Serum Cobalt Concentrations Research Articles

Serum Cobalt Concentration and DNA Methylation Signatures in Women with Obesity

Obesity, a multifactorial disorder, has been associated with alterations in metal metabolismand epigenetic modifications. This pilot case–control study aimed to investigate serum cobalt concentrations and associated DNA methylation patterns in women with obesity. Serum cobalt levels were measured using inductively coupled plasma mass spectrometry (ICP-MS), revealing significantly higher cobalt concentrations in participants with normal weight than in participants with obesity. Additionally, DNA methylation analysis identified differentially methylated positions (DMPs) associated with cobalt exposure, and DMPs between groups highlighted hypomethylation in the top DMPs in individuals with obesity. Functional enrichment analysis of these DMPs unveiled potential pathways implicated in apoptosis, cancer, and metabolic signaling, warranting further investigation into the mechanistic links. This study provides preliminary insights into the interplay between cobalt exposure, DNA methylation, and potential implications for obesity management.

Maternal cobalt concentration and risk of spontaneous preterm birth: the role of fasting blood glucose and lipid profiles.

Spontaneous preterm birth (SPB) is a significant cause of neonatal mortality, yet its etiology remains unclear. Cobalt, an essential trace element, might be a risk factor for SPB. This study aims to investigate the relationship between maternal serum cobalt concentration and SPB, and to clarify the role of blood lipids and fasting blood glucose (FBG) in this relationship. We conducted a nested case-control study within the Beijing Birth Cohort Study. Serum samples were obtained from 222 pregnant women with SPB and 224 controls during the first (7-13 weeks of pregnancy) and third trimesters (32-42 weeks of pregnancy). Serum cobalt concentration was determined using inductively coupled plasma mass spectrometry (ICP-MS). Fasting blood glucose and lipids levels were detected using a fully automated biochemical immunoassay instrument. Logistic regression models and linear regression models were established to explore the association between serum cobalt concentration and the risk of SPB in pregnant women, and to test the mediating effect of fasting blood glucose (FBG) and lipids. We found that the serum cobalt concentration in mothers with SPB and controls was similar in the first trimester, with values of 0.79 (0.58-1.10) ng/mL and 0.75 (0.51-1.07) ng/mL, respectively. However, in the third trimester, the cobalt concentration increased to 0.88 (0.59-1.14) ng/mL and 0.84 (0.52-1.19) ng/mL, respectively. In the logistic regression model, when considering the third trimester of pregnancy, after adjusting for ethnicity, pre-pregnancy body mass index (BMI), maternal age, education, income, and parity, it was observed that the medium level of cobalt concentration (0.63-1.07 ng/ml) had a negative correlation with the risk of SPB. The odds ratio (OR) was 0.56, with a 95% confidence interval of 0.34-0.90 ng/mL and a p-value of 0.02. This suggests that cobalt in this concentration range played a protective role against SPB. Additionally, it was found that FBG in the third trimester of pregnancy had a partial intermediary role, accounting for 9.12% of the association. However, no relationship between cobalt and SPB risk was found in the first trimester. During the third trimester, intermediate levels of maternal cobalt appear to offer protection against SPB, with FBG playing a partial mediating role. To further clarify the optimal cobalt concentrations during pregnancy for different populations, a multi-center study with a larger sample size is necessary. Additionally, exploring the specific mechanism of FBG's mediating role could provide valuable insights for improving the prevention of SPB.

Trace element concentrations in blood samples from dairy cows with uterine torsion and their neonatal calves.

Mineral deficiencies can lead to dystocia and abnormalities in neonates. Stillbirth of neonatal calves in dairy cows due to dystocia has become an economic problem. Uterine torsion (UT) is a common form of dystocia observed in dairy cows. However, to the best of our knowledge, there have been no reports on the characteristics of serum trace element concentrations in dairy cows with UT. This study aimed to comprehensively measure serum trace element concentrations in dairy cows with UT and dystocia. Dairy cows with (n = 15) and without (n = 27) UT and neonates (n = 9 and n = 26, respectively) were included in this study. Blood samples (10 mL) were collected, and serum trace element concentrations were evaluated using inductively coupled plasma mass spectrophotometry. The mortality rate at birth was significantly higher in calves delivered by cows with UT than those delivered by cows without UT. The odds ratio for mortality rate at birth in dairy cows with UT was 7.85. Serum zinc (Zn) levels were significantly lower in cows with UT than in cows without UT (p = 0.01). The copper: Zn ratio was significantly higher in cows with UT than in cows without torsion (p = 0.05). In contrast, serum Cobalt (Co) concentrations were significantly higher in neonates from cows with UT than in neonates from cows without UT (p = 0.01). Uterine torsion is associated with a high mortality rate at birth and considerable economic losses. Cows with UT had low serum Zn levels, and neonates born to these cows had high serum Co levels.

Are serum cobalt and chromium levels predictors for patient-reported outcome measures in the ASR hip resurfacing arthroplasty?

The aims of this study were to determine if an increasing serum cobalt (Co) and/or chromium (Cr) concentration is correlated with a decreasing Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Score (HOOS) in patients who received the Articular Surface Replacement (ASR) hip resurfacing arthroplasty (HRA), and to evaluate the ten-year revision rate and show if sex, inclination angle, and Co level influenced the revision rate. A total of 62 patients with an ASR-HRA were included and monitored yearly postoperatively. At follow-up, serum Co and Cr levels were measured and the HHS and the HOOS were scored. In addition, preoperative patient and implant variables and the need for revision surgery were recorded. We used a linear mixed model to relate the serum Co and Cr levels to different patient-reported outcome measures (PROMs). For the survival analyses we used the Kaplan-Meier and Cox regression model. We found that an increase of one part per billion (ppb) in serum Co and Cr levels correlated significantly with worsening of the HHS in the following year. This significant correlation was also true for the HOOS-Pain and HOOS-quality of life sub scores. The overall ten-year survival rate in our cohort was 65% (95% confidence interval (CI) 52.5 to 77.6). Cox regression analysis showed a significant hazard ratio (HR) of 1.08 (95% CI 1.01 to 1.15; p = 0.028) for serum Co level. No significance was found with sex or inclination angle. This study shows that increasing serum Co and Cr levels measured in patients with an ASR-HRA are predictive for deterioration in HHS and HOOS subscales in the following year. Increasing serum Co and Cr should forewarn both surgeon and patient that there is a heightened risk of failure. Continued and regular review of patients with an ASR-HRA implant by measurement of serum Co/Cr levels and PROMs remains essential.

Serum cobalt and chromium concentration following total hip arthroplasty: a Bayesian network meta-analysis

The present systematic review investigated the concentration of chromium (Cr) and cobalt (Co) in serum in patients who have undergone total hip arthroplasty (THA). The first outcome of interest was to investigate the mean concentration in serum of Cr and Co using different material combinations and to verify whether their concentrations change significantly using different patterns of head and liner in THA. The second outcome of interest was to investigate whether the time elapsed from the index surgery to the follow-up, BMI, sex, and side exert an influence on the mean concentration of Cr and Co in serum in patients who have undergone THA. The following material combinations were investigated (head-liner): Ceramic-Co Cr (CoCr), CoCr-CoCr, CoCr-Polyethylene, CoCr high carbide-CoCr high carbide. Data from 2756 procedures were retrieved. The mean length of follow-up was 69.3 ± 47.7 months. The ANOVA test evidenced good comparability in age, length of follow-up, BMI, and sex (P > 0.1). In patients who have undergone THA, the mean concentration in the serum of Co ranged between 0.5 µg/L and 3.5 µg/L, and the mean concentration of Cr from 0.6 to 2.6 µg/L. The difference in the concentration of Co and Cr in serum is strictly related to the implant configuration, with the coupling CoCr-CoCr showing the highest and CoCr-Polyethylene showing the lowest concentration. Patient characteristics, BMI, sex, side and the time elapsed from the index surgery to the last follow-up did not exert a significant influence on the concentration of Co and Cr in serum in patients who have undergone total hip arthroplasty (THA).

Serum Trace Minerals Profile in Anestrus Buffaloes Treated With Different Estrus Synchronization Protocols

The present study was conducted to analyse the serum trace minerals (copper, cobalt, iron, zinc, manganese and selenium) concentration in postpartum anestrus buffaloes. A total of 24 postpartum anestrus buffaloes were randomly selected after taking reproductive history and gynaeco-clinical examination 10 days apart. These 24 animals were divided into four groups; Group A (Ovsynch), Group B (Heatsynch) and Group C (CIDR plus Ovsynch) and Control group (no treatment) each containing six animals. Blood sample was collected on day 0, 7, 9 and 10 of treatment and serum was analysed for various trace minerals. The mean serum copper level (µg/ml) increased significantly (p<0.01) from day 0 to day 7, 9 and 10 in group A, B and C. The mean serum cobalt concentration increased significantly (p<0.05) from day 0 to day 7, 9 and 10 in group A, B and C. Serum iron concentration increased significantly (p<0.05) from day 0 to day 9 and 10 except on day 7 in group A, B and C and on day 9 in group A. The mean zinc level (µg/ml) increased significantly (p<0.05) in group B and C on day 9 and 10 except day 7. The serum manganese concentration on day 0 increased significantly (p<0.01) to day 9 and 10, the value on day 0 was also found significant from day 7 in group C. The mean serum selenium, the value on day 0 increased significantly (p<0.01) to day 7, 9 and 10 in group A, B and C except the value on day 7 in group B. Thus, it could be concluded that deficiency of copper, iron, zinc and selenium either alone or in combination could be responsible for anestrus condition. By improving the trace minerals status, fertility can be improved in buffaloes.

Careful patient selection together with optimal implant positioning may reduce but does not eliminate the risk of elevated serum cobalt and chrome levels following metal-on-metal hip resurfacing.

Elevated serum chrome (sCr) and cobalt (sCo) concentrations are associated with local tissue adverse reactions to metal debris following metal-on-metal hip resurfacing (MoM-HR). Serum metal ions <2 µg/l are probably of little clinical relevance and a pragmatic "safe" threshold <5 µg/l has been suggested.The primary aim of this study was to evaluate if a careful selection of patients combined with optimal implant positioning could eliminate cases with "unsafe" serum metal ion levels. A secondary aim was to study the association between different risk factors and having Co and/or Cr levels >5 µg/l. This is a retrospective, single-institution cohort study of 410 consecutive patients operated on with a Birmingham Hip Resurfacing (BHR) implant between 2001 and 2014. 288 of these had a unilateral MoM-HR, pelvic and true lateral radiographs, and a related sCo and sCr sample, and were included in the final analysis. They were allocated to either a presumed "optimal group" consisting of only men aged <60 years old, with femoral head component >48 mm diameter, and with a cup positioned within Lewinnek's safe zones, or a "suboptimal group" consisting of the remaining patients. Fisher's exact test and multiple logistic regression analyses were performed. In the optimal group 48% (47/97) had serum metal ions >2 µg/l and 8% (8/97) >5 µg/l compared to 61% (116/191) and 18% (34/191) in the suboptimal group, p = 0.059 and p = 0.034 respectively. Acetabular cups with an anteversion <5 degrees had the highest odds ratio, 6.5 (95% CI, 3.0-14.3), of having sCo and sCr concentrations exceeding 5 µg/l. A well oriented BHR acetabular component in a presumably "optimal" patient reduces the risk of having elevated serum metal ions but does not eliminate it. Insufficient cup anteversion seems to be the strongest associated factor of elevated serum metals.

Minimum 15-year results of metasul 28-mm metal-on-metal total hip arthroplasty in patients younger than 50 years of age

BackgroundSome propitious mid- and long-term studies had been reported for MoM bearings; however, most studies have addressed specific patient groups rather than younger, active patients, who probably represent the most suitable population for investigations on wear and osteolysis. The purpose of this study to evaluate the long-term results of second-generation metal-on-metal cementless total hip arthroplasty (THA) in patients aged <50 years.MethodsFrom December 1997 to January 2004, primary THA using a metal-on-metal bearing cementless implant was performed in 63 patients (72 hips) aged <50 years. The mean follow-up duration was 18.6 (range, 15.9–22.1) years, and the mean age at initial operation was 39 (range, 22–49) years. Clinical results, complications, survivorship, osteolysis, and aseptic loosening were evaluated.ResultsThe mean Harris hip score and Western Ontario and McMaster Universities Arthritis Index scores were improved from 57.8 (range, 28–69) points and 73.4 (range, 63–94) points preoperatively to 91.7 (range, 80–100) points and 25.5 points (range, 17–38) points, respectively, at the last follow-up. Osteolysis lesions were found in 12 hips (acetabulum, 6 and femur, 6). The notching occurred on the femoral stem neck occurred in 12 hips. The mean serum cobalt and chromium concentrations were 2.3 (range, 0.2–10.6) μg/L and 1.7 (range, 0.4–8.1) μg/L, respectively, at a mean follow-up of 12.7 years in 32 patients (50.1%). The Kaplan-Meier survivorship curve analysis with revision for any reason as the endpoint revealed that 93.1% survived at 18.6 years’ follow-up.ConclusionsSecond-generation metal-on-metal cementless THA was found to produce satisfactory clinical and radiographic results with a low revision rate for osteolysis and aseptic loosening in patients aged less than 50 years.

Incidence of Pseudotumors in a Dual Modular Stem Construct With and Without Metal-on-Metal Bearing Surface.

The purpose of this study was to compare the incidence of pseudotumors in metal-on-metal (MoM) titanium modular neck hip arthroplasties to non-MoM modular neck hip arthroplasties. A secondary goal was to determine whether a correlation exists between elevated metal concentrations and pseudotumor incidence. The data were collected and evaluated from 49 MoM joints and 26 non-MoM joints between the years 2012 and 2017. Hip ultrasonography was done after a minimum of 5 years postimplantation. Whole serum metal (titanium, cobalt, and chromium) concentrations were measured at the hip ultrasonography study. The average time elapsed between surgery and ultrasonography visit was 7.6 years. In the 49 patients with MoM joints, 22.4% (n = 11) had a pseudotumor. In the 26 patients with non-MoM joints, 9.1% of metal-on-polyethylene hips (n = 1) and 0% of ceramic-on-ceramic/polyethylene hips developed a pseudotumor. No significant statistical correlation was observed between serum metal concentrations and pseudotumor formation (P > 0.05). A significant correlation was observed of serum titanium concentration to pseudotumor size (P = 0.024). The incidence of pseudotumor formation in MoM total hip arthroplasties was more than five times the incidence associated with non-MoM bearings. The correlation between serum titanium concentration and pseudotumor size suggests that titanium levels may be a useful indicator for pseudotumor formation in patients with this particular titanium modular neck femoral implant. No notable correlation was observed between serum cobalt and chromium concentration and pseudotumor formation or size.

The Relationship Between Insulin Resistance and Trace Elements in Patients With Polycystic Ovary Syndrome

Objective: The study was investigate serum zinc (Zn), chromium (Cr), cobalt (Co) and manganese (Mn) concentrations in relation to hormone levels and polycystic ovary syndrome (PCOS).Materials and Methods: Fourty women between 18-40 years of age diagnosed with PCOS. We also seleceted 40 healty volunteers as the control group. Serum Zn, Cr, Mn, follicular stimulating hormone (FSH), luteinizing hormone(LH), Dehydroepiandrosterone sulfate (DHEA-S), total testosterone (TT), sex hormone binding globulin (SHBG), insulin, glucose, cholesterol, triglyceride, High Density Lipoprotein (HDL-C) and Low density lipoprotein (LDL-C) concentrations were determined. Results: Insulin, glucose, triglyceride, DHEA-S levels were significantly higher in the PCOS group than in the control group, while FSH and Mn levels were significantly lower in the HOMA-IR group than in the control group (p&amp;lt; 0.05). Conclusions: A possible association is perceptible in our study between some of serum trace elements and women with PCOS. The association attains a connotative level with the involvement of IR in it. Additional studies evaluating the effects of these elements supplementation would be required to confirm the hypothesis as well as to ascertain whether insulin resistance in the presence of manganese deficiency can directly lead to oxidative stress.

Echocardiographic Changes in the Context of Metal-on-Metal Versus Nonmetal-on-Metal Total Hip Arthroplasty

BackgroundThe purpose of this study is to determine if there is a difference in echocardiographic results between patients with metal-on-metal (MoM) vs non-MoM total hip arthroplasty (THA) and to determine if a correlation exists between serum metal levels and echocardiographic outcomes. MethodsSeventy-five patients with the same modular THA enrolled in this prospective cohort study, and 49 had MoM bearings. All patients had serum cobalt, chromium, and titanium levels drawn at 2 study visits with a transthoracic echocardiogram at the second visit. Serum metal concentrations and echocardiographic parameters were compared with 2-way t-tests. Multiple linear regression analyses identified any significant predictors of echocardiographic outcomes. ResultsMean serum cobalt and chromium levels were significantly greater in the MoM group at both time-points (P < .001 and P < .05, respectively). Titanium levels were similar between groups (P > .05). MoM patients had significantly lower global longitudinal strain compared with the non-MoM group (18.4% vs 20.2%; P = .026). Serum cobalt concentration was found to be an independent predictor of tricuspid annular plane systolic excursion (P = .02). ConclusionMoM THA bearings are associated with increased serum cobalt and chromium levels. Patients with MoM THAs had decreased global longitudinal strain, a measure of left ventricular function, but both groups remained within normal range. The clinical impact of the positive association between serum cobalt concentration and tricuspid annular plane systolic excursion, a marker of right ventricular function, deserves further study. These findings can reassure physicians and patients that metal-induced cardiomyopathy is not typical in the setting of MoM THA. Level of EvidenceLevel II, Prospective Cohort Study.

Serum cobalt concentrations remain at low levels at a minimum of 20 years following metal-on-metal total hip arthroplasty.

AimsSecond-generation metal-on-metal (MoM) articulations in total hip arthroplasty (THA) were introduced in order to reduce wear-related complications. The current study reports on the serum cobalt levels and the clinical outcome at a minimum of 20 years following THA with a MoM (Metasul) or a ceramic-on-polyethylene (CoP) bearing.MethodsThe present study provides an update of a previously published prospective randomized controlled study, evaluating the serum cobalt levels of a consecutive cohort of 100 patients following THA with a MoM or a CoP articulation. A total of 31 patients were available for clinical and radiological follow-up examination. After exclusion of 11 patients because of other cobalt-containing implants, 20 patients (MoM (n = 11); CoP (n = 9)) with a mean age of 69 years (42 to 97) were analyzed. Serum cobalt levels were compared to serum cobalt levels five years out of surgery.ResultsThe median cobalt concentration in the MoM group was 1.04 μg/l (interquartile range (IQR) 0.64 to 1.70) at a mean of 21 years (20 to 24) postoperatively and these values were similar (p = 0.799) to cobalt levels at five years. In the CoP control group, the median cobalt levels were below the detection limit (< 0.3 μg/l; median 0.15 μg/l, IQR 0.15 to 0.75) at 20 years. The mean Harris Hip Score was 91.4 points (61 to 100) in the MoM group and 92.8 points (63 to 100) in the CoP group.ConclusionThis study represents the longest follow-up series evaluating the serum cobalt levels after 28 mm head MoM bearing THA and shows that serum cobalt concentrations remain at low levels at a mean of 21 years (20 to 24) after implantation.Cite this article: Bone Joint Res. 2020;9(3):145–150.

Gross trunnion failure in metal on polyethylene total hip arthroplasty-a systematic review of literature.

Multiple cases of dissociation of the head from the neck termed as gross trunnion failure (GTF) in total hip replacement have been described. Very little quantitative data is available for patient and implant factors associated and predisposing to this complication. To systematically review and analyze all studies which have gross trunnion failure in case of metal on polyethylene (MoP) total hip replacement. PubMed database was searched. We also performed a secondary search by pearling bibliography of all full text articles obtained. Predefined inclusion and exclusion criteria were used for abstract screening by two independent observers. A total 46 cases met our inclusion criteria. These were included in the final analysis and data was pooled. Till date, 46 cases of GTF in MoP THR have been reported. The mean age at time of revision was 70.13years (range 50 to 89years). The mean time to revision surgery was 8.24years (range 4.7 to 14years). 91.4% cases were male. BMI was ≥ 25 in 38/41 cases and ≥ 30 in 21/41 cases. Pain (95.5%) and difficulty or inability to walk (97.7%) were the most common symptoms. A total of 19/44 cases described varying sounds like click, clunk, and pop before dislocation. Accolade TMZF/TMZF plus was the most common stem used in 34/46 cases. The stem neck angle was 127 degrees in 97% cases (32/33 cases). A positive neck offset of 4mm or more was used in 91.1% cases (40/44 cases). The head size ≥ 36mm in approximately 90% cases. The head material was cobalt chromium in all 45 cases, where data was available. Among the intra-operative findings, the most common findings were metallosis (41/44), black or brow coloured synovial fluid (21/44), pseudotumour (19/44), synovial hypertrophy (18/44), damage to the abductor musculature (17/44), proximal femoral osteolysis (5/44 cases), and heterotrophic ossification (2/44 cases). Histopathological analysis was available in 11 cases and was suggestive of fibrous tissue with chronic cellular infiltrate in all cases. The serum cobalt and chromium concentrations were raised above normal in 86.4% (19/22) and 21.7% cases (5/23) respectively. Gross trunnion failure may not be as uncommon as was previously thought. A number potential associations and predisposing factors of this complication have been highlighted in this review. But due to small sample size and weak level of evidence, further studies are needed in this field.

Elevated Serum Cobalt Concentrations Associated With Hydroxocobalamin Administration for Refractory Vasoplegia

Abstract Cobalt is a trace mineral important for normal metabolism. Elevated circulating cobalt concentrations may be seen after toxic ingestions, occupational exposure, and wear of metallic implants. We report a case of markedly elevated serum cobalt levels attributed to administration of hydroxocobalamin as a treatment for refractory hypotension. While excessive cobalt may be potentially toxic, the clinical significance of elevated serum cobalt associated with hydroxocobalamin administration remains to be elucidated. While hydroxocobalamin is an emerging therapy in a clinician's arsenal in treatment of vasodilatory shock, this case illustrates the need for a heightened level of awareness among clinicians for potential adverse effects and abnormal laboratory findings associated with this therapy.

Study on the treatment for abnormality of metal ions with EDTA complexing agent-loaded microsphere sustained release system

Objective To construct a new sustained-release system, hollow mesoporous silica nanoparticles (HMSNs), to control the release of ethylene diamine tetraacetic acid (EDTA) continuously, effectively and intelligently to treat the abnormal increase of metal ions in vivo. The disulfide bond can be broken or reconstructed with the change of H+ concentration to realize the construction of receptor, and the is constructed by blocking cucurbituril and alpha-cyclodextrin through disulfide bond. Thus, the abnormal increase of chromium and cobalt ions in rats can be accurately controlled and maintained at normal levels. Methods HMSNs-EDTA sensitive to H+ was prepared. HMSNs containing functional groups of alpha-cyclodextrin were constructed. The disulfide bond was formed between the HS group at the end of cucurbituril and the HS group of alpha-cyclodextrin as a switch. Cucurbituril and alpha-cyclodextrin are connected by disulfide bond to form a valve system, which can block silica channels and thus close EDTA. A rat model of elevated chromium and cobalt ions was established by intraarticular injection of CoCrMo nanoparticles suspension into the knee joint. Rat models were randomly divided into three groups: intraperitoneal injection of saline (control group), intraperitoneal injection of traditional drug sustained release (IgG-HMSNs-EDTA group), and intraperitoneal injection of H+ sensitive cucurbituril-HMSNs-EDTA sustained release (intelligent sustained release system group). During this process, nanoparticle suspension was injected continuously to observe the changes of serum chromium and cobalt concentration in rats. Results From the release curve of EDTA, it was found that the higher the concentration of H+ was, the faster the drug release was (H+ concentration group: 2 mmol/L>1 mmol/L>0.5 mmol/L>0.1 mmol/L). It shows that the sensor does control the valve with the change of H+ concentration. Compared with the slow-release body without valve, the release of EDTA in the new intelligent slow-release body is gentler. Within 20 weeks, the concentration of metal ions in the control group increased continuously and slowly due to the absence of EDTA treatment (Chromium 1.08±0.07 ug/L and cobalt 41.14±0.79 ug/L). In the traditional valve group, the metal ions decreased rapidly within 8 weeks and were once lower than the normal values in rats. Subsequently, due to the release of EDTA, metal ions will still increase abnormally (Chromium ion 0.61±0.52 ug/L, cobalt ion 28.72±16.93 ug/L). The intelligent sustained-release system group can more effectively, continuously and accurately control the abnormal changes of chromium and cobalt ions in vivo, and the difference is statistically significant (Chromium ion 0.65±0.13 ug/L, cobalt ion 29.68±3.24 ug/L). Conclusion According to the principle that disulfide bond can be broken or reconstructed with the change of H+ concentration, the application of cucurbituril-HMSNs-EDTA intelligent microsphere sustained release system to treat patients with increased chromium and cobalt ions caused by plants in metal will control the drug release more accurately and intelligently. The intelligent sustained-release system can not only avoid the side effects caused by the rapid and excessive release of drugs, which lead to the disorder of normal trace metal elements in vivo, but also prolong the treatment time, and can maintain the chromium and cobalt ions in rats at normal levels for a long time. Key words: Metal; Coordination complexes; Nanostructures

Association between maternal and umbilical cord serum cobalt concentration during pregnancy and the risk of preterm birth: The Ma'anshan birth cohort (MABC) study

Cobalt is an essential trace element and has been suggested to be involved in oxidative stress and inflammatory responses. However, researches have paid little attention to the association between serum cobalt levels during pregnancy and the risk of preterm birth (PTB, <37 week of gestation). The purpose of this study was to determine the association between maternal and umbilical cord serum cobalt concentrations and the risk of PTB. A total of 2951, 3080, and 2698 serum samples were obtained from pregnant women in the first, the second trimester, and the umbilical cord blood, respectively. The tertile levels of ln-transformed cobalt were defined as low, medium and high levels for cobalt respectively. In our study, the rate of PTB (<37 weeks of gestation) was elevated in subjects with low cobalt levels in the first trimester of pregnancy (adjusted OR 1.61, 95% CI: 1.01, 2.58) and the second trimester of pregnancy (adjusted OR 1.62, 95% CI: 1.03, 2.54). The adjusted OR for PTB was 2.46 (95% CI: 1.34, 4.53) among subjects with low cobalt levels and 2.22 (95% CI: 1.19, 4.15) among subjects with medium cobalt levels in the umbilical cord serum. Our findings demonstrated that the lower levels in maternal and umbilical cord serum cobalt were associated with the increased the risk of PTB.

Retrieval Findings of Recalled Dual-Taper Hips.

Background:The recent high-profile recalls of several dual-taper hip designs pose questions regarding why those designs perform poorly. We aimed to characterize taper damage in 1 recalled design to understand failure mechanisms to inform surgeons on which patients should be considered at risk of revision and when to revise.Methods:High-precision measurement equipment was used to characterize the metal loss from the neck-stem interface of 116 retrieved Rejuvenate femoral stems (Stryker Howmedica Osteonics) revised because of an adverse reaction to metal debris. Head-neck taper surfaces were also investigated, and clinical and laboratory data were examined.Results:The neck-stem junction of each implant was moderately to severely corroded and showed a characteristic wear pattern on both male and female taper surfaces. The severity of taper damage was positively correlated with time to revision (coefficient, 0.040 [95% confidence interval (CI), 0.028 to 0.051]; p < 0.0001) and with serum cobalt concentration (coefficient, 0.02 [95% CI, 0.01 to 0.02]; p < 0.0001) and serum chromium concentration (coefficient, 0.04 [95% CI, 0.009 to 0.070]; p = 0.0142).Conclusions:A forensic examination of the retrieved components that failed secondary to an adverse reaction to metal debris showed, in all cases, visible corrosion. Of the implant and patient factors investigated, we did not identify any predictors of corrosion. The severity of damage was found to increase with time; cobalt was significantly elevated over chromium.Clinical Relevance:Surgeons should scrupulously follow and consider revision for patients with this implant design to avoid extensive tissue excision. Blood metal ion tests may aid in identifying the mechanisms of taper corrosion.

Outcomes after revision of metal on metal hip resurfacing to total arthroplasty using the direct anterior approach.

Function after revision total hip arthroplasty (THA) in failed metal-on-metal (MoM) hip resurfacing arthroplasty (HRA) is variable, but post-operative complication rates are reportedly high. We hypothesized HRA conversion to THA using the direct anterior approach (DAA) would be associated with optimal outcome. Seventeen MoM-HRAs in 15 patients (seven males, eight females) were revised through the DAA. The mean age was 45years (28-59yrs). The most common indications for revision were aseptic loosening of the acetabular component or of the femoral component and femoral neck fracture. In 16 hips, a conversion to a ceramic-on-ceramic (CoC) (13 hips) or to a metal-on polyethylene (MOP) (2), or to a large-head MoM (1) THA was done. An isolated femoral revision was done in one hip. After 6.7 ± 3years, no hip had required a re-revision. The Postel-Merle d'Aubigne (PMA) functional score improved from 9 (4-14) to 16 (12-18) (p < 0.001). An intra-operative fracture of the greater trochanter (one hip) and dysesthesia of the lateral femoral cutaneous nerve (four hips) were reported. Mean serum chromium concentration decreased from 33.2μg/L (11.8-62μg/L) pre-operatively to 5.8μg/L (0.4-35.5μg/L) post-operatively (p < 0.001), and mean serum cobalt concentration decreased from 35.8μg/L (6.3-85.5μg/L) to 4.7μg/L (0.26-25.7μg/L) (p = 0.003). Revision of failed MoM-HRA using the DAA resulted in an acceptable clinical outcome, no specific complication and no further surgery. A consistent decline in serum ion levels may be expected following HRA conversion to THA.

Frank Stinchfield Award: Identification of the At-risk Genotype for Development of Pseudotumors Around Metal-on-metal THAs.

Once touted as the future of hip arthroplasty, metal-on-metal (MoM) bearing surfaces have fallen sharply from favor with the emergence of a strong body of evidence demonstrating unacceptably high premature implant failure rates. The previously unpredictable development of adverse local tissue reactions (ALTRs) has been a substantive contributor to this. Although the underlying pathophysiology of these so-called "pseudotumors" is now well understood, the fundamental predisposing patient risk factors have remained elusive. The aim of this research, as a clinical-genotype correlation analysis, was to identify specific alleles (genes) associated with the development of ALTRs in patients with in situ MoM THAs. A case-control study of patients who received a large-head, primary MoM THA between 2005 and 2008 was performed with a minimum followup of 5 years. Twenty-six patients who had undergone revision of a primary MoM THA secondary to symptomatic ALTRs were recruited. The mean timeframe from primary MoM THA to symptomatic revision was 5.5 years (range, 1-10 years). Twenty-eight control subjects were randomly selected asymptomatic patients with no evidence of ALTRs on protocol-specific screening. Baseline demographics and high-resolution genotype (human leukocyte antigen [HLA] Class II) were collected for all patients. Cohorts were similar with respect to age at the time of primary MoM THA (mean, 54.8 versus 54.9 years, p = 0.95) and serum cobalt (mean, 5.5 versus 8.5 μg/L, p = 0.09) and chromium concentrations (mean, 2.9 versus 4.2 μg/L, p = 0.27). The association between genotype and revision surgery secondary to ALTRs was determined with gender as a covariate. The prevalence of the risk genotype was 30% (16 of 54) among the entire cohort. Adjusting for sex, the odds of revision were 6.1 times greater among patients with the risk genotype present than among patients without (95% confidence interval [CI], 1.5-25.4; p = 0.01). Among females, the specificity of the risk genotype was 1.0 (95% CIexact, 0.5-1.0; pexact = 0.03), and for males, it was 0.8 (95% CIexact, 0.6-0.9; pexact < 0.01). The findings of this study suggest that, among patients with a primary MoM THA, allelic variation within the HLA Class II loci may be a strong, independent risk factor associated with the need for subsequent revision surgery secondary to pseudotumor formation. Given the hypothesis-generating nature of this novel undertaking, confirmatory prospective clinical studies are required to further elucidate this correlation and to explore the clinical utility of targeted genetic screening in this specific population. This research may, however, represent a key missing piece in the puzzle that is metal ion-induced pseudotumor formation.

A Randomized Seven-Year Study on Performance of the Stemmed Metal M2a-Magnum and Ceramic C2a-Taper, and the Resurfacing ReCap Hip Implants

BackgroundThe large-diameter metal-on-metal hip prostheses were expected to have low wear and reduced dislocation rate compared to the traditional metal-on-polyethylene implants. We compare 2 such prostheses, the ReCap resurfacing implant and the M2a-Magnum stemmed implant, with the C2a ceramic-on-ceramic stemmed implant as to clinical performance, serum concentrations of prosthesis metals, and the durability of the implants in a randomized, controlled clinical trial at 7 years of follow-up. MethodsAll included patients had osteoarthritis. Preoperatively, the size of the implants was estimated from a magnetic resonance imaging (MRI) scan. Follow-up data included serum cobalt and chromium concentrations, Oxford and Harris Hip Scores, leg press and abduction force, 6-minute walk distance, WOMAC and SF-36 self-assessment scores, and from the 7th postoperative year also ultrasonography (US) examination of the soft tissue adjacent to the implant as well as MRI with metal artifact reduction sequence (MARS-MRI) when indicated. ResultsOne hundred fifty-two hips in 146 patients were included. The serum cobalt and chromium concentrations were significantly higher for the 2 metal-on-metal prostheses than for the ceramic-on-ceramic, with the M2a-Magnum as the highest. No significant difference was found between the groups concerning physical performance measurements and scores as well as dislocations and prosthesis survival. Five revisions were done and concerned all groups, for reasons of pain, high serum cobalt and chromium concentrations, cystic fluid collection around the joint, and infection. Metal concentrations, US, and MARS-MRI contributed to the decision making regarding prosthesis revision. ConclusionMetal concentrations were significantly higher for the metal-on-metal prostheses than for the ceramic-on-ceramic. The clinical performance was good in all 3 prosthesis groups. Metal concentrations, US, and MARS-MRI findings were of use to identify hips needing revision.ID Number in ClinicalTrials.gov PRS: NCT00284674