bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of Influential Factors for the Relationship between PM2.5 and AOD in Beijing
Authors: Zheng Caiwang , Zhao Chuanfeng , Zhu Yannian , Wang Yang , Shi Xiaoqin , Wu Xiaolin , Chen Tianmeng , Wu Fang , Qiu Yanmei
Published: February 2017

Abstract. Relationship between aerosol optical depth (AOD) and PM2.5 is often investigated in order to obtain surface PM2.5 from satellite observation of AOD with a broad area coverage. However, various factors could affect the AOD-PM2.5 regressions. Using both ground and satellite observations in Beijing from 2011 to 2015, this study analyzes the influential factors including the aerosol type, relative humidity (RH), atmospheric boundary layer height (PBLH), wind speed and direction, and the vertical structure of aerosol distribution. The ratio of PM2.5 to AOD, which is defined as η, and the square of their correlation coefficient (R2) have been examined. It shows that η varies from 54.32 to 183.14, 87.32 to 104.79, 95.13 to 163.52 and 1.23 to 235.08 μg/m3 with aerosol type in four seasons respectively. η is smaller for scattering-dominant aerosols than for absorbing-dominant aerosols, and smaller for coarse mode aerosols than for fine mode aerosols. Both RH and PBLH affect the η value significantly. The higher the RH, the larger the η, and the higher the PBLH, the smaller the η. For AOD and PM2.5 data with the correction of RH and PBLH compared to those without, R2 of monthly averaged PM2.5 and AOD at 14:00 LT increases from 0.63 to 0.76, and R2 of multi-year averaged PM2.5 and AOD by time of day increases from 0.01 to 0.93, 0.24 to 0.84, 0.85 to 0.91 and 0.84 to 0.93 in four seasons respectively. Wind direction is a key factor to the transport and spatial-temporal distribution of aerosols originated from different sources with distinctive physicochemical characteristics. Similar to the variation of AOD and PM2.5, η also decreases with the increasing surface wind speed, indicating that the contribution of surface PM2.5 concentrations to AOD decreases with surface wind speed. The vertical structure of aerosol exhibits a remarkable change with seasons, with most particles concentrated within about 500 m in summer and within 150 m in winter. Compared to the AOD of the whole atmosphere, AOD below 500 m has a better correlation with PM2.5, for which R2 is 0.77. This study suggests that all the above influential factors should be considered when we investigate the AOD-PM2.5 relationships.
Modelling a century of soil redistribution processes and carbon delivery from small watersheds using a multi-class sediment transport model
Authors: Wilken Florian , Fiener Peter , Van Oost Kristof
Published: February 2017

Abstract. Over the last few decades, soil erosion and carbon redistribution modelling has received a lot of attention due to large uncertainties and conflicting results. For a physically based representation of event dynamics, coupled soil and carbon erosion models have been developed. However, there is a lack of research utilizing models which physically represent preferential erosion and transport of different carbon fractions (i.e. mineral bound carbon, carbon encapsulated by aggregates and particulate organic carbon). Furthermore, most of the models that have a high temporal resolution are applied to relatively short time series (< 10 yr−1), which might not cover the episodic nature of soil erosion. We applied the event-based multi-class sediment transport (MCST) model to a 100-year time series of rainfall observation. The study area was a small agricultural catchment (3 ha) located in the Belgium loess belt about 15 km southwest of Leuven, with a rolling topography of slopes up to 14 %. Our modelling analysis indicates (i) that interrill erosion is a selective process which entrains primary particles, while (ii) rill erosion is non-selective and entrains aggregates, (iii) that particulate organic matter is predominantly encapsulated in aggregates, and (iv) that the export enrichment in carbon is highest during events dominated by interrill erosion and decreases with event size.
The Finite-volumE Sea ice–Ocean Model (FESOM2)
Authors: Danilov Sergey , Sidorenko Dmitry , Wang Qiang , Jung Thomas
Published: February 2017

Abstract. Version 2 of the unstructured-mesh Finite-Element Sea ice–Ocean circulation Model (FESOM) is presented. It builds upon FESOM1.4 (Wang et al., 2014) but differs by its dynamical core (finite volumes instead of finite elements), and is formulated using the arbitrary Lagrangian Eulerian (ALE) vertical coordinate, which increases model flexibility. The model inherits the framework and sea ice model from the previous version, which minimizes the efforts needed from a user to switch from one version to the other. The ocean states simulated with FESOM1.4 and FESOM2.0 driven by CORE-II forcing are compared on a mesh used for the CORE-II intercomparison project. Additionally, the performance on an eddy-permitting mesh with uniform resolution is discussed. The new version improves the numerical efficiency of FESOM in terms of CPU time by at least 3 times while retaining its fidelity in simulating sea ice and the ocean. From this it is argued that FESOM2.0 provides a major step forward in establishing unstructured-mesh models as valuable tools in climate research.
Diabetic Macular Edema Outcomes in Eyes Treated with Fluocinolone Acetonide 0.2 µg/d Intravitreal Implant: Real-World UK Experience
Authors: El-Ghrably Ibraheem , Steel David H.W. , Habib Maged , Vaideanu-Collins Daniela , Manvikar Sridhar , Hillier Roxane J.
Published: February 2017

Purpose

To conduct an observational, multicenter study to evaluate real-world clinical efficacy and safety of the 0.2 µg/day fluocinolone acetonide (FAc) implant in the treatment of patients with chronic diabetic macular edema (DME) in 3 large hospital ophthalmology departments in the United Kingdom.

Methods

Fluocinolone acetonide implants were inserted into the study eyes following a suitable washout period; phakic eyes received FAc implant following cataract surgery. Follow-up visits took place 2-4 weeks postinjection and then at 3, 6, and 12 months; change in central macular thickness (CMT) from baseline was measured by optical coherence tomography and best-corrected visual acuity (BCVA) was also assessed. Adverse events and changes in intraocular pressure (IOP) were recorded in order to evaluate the safety profile for the FAc implant.

Results

Improvements in BCVA and CMT were observed from 3 months and sustained for the duration of observation. At 12 months, the overall mean change from baseline CMT was -126 μm and mean increase in BCVA from baseline was 5.1 letters. Increases in IOP following FAc implant were easily managed with IOP-lowering medication. Implant migration into the anterior chamber occurred in 2 eyes where prior vitrectomy had resulted in a posterior capsule defect; this was rectified and resolved.

Conclusions

The results of this study provide further efficacy and safety profile data for FAc implant treatment of chronic DME in a real-world clinical setting; the FAc implant appears to be a valuable therapeutic approach for patients with chronic DME who have suboptimal response to other treatment options.
Sutureless Extraocular Muscle Biopsy Technique
Authors: Kornhauser Tom , Imtirat Ahed , Levy Jaime , Tsumi Erez
Published: February 2017

Purpose

To describe a simple and novel technique of obtaining an extraocular muscle (EOM) biopsy.

Methods

Our sutureless method involves obtaining a full-thickness 3-mm EOM specimen using a disposable punch biopsy.

Results

The procedure was performed successfully, with no worsening of eye movement, muscle weakness, or cosmetic defects postoperatively. The acquired full-thickness specimen was sufficient for analysis.

Conclusions

This technique to obtain an EOM biopsy allows a straightforward sutureless method, providing an adequate sample for tissue scrutiny.
Impact of Patient-Held Record on Knowledge at 1-Year Follow-Up for Glaucoma Patients: Single-Center Randomized Controlled Trial
Authors: Forbes Marina , Fairlamb Helen , Jonker Leon
Published: February 2017

Purpose

To assess whether provision of a personalized patient-held eye health summary (glaucoma personal record) improves patients’ knowledge of glaucoma at 1-year follow-up. The National Institute for Clinical Excellence has recommended such an approach to ascertain if this may ultimately help slow disease progression.

Methods

Recruited patients, newly diagnosed with glaucoma conditions, were randomly allocated to receive standard clinical care or an additional glaucoma personal record, detailing the current state of each individual's eye condition. Mann-Whitney U test was applied for comparison of knowledge scores between groups at 1-year follow-up, using a validated questionnaire. Multiple linear regression analysis was applied to detect any factors significantly associated with a difference in glaucoma knowledge.

Results

A total of 122 patients were recruited; 57 controls and 44 intervention patients were tested for their glaucoma knowledge, equating to 83% retention rate. Out of a maximum available 100% converted score, the median scores were 58% and 53% for the control and intervention arm, respectively (p = 0.85). Regression analysis showed that age (p = 0.015) had a negative association and level of education (p = 0.002) had a positive association with glaucoma knowledge.

Conclusions

The glaucoma personal record does not impact on a patient's knowledge of glaucoma in either a positive or negative way. Other approaches to improve health literacy among glaucoma patients, particularly for patients who are elderly or have a limited educational background, must be considered to improve patients’ awareness and knowledge of their own condition.

Trial registration

International Standard Randomized Controlled Trial Number Registry: ISRCTN41306818.
Increase in Physical Activity after Resurfacing Hip Arthroplasty is Associated with Calcar and Acetabular Bone Mineral Density Changes
Authors: Gerhardt Davey M.J.M. , Hannink Gerjon , Rijnders Ton , Van Susante Job L.C.
Published: February 2017

Purpose

Bone preservation is an important advantage of the resurfacing hip arthroplasty (RHA) concept. We hypothesised that patients’ increase in physical activity level after RHA would positively relate with periprosthetic bone mineral density (BMD) changes and thus facilitate bone preservation.

Methods

BMD-changes were prospectively recorded in 38 patients after RHA. Dual-energy absorptiometry was used to quantify BMD-changes in 6 periprosthetic regions of interest preoperatively, at 6 months, 1, 2 and 3 years postoperative. The effect estimates of patients’ physical activity, according to their Harris Hip Score (HHS) and University of California at Los Angeles (UCLA) Activity Score, on these BMD changes were assessed in linear mixed models.

Results

The UCLA (coefficient = 0.02 (95% CI, 0.010-0.034); p<0.001) and HHS (coefficient = 0.002 (95% CI, 0.001-0.003); p<0.001) were associated with the BMD in the calcar region. As for BMD changes in the femoral neck only the HHS was associated (coefficient = 0.0006 (95% CI, <0.0001-0.001); p = 0.04). Both the UCLA and the HHS were inversely associated with BMD in the medial acetabular region (UCLA: coefficient = -0.02 (95% CI, -0.038 to -0.007); p = 0.005, HHS: coefficient = -0.002 (95% CI, -0.003 to -0.001), the same accounted for the HHS to BMD-change cranial to the acetabulum (-0.001 [95% CI, -0.0018 to -0.0001]; p = 0.03). For the caudal acetabular and femoral subtrochanteric region no relation with BMD-changes was found.

Conclusions

The increase in activity scores after RHA was indeed associated with an increase in BMD in the calcar region, however unexpectedly also with a BMD decrease on the acetabular side. Stress shielding from the implant is the most likely causative factor.
Femoral Impaction Allografting for Significant Bone Loss in Revision Hip Arthroplasty
Authors: Goff Thomas A.J. , Bobak Peter
Published: February 2017

Introduction

Femoral impaction bone allografting in revision hip arthroplasty facilitates physiological reconstruction with restoration of bone stock, allowing implantation of a standard cemented femoral component. The purpose of this study was to report our experience in femoral component revision arthroplasty with impaction morsellised cancellous bone allograft using custom impactors and a cemented triple-taper polished stem.

Methods

Retrospective analysis of all cases of femoral component revision hip arthroplasty with impaction bone grafting undertaken by a single surgeon from 2005 to 2011. Outcome measures included radiographic analysis of stem subsidence over time, graft remodelling and incorporation, and clinical progress.

Results

We reviewed 47 consecutive hips in 44 patients, mean age 62 years (37-88). Femoral impaction with allograft was performed as either single stage (41 cases) or 2-stage (6 cases) procedures. All patients received a cemented C-stem prosthesis. The mean follow-up period was 5.1 (1.3-9.4) years. The median pre-operative bone defect score was 3 (interquartile range [IQR] 2-3) using the Endo-Klinik classification. Radiological evidence of graft incorporation was observed in 89% (281 of 315 zones) with additional remodelling observed in 33% (103 of 315 zones). The median stem subsidence at 1-year follow-up was 1.1 mm (standard deviation [SD] 1.24 mm, range 0-6 mm). The median Oxford Hip Score at the most recent follow-up was 36.5. To date no femoral component has undergone further revision.

Conclusions

Encouraging results have been obtained with this technique for the treatment of significant bone loss in revision hip arthroplasty, allowing implantation of a standard prosthesis.
Outcomes after Total Hip Arthroplasty in Young Patients with Osteonecrosis of the Hip
Authors: Swarup Ishaan , Shields Marisa , Mayer Erik N. , Hendow Chelsea J. , Burket Jayme C. , Figgie Mark P.
Published: February 2017

Background

Osteonecrosis of the hip is a clinical, radiographic, and pathologic entity that commonly affects young patients. This study evaluates long-term implant survival and patient-reported outcomes after primary total hip arthroplasty (THA) in patients with osteonecrosis aged 35 or younger.

Methods

A retrospective study with prospective follow-up was conducted at a major academic medical center. Chart review was performed to identify young THA patients with osteonecrosis, and follow-up surveys were conducted to determine implant survival and patient-reported outcomes. Kaplan-Meier survival analysis was performed to evaluate implant survival, and the hip disability and osteoarthritis outcome score (HOOS) was used to describe patient-reported outcomes.

Results

The study included 135 patients (204 THAs) with a mean time to follow-up of 14 years. In this group, 10-year implant survival was 86% and 20-year implant survival was 66%. Implant survival was longer in male patients (p = 0.02) and patients that were over the age of 25 at the time of surgery (p = 0.03). The mean HOOS scores at follow-up were 87 for pain, symptoms, and ADLs, and 77 for sports. All HOOS measures were lower in patients that underwent a revision THA, and HOOS-Pain and HOOS-Sport scores were lower in patients that were over the age of 25 at the time of surgery (p<0.05).

Conclusions

Young patients with osteonecrosis have good implant survival and long-term outcomes after THA. Patient factors and implant characteristics should be considered when predicting implant survival and outcomes after THA in young patients with osteonecrosis.
Outcome of Revision Arthroplasty for Failed Metal-On-Metal Total Hip Replacements; is there a Relation with Metal Ions?
Authors: Iqbal Hafiz J. , Al-Azzani Waheeb A.K. , Jackson-Taylor Esther , Clatworthy Elizabeth , John Alun
Published: February 2017

Purpose

We aimed to assess the early outcome following revision arthroplasty for failed metal-on-metal (MoM) total hip replacements (THR) due to adverse reaction to metal debris (ARMD).

Methods

We reviewed 106 consecutive revision arthroplasties. Case notes and radiological investigations were reviewed to assess the complications. Oxford Hip Score (OHS) and Euroqol (EQ-5D-3L) scores were used to assess the functional outcome and improvement of quality of life.

Results

At a mean follow-up of 20 months (12-48 months), the mean OHS was 28.7. Pain improved in 61% patients. A majority of patients were in level 2 for all the EQ-5D-3L dimensions. The overall complication rate was 16%. Survivorship free from further revision for any cause was 94.3% at 48 months. There was no correlation between pre-revision blood metal ions and the final outcome.

Conclusions

Revision surgery for failed MoM hip replacement due to ARMD is associated with a relatively higher rate of complications and risk of chronic pain. There is poor correlation between serum metal ions and development of ARMD and outcome following revision surgery.
Increase in Safe Zone Area of the Acetabular Cup Using Dual Mobility Cups in THA
Authors: Ohmori Takaaki , Kabata Tamon , Maeda Toru , Kajino Yoshitomo , Taga Tadashi , Hasegawa Kazuhiro , Inoue Daisuke , Yamamoto Takashi , Takagi Tomoharu , Tsuchiya Hiroyuki
Published: February 2017

Background

Dual mobility cup (DMC) inserts reduce the risk of dislocation after total hip arthroplasty (THA). No available research has clearly delineated stability advantages of DMC inserts in primary and revision THA. We investigated: (i) the degree of change in the safe zone of the cup when a DMC insert is used compared to a fixed insert; (ii) the method of selecting candidates for a DMC insert without changing the position of the acetabular (cup) component during revision THA in frequent dislocation cases caused by implant impingement.

Methods

A model of the pelvis and femur was developed from computed tomography images. The safe zone was defined as the area in the acetabular component, over which conditions for stable range of motion were satisfied. The safe zone was calculated for both a fixed and a DMC insert over a predetermined range of 3-D motion, and the effect of increasing the anteversion position of the femoral component from 5° to 35° was quantified.

Results

The lowest ratio of the area of the safe zone was about 4.9 at 20° anteverison of the femoral component. Safe zone of DMC inserts zone had increased stability of 10°-15° in both vertical and horizontal directions, compared to fixed inserts. A 5- to10-fold expansion of the safe zone can be expected with the use of DMC insert.

Conclusions

DMC insert could help to set the acetabular component more accurately in primary and revision THA.
Early Periprosthetic Joint Infection and Debridement, Antibiotics and Implant Retention in Arthroplasty for Femoral Neck Fracture
Authors: Mellner Carl , Eisler Thomas , Knutsson Björn , Mukka Sebastian
Published: February 2017

Introduction

Periprosthetic joint infection (PJI) is a severe complication of hip arthroplasty for femoral neck fractures (FNF). Debridement, antibiotics and implant retention (DAIR) is recommended in early PJI in association with stable implants. Few studies have evaluated the outcome of DAIR in this fragile population. The purpose of this study was to analyse risk factors for PJI and the short-term outcome of DAIR in FNF patients treated with a hip arthroplasty.

Methods

A consecutive series of 736 patients (median age 81 years, 490 women, 246 men) had been treated with either a total hip arthroplasty or a hemi hip arthroplasty for a displaced FNF at our institution. 33 (4.5%) of the hips developed an early (<6 weeks post operatively) PJI and 28 (3.8%) of these patients were treated according to the DAIR-protocol. Regression analyses were performed to assess risk factors for developing a PJI.

Results

DAIR eradicated the PJI in 82% (23/28) of patients at a median follow-up of 31 (SD 29.8) months of the infected hips. The logistic regression analysis indicated that 2 or more changes of the primary dressing due to wound bleeding was associated with an increased risk for developing PJI (OR 4.9, 95% 1.5 to 16.1, p = 0.01).

Conclusions

The short-term success-rate of DAIR was unexpectedly favourable in this fragile patient population; the results being on par with that after PJI in osteoarthritis patients. The need for repeated bandage changes postoperatively indicates an increased risk for PJI and should prompt early surgical intervention.
Screw-Hole Clusters in Acetabular Cups: A Morphological Study of Optimal Positioning of Screw-Holes
Authors: Yin Xinghua , Zhou Yixin , Tang Qiheng , Yang Dejin , Tang Hao , Huang Xingjian
Published: February 2017

Background

Rigid and safe transacetabular screw fixation in total hip arthroplasty (THA) is achieved by pursuing deeper bone stock and avoiding injuries to the neurovascular structures, but these efforts can be restricted by the distribution of screw-holes on cups by the manufacturer. We therefore tried to determine: (i) optimal screw-hole positions on cups to allow anatomical placement of screws; (ii) rationality of the basic 3-screw-hole cluster on commercial cups; and (iii) the optimum method for placing commercial cups in accordance with acetabular anatomy.

Methods

Periacetabular osseous structure of 64 hips and arterial structures of 50 hips were three-dimensionally reconstructed. Simulated transacetabular screw fixation during THA was performed in these hips with 3 different screw lengths (15, 25, and 35 mm) to define deeper and safer screw trajectories. Screw-hole locations of 7 commercially available cups were measured and matched with the periacetabular anatomy.

Results

When the cup was placed into the acetabulum at 45° of abduction and 20° of anteversion, the optimal locations of 2 screw-holes on the cups were at 30° and 64° of latitude, with a 35° separation angle. The inversetriangle distribution pattern was safer than the triangle pattern in basic 3-screw-hole-cluster cups. When placing the commercial cups, 5°-10° of anterior rotation can be added to allow better screw trajectories.

Conclusions

Our study determined optimal screw-hole positions and their distribution pattern on cups. We describe methods to place the commercial cups that are not designed according to acetabular anatomy.
Evaluation of Repair of the Hip Labrum under Simulated Full Weight-Bearing
Authors: Koh Jason L. , Gupta Kavish
Published: February 2017

Introduction

Repairs of labral tears are performed for unstable tears, hip instability, and after detachment concomitant to the treatment of femoroacetabular impingement (FAI), but limited data is known about the strength of repair. This study evaluated the effect of simulated axial weight-bearing on suture anchor based repair of the acetabular labrum.

Methods

3 cadaveric pelvises underwent creation of a 1.5 cm anterior-superior labral tear in each hip. The tears were then repaired using 2 suture anchors per hip. Following repair, the hip joint underwent axial cyclic loading to 756 N, and were inspected for separation of the labrum from the acetabulum. The strength of the suture anchor repair was evaluated by testing load to failure, in-line with insertion.

Results

Upon visual examination, all 6 repairs remained fully intact following loading with no visible gap formation or damage at the repair site. In all cases an arthroscopic probe could not be inserted under the edge of the repair. The mean failure force of the 12 suture anchors, in-line with insertion, was 154 N ± 44 N.

Conclusions

Acetabular labral suture anchor repairs may be able to immediately withstand the physiological loads of axial weight-bearing. Labral repair may be able to tolerate axial weight-bearing immediately after repair, preserving the strength and integrity of muscles and soft tissues.
Rotational Alignment of the Knee is Different in Osteological Specimens with and without a Large Cam Deformity of the Proximal Femur
Authors: Gebhart Jeremy J. , Streit Jonathan J. , Goodman Avi , Etscheidt Jordan , Weinberg Douglas S. , Bedi Asheesh , Nho Shane J. , Salata Michael J.
Published: February 2017

Purpose

We studied a large osteological collection for differences in knee rotation based upon the presence or absence of a large cam deformity of the proximal femur.

Methods

We obtained 357 matched tibiae and femora from the Hamann-Todd Osteological Collection and measured: femoral head-neck alpha angle, anteroposterior axis (or Whiteside's line) at the distal femur relative to the posterior condylar axis, and position of the tibial tubercle with respect to the posterior condylar axis of the proximal tibia. We then divided these specimens into two groups based upon alpha angle <45° (Group 1, n = 73) or alpha angle >60° (Group 2, n = 122) and performed an independent samples t-test to evaluate for differences in measured parameters between groups using this subset of specimens.

Results

The mean alpha angles in Group 1 and 2 were 40.9° ± 3.3° and 67.0° ± 5.6°, respectively. Whiteside's line was externally rotated with respect to the posterior femoral condylar axis by a mean of 1.8° ± 6.8° in Group 1, vs. 3.0° ± 3.7° in Group 2 (p = 0.03). The tibial tubercle was externally rotated by a mean of 19.4° ± 6.8° in Group 1, versus 16.6° ± 5.1° in Group 2 (p = 0.003).

Conclusions

Specimens with femoral head-neck alpha angle >60° demonstrated greater external rotation of the distal femur and a more internally-rotated tibial tubercle compared to specimens with an alpha angle <45°. Differences in anatomic characteristics of the knee may play a role in the development of patellofemoral pain in patients with a large cam deformity.
Correlation between Serum Metal Ion Levels and Adverse Local Tissue Reactions after Conserve® plus Hip Resurfacing Arthroplasty
Authors: Amstutz Harlan C. , Le Duff Michel J.
Published: February 2017

Background

Adverse local tissue reactions (ALTR) have been associated with the use of metal-on-metal (MoM) bearings and the monitoring of cobalt (Co) and chromium (Cr) ion levels in blood or serum may be the best way to evaluate in vivo the wear of these bearings. However, the relationship between Co and Cr ion concentrations and the formation of ALTR remains unclear.

Methods

We investigated the relationship between ALTR and serum Co and Cr ion levels and identified the clinical factors influencing the formation of ALTR in patients treated with MoM hip resurfacing arthroplasties. 228 patients with unilateral Conserve® Plus MoM hip resurfacing had serum metal ion studies performed more than 1 year after surgery. Metal artifact reduction sequence magnetic resonance imaging (MARS MRI) was performed on subjects at risk for ALTR as determined by a screening protocol.

Results

12 patients had ALTR. Logistic regression showed a strong association of ALTR with elevated ion levels and with low (<10 mm) contact patch to rim distance.

Conclusions

MoM bearings require enough functional coverage of the socket by design and then precise implantation to maximise functional coverage of the femoral ball, enhance lubrication, and avoid edge-loading wear.
The Use of Polycarbonate-Urethane as an Acetabular Shell Bearing Surface: A 5-Year Prospective Study
Authors: Mai Sabine , Mai Burkhard , Siebert Werner E.
Published: February 2017

Aim

To evaluate the clinical performance of a polycarbonate-urethane liner as a bearing material inside a cobalt-chrome acetabular shell.

Methods

Between December 2007 and July 2011, this material combination was used in 27 total hip replacement patients, most of whom had an indication of osteoarthritis. This report focuses on the first 5-year results of the clinical use of this material combination in the TriboFit® Hip System.

Results

Mean Harris Hip Score showed significant improvement from 40 to 86 after 5 years, similar to studies in the literature. No adverse events - revisions or complications - or disadvantages that have been reported for other total hip materials were observed over the 5-year period. The radiographs showed no signs of wear, migration or loosening of the implants.

Conclusions

These early results indicate this new material combination offers promise as a safe and effective alternative bearing material for use in total hip systems. Further clinical trials are necessary to reconfirm these findings.
Chronological Changes in Functional Cup Position at 10 Years after Total Hip Arthroplasty
Authors: Okanoue Yusuke , Ikeuchi Masahiko , Takaya Shogo , Izumi Masashi , Aso Koji , Kawakami Teruhiko
Published: February 2017

Purpose

This study aims to clarify the chronological changes in functional cup position at a minimum follow-up of 10 years after total hip arthroplasty (THA), and to identify the risk factors influencing a significant difference in functional cup position during the postoperative follow-up period.

Methods

We evaluated the chronological changes in functional cup position at a minimum follow-up of 10 years after THA in 58 patients with unilateral hip osteoarthritis. Radiographic cup position was measured on anteroposterior pelvic radiographs with the patient in the supine position, whereas functional cup position was recorded in the standing position. Radiographs were obtained before, 3 weeks after, and every 1 year after surgery.

Results

Functional cup anteversion (F-Ant) increased over time, and was found to have significantly increased at final follow-up compared to that at 3 weeks after surgery (p<0.01). The maximum postoperative change in F-Ant was 17.0° anteriorly; 12 cases (21%) showed a postoperative change in F-Ant by >10° anteriorly. Preoperative posterior pelvic tilt in the standing position and vertebral fractures after THA were significant predictors of increasing functional cup anteversion.

Conclusions

Although chronological changes in functional cup position do occur after THA, their magnitude is relatively low. However, posterior impingement is likely to occur, which may cause edge loading, wear of the polyethylene liner, and anterior dislocation of the hip. We believe that, for the combined anteversion technique, the safe zone should probably be 5°-10° narrower in patients predicted to show considerable changes in functional cup position compared with standard cases.
Concomitant Pulsatile and Continuous Flow VAD in Biventricular and Univentricular Physiology: A Comparison Study with a Numerical Model
Authors: Di Molfetta Arianna , Ferrari Gianfranco , Iacobelli Roberta , Filippelli Sergio , Guccione Paolo , Fresiello Libera , Perri Gianluigi , Amodeo Antonio
Published: February 2017

Introduction

To develop and test a lumped parameter model to simulate and compare the effects of the simultaneous use of continuous flow (CF) and pulsatile flow (PF) ventricular assist devices (VADs) to assist biventricular circulation vs. single ventricle circulation in pediatrics.

Methods

Baseline data of 5 patients with biventricular circulation eligible for LVAD and of 5 patients with Fontan physiology were retrospectively collected and used to simulate patient baselines. Then, for each patient the following simulations were performed: (a) CF VAD to assist the left ventricle (single ventricle) + a PF VAD to assist the right ventricle (cavo-pulmonary connection) (LCF + RPF); (b) PF VAD to assist the left ventricle (single ventricle) + a CF VAD to assist the right ventricle (cavo-pulmonary connection) (RCF + LPF)

Results

In biventricular circulation, the following results were found: cardiac output (17% RCF + LPF, 21% LCF + RPF), artero-ventricular coupling (-36% for the left ventricle and -21.6% for the right ventricle), pulsatility index (+6.4% RCF + LPF, p = 0.02; -8.5% LCF + RPF, p = 0.00009). Right (left) atrial pressure and right (left) ventricular volumes are decreased by the RCF + LPF (by RPF + LCF). Pulmonary arterial pressure decreases in the LCF + RPF configuration. In Fontan physiology: cardiac output (LCF + RPF 35% vs. 8% in RCF + LPF), ventricular preload (+4% RCF + LPF, -10% LCF + RPF), Fontan conduit pressure (-5% RCF + LPF, +7% LCF + RPF), artero-ventricular coupling (-14% RCF + LPF vs. -41% LCF + RPF) and pulsatility (+13% RCF + LPF, - 8% LCF + RPF).

Conclusions

A numerical model supports clinicians in defining and innovating the VAD implantation strategy to maximize the hemodynamic benefits. Results suggest that the hemodynamic benefits are maximized by the LCF + RPF configuration.
Effect of Topical Antiinflammatory Drugs on Mechanical Behavior of Rabbit Cornea
Authors: Lepore Domenico , De Santis Roberto , Pagliara Monica M. , Gloria Antonio , Oliviero Olimpia , Nucci Carlo , Improta Giovanni , Triassi Maria , Ambrosio Luigi
Published: February 2017

Background

A variety of antiinflammatory therapies are employed to promote corneal wound healing. The effects of steroidal and nonsteroidal antiinflammatory drugs on the biomechanical properties of rabbit cornea were investigated over time using tensile tests.

Methods

Full-thickness incisions were made and used to analyze the effects of dexamethasone sodium phosphate 0.1% and diclofenac sodium 0.1% on corneal biomechanical properties during wound healing at 7, 14 and 21 days after surgery.

Results

The full-thickness incision deeply modified all of the mechanical properties. At 3 weeks after incision, regardless of the drug therapy, the tensile modulus was about 70% of the value for the intact cornea.

Conclusions

Topical treatment with dexamethasone was particularly effective during the first week after surgery; the second week after surgery, a similar result was observed in the corneas treated with diclofenac. Low doses of steroidal and nonsteroidal antiinflammatory drugs would seem to have the potential to improve biomechanical properties only during the early stage of the healing process of the cornea.
Laparoscopic Dissection of the Ureter in Deep-Infiltrating Endometriosis (DIE) of the Pelvis using Ultrasonically Activated Shears
Authors: Rampinelli Fabio , Donarini Paolo , Antonelli Alessandro , Visenzi Chiara , Ciravolo Giuseppe
Published: February 2017

Objective

The technique for freeing the ureter in the endoscopic treatment of deeply infiltrating endometriosis (DIE).

Methods

One hundred and forty-nine patients with complete obliteration of the cul-de-sac submitted to laparoscopic dissection of the ureter using ultrasonically activated shears, were retrospectively evaluated. Surgical technique, operative time and morbidity were analyzed.

Results

Two hundred and ninety-nine ureters were dissected in 149 patients affected by endometriosis of the posterior compartment. The average time to unroof the ureter on one side was 16 min. In three cases the ureter was damaged and promptly repaired without ureteronephrosis with a further 18-month radiographic control.

Conclusions

An important step in laparoscopic surgical treatment of DIE obliterating cul-de-sac, is dissection of the ureter at its crossing with the uterine artery, to avoid ureteral damage. In this paper, we describe a feasible and safe technique for ureteral dissection in DIE with the use of ultrasonic energy, even with rectal involvement. The use of ultrasonic energy reduces potential complications related to electrical energy.
Arteriovenous access does not perform as well for plasmapheresis
Authors: Wooster Mathew , Wilson Rachel , Shames Murray , Moudgill Neil
Published: February 2017

Purpose

Access surgeons are occasionally asked to create arteriovenous access for non-dialysis functions. Subjectively noting overall poor results, we seek to present our experience with arteriovenous access creation for apheresis.

Methods

Billing records were reviewed using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-9) codes to identify patients undergoing arteriovenous access creation for diseases other than renal failure from January 2007 to August 2014. Inpatient and outpatient records were reviewed to identify patient demographics, disease-specific medications/treatments, access-specific characteristics, patency data, and reinterventions required.

Results

A total of 16 access creation procedures were performed for 8 patients, accounting for just 1.6% of total access creations during the period. Treatment was for myasthenia gravis (n = 6), chronic inflammatory degenerative polyneuropathy (n = 9), and stiff man syndrome (n = 1). Access failure was by thrombosis (n = 7), non-maturation (n = 4), and infection/steal syndrome (n = 1), with four accesses still functional at conclusion of review. There was 50% autogenous access creation and overall maturation rate of 37.5%. Mean primary patency was 236 days (range 10-878), with secondary patency achieved in three patients adding a mean of 174 days (range 2-517). Cumulative 3-month and 1-year patency rates were 36.5% and 25%, respectively.

Conclusions

Arteriovenous access creation for plasmapheresis represents a minority of access procedures. Though it remains unclear why, patency and maturation rates are significantly lower than expected when compared to access for hemodialysis access. These high failure rates must be taken into account when considering replacement of temporary catheters with surgical access for non-hemodialysis needs.
A randomized study of training with large versus small vessel size on successful ultrasound-guided peripheral venous access
Authors: Davis Joshua , Faust Timothy , Tajani Azeem , Bates Amanda , Jarriel Jenna , Au Arthur , Fields Jason Matthew
Published: February 2017

Purpose

Our objective was to investigate whether training on phantoms with smaller or larger vessels would improve success rate in novice medical students learning this skill.

Methods

Medical students who participated in a voluntary, extracurricular ultrasound training day were asked to participate in the study as part of their procedural training. They were given a standardized education and demonstration of how to use ultrasound to place a peripheral intravenous (IV) catheter. They were then randomized to practice three times on homemade phantom models with either a 5-mm or a 2.5-mm diameter simulated vessel. Afterwards, they were observed attempting to place an ultrasound-guided IV on a 5-mm diameter vessel. Successful cannulation rates was the primary outcome.

Results

Fifty-one students from five institutions were included in the analysis. No significant difference in success rate, time to cannulation, number of sticks, or number of redirects was seen between the group who trained on the phantoms with the smaller vessels versus those who trained on the phantoms with the larger vessel. A trend towards significance was seen for success rate and number of redirects, favoring the group trained on the smaller vessels, but this did not reach significance.

Conclusion

In our small sample, there was no difference in success rate of novice students trained in ultrasound-guided peripheral IV access using either a smaller or a larger vessel phantom. Future work should focus on elucidating other aspects of training in ultrasound-guided procedures and should attempt a similar study with a larger sample size.
The independent association of preoperative serum albumin on the functional maturation of radiocephalic arteriovenous fistulae
Authors: Kordzadeh Ali , Tokidis Evripidis , Askari Alan , Hoff Mekhola , Panayiotopoulos Yiannis
Published: February 2017

Purpose

The aim of this study is to test the null hypothesis that preoperative albumin along with other preoperative confounders have no impact on the functional maturation of radiocephalic arteriovenous fistulae (RCAVF).

Methods

A retrospective cohort study of n = 195 individuals undergoing RCAVF formation from July 2013 to December 2015 was conducted. The null hypothesis was assessed through chi squared test. Independent association of each variable was evaluated through univariate and multivariate logistic regression model. Pearson's correlation test was also performed between scale variables to establish their causal link.

Results

Preoperative hypoalbuminaemic group of individuals demonstrated significant failure of maturation (49.3% vs. 27.2%, p = 0.002). At multivariate analysis, hypoalbuminemia remained an independent marker of fistula failure (OR 0.40, 95% CI 0.21-0.76, p = 0.004) and demonstrated a weak but a positive correlation at the endpoint of maturation (R = 0.223, p = 0.002).

Conclusions

Preoperative hypoalbuminemia (<35 mg/dL) is independently associated with 40% reduction in the functional maturation of RCAVF. Stratification of this readily available biomarker prior to RCAVF formation may require consideration subjected to further research.
“Extended subcutaneous route” technique: a quick subcutaneous tunnelling technique for PICC insertion
Authors: Elli Stefano , Abbruzzese Chiara , Cannizzo Luigi , Vimercati Simona , Vanini Stefania , Lucchini Alberto
Published: February 2017

Purpose

To describe a quick tunnelling technique for peripherally inserted central catheter (PICC) insertion called the “extended subcutaneous route” technique.

Methods

The “extended subcutaneous route” technique is described step by step.

Results

In 18 consecutive PICCs, inserted with extended route technique in ASST Monza, no complications during insertion were registered. In 969 catheter days observed, we identified only one accidental dislodgement. No other mid-term complications were observed.

Conclusions

Extended subcutaneous route technique allows the creation of a subcutaneous tunnel <5 cm, without skin incision and additional manipulation. Extended subcutaneous route technique may be feasible and useful, particularly for patients with high risk of bleeding or infection.
Surgical reconstruction of central venous obstruction in salvaging upper extremity dialysis accesses
Authors: Babadjanov Jurabek , Bernstein Rick , Kirksey Lee
Published: February 2017

Background

Central vein thrombosis or obstruction is a common complication associated with central venous catheters placed for intermittent hemodialysis. The reported outcomes of percutaneous catheter-based interventions reveal high rates of lesion recurrence with varying and frequently limited patency intervals. We present the case of open venous bypass in the treatment of catheter-associated chronic central vein occlusion.

Methods

We report a case of symptomatic arm swelling secondary to central vein stenosis and failed endovascular venous intervention treated by central vein bypass with prosthetic graft through median sternotomy.

Results

Patient had an open axillary to innominate venous bypass via median sternotomy incision, which resulted in resolution of patient's symptoms and uninterrupted patency of the pre-existing vascular access.

Conclusions

Open venous bypass is a reliable alternative to endovascular intervention in the symptomatic patient with extensive central vein occlusion as a primary intervention or in whom prior endovascular therapy has failed.
Chlorhexidine-impregnated transparent dressings decrease catheter-related infections in hemodialysis patients: a quality improvement project
Authors: Apata Ibironke W. , Hanfelt John , Bailey James L. , Niyyar Vandana Dua
Published: February 2017

Purpose

Central venous catheters (CVC) are associated with increased infection rates, morbidity and mortality compared to other hemodialysis vascular access. Chlorhexidine-impregnated transparent (CHG-transparent) dressings allow for continuous antimicrobial exposure and easy visibility of the CVC insertion site. We conducted a quality improvement project to compare catheter-related infection (CRI) rates in two dressing regimens – CHG-transparent dressings and adhesive dry gauze dressing in hemodialysis patients with tunneled CVCs.

Methods

The study was conducted in two phases. In phase 1, CHG-transparent dressing was introduced to EDC hemodialysis unit, while EDG and EDN hemodialysis units, served as the control sites and maintained adhesive dry gauze dressing. Phase 2 of the study involved replacing the adhesive dry gauze dressing with CHG-transparent dressing at EDG and EDN and maintaining CHG-transparent dressing at EDC. CRI rates at each hemodialysis unit during the 12-month intervention were compared to CRI rates for the 12-month pre-intervention period for each study phase. CRI rates were also compared between all three hemodialysis units.

Results

In phase 1, CRI rates (per 1000 days) in EDC (intervention site) decreased by 52% (1.69 vs. 0.82, p<0.05) and increased by 12% (1.80 vs. 2.02, p = 0.75) at EDG, and 35% (0.91 vs. 1.23, p = 0.40) at EDN. In phase 2, CRI rates at EDG and EDN (intervention sites) decreased by 86% (1.86 vs. 0.26 p<0.05), and 53% (1.89 vs. 0.88, p<0.05), respectively, and decreased by 20% at EDC (0.73 vs. 0.58, p = 0.65).

Conclusions

Replacing adhesive dry gauze dressing with CHG-transparent dressing for hemodialysis patients with tunneled CVC was associated with decreased CRI rates.
Mechanical recanalization for clot occlusion of venous access ports: experimental study using ports with clot occlusion
Authors: Song Myung Gyu , Seo Tae-Seok , Kim Baek-hui , Kim Jeong Ho
Published: February 2017

Purpose

To test the hypothesis that mechanical injection of saline is safe and effective in restoring patency of totally implantable venous access ports (TIVAPs) with clot occlusion. We devised an experimental port model for the evaluation of mechanical TIVAP recanalization prior to its clinical application.

Materials and Methods

The clot TIVAP occlusion model was constructed by filling the catheter with swine blood and incubating it at 37.5°C. The model was incubated for different lengths of time ranging from 1 day to 7 days. Each incubation time point included 20 ports. Total catheter occlusion of the TIVAPs was assessed with a 10-mL saline syringe equipped with a non-coring needle. Occlusion was defined as no passage of saline through the catheter when it was aspirated and infused gently with the 10-mL saline syringe. Pressure was evaluated during recanalization with an indeflator. Histological examination was performed on the clot obtained during recanalization.

Results

Among the 140 total experimental ports, 65 occlusions (46.4%) were detected. Of these 65 occlusions, 56 (86.1%) were recanalized by mechanical saline pressure via the indeflator. The indeflator pressure ranged from 29 pound per square-inch (psi) to 265 psi at mechanical catheter recanalization (mean: 110 psi). Histologically, all specimens from the model ports exhibited a similar appearance; specifically, erythrocytes, cells, and fibrin were evenly scattered throughout the clot.

Conclusions

Our data indicate that it is feasible to generate a TIVAP clot occlusion model with swine blood. Moreover, mechanical recanalization was suitable for resolving occluded catheters without thrombolytic agents.
Prostatic Abscess in a Patient with Chronic Granulomatous Disease: A Multi-Disciplinary Intervention
Authors: Martini Alberto , Katafigiotis Ioannis , Kalantzi Sofia , Anastasiou Ioannis , Adamakis Ioannis , Toskas Aggelos , Constantinides Constantinos A.
Published: February 2017

Introduction

Chronic granulomatous disease (CGD) is a rare pathology that increases patients’ susceptibility to infections, given the inability to generate oxygen radicals to fight microorganisms. In the context of CGD, primary prostatic involvement has been described only once in the past, in a pediatric patient.

Case Report

We report the case of a 35-year old patient with CGD presenting with persistent fever. After hospital admission, blood and urine were sent for culture and antibiotic therapy was initiated. Patient's conditions continued to deteriorate and an aggressive antibiotic therapy was administered to treat the septic scenario. Urine culture grew a multidrug-resistant Escherichia Coli. After patient's condition improved, a CT scan was performed. The depiction showed multiple abscesses within the prostate. A rectal approach was excluded given patient's underlying disease. A TURP was performed and prostatic pathology resolved. Patient was discharged on postoperative day 14. At 6-month follow-up he hasn't experienced major infections. To the best of our knowledge, this is the first case of septic shock originating from a prostatic abscess in an adult patient with CGD.

Conclusions

Aggressive medical therapy along with TURP resulted curative in our case. A multi-disciplinary approach was mandatory.