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OBJECTIVE: The purpose of this study was to test the effectiveness of a cognitive-behavioral intervention program designed to affect perceptions of control and coping patterns in women with rheumatoid arthritis (RA). DESIGN: Quasi-experimental. SETTING: Not given. POPULATION: Ninety women with rheumatoid arthritis between the ages of 24 and 80 were recruited and enrolled in the program over an 18-month period. The average length of time since diagnosis with RA was 10.3 years. INTERVENTIONS: After meeting entry criteria and giving written informed consent, participants completed and mailed back a battery of self-report instruments 6 weeks prior to beginning the intervention, labeled Time 1. Participants also completed these same measures during the week prior to beginning the intervention, labeled Time 2, immediately after the intervention, labeled Time 3, and at a 3-month follow-up, labeled Time 4. The intervention program, called Rising Above Arthritis, was designed to help women with RA develop a sense of competence with respect to both arthritis-related problems and other life stressors. Participants watched a videotape and reviewed manual material prior to attending each of the three small-group sessions scheduled 2 weeks apart. A major theme of the intervention program is that individuals have some control over their responses to stressors, even if it is only attitudinal control. MAIN OUTCOME MEASURE(S): The measures were selected because of their conceptual congruency with this investigation and because their reliability and validity for this population have been well established. The Perceived Health Competence Scale is an eight-item measure of the extent to which individuals perceive control over their health status in general. The Arthritis Self-Efficacy Scales for pain were used to assess competency beliefs related to arthritis symptomatology. Other measures used included the five-item Helplessness subscale from the Arthritis Helplessness Index, a shortened version of the Vanderbilt Multidimensional Pain Coping Inventory, the five-item Satisfaction with Life Scale and the 2-item version of the Positive and Negative Affect Schedule (PANAS). RESULTS/CONCLUSIONS: The MANOVA results were significant, indicating that the set of personal coping resources changed significantly over time. All of the gains established during the course of the program were maintained over the subsequent 3 months. The answer to the first research question related to the impact of the program on disease symptomatology depends on which symptom is considered. The program had the greatest impact on personal coping resources such as self-efficacy for controlling arthritis symptomatology. The majority of the significant improvement in the MANOVA of disease symptomatology was due to the highly significant improvement in perceived fatigue. [CINAHL abstract] [ABSTRACT FROM AUTHOR]

Abstract Background Bacillus anthracis, Bacillus thuringiensis and Bacillus cereus are closely related members of the B. cereus-group of bacilli. Suppressive subtractive hybridization (SSH) was used to identify specific chromosomal sequences unique to B. anthracis. Results Two SSH libraries were generated. Genomic DNA from plasmid-cured B. anthracis was used as the tester DNA in both libraries, while genomic DNA from either B. cereus or B. thuringiensis served as the driver DNA. Progressive screening of the libraries by colony filter and Southern blot analyses identified 29 different clones that were specific for the B. anthracis chromosome relative not only to the respective driver DNAs, but also to seven other different strains of B. cereus and B. thuringiensis included in the process. The nucleotide sequences of the clones were compared with those found in genomic databases, revealing that over half of the clones were located into 2 regions on the B. anthracis chromosome. Conclusions Genes encoding potential cell wall synthesis proteins dominated one region, while bacteriophage-related sequences dominated the other region. The latter supports the hypothesis that acquisition of these bacteriophage sequences occurred during or after speciation of B. anthracis relative to B. cereus and B. thuringiensis. This study provides insight into the chromosomal differences between B. anthracis and its closest phylogenetic relatives.

Objective: The patient's knee implant performance (PKIP) is a patient-reported outcome measure, developed in the USA in English that evaluates knee functional performance before and after primary total knee arthroplasty (TKA). The PKIP assesses the level of satisfaction, confidence, and stability, while performing various activities, as well as the need for changing ways of doing activities. It comprises 24 items. The objective of this study was to present the methodology of the linguistic validation of the PKIP., Methods: The Japanese version of the PKIP was developed using a standard linguistic validation (LV) process. The LV involved the following steps: (1) conceptual analysis of the original version; (2) translation into Japanese using a dual forward/backward translation process; (3) review by an orthopaedics surgeon; (4) test on five respondents; and (5) proofreading., Results: The translation itself did not reveal major translatability issues, either cultural, semantic, or syntactic. Most of the activities listed (e.g., going up stairs, getting in/out of a car, and walking up a hill/ramp/incline) were easily translated. Only one activity was culturally sensitive and raised some discussion, i.e., "sitting down on a toilet," since the style of Japanese toilets is different from the western style. Overall, the respondents well understood the questionnaire. However, the expression "how your knee is working with your body" used in the opening sentence was an issue for both the clinician and the respondents. A compromise was found by using a Japanese equivalent of "how your knee functions with your legs.", Conclusion: The rigorous translation process, which involved the collaboration of a minimum of thirteen people (sponsor, four translators, two coordinators (one in Japan and one in Europe), one clinician, and five respondents) enabled the production of a Japanese version of the PKIP conceptually equivalent to the USA English original., Competing Interests: Dr. Minoda executed the Service Agreement with Johnson & Johnson K.K as a medical expert and he supported to development of the Japanese version of the PKIP. The other authors declare that they have no conflicts of interest., (Copyright © 2024 Fumiya Ohmasa et al.)

Introduction: This study evaluated total knee arthroplasty (TKA) outcomes for an Existing-TKA versus New-TKA from the same manufacturer., Methods: TKA outcomes for 752 with Existing-TKA versus 1129 subjects with New-TKA were followed through 2 years using patient-reported outcome measures (PROMs). Responders were assessed per Outcome Measures in Rheumatology-Osteoarthritis Research Society International criteria. Kaplan-Meier implant survivorship was estimated. Radiographs had an independent radiographic review., Results: Two-year follow-up was 84.6% (636/752) for Existing-TKA and 82.5% (931/1129) for New-TKA. Two-year PROMs mean outcomes for New-TKA versus Existing-TKA at 2 years were: Knee Injury and Osteoarthritis Outcome Score (ADL: 89.0 versus 86.8, P = 0.005; pain: 88.9 versus 87.1, P = 0.019; symptoms: 84.1 versus 82.2, P = 0.017; Sport/Rec: 63.9 versus 58.8, P = 0.001; and QOL: 77.0 versus 73.5, P = 0.003), Patient's Knee Implant Performance (overall: 76.5 versus 73.5, P = 0.003; confidence: 8.4 versus 8.1, P = 0.004; stability: 8.6 versus 8.3, P = 0.006; satisfaction: 8.3 versus 8.1, P = 0.042; and modifying activities: 6.6 versus 6.4, P = 0.334), Oxford Knee Score (41.9 versus 41.1, P = 0.027), and EQ5D-3L (0.88 versus 0.88, P = 0.737). Two-year responder rates using WOMAC were 93.9% versus 90.6% (P = 0.018) for New-TKA versus Existing-TKA. Independent radiographic review showed that tibial and femoral radiolucencies ≥2 mm were similar (P ≥ 0.05) or favored New-TKA. Implant survivorship was similar between groups (log-rank P = 0.9994)., Discussion: New-TKA versus Existing-TKA demonstrated slightly better PROMs with similar radiographic and implant survivorship outcomes., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Background: This study provides an example for evaluating learning curve when introducing a new knee system., Methods: Thirty-five investigators across 22 sites prospectively implanted 843 subjects with currently available products (group A). Seventy-seven investigators across 48 sites prospectively implanted 2330 subjects with the ATTUNE Knee System; in which the first 10 subjects for each surgeon were the learning curve cases (group B, N = 611), and the later subjects were designated as group C (N = 1719). Surgical time, rates of intraoperative and early postoperative complications, and patient-reported outcome measures (PROMs) at a minimum of 1 year were compared., Results: Mean (standard deviation) surgical time was 72.0 (21.6) minutes for group A, 83.0 (24.2) for group B, and 72.1 (24.1) for group C ( P < .001 for group B vs group C; P  = .955 for group C vs group A). Intraoperative, early (<90 day) complication rates, and PROMs were similar for all groups., Conclusions: The new knee system learning curve was characterized by a slightly longer surgical time with no negative impact on complications or PROMs., Level of Evidence: III.

Background: Quantitative assessment of postsurgical knee motion provides sensitive measurements, but results are technical and may not be meaningful to patients. Although several knee-specific instruments exist, no patient-reported outcome (PRO) measure correlates function with improved stability, motion, satisfaction, and confidence., Objective: To address both the above limitations by developing a PRO measure to assess the phenomenon of a "normal" knee after primary total knee arthroplasty (TKA)., Methods: A draft conceptual model linking the impact of clinical mechanics to hypothesized functional outcomes was generated after a literature review of available assessment tools. Participants aged 18 to 80 years having undergone TKA within the past 10 to 18 months were identified and screened by clinical sites to participate in phase 1 focus groups or phase 2 in-depth interviews. Participants were asked to describe their TKA experiences, including how their knee feels now, followed by cognitive debriefing of Patient's Knee Implant Performance (PKIP) draft items., Results: Phase 1 results indicated that concepts of confidence, stability, and satisfaction in patients' replacement knee when performing certain activities were distinct and important in the patients' assessment of their TKA. Phase 2 efforts yielded a final version of the PKIP measure containing nine items assessing the broader concepts of stability, confidence, and satisfaction in association with activities. Presurgical and postsurgical versions of the measure were created., Conclusions: Results of this qualitative study support use of the PKIP as a complementary PRO measure to assess performance after primary TKA. Psychometric evaluation of the PKIP is planned., (Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.)

From March 2006 to August 2008, 93 subjects (186 knees) underwent simultaneous bilateral total knee arthroplasty performed by eight surgeons at North American centers. This randomized study was conducted to determine whether non-weight-bearing passive flexion was superior for knees receiving a posterior stabilized high flexion device compared to a posterior stabilized standard device in the contra-lateral knee. Weight-bearing single leg active flexion was one secondary endpoint. Follow-up compliance was 92.5%. Results show small, but significant superiority in the motion metrics for the high flexion device compared to the standard device 12 months after surgery, especially for a subgroup of patients with pre-operative flexion less than 120° in both knees. Thus, the ideal candidate for the high flexion device may be one with lesser pre-operative flexion., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To determine if patients from a community health clinic have access to computers and/or the Internet and if they believe a computer is useful in their medical care., Methods: A convenience sample of 100 subjects, aged 50 years and older, from a community health clinic in Nashville, Tennessee, completed a structured interview and a health literacy assessment., Results: Of the 100 participants, 40 did not have any computer access, 27 had computer but not Internet access, and 33 had Internet access. Participants with computer access (with or without Internet) had higher incomes, higher educational status, and higher literacy status than those without computer access. Of participants reporting current computer use (n = 54), 33% reported never using their computer to look up health and medical information. Of those who "never'' used their computer for this activity, 54% reported they did not have Internet connectivity, whereas 31% reported they did not know how to use the Internet. Although this group of individuals reported that they were comfortable using a computer (77%), they reported being uncomfortable with accessing the Internet (53%)., Conclusions: Not only does access to computers and the Internet need to be improved before widespread use by patients, but computer users will need to be instructed on how to navigate the Internet.

Objective: To determine if health literacy is associated with knowledge of colorectal cancer (CRC) and CRC screening tests, with perceived benefits and barriers to CRC screening, with perceived risk of CRC, with reported self-efficacy for completing CRC screening and with receipt of CRC tests., Methods: A convenience sample of 99 subjects completed a health literacy assessment, the Rapid Estimate of Adult Literacy in Medicine (REALM) and a structured interview., Results: Limited or inadequate health literacy was significantly associated with less knowledge about CRC and CRC screening and with more reported barriers to completing fecal occult blood testing (FOBT) and colonoscopy in multivariate analysis. Health literacy was not associated with perceived benefits or reported self-efficacy for completing FOBT or colonoscopy, with perceived risk of developing CRC or with completing CRC tests. However, our small sample size limited our power to detect differences., Conclusions: Patients with limited health literacy have less knowledge about CRC and CRC screening and report more barriers to completing FOBT and colonoscopy. Interventions to improve CRC screening should consider the health literacy of patients, especially when addressing barriers to screening. Future studies are needed to better define the role of health literacy in CRC screening.

Objectives: Patients are assuming responsibility for their own health by self-medicating with dietary supplements, often without physician knowledge or oversight. The objectives of this study were to determine: 1) pediatric dietary supplement use by surveying parents of children who were hospitalized in a university institution; 2) if any health care professional inquired about supplement use at the time the child was hospitalized; 3) whether the use of a supplement was documented in the patient's medical record; and 4) parents' attitudes about dietary supplements., Study Design: Parents of 100 hospitalized pediatric patients (<18 years of age) were randomly selected to complete a survey about their child's use of dietary supplements prior to and during hospitalization. They were also asked if they intended to use these products after hospitalization. The purpose of the study was explained, informed consent was obtained, and parents were given ample time to complete the survey., Results: Fifty percent of parents reported giving their child a dietary supplement prior to hospitalization; 17% reported use of an herbal supplement. Only 24% of parents reported being asked about supplement use by a health care professional upon admission or during the hospital stay. The response to only five of these queries was documented in the child's medical record., Conclusions: Increasing dietary supplement use mandates that all health care professionals elicit this information as part of the routine History and Physical Examination at the time a child is hospitalized. This information should also be documented in the patient's medical record. Likewise, parents should be encouraged to discuss the use of these products with their physician and pharmacist.

Designing an outcomes evaluation plan is a complex, multifaceted process. Eight key decision points have been identified and are reviewed in this article. These key decision points include (1) making a decision about the question(s) of interest, (2) selecting an organizing framework, (3) designing the operational plan for the work environment, (4) determining the relevant information to collect, (5) selecting the measures and forms for data collection, (6) determining the sample to be studied, (7) preparing staff for implementation, and (8) conducting a pilot study. Careful decision making at each of these steps enhances the opportunity for successfully designing and implementing an outcomes evaluation plan.

This article examines the utility of using a multidimensional instrument to assess pain coping in two samples of persons with rheumatoid arthritis (total N = 378). The predictive validity of the newly developed Vanderbilt Multidimensional Pain Coping Inventory (VMPCI), which assesses eleven distinct coping strategies, was compared to that of the previously validated Vanderbilt Pain Management Inventory (VPMI), which assesses the two broad dimensions of active and passive coping. In both samples, the VMPCI demonstrated reliable incremental validity over the VPMI in predicting both positive and negative psychological adjustment, and the predictive ability of the VPMI was highly redundant with that of the VMPCI. Moreover, using the VMPCI, both positive and negative adjustment were related to multiple coping strategies in ways that could not be revealed by the VPMI. These results offer considerable validation to the VMPCI and illustrate the value of assessing coping multidimensionally.

Introduction: Health status, and consequently productivity and quality of life, depends on a multitude of factors. Numerous psychosocial factors have been associated with the concurrent health status of individuals with chronic disease. Previous studies have examined the relationship between singular psychosocial factors and health status in rheumatoid arthritis. This study evaluated the simultaneous interrelationships among selected psychosocial variable and health outcomes using data from a study of younger women diagnosed with rheumatoid arthritis (RA)., Methods: The hypothesized models were examined using data from a survey of 185 women with a mean age of 43 years, diagnosed with RA for an average of 6.6 years. Participants in the study completed the following measures: (1) Arthritis Impact Measurement Scales, (2) Multidimensional Pain Inventory, (3) Daily Hassles Scale, (4) Interpersonal Support Evaluation List, and (5) Perceived Self-Efficacy Scale., Results: Using path analysis, the information provided by the LISREL program, and extant theory, two models were tested. The data provided support for all but two of the hypothesized relationships in the model predicting physical functioning. Pain severity and self-efficacy emerged as important variables in understanding individual variations in perceived physical functioning. In the second model, using perceived well-being as the outcome, two bidirectional relationships were noted: one between affective distress and social support, and the second between perceived well-being and daily stress., Conclusions: The models evaluated in this study support the provision of multifaceted interventions aimed at enhancing a woman's ability to manage her pain and stress while also enhancing her beliefs in her own abilities.

Objective: This study examined the relationship of gender and psychological well-being (PWB) in community-dwelling persons with rheumatoid arthritis (RA)., Method: Data from the first wave of two longitudinal panel studies of persons with RA were examined (93 men and 276 women in panel 1; 60 men and 147 women in panel 2). Subjects completed self-report questionnaires on behavioral aspects of RA. Psychological well-being was assessed in both panels by the Center for Epidemiologic Studies-Depression Scale, using its 4 subcomponents, including positive and negative affect. Panel 2 had additional measures of PWB, namely the Positive and Negative Affect Schedule and the Satisfaction With Life Scale. Potential explanatory variables were then examined in an attempt to account for the observed gender differences., Results: Gender differences were found for negative indicators of PWB, while positive indicators of PWB showed no significant differences by gender. As with other community samples, women reported higher levels of depressive symptoms and negative mood than men. Quality of emotional support, passive pain coping, and physical functional impairment could only partially explain the observed gender differences in this study., Conclusion: The relationship of gender to negative indicators of PWB cannot easily be diminished or dismissed. The mechanisms by which gender differentially affects PWB need to be further explored in order to intervene appropriately to help men and women with RA achieve an optimal quality of life.

The degree to which self-reports of health and functioning reflect negativity (NA), a dispositional tendency to emphasize the negative, was examined with data from a 7-year longitudinal study of adaptation to rheumatoid arthritis. Principal component analyses performed on each of 8 waves of data consistently indicated that the dominant factor in these data was defined by measures of pain and functional impairment. In the final wave, Disease Impact, a scale derived from this component, was directly compared to NA. The 2 scales demonstrated considerable discriminant validity, and most of the significant intercorrelations among Disease Impact and the other variables examined remained statistically significant after the influence of NA was partialed out. These results suggest that reports of pain, impairment, and associated variables reflected disease-related outcomes and processes and not simply NA.

An 11.1% incidence of femoral osteolysis (30 cases in 28 patients) was identified in a series of 271 primary total knee arthroplasties. Two minimally constrained total knee designs (Synatomic [Depuy, Warsaw, IN] and Porous-Coated Anatomic [PCA, Howmedica, Rutherford, NJ] were used in this patient population. Femoral osteolysis was observed in 26 Synatomic and 4 PCA knees. The average follow-up period was 52 months (range, 24-96 months). Osteolytic lesions were identified radiographically, adjacent to the nonporous-coated (smooth) regions of the anterior and posterior flanges of the Synatomic and PCA femoral components. The average time to the diagnosis of femoral osteolysis was 31 months (range, 7-96 months). The average patient age at the time of primary total knee arthroplasty was 63 years (range, 43-83 years) and the average weight was 180 lb. (range, 107-278 lb.). Sixteen of the 30 cases were in men. All of the cases with femoral osteolysis had cementless implantation. Tissue specimens were obtained from the 18 cases requiring revision. Implants remained in situ an average of 66 months (range, 15-96 months) prior to revision. In 16 of the 18 cases revised, the femoral component was clinically and radiographically stable. Six of 18 cases were revised for severe osteolysis. The remaining 12 cases were revised for failed metal-backed patellae, failed cementless tibial fixation, or advanced polyethylene wear. Wear of the thin tibial inserts and patellar components were the two sources of particulate polyethylene. Polyethylene debris was observed in all tissue specimens. In cases with failed metal-backed patellae or impingement of the tibial locking pin-and-clip, fine metallic debris was also noted in tissue specimens. Microscopic evaluation of the osteolytic tissue revealed a florid histiocytic response with occasional giant cells. Intracellular submicron particulate polyethylene was identified with polarized light microscopy and oil-red-O staining techniques. In the study population, statistically significant factors associated with femoral osteolysis included male gender (P < .05), younger age (P < .05), increased patient weight (P < .05), positive tibial osteolysis (P < .001), osteoarthritis (P < .07), and length of time in situ (P < .001). In addition, patients with a Synatomic prosthesis were at increased risk for osteolysis compared to patients with a PCA device (P < .02). The authors postulate that histiocytic granuloma gained access to the proximal femur primarily via the unbonded interface between the smooth metal and bone.

The prevalence and characteristics of osteolysis were studied after 174 consecutive total knee arthroplasties, performed without cement; 16 per cent (twenty-seven) of the implants (in twenty-six patients) were identified as being associated with osteolysis. The diagnosis was made an average of thirty-five months after the operation. Fifteen (56 per cent) of the twenty-seven prostheses were revised after an average of forty-five months in situ. The remaining twelve implants were still in situ five years or more postoperatively. In the patients who were managed with revision, six implants were judged to be stable radiographically and intraoperatively. The remaining nine implants were loose. The average age of the patients who had osteolysis was sixty-three years, and the average weight was seventy-six kilograms (168 pounds). Eighteen of the twenty-six patients who had osteolysis were women. The medial aspect of the tibial metaphysis was the most common site for resorption of bone (twenty-four knees). Sequential radiographs demonstrated progressive extension of the osteolytic process around the tibial base-plate of the prosthesis and distally into the tibial metaphysis along the screw-bone interface in all patients. Histological evaluation of tissue obtained at the revision procedures revealed sheets of histiocytes and occasional giant cells. Intracellular particulate polyethylene and metal were found; most particles were less than one micrometer in size, although particles as large as three micrometers were identified. Mechanical failure of the thin, modular, polyethylene tibial insert; excessive abrasion of the prominent polyethylene tibial eminence, with secondary wear and impingement of the pin on the femoral component; and failure of the metal-backed patellar component all contributed to the extensive amount of polyethylene and the variable amount of metal debris that were generated. Corrosion between the angulated titanium screws and the cobalt-chromium base-plate also contributed particulate metal to the osteolytic process locally. This study demonstrated that osteolysis occurs in association with cementless total knee replacement.

Objective: To describe and compare with standard cardiopulmonary resuscitation (CPR) in humans a new form of CPR that involves both active compression and active decompression of the chest., Design: Patients in cardiac arrest in whom standard advanced cardiac life support failed were randomized to receive 2 minutes of either standard or active compression-decompression (ACD) CPR using a custom, hand-held suction device, followed by 2 minutes of the alternate technique. The ACD device was applied midsternum and used to perform CPR according to the guidelines of the American Heart Association: 80 compressions per minute, compression depth of 3.8 to 5 cm, 50% duty cycle, and constant-volume ventilation. Mechanical Thumper CPR was also compared in five patients. End-tidal carbon dioxide (ETCO2) concentrations and hemodynamic variables were measured. Transesophageal Doppler echocardiography was used to assess contractility, the velocity time integral (an analogue of cardiac output), and diastolic myocardial filling times., Results: Ten patients were enrolled. The mean +/- SD ETCO2 was 4.3 +/- 3.8 mm Hg with standard CPR and 9.0 +/- 3.9 mm Hg with ACD CPR (P less than .0001). Systolic arterial pressure with standard CPR was 52.5 +/- 14.0 mm Hg and with ACD CPR, 88.9 +/- 24.7 mm Hg (P less than .003). The velocity time integral increased from 7.3 +/- 2.6 cm with standard CPR to 17.5 +/- 5.6 cm with ACD CPR (P less than .0001), and diastolic filling times increased from 0.23 +/- .09 seconds with standard CPR to 0.37 +/- .12 seconds with ACD CPR (P less than .004). Mechanical Thumper CPR consistently underperformed both standard and ACD CPR. Minute ventilation obtained in four patients during ACD CPR without endotracheal ventilation was 6.6 +/- 0.9 L/min. After 1 hour of standard CPR failed, three of 10 patients randomized to ACD CPR rapidly converted to a hemodynamically stable rhythm following 2 minutes of ACD CPR., Conclusion: ACD CPR is a simple manual technique that improved cardiopulmonary circulation in 10 patients during cardiac arrest. Although ACD CPR may have produced a return of spontaneous circulation in three patients refractory to standard measures, its impact on survival when used early in cardiac arrest remains to be determined.

The pharmacokinetics and tissue distribution of a human relaxin were investigated after intravenous (iv) bolus administration to pregnant or nonpregnant rats. Human gene-2 relaxin (hRlx-2) serum concentrations after iv bolus administration were described as the sum of three exponentials. The pharmacokinetics were comparable in pregnant and nonpregnant rats. The serum clearance (CL) was 7.4-10.2 ml/min/kg at doses of 46-93 micrograms/kg and was linear in this range. The half-lives were 1.1-2.0, 15.1-16.4, and 53.7-67.9 min, respectively. The volume of the central compartment (Vc) was 48-79 ml/kg and the volume of distribution at steady state (Vss) was 271-336 ml/kg. Increasing the dose to 463 micrograms/kg increased the dose-corrected area under the serum concentration-time curve and significantly decreased CL and Vss. The distribution of radioactivity in the tissues of pregnant rats was followed after iv bolus dosing with hRlx-2 internally labeled with 35S-cysteine. Comparison of the extent of organ uptake of radiolabel after 35S-hRlx-2 or 35S-cysteine administration suggested that the kidneys were the principal site of uptake; the liver was of secondary importance. In perfusion experiments utilizing livers isolated from pregnant or nonpregnant rats, 36-52% of the dose of hRlx-2 was cleared from the perfusate in 2 hr. These studies showed that the pharmacokinetics of hRlx-2 in rats appeared to be unaffected by pregnancy and suggested that the kidneys and liver both play a role in the elimination of hRlx-2.

This study analyzed data from 313 posterior-cruciate-sparing total knee replacements to determine the influence of preoperative flexion on postoperative flexion. The patients with limited flexion preoperatively demonstrated an improvement in flexion postoperatively. By contrast, patients with more than 105 degrees of flexion preoperatively demonstrated a decrease in flexion postoperatively. The study indicated a migration towards the mean range of motion. These findings were true for the total pool of patients and for each subgroup of patients based on diagnosis, cement status of the tibia, and implant type. The data suggests that flexion does not change beyond the first postoperative year.