramic and to avoid complications.

We evaluated the treatment and outcome of 47 cases of periprosthetic femoral fracture presenting to our unit over a nine-year period. The average follow-up period was 48 months (range 24-114). Surgical treatment involved stem revision in 29 hips, open reduction and internal fixation in 11 hips and conservative treatment in seven hips. The mean HHS at the most recent follow-up was 74 (range 49-91). Twenty-five patients were pain-free (53%), 10 patients had occasional mild pain (21%), eight patients had a limp and pain (17%) and four patients had severe disability (9%). Postoperative radiographs showed complete fracture union in all 47 patients. There were 11 complications: three further periprosthetic fractures, two aseptic loosenings, two dislocations, two aseptic loosenings of the primary prostheses, one stem breakeage, and one intraoperative fracture. Our results suggest cementless revision with tapered fluted stems used without cortical strut grafts are a valid procedure for the treatment of Vancouver B2 and B3 periprosthetic fractures.

The complexity of pelvic anatomy and the extent of tumor growth makes treatment of patients with primary bone sarcomas in the pelvis difficult in terms of local control. Before the 1970s, most tumors in the bony pelvis were surgically treated with hindquarter amputation. Currently, improved techniques for clinical staging, adjuvant treatments, evolutions in metallurgy, and development of new surgical techniques make limb-salvage surgery and reconstruction possible alternatives to hemipelvectomy and resection–arthrodesis. The advantages of amputation over resections at the pelvis are a lower incidence of complications, a limited area at risk for recurrence, and a faster recovery time compared with all but the most limited pelvic resections. The disadvantages, especially after periacetabular resections, are leg-length discrepancy and impaired hip and gait function. The indication for limb salvage is the ability to obtain wide margins without compromising survival and function. Although having to resect the sciatic nerve to obtain adequate margins does not always mean that an amputation should be performed, the combination of a major pelvic resection and the functional consequences of sciatic nerve resection results in an extremity usually not worth saving; loss of femoral nerve function does not result in a significant gait disturbance, especially if the hemipelvis is stable. Reconstruction options after major pelvic resections have also evolved, but they remain difficult, especially when the acetabulum is involved.

Radiation therapy and chemotherapy, while they remain an essential part of the multidisciplinary treatment of cancers, they have led to unwanted complications. Radiation-induced complications include wound and bone, growth, nervous system, tumorigenic, lung, gastrointestinal, hepatic and other complications. In this article we review the side effects of radiation therapy in musculoskeletal oncology emphasizing on bone, present our long experience, and discuss the current literature regarding radiation-induced bone complications and their management and outcome.

In order to clarify the alterations of granuloblastic cells in chronic and acute myeloid leukemia, the colony growth behavior of cultured CFU-GM from the peripheral blood of normal and leukemic subjects was examined in basal conditions and after adding to the medium T3 or T4 and/or thioproline and/or flurbiprofen. These drugs had in previous investigations proved their ability to modify cellular receptors and the uptake of thyroid hormones. The study was carried out in semisolid (double agar layer) and liquid medium, utilizing the techniques described previously. Both thyroid hormones enhanced the colony growth from normal peripheral blood CFU-GM and the response was more evident with T4 than T3. The effect on leukemic CFU-GM (from CML and AML) was less clear, probably due to the presence in leukemic cells of a defect of cellular uptake and to the utilization of T3 and T4. Indeed, on addition to the culture medium of thioproline, which modifies membrane permeability, and of fluorbiprofen, which inhibits PGE synthesis, the colony number and growth from leukemic CFU increased considerably in accordance with the results of our previous studies on these substances showing that they are able to modify cellular receptors for thyroid and several other hormones.

ABSTRACTThe seroprevalence of the recently discovered human Malawi polyomavirus (MWPyV) was determined by virus-like particle-based enzyme-linked immunosorbent assay (ELISA) in age-stratified Italian subjects. The findings indicated that MWPyV infection occurs early in life, and seroprevalence was shown to reach 42% in adulthood.