Developmental Dysplasia of Hip and Post-natal Positioning: Role of Swaddling and Baby-Wearing

IntroductionTraditional swaddling, which implies restrictive immobilisation of the infant’s lower limbs with the hips in forced extension and adduction, has been shown to be a risk factor for Developmental Dysplasia of Hip (DDH).MethodsWe reviewed the literature regarding the correlation between DDH and post-natal positioning by swaddling and baby-wearing, to draw awareness of healthcare professionals towards an important risk factor for DDH that has often been overlooked.ResultsThere is overwhelming evidence in the literature, by both experimental and clinical studies, that proves the close association between improper post-natal positioning of the baby’s hips in extension-adduction and an increased incidence of DDH. On the other hand, “hip safe” swaddling which allows unrestricted flexion-abduction movements of the infants’ hips, and the use of baby-wearing devices which keep the lower limbs in an attitude of hip flexion-abduction and knee flexion, is optimal for hip development. Populations which practice these “hip-safe” techniques of infant immobilisation have a lower incidence of DDH as compared to those which practice restrictive immobilisation. Furthermore, populations which have adopted “hip-safe” positioning have demonstrated a significant decrease in the incidence of DDH. Understanding this association is vital, since this is a modifiable risk factor, rectification of which can decrease the incidence of DDH.ConclusionPolicy makers and governments must design educational campaigns tailored to their respective populations to increase awareness regarding the benefits of “hip-safe” techniques of infant positioning, since this simple intervention has the potential of decreasing the incidence of DDH.     

Chemical vapour deposition (CVD) of nickel oxide using the novel nickel dialkylaminoalkoxide precursor [Ni(dmamp′)2] (dmamp′ = 2-dimethylamino-2-methyl-1-propanolate)

Nickel oxide (NiO) has good optical transparency and wide band-gap, and due to the particular alignment of valence and conduction band energies with typical current collector materials has been used in solar cells as an efficient hole transport-electron blocking layer, where it is most commonly deposited via sol–gel or directly deposited as nanoparticles. An attractive alternative approach is via vapour deposition. This paper describes the chemical vapour deposition of p-type nickel oxide (NiO) thin films using the new nickel CVD precursor [Ni(dmamp′)₂], which unlike previous examples in literature is synthesised using the readily commercially available dialkylaminoalkoxide ligand dmamp′ (2-dimethylamino-2-methyl-1-propanolate). The use of vapour deposited NiO as a blocking layer in a solar-cell device is presented, including benchmarking of performance and potential routes to improving performance to viable levels.

We describe CVD of nickel oxide (NiO) thin films using a new precursor [Ni(dmamp′)₂], synthesised using a readily commercially available dialkylaminoalkoxide ligand (dmamp′), which is applied to synthesis of a hole transport-electron blocking layer.     

Malignant cancer and invasive placentation: A case for positive pleiotropy between endometrial and malignancy phenotypes

Cancer metastasis is an invasive process that involves the transplantation of cells into new environments. Since human placentation is also invasive, hypotheses about a relationship between invasive placentation in eutherian mammals and metastasis have been proposed. The relationship between metastatic cancer and invasive placentation is usually presented in terms of antagonistic pleiotropy. According to this hypothesis, evolution of invasive placentation also established the mechanisms for cancer metastasis. Here, in contrast, we argue that the secondary evolution of less invasive placentation in some mammalian lineages may have resulted in positive pleiotropic effects on cancer survival by lowering malignancy rates. These positive pleiotropic effects would manifest themselves as resistance to cancer cell invasion. To provide a preliminary test of this proposal, we re-analyze data from Priester and Mantel (Occurrence of tumors in domestic animals. Data from 12 United States and Canadian colleges of veterinary medicine. J Natl Cancer Inst 1971;47:1333-44) about malignancy rates in cows, horses, cats and dogs. From our analysis we found that equines and bovines, animals with less invasive placentation, have lower rates of metastatic cancer than felines and canines in skin and glandular epithelial cancers as well as connective tissue sarcomas. We conclude that a link between type of placentation and species-specific malignancy rates is more likely related to derived mechanisms that suppress invasion rather than different degrees of fetal placental aggressiveness.     

Design, synthesis, and anti-inflammatory properties of orally active 4-(phenylamino)-pyrrolo[2,1-f][1,2,4]triazine p38alpha mitogen-activated protein kinase inhibitors

A novel structural class of p38 mitogen-activated protein (MAP) kinase inhibitors consisting of substituted 4-(phenylamino)-pyrrolo[2,1- f][1,2,4]triazines has been discovered. An initial subdeck screen revealed that the oxindole-pyrrolo[2,1- f][1,2,4]triazine lead 2a displayed potent enzyme inhibition (IC 50 60 nM) and was active in a cell-based TNFalpha biosynthesis inhibition assay (IC 50 210 nM). Replacement of the C4 oxindole with 2-methyl-5- N-methoxybenzamide aniline 9 gave a compound with superior p38 kinase inhibition (IC 50 10 nM) and moderately improved functional inhibition in THP-1 cells. Further replacement of the C6 ester of the pyrrolo[2,1- f][1,2,4]triazine with amides afforded compounds with increased potency, excellent oral bioavailability, and robust efficacy in a murine model of acute inflammation (murine LPS-TNFalpha). In rodent disease models of chronic inflammation, multiple compounds demonstrated significant inhibition of disease progression leading to the advancement of 2 compounds 11b and 11j into further preclinical and toxicological studies.     

Glial-released proteins: II. Two-dimensional electrophoretic identification of proteins regulated by hydrocorti sone

The proteins released into the culture medium (CM) by confluent C6 glioma cell monolayers were analyzed by two-dimensional sodium dodecyl sulfate polyacrylamide gel electrophoresis (2-D SDS-PAGE). These cells synthesize and release a complex set of proteins which can be resolved on the basis of molecular charge and size. Over 400 spots on fluorograms corresponding to radio-labeled glial-released protein (GRP) were detected and classified according to their positions in 2-D gels. The marked species charge heterogeneity of the 2-D pattern was used as a criterion to assign the majority of GRP components to ‘series’. Series are composed of families of related proteins or glycoproteins distributed in a line of evenly spaced members in the isoelectric focusing dimension. Long-term exposure of monolayers to 2 μM hydrocortisone influenced the accumulation in the culture medium of half of the classified GRP species. Five classes of GRP were identified based on their steroid-responsiveness as seen in the deviation of GRP radiolabel ratios from control and hormone-treated culture CM. Hormonal response, verified by reverse-label experiments, showed a number of GRP in CM are either consistently increased 1-to-fold (Classes I and II) or decreased 1-to 3-fold (Classes IV and V). The remaining GRP (Class III) included those proteins which were found to be uninfluenced or to change in a weak or inconsistent manner. Some GRP series were coordinately induced while other series gave graded responses. These results represent the first high-resolution classification of GRP by physical and biological properties.     

Fractures of the Proximal Femur in Childhood: A Review

BackgroundFemoral neck fractures in children are rare injuries, occurring due to high-energy trauma. Due to the unique anatomy and blood supply of the proximal femur in growing children, these fractures are notorious for high rates of complications despite appropriate management. Classification of these fractures is according to the Delbet system, which not only guides management but also gives prognostic clues. Multiple fixation methods have been described and there is no consensus on what constitutes the best treatment. Osteonecrosis, non-union, coxa vara and premature physeal arrest are the most frequent complications.PurposeTo review the current knowledge, discuss controversial aspects, and provide suggestions for future research.MethodsWe have reviewed the literature on paediatric proximal femur fractures and have provided an evidence-based guide to the diagnosis and management of these injuries. Common complications have been elaborated and options for their prevention and/or management discussed.ConclusionThere is universal agreement that anatomic reduction and stable internal fixation, supplemented by spica immobilization in younger children, are essential to obtain good outcomes. The role of capsular decompression, choice and configuration of implant, and appropriate timing of surgery are aspects that continue to be debated. Multicenter prospective studies are necessary to standardize treatment of these challenging injuries.     

Developmental Dysplasia of the Hip: An Examination of Care Practices of Orthopaedic Surgeons in India

BackgroundWe evaluated screening, referral and treatment practices for developmental dysplasia of the hip (DDH) in India by surveying Orthopaedic surgeons who treat patients with DDH. The survey assessed the timing of DDH presentation, resource availability, and current state of screening and diagnosis, which would help in the development of a DDH care pathway for India.MethodsAn online survey was distributed to Orthopaedic surgeons practicing in India via email and administered onsite to those attending the annual conference of the Pediatric Orthopaedic Society of India in 2019.Results173 completed surveys were received from surgeons practicing in a predominantly urban setting. 68.8% of respondents had performed initial evaluations on children with DDH aged over 1 year in the past 12 months, and 49.1% had assessed children with DDH aged > 2 years on initial presentation. There was no consistent use of established guidelines, with only 30% of respondents stating that a care pathway was in place at their institution. However, 91.9% would support the implementation of a care pathway developed in India, to decrease the incidence of delayed diagnosis and facilitate earlier intervention. 85% of respondents had ready access to ultrasound scans and 95.4% had access to X-rays.ConclusionsIn India, there is still a large number of late-presenting cases of DDH, which could be improved with effective screening. The development of a care pathway for DDH in India is well-supported by Orthopaedic surgeons and may help decrease the incidence of late presenting cases; potentially improving outcomes, decreasing morbidity, and upskilling local practitioners.Electronic supplementary materialThe online version of this article (10.1007/s43465-020-00233-0) contains supplementary material, which is available to authorized users.