Stem Cell Numbers and Quality in a Group of Patients Undergoing Hip Replacement Surgery: Increasing Marrow Fat and Plasma IL-6 Concentrations with Aging.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4249-4249
Author(s):  
Timothy R. McGuire ◽  
Susan K. Brusnahan ◽  
John Jackson ◽  
Ann M. Berger ◽  
Kevin L. Garvin ◽  
...  
Keyword(s):  
Stem Cell ◽  
Inflammatory Cytokines ◽  
Hip Replacement ◽  
Side Population ◽  
Fat Content ◽  
Negative Effects ◽  
Marrow Fat ◽  
Cell Numbers ◽  
Replacement Surgery ◽  
Hip Replacement Surgery

Abstract Diseases such as anemia which increase with age may be indicative of a decline in stem cell numbers and quality. Anemia in many elderly patients is thought to be mediated by inflammatory cytokines. Interleukin-6 (IL-6) has been reported to increase with age and to have negative effects on myelopoiesis. Another change which may correlate with age and a related decline in stem cell quality is an increase in marrow fat content. The present investigation was designed to evaluate stem cell numbers and quality in a group of patients undergoing hip replacement surgery and correlate stem cell characteristics with the percentage of fat in the marrow and plasma IL-6 concentrations. Marrow stem cells were obtained from the femoral head and trochanter at surgery. Quality was assessed by measuring the proportion of cells in the lower tip of the marrow side population compared to the upper side population by flow cytometry. Fat content in the marrow was measured as a percentage of total volume after sedimentation. A sandwiched-type ELISA was used to measure plasma IL-6 concentrations (R and D Systems). A total of 30 patients were analyzed (36–87 years of age). The number of side-population cells (stem cell numbers) declined with increasing fat content of the marrow. No difference was seen in the ratio between lower and upper side populations (stem cell quality) with age or fat content. Plasma IL-6 concentrations significantly increased with age confirming prior reports (r=0.37; p=0.03). IL-6 concentrations did not correlate with fat content of the marrow. This data suggests that marrow conversion from red (low fat) to yellow (high fat) increases with age along with plasma IL-6 concentrations but these are independent processes. Other inflammatory cytokines are currently under evaluation as potential mediators of the decline in the stem cell compartment with age with particular emphasis on various adipokines since the decline appears to correlate with increased marrow fat content.

scholarly journals Changes in human bone marrow fat content associated with changes in hematopoietic stem cell numbers and cytokine levels with aging

2011 ◽  
Vol 219 (5) ◽  
pp. 574-581 ◽  
Author(s):  
Sonal R. Tuljapurkar ◽  
Timothy R. McGuire ◽  
Susan K. Brusnahan ◽  
John D. Jackson ◽  
Kevin L. Garvin ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Fat Content ◽  
Human Bone ◽  
Marrow Fat ◽  
Hematopoietic Stem ◽  
Cell Numbers ◽  
Bone Marrow Fat ◽  
Cytokine Levels

scholarly journals The effects of competition and bundled payment on patient reported outcome measures after hip replacement surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fanny Goude ◽  
Sverre A. C. Kittelsen ◽  
Henrik Malchau ◽  
Maziar Mohaddes ◽  
Clas Rehnberg
Keyword(s):  
Hip Replacement ◽  
Health Gain ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Economic Incentives ◽  
Bundled Payment ◽  
Treatment Groups ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Patient Reported

Abstract Background Competition-promoting reforms and economic incentives are increasingly being introduced worldwide to improve the performance of healthcare delivery. This study considers such a reform which was initiated in 2009 for elective hip replacement surgery in Stockholm, Sweden. The reform involved patient choice of provider, free establishment of new providers and a bundled payment model. The study aimed to examine its effects on hip replacement surgery quality as captured by patient reported outcome measures (PROMs) of health gain (as indicated by the EQ-5D index and a visual analogue scale (VAS)), pain reduction (VAS) and patient satisfaction (VAS) one and six years after the surgery. Methods Using patient-level data collected from multiple national registers, we applied a quasi-experimental research design. Data were collected for elective primary total hip replacements that were carried out between 2008 and 2012, and contain information on patient demography, the surgery and PROMs at baseline and at one- and six-years follow-up. In total, 36,627 observations were included in the analysis. First, entropy balancing was applied in order to reduce differences in observable characteristics between treatment groups. Second, difference-in-difference analyses were conducted to eliminate unobserved time-invariant differences between treatment groups and to estimate the causal treatment effects. Results The entropy balancing was successful in creating balance in all covariates between treatment groups. No significant effects of the reform were found on any of the included PROMs at one- and six-years follow-up. The sensitivity analyses showed that the results were robust. Conclusions Competition and bundled payment had no effects on the quality of hip replacement surgery as captured by post-surgery PROMs of health gain, pain reduction and patient satisfaction. The study provides important insights to the limited knowledge on the effects of competition and economic incentives on PROMs.

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