bluuebunny/crossref_metadata_2025 huggingface dataset:
Femoral derotation for increased hip anteversion. A new surgical technique with a modified Ilizarov frame
Authors: Moens P , Lammens J , Molenaers G , Fabry G
Published: February 2018

We describe a technique of femoral derotation osteotomy performed according to the Ilizarov principles of percutaneous corticotomy and fixation with a frame. We performed 24 femoral osteotomies in 16 patients, four with cerebral palsy and 12 with idiopathic femoral anteversion. All had rapid union and there were few complications. The advantages of the method include early ambulation, good control of rotation and axial alignment, and minimal scarring.
Diagnosis of infection by frozen section during revision arthroplasty
Authors: Athanasou NA , Pandey R , de Steiger R , Crook D , Smith PM
Published: February 2018

We assessed the efficacy of intraoperative frozen-section histology in detecting infection in failed arthroplasties in 106 hips and knees. We found inflammatory changes consistent with infection (an average of one or more neutrophil polymorphs or plasma cells per high-power field in several samples) in 18 cases; there was a significant growth on bacterial culture in 20 cases. Compared with the bacterial cultures, the frozen sections provided two false-negative results and three false-positive results (sensitivity, 90%; specificity, 96%; and accuracy, 95%). The positive predictive value was 88%, the negative value, 98%. These results support the inclusion of intra-operative frozen-section histology in any protocol for revision arthroplasty for loose components.
Sterilisation of canine anterior cruciate allografts by gamma irradiation in argon. Mechanical and neurohistological properties retained one year after transplantation
Authors: Goertzen MJ , Clahsen H , Burrig KF , Schulitz KP
Published: February 2018

Bone-ACL-bone allograft transplantation is a potential solution to the problem of reconstruction of the anterior cruciate ligament (ACL), but sterilisation by gamma irradiation or ethylene oxide causes degradation of the graft. We have studied the biomechanical and histological properties of deep-frozen canine bone-ACL-bone allografts sterilised by gamma irradiation (2.5 Mrad) under argon gas protection. Particular attention was paid to their collagen structure and neuroanatomy compared with those of non-irradiated allografts. We used 60 skeletally mature foxhounds. In 30 animals one ACL was replaced by an irradiated allograft and in the other 30 a non-irradiated graft was used. In both groups the graft was augmented by a Kennedy Ligament Augmentation Device. Examination of the allografts at 3, 6 and 12 months after implantation included mechanical testing, histology, collagen morphometry, neuroanatomical morphology (silver and gold chloride stain) and studies of the microvasculature (modified Spalteholz technique). At 12 months the irradiated ACL allografts failed at a mean maximum load of 718.3 N, 63.8% of the strength of the normal canine ACL. The non-irradiated allografts failed at 780.1 N, 69.1% of normal. All the allografts showed a well-orientated collagen structure one year after transplantation and there was no difference between the irradiated grafts and the others. The silver staining technique demonstrated Golgi tendon organs and free nerve endings within both groups of allografts. As in the normal ACL these structures were most commonly found near the surface of the graft and at its bony attachments. At 12 months the irradiated allografts showed slight hypervascularity compared with the non-irradiated grafts.(ABSTRACT TRUNCATED AT 250 WORDS)
Total hip replacement and cancer. A cohort study
Authors: Mathiesen EB , Ahlbom A , Bermann G , Lindgren JU
Published: February 2018

The incidence of cancer after hip replacement was studied in the 1.6 million inhabitants of Stockholm County, Sweden. A cohort of 10,785 individuals who had had hip replacement between 1974 and 1988 was followed from the date of operation to the first malignant tumour, to death, or to the end of 1989. The follow-up was based on 58,437 person-years at risk as calculated from information obtained by record-linkage with the National Cancer Registry and the National Cause-of-Death Register. The Standardised Morbidity Ratio (SMR) for all cancer sites, disregarding the length of follow-up, was 0.96 (95% CI 0.90 to 1.03). For lymphoma and leukaemia the corresponding SMR was 0.89 (0.68 to 1.14). Our results do not support previous suggestions of an increased incidence of leukaemia and lymphoma after total hip replacement.
The influence of a diastasis screw on the outcome of Weber type-C ankle fractures
Authors: Chissell HR , Jones J
Published: February 2018

We performed a retrospective study of the factors affecting the outcome of Weber type-C ankle fractures in 43 patients reviewed at two to nine years after injury. We determined the functional result in relation to the use of a diastasis screw, the accuracy of reduction, the presence of tibiotalar dislocation, and of injury to the medial side of the ankle by medial malleolar fracture or deltoid ligament rupture. We assessed the use of a diastasis screw as appropriate or inappropriate on the basis of an anatomical study performed by Boden et al (1989). The diastasis screw was used unnecessarily in 19 of the 31 patients so treated, but this did not appear to affect the final functional result. The worse functional results were in ankles dislocated at the initial injury, and in those with medial malleolar fractures as opposed to those with deltoid ligament ruptures. The best results were after accurate reduction of the fibula and the syndesmosis, and greater increase in the width of the syndesmosis was associated with a worse result. Our results suggest that an increase of more than 1.5 mm in syndesmosis width is unacceptable. We recommend that when the deltoid ligament is ruptured, a diastasis screw should be used if the fibular fracture is more than 3.5 cm above the top of the syndesmosis. When a medial malleolar fracture has been rigidly repaired a diastasis screw is required if the fibular fracture is more than 15 cm above the syndesmosis.
Transcardiac echocardiography during invasive intramedullary procedures
Authors: Christie J , Robinson CM , Pell AC , McBirnie J , Burnett R
Published: February 2018

We performed transoesophageal echocardiography in 111 operations (110 patients) which included medullary reaming for fresh fractures of the femur and tibia, pathological lesions of the femur, and hemiarthroplasty of the hip. Embolic events of varying intensity were seen in 97 procedures and measured pulmonary responses correlated with the severity of embolic phenomena. Twenty-four out of the 25 severe embolic responses occurred while reaming pathological lesions or during cemented hemiarthroplasty of the hip and, overall, pathological lesions produced the most severe responses. Paradoxical embolisation occurred in four patients, all with pathological lesions of the femur (21%); two died. In 12 patients large coagulative masses became trapped in the heart. Extensive pulmonary thromboembolism with reamed bone and immature clot was found at post-mortem in two patients; there was severe systemic embolisation of fat and marrow in one who had a patent foramen ovale and widespread mild systemic fat embolisation in the other without associated foraminal defect. Sequential analysis of blood from the right atrium in five patients showed considerable activation of clotting cascades during reaming.
Medullary lavage reduces embolic phenomena and cardiopulmonary changes during cemented hemiarthroplasty
Authors: Christie J , Robinson CM , Singer B , Ray DC
Published: February 2018

We randomised 24 patients before they had a cemented hemiarthroplasty for hip fracture to receive either thorough or minimal saline lavage of the femoral canal. We then determined the effect in each group on the thromboembolic and cardiopulmonary responses to the pressurised insertion of cement, using transoesophageal echocardiography to show the echogenic embolic response. We found a statistically significant reduction in both the duration of the response and the number of large emboli in patients who had had thorough lavage as compared with the control group with minimal lavage. There was also less disturbance of pulmonary function, as assessed by the change in end-tidal CO2 levels and oxygen saturation, in patients who had thorough lavage. Three patients had a significant fall in blood pressure during cement insertion; all had only minimal lavage. We consider that thorough lavage should be an essential part of the preparation of the proximal femur before cement insertion.
The response of muscle to leg lengthening
Authors: Simpson AH , Williams PE , Kyberd P , Goldspink G , Kenwright J
Published: February 2018

We used an experimental rabbit model of leg lengthening to study the morphology and function of muscle after different distraction rates. Lengthening was in twice-daily increments from 0.4 to 4 mm per day. New contractile tissue formed during lengthening, but some damage to the muscle fibres was seen even at rates of less than 1 mm per day; abnormalities increased with larger rates of lengthening. There was proliferation of fibrous tissue between the muscle fibres at distraction rates of over 1 mm per day. Active muscle function showed adaptation when the rate was 1.0 mm per day or less, but muscle compliance was normal only after rates of 0.4 mm per day. Muscle responded more favourably at rates of distraction slower than those shown to lead to the most prolific bone formation. At present the rate of distraction in clinical practice is determined mainly by factors which enhance osteogenesis. Our study suggests that it may be advisable to use a slower rate of elongation in patients with poor muscle compliance associated with the underlying pathology; this will allow better accommodation by the contractile and connective tissues of the muscles.
In vivo corrosion of cobalt-chromium and titanium wear particles
Authors: Shahgaldi BF , Heatley FW , Dewar A , Corrin B
Published: February 2018

Tissue reaction to wear particles from metal implants may play a major role in the aseptic loosening of implants. We used electron microprobe elemental analysis to determine the chemical composition of wear particles embedded in the soft tissues around hip and knee implants from 11 patients at revision surgery for aseptic loosening. The implants were made of cobalt-chromium-molybdenum alloy or titanium-aluminium-vanadium alloy. Histological examination showed a widespread giant-cell reaction to the particles. Elemental analysis showed that the chemical composition of the particles was different from that of the implanted alloys: cobalt and titanium were reduced, often down to zero, whereas chromium and aluminium persisted. Our findings indicate that corrosion is continually changing the shape, size and chemical composition of the implanted alloy. This may alter the biochemical environment of the tissue surrounding an implant to favour bone resorption.
HISTOLOGICAL FEATURES OF LARGE BONE ALLOGRAFTS
Authors: Gouin F. , Passuti N. , Verriele V. , Delecrin J. , Bainvel J. V.
Published: February 2018

We performed biopsies during reoperation for minor complications in two active young patients 9 and 19 months after massive bone allograft implantation for bone tumour. The grafts were dead and resorption-apposition activity, when present, was predominantly in subperiosteal areas. Inflammatory infiltration was very seldom found.

Features considered as ‘microfractures’ or ‘microcracks’ were noted in the cortical ring together with the formation of woven bone, in areas with remodelling. Such cracks are likely to be of mechanical origin and do not inevitably lead to complications.
LOCAL CORTICOSTEROID INJECTION VERSUS CYRIAX-TYPE PHYSIOTHERAPY FOR TENNIS ELBOW
Authors: Verhaar J. A. N. , Walenkamp G. H. I. M. , van Mameren H. , Kester A. D. M. , van der Linden A. J.
Published: February 2018

We performed a prospective, randomised trial on 106 patients to compare the effects of local corticosteroid injections with physiotherapy as advocated by Cyriax in the treatment of tennis elbow. The main outcome measures were the severity of pain, pain provoked by resisted dorsiflexion of the wrist, and patient satisfaction.

At six weeks 22 of 53 patients in the injection group were free from pain compared with only three in the physiotherapy group. In the corticosteroid-treated group 26 patients had no pain on resisted dorsiflexion of the wrist compared with only three in the physiotherapy group. Thirty-five patients who had injections and 14 who had physiotherapy were satisfied with the outcome of treatment at six weeks. At the final assessment there were 18 excellent and 18 good results in the corticosteroid group and one excellent and 12 good results in the physiotherapy group. There was a significant increase in grip strength in both groups but those with injections had a significantly better result.

After one year there were no significant differences between the two groups. Half of the patients, however, had received only the initial treatment, 20% had had combined therapy and 30% had had surgery.

We conclude that at six weeks, treatment with corticosteroid injections was more effective than Cyriax physiotherapy and we recommend it because of its rapid action, reduction of pain and absence of side-effects.
EXTENSILE POSTERIOR APPROACH TO THE ANKLE
Authors: Hayes A. G. , Nadkarni J. B.
Published: February 2018

Surgical exposure of the ankle is usually obtained by an anterior approach, especially for replacement arthroplasty. The transfibular approach has been popular for arthrodesis.

We describe a new posterior approach to the ankle and posterior subtalar joint based on an extra-articular vertical calcaneal osteotomy behind the subtalar joint. The posterior flap so formed is hinged medially and offers wide exposure of the back of the ankle and posterior subtalar joint. This hinge allows safe and stable reduction of the osteotomised calcaneum, and the plane of dissection follows an ‘internervous plane’ behind the fibula.

We have had good results after using this incision in 12 patients with osteoarthritis or rheumatoid arthritis and there have been no difficulties with wound healing.
HYPERSENSITIVITY IN ASEPTIC LOOSENING OF TOTAL HIP REPLACEMENTS
Authors: Haddad F. S. , Cobb A. G. , Bentley G. , Levell N. J. , Dowd P. M.
Published: February 2018

Aseptic loosening is seen in a significant proportion of cemented total hip replacements (THR). In a small subgroup of patients who suffer early loosening polyethylene debris is unlikely to be responsible. We recently reported one case of allergic contact dermatitis to N,N-dimethylparatoluidine (DMT), an accelerator used in bone cement. We have therefore investigated this using skin-patch tests to a variety of substances including metals, polyethylene and the separated individual components of Simplex cement.

We studied 70 patients, 15 with aseptic loosening less than two years after THR, 25 with satisfactory long-term cemented fixation, five with infected loosening of cemented THRs and 25 awaiting hip arthroplasty. We found seven positive reactions to DMT, all of them in patients with the rapid onset of aseptic loosening.

Allergy to DMT is recognised in the dental profession in respect of the ‘denture sore mouth’ syndrome, and could also be an occupational hazard since some industrial glues contain DMT. Our results suggest the need for awareness of possible previous dental or occupational exposure to the constituents of bone cement. We recommend the use of skin-patch testing in high-risk cases.
QUESTIONNAIRE ON THE PERCEPTIONS OF PATIENTS ABOUT SHOULDER SURGERY
Authors: Dawson J. , Fitzpatrick R. , Carr A.
Published: February 2018

We developed a 12-item questionnaire for completion by patients having shoulder operations other than stabilisation. A prospective study of 111 patients was undertaken before operation and at follow-up six months later. Each patient completed the new questionnaire and the SF36 form. Some filled in the Stanford Health Assessment Questionnaire (HAQ). An orthopaedic surgeon assessed the Constant shoulder score.

The single score derived from the questionnaire had a high internal consistency. Reproducibility, examined by test-retest reliability, was found to be satisfactory. The validity of the questionnaire was established by obtaining significant correlations in the expected direction with the Constant score and the relevant scales of the SF36 and the HAQ. Sensitivity to change was assessed by analysing the differences between the preoperative scores and those at follow-up. Changes in scores were compared with the patients’ responses to postoperative questions about their condition. The standardised effect size for the new questionnaire compared favourably with that for the SF36 and the HAQ. The new questionnaire was the most efficient in distinguishing patients who said that their shoulder was much better from all other patients.

The shoulder questionnaire provides a measure of outcome for shoulder operations which is short, practical, reliable, valid and sensitive to clinically important changes.
AVASCULAR NECROSIS AND THE PAVLIK HARNESS
Authors: Suzuki S. , Kashiwagi N. , Kasahara Y. , Seto Y. , Futami T.
Published: February 2018

We analysed the incidence of avascular necrosis in 101 hips of 90 infants with congenital dislocation treated with the Pavlik harness and followed up for more than one year. Using ultrasonography in the flexed-abducted position the hips were classified as type A when the femoral head was displaced posteriorly, but within the socket and making contact with the posterior inner wall of the acetabulum; type B when it was in contact with the posterior margin of the acetabulum, with its centre at this level or anterior to it; and type C when it was displaced out of the socket, with its centre posterior to the posterior rim of the acetabulum.

Eighty-seven hips were reduced by the harness (86%), and seven of these developed avascular necrosis (8%). All 69 hips with type-A dislocation were reduced, and only one (1.4%) showed slight avascular necrosis. Eighteen (78.3%) of 23 hips with type-B dislocation were reduced, and six developed avascular necrosis (33.3%). In one hip, the femoral head was severely damaged. None of the nine hips with type-C dislocation was reduced in the harness.

We conclude that the Pavlik harness is indicated for type-A, but not for type-B or type-C dislocations.
SALINE LOAD TEST FOR PENETRATION OF PERIARTICULAR LACERATIONS
Authors: Voit G. A. , Irvine G. , Beals R. K.
Published: February 2018

We used a saline load test in 50 consecutive patients with periarticular lacerations suggestive of joint penetration. The surgeon had predicted on clinical grounds whether or not the laceration penetrated the joint.

Joint penetration was demonstrated in 14 and was absent in 36. A comparison of the prediction and the test results showed that there were false-positive clinical results in 39% and false-negative in 43%. There were no complications from the use of the test.

Our findings support the use of a saline load test in evaluating periarticular lacerations.
LONG-TERM COMPARISON OF CHARNLEY AND STANMORE DESIGN TOTAL HIP REPLACEMENTS
Authors: Britton A. R. , Murray D. W. , Bulstrode C. J. , McPherson K. , Denham R. A.
Published: February 2018

We reviewed the records of the long-term outcome of 208 Charnley and 982 Stanmore total hip replacements (THR) performed by or under the supervision of one surgeon from 1973 to 1987. The Stanmore implant had a better survival rate before revision at 14 years (86% to 79%, p = 0.004), but the difference only became apparent at ten years.

The later Stanmore implants did better than the early ones (97% to 92% at ten years, p = 0.005), the improvement coinciding with the introduction of a new cementing technique using a gun. Most of the Charnley implants were done before most of the Stanmore implants so that the difference between the results may in part be explained by improved methods, but this is not the complete explanation since a difference persisted for implants carried out during the same period of time.

We conclude that improved techniques have reduced failure rates substantially. This improvement was much greater than that observed between these two designs of implant. Proof of the difference would require a very large randomised controlled trial over a ten-year period.
Total meniscectomy in adolescence
Authors: McNicholas M. J. , Rowley D. I. , McGurty D. , Adalberth T. , Abdon P. , Lindstrand A. , Lohmander L. S.
Published: February 2018

We have carried out a prospective, longitudinal 30-year review of 95 adolescents who underwent total meniscectomy in one knee, and have compared the results with those observed 13 years earlier. All the medical records were scrutinised. Of the 63 patients reviewed clinically, 47 reported decreased sporting activity, although subjective satisfaction rose by 3% to 71%. The scores on the WOMAC osteoarthritis index differed significantly between patients grouped by subjective global assessment. Satisfactory function scores increased from 48% to 60%. In the 53 patients consenting to bilateral radiography of the knee, the incidence of narrowing of the articular cartilage in the operated knee increased significantly between the reviews (19% to 36%). Progression of degenerative change paralleled reduction in activity. Outcome measures were best after medial, intermediate after lateral and worst after double meniscectomy.
Arthrodesis of the shoulder after septic arthritis
Authors: Wick M. , Müller E. J. , Ambacher T. , Hebler U. , Muhr G. , Kutscha-Lissberg F.
Published: February 2018

We analysed the long-term results of arthrodesis of the shoulder after infection in 15 patients. At the time of operation, 14 cultures were positive for Staphylococcus aureus. The mean follow-up was 8.3 years (3 to 14) and 90% of the patients were satisfied with the outcome. There were complications in five patients (33%); in three there was nonunion with loosening of the implant. One patient had a sound bony union but with a persistent sinus six years after arthrodesis and another had a sinus which healed after the metal was removed. Four of these five patients (80%) were heavy smokers (> 20 cigarettes/day). Cancellous bone grafting did not affect the incidence of complications. The mean age of the patients with complications was 58.6 v 48.6 years for those without (p = 0.2808 ; not significant). Those with complications had had more previous operations (6.4 v 2.5, p < 0.05). Antibiotics, as determined by the bacteriological cultures, were administered for six weeks.

The complication rate was higher in patients with active sepsis but the younger the patient and the fewer number of previous operations (< 50 years, < four previous operations), the better was the outcome. Considering the rate of complications, we recommend early surgery in these patients.
Dislocation after total hip replacement in relation to metal-on-metal bearing surfaces
Authors: Clarke M. T. , Lee P. T. H. , Villar R. N.
Published: February 2018

Metal-on-metal (MOM) is a commonly used bearing notable for its ‘suction fit’ when lubricated. In this study, we examined the capacity for MOM bearings to protect against dislocation after total hip replacement (THR).

We undertook a clinical investigation to compare the rate of dislocation of MOM bearings with those of ceramic-on-polyethylene (COP) bearings and found that one MOM bearing dislocated in a series of 109 hips (0.9%) compared with nine of 145 hips (6.2%) in the COP group (p = 0.02).

We also performed an in vitro investigation comparing the peak forces generated during forced separation of the two bearings of the same dimensions at velocities from 1 to 50 cm/s. This revealed that the MOM bearing generated significant resistance to separation at all velocities (maximum mean 24 N), whereas the COP did not (maximum mean 1.9 N, p < 0.001). We conclude that MOM bearings are more stable to dislocation than COP bearings as a result of the interfacial forces provided by a thin, lubricating fluid.
Incidence and natural history of deep-vein thrombosis after total hip arthroplasty
Authors: Kim Y.-H. , Oh S.-H. , Kim J.-S.
Published: February 2018

There are many reports concerning the aetiology and prophylaxis of deep-vein thrombosis (DVT) but little is known about its natural history. The purpose of our study was to identify the incidence and site of DVT, the risk factors for pulmonary embolism and the natural history of DVT after total hip replacement (THR) in patients who do not receive any form of prophylactic or therapeutic treatment for DVT.

Two hundred patients who had a primary THR were included: 100 had one-staged bilateral THR and 100 had unilateral THR and 150 implants were cemented and 150 cementless. Coagulation assays, a full blood count, blood typing and serum chemical profile tests were performed for all patients on three separate occasions. Bilateral simultaneous or unilateral venograms were performed on the sixth or seventh postoperative day and perfusion lung scans preoperatively and on the seventh or eighth postoperative day. Further venograms were performed in all patients who had thrombi six months later.

In the patients with bilateral THR, 52 (26%) venograms were positive for thrombi, while in the patients with unilateral THR 20 (20%) were positive (p = 0.89). In the patients with a cemented THR, 31 venograms (20.7%) were positive for thrombi, while in those with a cementless THR 41 (27.3%) were positive (p = 0.654). Further venograms in all 72 patients who had thrombi at six months after operation showed that they resolved completely and spontaneously regardless of their site and size. No patients had symptoms of pulmonary emboli and none were seen on the perfusion lung scans. Two patients died from unrelated causes.

Although the prevailing opinion is that patients with proximal venous thrombosis should be treated with anticoagulants, our study has shown that all thrombi regardless of their site and size resolve spontaneously without associated pulmonary embolism.
Spontaneous tendon ruptures in alkaptonuria
Authors: Manoj Kumar R. V. , Rajasekaran S.
Published: February 2018

Ochronosis, the musculoskeletal manifestation of alkaptonuria, is known to lead to degenerative changes of the spine and weight-bearing joints. Symptoms related to degeneration of tendons or ligaments with spontaneous ruptures have not previously been reported. Three patients are described with four spontaneous ruptures of either the patellar tendon or tendo Achillis as the first symptom of alkaptonuria.
Carpal tunnel release
Authors: Wong K. C. , Hung L. K. , Ho P. C. , Wong J. M. W.
Published: February 2018

Endoscopic carpal tunnel release has the advantage over open release of reduced tissue trauma and postoperative morbidity. Limited open carpal tunnel release has also been shown to have comparable results, but is easier to perform and is safer. We have compared the results of both techniques in a prospective, randomised trial. Thirty patients with bilateral carpal tunnel syndrome had simultaneous bilateral release. The technique of release was randomly allocated to either two-portal endoscopic release (ECTR) or limited open release using the Strickland instrumentation (LOCTR).

The results showed that the outcome was similar at follow-up of one year using both techniques. However, the LOCTR group had significantly less tenderness of the scar at the second and fourth postoperative week (p < 0.01). There was also less thenar and hypothenar (pillar) pain after LOCTR. Subjective evaluation showed a preference for LOCTR.
3M integral bipolar cup system for dysplastic osteoarthritis
Authors: Torisu T. , Kaku N. , Tumura H. , Taira H. , Tomari K.
Published: February 2018

Between 1995 and 1997 we undertook 40 bipolar hip arthroplasties in 35 patients with dysplastic osteoarthritis. The steep and shallow acetabulum was excavated and the bipolar socket was placed high with an adjustment of leg-length. At follow-up of between five and seven years, there were 19 excellent, 16 good and five fair results according to the scoring system of Merle d’Aubigné and Postel. The mean radiographic superior migration of the bipolar socket was 2.1 mm (0 to 10). Osteolysis was noted in three hips within three years of the operation. Abduction on weight-bearing was recorded in 24 hips and the bipolar system was found to be functioning predominantly between the inner bearing and the metal femoral head in 20.
Hip arthroplasty in patients with cirrhosis of the liver
Authors: Hsieh P.-H. , Chen L.-H. , Lee M.-S. , Chen C.-H. , Yang W.-E. , Shih C.-H.
Published: February 2018

We retrospectively reviewed 45 hip arthroplasties which were performed over a period of 20 years in 38 patients with cirrhosis of the liver. There was a high perioperative 30-day complication rate (26.7%). Advanced cirrhosis was associated with a higher risk of complications (p = 0.004) as also was increased age, a high level of creatinine, a low level of albumin, a low platelet count, ascites, encephalopathy and an increased operative blood loss. The survival of the prosthesis at five years was 77.8% and infection was a major cause of failure.

In view of the high rate of early complications and the limited longevity of the prosthesis, surgeons who perform hip arthroplasty on such patients should counsel them appropriately preoperatively.
Bone growth into a ceramic-filled defect around an implant
Authors: Clarke S. A. , Brooks R. A. , Lee P. T.H. , Rushton N.
Published: February 2018

Synthetic bone substitutes provide an alternative to autograft but do not give equivalent clinical results. Their performance may be enhanced by adding osteogenic growth factors. In this study, TGFβ1 was absorbed on to a carrier of β tricalcium phosphate and Gelfoam® and used to fill a defect around a tibial implant in a rat model of revision arthoplasty.

We added 0.0, 0.02 μg, 0.1 μg or 1.0 μg of TGFβ1 to the carrier and then implanted it around an hydroxyapatite-coated stainless-steel pin in the proximal tibia of rats. The tibiae were harvested at three, six or 26 weeks and the amount of bone formation and ceramic resorption were assessed.

TGFβ1 had no effect on the amount of bone in the defect, the amount of fluorescent label incorporated or the rate of mineral apposition. The growth factor did not significantly affect the amount of β TCP remaining in the tissue at any of the time points.
Results of isolated Lisfranc injuries and the effect of compensation claims
Authors: Calder J. D. F. , Whitehouse S. L. , Saxby T. S.
Published: February 2018

The results of treatment of Lisfranc injuries are often unsatisfactory. This retrospective study investigated 46 patients with isolated Lisfranc injuries at a minimum of two years after surgery. Thirteen patients had a poor outcome and had to change employment, or were unable to find work as a result of this injury. The presence of a compensation claim (p = 0.02) and a delay in diagnosis of more than six months were associated with a poor outcome (p = 0.01). There was no association between poor functional outcome and age, gender, mechanism of injury or previous occupation. This study may have medico-legal implications on reporting the prognosis for such injuries, and highlights the importance of prompt diagnosis and treatment.
Evolution of late presenting developmental dysplasia of the hip and associated surgical procedures after 14 years of neonatal ultrasound screening
Authors: Wirth T. , Stratmann L. , Hinrichs F.
Published: February 2018

Between 1985 and 1998, 12 331 patients were included in the general neonatal ultrasound hip screening programme for developmental dysplasia of the hip (DDH). Patients who needed treatment (604) were compared with a second group of 73 unscreened children treated conservatively and surgically for DDH.

The incidence of Graf sonographic hip types IIc to IV varied throughout the observation period. Femoral and pelvic osteotomies were almost entirely restricted to the unscreened group of patients. The six to ten per year recorded in the period 1985 to 1990 declined subsequently to three or less per year. The yearly admissions to hospital fell noticeably after six years of screening. Late presentations of DDH were reduced to three or less per year from 1990 to 1994, none between 1995 and 1998 and one or two per year from 2000.

We conclude that general neonatal sonographic hip screening can reduce significantly surgical procedures, hospitalisation and late presentation of DDH.
Management of diabetes mellitus. The new period of self-control: detection of glucose trends and patterns
Authors: Petunina Nina A. , Goncharova Ekaterina V. , Terekhova Anna L.
Published: February 2018

Modern representation of self-monitoring blood glucose can be characterised by new technologies introduced in recent years, including tools to identify trends and patterns of glycaemia (PatternAlert ). These technologies simplify self-monitoring and help avoid errors in the interpretation of blood glucose levels in patients. This study examines the primary trends in the management and control of diabetes, as well as the strengths and weaknesses of the control of glycated haemoglobin (HbA1c). In addition, this study raises broader questions on self-control in patients with diabetes mellitus, which are beyond the issues of the normalisation of blood glucose levels.
Modern methods of diagnosing chronic kidney disease in patients with diabetes mellitus
Authors: Markova Tatiana N. , Sadovskaya Viktoriia V. , Bespyatova Marina Y.
Published: February 2018

Chronic kidney disease (CKD) is a general concept that involves renal tissue regardless of the aetiology of the leading disease. CKD occurs in one out of every two patients with diabetes mellitus (DM) and appreciably limits the duration and quality of life. CKD can be diagnosed by glomerular filtration rate (GFR), which is recognised as the most representative indicator of the quantity and total workload of nephrons. However, the decrease in GFR occurs at an advanced stage of nephropathy and causes irreversible renal damage, which ultimately requires substitutive renal therapy and, thereby, increases the expense. In this regard, clinical trials have been conducted to identify the biomarkers of CKD reflecting renal damage at earlier stages of the disease. This article presents an overview of modern methods for the diagnosis of CKD and preclinical markers of kidney injury in patients with DM.
Cost-of-Illness Analysis of Type 2 Diabetes Mellitus in the Russian Federation: Results from Russian multicenter observational pharmacoepidemiologic study of diabetes care for patients with type 2 diabetes mellitus (FORSIGHT-Т2DM)
Authors: Dedov Ivan I. , Kalashnikova Marina F. , Belousov Dmitriy Y. , Kolbin Aleksey S. , Rafalskiy Vladimir V. , Cheberda Aleksey E. , Kantemirova Mariya A. , Zakiev Vadim D. , Fadeyev Valentin V.
Published: February 2018

Background: Cost-of-Illness Analysis (COI) constitutes the basis for the decision-making process on the budget and allocation in a modern health care system. Considering the wide prevalence of type 2 diabetes mellitus (Т2DM), it is important to perform COI in the Russian Federation (RF).
Aim: The aim of the secondary objective FORSIGHT-Т2DM study was to conduct Cost-of-Illness Analysis (COI) of Т2DM in the Russian Federation in relation to taking into consideration the presence of complications and concomitant diseases.
Materials and methods: COI of Т2DM was performed using the data obtained in Russian multicenter observational, pharmacoepidemiologic cross-sectional study of diabetes care for assessing routine healthcare pattern of T2DM in the Russian Federation (FORSIGHT-Т2DM). Information for each patient was collected from primary medical records and By asking patients to fill out a questionnaire. Total costs were calculated as the sum of direct medical costs (DCm), direct non-medical costs (DCn) and indirect costs (IC).
Results: The final analysis included data from 2014 patients with T2DM residing in 45 cities of RF. Total direct medical costs (DCm) of treating Т2DM and its complications and comorbidities amounted to 105 337 rubles ($2742) per patient per year; direct non-medical costs (DCn) amounted to 24 518 rubles ($638) per patient per year; indirect costs (IC) amounted to 149 754 rubles ($3898) per patient per year. The total cost of T2DM in RF in 2014 year amounted to 279 609 rubles ($7278) per patient. The total cost of T2DM in RF in 2014 amounted to 279 609 rubles per patient.
Conclusions: More than half (53,5%) of the total cost of T2DM is the loss of GDP due to patients disability. The DCm constitute 37,7% of the total cost of the disease, of which 57% is spent on treatment of T2DM complications and concomitant diseases, while only 10% is spent on glucose-lowering therapies.
Heavy metal toxicity in agricultural soil due to rapid industrialization in Bangladesh: a review
Authors: Proshad Ram , Kormoker Tapos , Mursheed Niaj , Monirul Islam Md. , Bhuyan Md. Isfatuzzaman , Sazedul Islam Md. , Mithu Tanvir Nahid
Published: February 2018

Heavy metal is a member of loosely defined subset of elements that exhibit metallic properties. It mainly includes the transition metals, some metalloids, lanthanides, and actinides. Heavy metals are ubiquitous in the environment, as a result of both natural and anthropogenic activities. They are stable and cannot be destroyed, and therefore tend to accumulate in the environment. In recent years, there has been a substantial concern over the extent of contamination of the environment with toxic elements. Soil pollution caused by rapid industrial activities has become a worrisome phenomenon due to its impact on soil and environment. Heavy metal pollution in soil arising from industrial discharges significantly poses a great threat to the environment. Heavy metals come to the soil by several ways and the soil becomes toxic which cause serious problem to the environment. In toxic soil, microorganisms cannot persist and there create an imbalance situation in the soil. The main objective of this study was to assess the problem of heavy metal contamination in industrial area soil in Bangladesh with environmental risk assessment.
Decision Support System for Thesis Graduation Recommendation Using AHP-TOPSIS Method
Authors: Sari Desi Ratna , Windarto Agus Perdana , Hartama Dedy , Solikhun Solikhun
Published: February 2018

This research proposes a decision support system in determining thesis exam graduation using AHP and TOPSIS method. The AHP method weighted the criteria to generate values for each criterion, in which the value of each criterion was used to obtain a ranking of some alternatives with TOPSIS. The criteria used for the assessment are 5 chapters (C1), neatness (C2), manners (C3), material delivery (C4) and material mastery (C5). Merging the AHP and TOPSIS methods can optimize the weighting of criteria values that affect the more objective alternative ranking results. The resulting Hamming distance is 96.2% and the Euclidean distance is 0.8096 for 95 students.
Pengenalan dan Analisis Ucapan pada Sistem Kontrol Perangkat Listrik Menggunakan Arduino Uno
Authors: Eridani Dania , Sanusi Ivan , Widianto Eko Didik
Published: February 2018

This study aims to develop an electrical device control system using speech recognition and perform the analysis factors that affect the accuracy of speech recognition. The system used the Arduino Uno as the main control board of the system, an Elechouse's voice recognition module as speech processing device and several output devices such as relays, LEDs and an LCD. This research resulted in 92,7% accuracy of speech recognition at the ideal condition and 66,85% at the noise condition. This study shows that the frequency, amplitude, slow tempo and timbre of command speech greatly affect the success of speech recognition.
“You have to teach to your personality”: Caring, sharing and teaching with technology
Authors: Shelton Chris
Published: February 2018

Studies of teachers in higher education have acknowledged the relationship between teaching and teacher identity. Teacher identity is seen as dynamic, context-specific, and encompassing a teachers’ sense of meaning, values and self-esteem. This article considers the relationship between the values dimension of teacher identity and the use of technology. Using qualitative data from a multisite case study, it explores three aspects of the relationship between values and technology in teaching: firstly, the extent to which technology allows university teachers to share their values and their personality with students; secondly, the way in which technology affects the performance of teaching; thirdly, the ways in which teachers enact their care for and commitment to students though technology-mediated means. The article suggests that technology can be used in ways that teachers feel support or hinder their ability to communicate their values and shows how an individual’s use of technology may be shaped by aspects of their identity as a teacher.
Creep Fatigue Interaction under Different Test Variables: Mechanics and Mechanisms
Authors: Barat Kaustav , Sivaprasad S. , Kar S. , Tarafder S.
Published: February 2018

We present detailed analyses of dwell characteristics of various waveforms of creep fatigue interaction tests performed on the nickel-based superalloy IN 718. We discuss the effects of different dwell modes (strain, stress, and mixed) on creep fatigue properties. Strain dwell tests cause relaxation/accumulation of the mean stress, and stress dwell tests cause accumulation/relaxation of mean strain. True interaction of strain-controlled low cycle fatigue and creep takes place when stress-controlled dwell has been introduced within a strain-controlled cycling. In this article, the effects of pure and mixed modes have been compared in terms of the creep strain accumulation rate at dwell positions. It has been found, irrespective of creep and fatigue, that there is also a second competitive process that goes on, like tensile strain accumulation and compressive strain accumulation. These two processes compete with each other and show a difference in evolution with cycles. Mean strain rates for different stress and mixed control tests have also been determined; by comparing the creep strain accumulation rate and plastic strain rate, the competition of creep and fatigue processes has also been demonstrated in this article. The mechanism of cracking and cavity formation has also been illustrated by computed microtomography and subsequent fractography.
LTP or LTD? Modeling the Influence of Stress on Synaptic Plasticity
Authors: Peters Achim , Reisch Cordula , Langemann Dirk
Published: February 2018

In cognitive memory, long-term potentiation (LTP) has been shown to occur when presynaptic and postsynaptic activities are highly correlated and glucocorticoid concentrations are in an optimal (i.e., low normal) range. In all other conditions, LTP is attenuated or even long-term depression (LTD) occurs. In this paper, we focus on NMDA receptor (NMDA-R)-dependent LTP and LTD, two processes involving various molecular mechanisms. To understand which of these mechanisms are indispensable for explaining the experimental evidence reported in the literature, we here propose a parsimonious model of NMDA-R-dependent synaptic plasticity. Central to this model are two processes. First, AMPA receptor-subunit trafficking; and second, glucocorticoid-dependent modifications of the brain-derived neurotrophic factor (BDNF)-receptor system. In 2008, we have published a core model, which contained the first process, while in the current paper we present an extended model, which also includes the second process. Using the extended model, we could show that stress attenuates LTP, while it enhances LTD. These simulation results are in agreement with experimental findings from other labs. In 2013, surprising experimental evidence showed that the GluA1 C-tail is unnecessary for LTP. When using our core model in its original form, our simulations already predicted that there would be no requirement for the GluA1 C-tail for LTP, allowing to eliminate a redundant mechanism from our model. In summary, we present a mathematical model that displays reduced complexity and is useful for explaining when and how LTP or LTD occurs at synapses during cognitive memory formation.
Reliability-Weighted Integration of Audiovisual Signals Can Be Modulated by Top-down Attention
Authors: Rohe Tim , Noppeney Uta
Published: February 2018

Behaviorally, it is well established that human observers integrate signals near-optimally weighted in proportion to their reliabilities as predicted by maximum likelihood estimation. Yet, despite abundant behavioral evidence, it is unclear how the human brain accomplishes this feat. In a spatial ventriloquist paradigm, participants were presented with auditory, visual, and audiovisual signals and reported the location of the auditory or the visual signal. Combining psychophysics, multivariate functional MRI (fMRI) decoding, and models of maximum likelihood estimation (MLE), we characterized the computational operations underlying audiovisual integration at distinct cortical levels. We estimated observers’ behavioral weights by fitting psychometric functions to participants’ localization responses. Likewise, we estimated the neural weights by fitting neurometric functions to spatial locations decoded from regional fMRI activation patterns. Our results demonstrate that low-level auditory and visual areas encode predominantly the spatial location of the signal component of a region’s preferred auditory (or visual) modality. By contrast, intraparietal sulcus forms spatial representations by integrating auditory and visual signals weighted by their reliabilities. Critically, the neural and behavioral weights and the variance of the spatial representations depended not only on the sensory reliabilities as predicted by the MLE model but also on participants’ modality-specific attention and report (i.e., visual vs. auditory). These results suggest that audiovisual integration is not exclusively determined by bottom-up sensory reliabilities. Instead, modality-specific attention and report can flexibly modulate how intraparietal sulcus integrates sensory signals into spatial representations to guide behavioral responses (e.g., localization and orienting).
Resilient by design: the case for increasing resilience of buildings and their linked food-energy-water systems
Authors: Tien Iris
Published: February 2018

The resilience of buildings and food, energy, and water systems (FEWS) to natural or manmade disruptions are closely linked. The resilience of a building goes beyond the safety of its structural elements and must include the resilience of its supporting systems and the services they supply. The resilience of FEWS, in turn, can increase through design elements of a building that affect generation and storage of FEW resources. In this commentary, I discuss increasing the resilience of buildings and their linked FEWS—improving their resistance, absorption, restoration, and adaptive capacities—through new integrated systems design practices. I begin with a discussion of the current state of building design at the FEW nexus. I then use the prior establishment and current use of sustainability design objectives as an analogue to developing and implementing resilience design objectives. I review progress and limitations of specific drivers for increasing resilient design practices, including economic incentives, regulations, extralegal programs and initiatives, and societal incentives. My recommendations for leveraging these drivers to increase resilient design include: for economic incentives, quantify the costs and benefits to make the business case for resilience; for formal regulations, specify increased building requirements with performance-based resilience objectives; for extralegal initiatves, integrate these resilience objectives with existing certification programs and award designs that address FEWS as an integrated network rather than as disparate systems; and for societal incentives, demonstrate public benefit to shift societal perceptions of resilience. Together, these actions will motivate the design of more resilient building and FEW systems to increase their longevity, performance, and robustness.