bluuebunny/crossref_metadata_2025 huggingface dataset:
Revision of the femoral prosthesis with impaction allografting and a Charnley stem
Authors: Piccaluga F. , Valle A.González Della , Fernández J. C. Encinas , Pusso R.
Published: February 2018

Impacted morcellised bone allograft and a Charnley stem was used to revise 59 loose femoral components in 57 consecutive patients. Femoral bone loss was rated as Endo-Klinik grade 2 in nine patients, grade 3 in 41, and grade 4 in nine. The immediate postoperative radiographs and those taken at the most recent follow-up were compared for radiolucencies, subsidence and incorporation of the graft. One patient was lost to follow-up and two were not available for radiological analysis.

The mean clinical follow-up in 58 procedures was 56.7 months (24 to 144) and the mean radiological review of 56 reconstructions was 54.4 months (24 to 144). An intraoperative femoral fracture occurred in one patient (1.7%) and was successfully treated by strut grafting and cerclage wiring. Extrusion of cement through perforations or incomplete hoop fractures was detected in the postoperative radiographs of ten procedures (17%); none of these patients sustained a complete fracture. Three patients had dislocations (5%) and two (3.5%) developed painful subsidence of the stem which required a further revision. The latest follow-up radiographs in 56 reconstructions showed a well fixed stem and radiological healing of the graft in 52 (93%), and definite loosening in four (7%). Of these four, two were revised again and two were asymptomatic after a follow-up of 120 months each. The mean subsidence in the 52 successful revisions was 0.38 mm (0 to 4). Impaction allografting with a Charnley stem restored bone stock and provided adequate fixation of the stem in 93% of the hips. There was a low rate of rerevision (3.5%) and a low incidence of intraoperative and postoperative complications.
The natural history and significance of radiolucent lines at a cemented femoral interface
Authors: Iwaki H. , Scott G. , Freeman M. A. R.
Published: February 2018

We studied 185 total hip replacements and related the identification of radiolucent lines (RLLs) at two years to the later development of lytic lesions and loosening. Linear polyethylene wear was also measured.

RLLs appeared in 34 hips at a mean of 2.0 years after operation, and lytic lesions in ten hips at 5.7 years. Of 151 THRs without RLLs there was neither rapid migration nor loosening and only one developed a possible lytic lesion. Of 23 hips with non-progressive RLLs there was neither rapid migration nor loosening, but six developed a lytic lesion. By contrast, 11 THRs with progressive RLLs migrated rapidly and seven developed a lytic lesion. Six THRs with progressive RLLs failed. The wear rates were the same in all groups, although limited numbers were available for study.

If the surgeon achieves secure initial fixation as shown by slow or no migration and no RLLs during the first two years, it is likely that no lytic lesions will develop by five years or aseptic loosening by ten years. If an imperfect, but adequate, interface is achieved, as shown by slow migration and non-progressive RLLs lytic lesions adjacent to the RLLs may develop by five years, but aseptic loosening will be unlikely at ten. Insecure initial fixation, as shown by more rapid migration and progressive RLLs at two years, is likely to lead to the formation of lytic lesions at five years and loosening at ten. The outcome after THR is therefore determined at the initial operation and may be predicted at two years. The presence of lytic lesions reflects soft tissue at the interface as shown by the RLLs which accompany and promote loosening but, in our study, did not cause it.
Dislocation of the bearing of the Oxford lateral unicompartmental arthroplasty
Authors: Robinson B. J. , Rees J. L. , Price A. J. , Beard D. J. , Murray D. W. , Smith P. McLardy , Dodd C. A. F.
Published: February 2018

When the Oxford unicompartmental meniscal bearing arthroplasty is used in the lateral compartment of the knee, 10% of the bearings dislocate. A radiological review was carried out to establish if dislocation was related to surgical technique.

The postoperative radiographs of 46 lateral unicompartmental arthroplasties were analysed. Five variables which related to the position and alignment of the components were measured. Dislocations occurred in six knees.

Only one of the five variables, the proximal tibial varus angle, had a statistically significant relationship to dislocation. This variable quantifies the height of the lateral joint line. The mean proximal tibial varus angle for knees the bearings of which had dislocated was 9° and for those which had not it was 5°. In both groups it was greater than would be expected in the normal knee (3°).

Our study suggests that a high proximal tibial varus angle is associated with dislocation. The surgical technique should be modified to account for this, with care being taken to avoid damage to or over-distraction of the lateral soft tissues.
Deformities of the elbow in achondroplasia
Authors: Kitoh H. , Kitakoji T. , Kurita K. , Katoh M. , Takamine Y.
Published: February 2018

Lack of full extension of the elbow is a common abnormality in patients with achondroplasia. We studied 23 patients (41 elbows) clinically and radiologically. Extension of the elbow was assessed clinically and the angle of posterior bowing of the distal humerus was measured from lateral radiographs.

There was limited extension of the elbow in 28 (68.3%) and the mean loss of extension was 13.1°. Posterior bowing of the humerus was seen in all elbows with a mean angle of 17.0°. There was a positive correlation between these two measurements. Posterior bowing greater than 20° caused a loss of full elbow extension. Posterior dislocation of the radial head was seen in nine elbows (22.0%). The mean loss of extension of the elbows was 28.7° which was significantly greater than that of these elbows in which the head was not dislocated (8.7°), although posterior bowing was not significantly different between these two groups (19.3° and 16.3°).

Posterior bowing of the distal humerus is a principal cause of loss of extension of the elbow. Posterior dislocation of the radial head causes further limitation of movement in the more severely affected joints.
Biaxial total wrist replacement in patients with rheumatoid arthritis
Authors: Takwale V. J. , Nuttall D. , Trail I. A. , Stanley J. K.
Published: February 2018

We have implanted 76 biaxial total wrist prostheses as a primary procedure in patients with rheumatoid arthritis of the wrist. A total of 66 was reviewed at a mean follow-up time of 52 months. Pain was relieved in 67% of the surviving wrist replacements. On the basis of the Hospital for Special Surgery scoring system, 49 wrists (74%) were graded as fair to excellent. More than half of the 27 patients who had an arthrodesis on the contralateral wrist would have preferred a second arthroplasty. Five replacements were revised or fused because of loosening and a further nine showed signs of radiological loosening, three of which were asymptomatic.

The probability of survival of the biaxial total wrist replacement at eight years was 83% with revision surgery as the terminal event, 78% with radiological loosening as the endpoint and 82% with dorsal migration and displacement from the metacarpal as the terminal event. There was a linear relationship between subsidence of the component and distal loosening. There was no evidence that the length of the stem of the carpal component, within the third metacarpal, affected any of the terminal events. The position and alignment of the carpal component within the bone at the time of surgery significantly affect the outcome and can be used to predict failure.
Impaction grafting of the femur in two-stage revision for infected total hip replacement
Authors: English H. , Timperley A. J. , Dunlop D. , Gie G.
Published: February 2018

We report the mid-term results of femoral impaction grafting which was used in 53 patients during the second stage of a two-stage revision for an infected total hip replacement. We reviewed all cases performed between 1989 and 1998. All patients underwent a Girdlestone excision arthroplasty, received local and systemic antibiotics and subsequently underwent reconstruction, using femoral impaction grafting.

Four patients had further infection (7.5%), and four died within 24 months of surgery. One patient underwent revision of the stem for a fracture below its tip at ten months. This left 44 patients with a mean follow-up of 53 months (24 to 122). All had improved clinical scores and a satisfactory radiological outcome.
Stage-IIB osteosarcomas around the knee
Authors: Foukas A. F. , Deshmukh N. S. , Grimer R. J. , Mangham D. C. , Mangos E. G. , Taylor S.
Published: February 2018

We studied 55 patients with stage-IIB osteosarcoma around the knee with respect to the expression of matrix metalloproteinase (MMP)-9 in the surviving tumour cells in surgical resection specimens. They were followed up for a minimum of 2.5 years.

Factors significantly associated with poor overall survival were a high serum level of alkaline phosphatase at diagnosis and tumour cells expressing MMP-9 in the resection specimens. The only factor strongly associated with disease-free survival was the immunohistochemical status of tumour cells for MMP-9 in the resection specimens. The percentage of necrosis after chemotherapy failed marginally to reach statistical significance. On Cox regression analysis only MMP-9 remained significant for overall and disease-free survival.
Total vertebrectomy for primary malignant tumours of the spine
Authors: Krepler P. , Windhager R. , Bretschneider W. , Toma C. D. , Kotz R.
Published: February 2018

Primary malignant tumours should be resected with wide margins. This may be difficult to apply to lesions of the spine. We undertook total vertebrectomy on seven patients, four males and three females with a mean age at operation of 26.5 years (6.3 to 45.8). The mean follow-up was 52.3 months. Histological examination revealed a Ewing’s sarcoma in two patients and osteosarcoma, leiomyosarcoma, spindle-cell sarcoma, chondrosarcoma and malignant schwannoma in one each. In five patients, histological examination showed that a wide resection had been achieved. At follow-up there was no infection and a permanent neurological deficit was only seen in those patients in whom the surgical procedure had required resection of nerve roots. Despite the high demands placed on the surgeon and anaesthetist and the length of postoperative care we consider total vertebrectomy to be an appropriate procedure for the operative treatment of primary malignant lesions of the spine.
The role of inducible nitric oxide synthase in aseptic loosening after total hip arthroplasty
Authors: Suh K. T. , Chang J. W. , Jung J. S.
Published: February 2018

We collected 16 samples of the membrane which surrounds loose hip prostheses from patients undergoing revision operations for aseptic loosening. To serve as the control group, samples of the synovial tissue and the fibrous capsular tissue were collected from 11 patients undergoing primary hip arthroplasties. Analyses of the expression levels of inducible nitric oxide synthase (iNOS), tumour necrosis factor-α (TNF-α), and cytosolic phospholipase A2 (cPLA2) mRNAs were performed by a reverse transcription polymerase chain reaction, and the content of nitrite was measured by the Griess reaction using sodium nitrite as the standard.

The expression levels of iNOS, TNF-α, and cPLA2 mRNAs in the membranes were significantly higher than those in the control samples (p < 0.05). The expression levels of iNOS mRNA and the nitrite content in the membranes significantly correlated with those of TNF-α and cPLA2 mRNAs, respectively. In addition, the expression levels of iNOS, TNF-α, and cPLA2 mRNAs were significantly higher in membranes from cementless than in those from cemented implants (p < 0.05).

Our results suggest that the expression levels of iNOS, TNF-α, and cPLA2 mRNAs in the membranes are regulated by closely-related mechanisms and that these have a significant role in aseptic loosening.
Injury to the lateral femoral cutaneous nerve during harvest of iliac bone graft, with reference to the size of the graft
Authors: Murata Y. , Takahashi K. , Yamagata M. , Sameda H. , Moriya H.
Published: February 2018

In patients who underwent autogenous iliac bone grafting we studied prospectively injury to the lateral femoral cutaneous nerve (LFCN) in relation to the size (length, depth, width) of the graft. We also examined the neurological deficit, by questioning them about numbness and/or pain in the lateral thigh.

The risk of injury was significantly higher in those in whom the depth of the graft was more than 30 mm. With regard to the length of the graft the incidence of nerve injury was 20% when the graft was 45 mm long or more, 16% when it was between 30 mm and 45 mm long, and 8% when it was less than 30 mm long. We should inform patients of the possibility of such injury, and take size into consideration when harvesting grafts from the ilium.
The Johnson-Elloy (Accord) total knee replacement
Authors: Norton M. R. , Vhadra R. K. , Timperley A. J.
Published: February 2018

We have found poor mid-term results in a multisurgeon series of 94 Johnson-Elloy (Accord) total knee replacements. A total of 27 knees (29%) has required revision, in 26 for aseptic loosening. Only 18 (19%) remain in situ, and these give poor function, are painful and most show radiological evidence of early failure. At 12 to 13 years the survival rate is 43% (confidence interval 29 to 57) with failure requiring revision as the endpoint. Proximal migration of the femoral component is associated with considerable loss of bone stock. We believe that all patients who have this implant should be recalled for regular review in order to anticipate this problem.
The treatment of sacral giant-cell tumours by serial arterial embolisation
Authors: Lackman R. D. , Khoury L. D. , Esmail A. , Donthineni-Rao R.
Published: February 2018

Giant-cell tumours of the sacrum are difficult to treat. Surgery carries a high risk of morbidity, local recurrence and mortality. Radiation is effective in some patients, but has a risk of malignant change.

We evaluated the effectiveness of serial arterial embolisation as an alternative to surgery. Five patients with giant-cell tumours of the sacrum which had been primarily treated by serial embolisation were retrospectively reviewed for changes in the size of the tumour. In four the symptoms resolved with full return of function and arrest in the growth of the tumour. They remained free from growth, recurrence, or metastases at follow-up (4 to 17 years). One patient died from metastatic disease within 18 months of the initial diagnosis.
Roentgen single-plane photogrammetric analysis (RSPA)
Authors: Yuan X. , Ryd L. , Tanner K. E. , Lidgren L.
Published: February 2018

We present a new approach for the accurate reconstruction of three-dimensional skeletal positions using roentgen single-plane photogrammetric analysis (RSPA). This technique uses a minimum of three markers embedded in each segment which allow continuous, real-time, internal skeletal movement to be measured from single-plane images, provided that the precise distance between the markers is known.

A simulation study indicated that the error propagation in this approach is influenced by focus position, object position, the number of control points, the accuracy of the previous measurement of the distance between markers and the accuracy of image measurement. For reconstruction of normal movement of the knee with an input measurement error of sd = 0.02 mm, the rotational and translational differences between reconstructed and original movement were less than 0.27° and 0.9 mm, respectively.

Our results showed that the accuracy of RSPA is sufficient for the analysis of most movement of joints. This approach can be applied in combination with force measurements for dynamic studies of the musculoskeletal system.
The anatomy of the iliolumbar vein
Authors: Jasani V. , Jaffray D.
Published: February 2018

We carried out a cadaver study of 16 iliolumbar veins in order to define the surgical anatomy. Two variants were found; a single vein at a mean distance of 3.74 cm from the inferior vena cava (11 of 16) and two separate draining veins at a mean distance from the vena cava of 2.98 cm for the proximal and 6.24 cm for the distal stem (5 of 16). Consistently, the proximal vein tore on attempted medial retraction of the great vessels. The mean length of the vein was 1.6 cm and its mean width 1.07 cm. Three stems were shorter than 0.5 cm. Two or more tributaries usually drained the iliacus and psoas muscles, and the fifth lumbar vertebral body. The obturator nerve crossed all veins superficially at a mean of 2.76 cm lateral to the mouth. In four of these, this distance was less than 1.5 cm. Usually, the lumbosacral trunk crossed deep, at a mean distance of 2.5 cm lateral to the mouth, but in three veins, this distance was 1 cm or less.

Our findings emphasise the need for proper dissection of the iliolumbar vein before ligature during exposure of the anterior lumbar spine.
High-pressure irrigation increases adipocyte-like cells at the expense of osteoblasts in vitro
Authors: Bhandari M. , Schemitsch E. H.
Published: February 2018

High-pressure lavage produces greater visible damage to bone at a macroscopic and microscopic level when compared with low-pressure lavage and can result in delay in the healing of fractures. Osteoblasts and adipocytes are derived from mesenchymal stem cells. Conditions which lead to bone loss often involve a switch from the osteoblast to adipocyte lineage. We have therefore examined the effect of high- and low-pressure irrigation on the differentiation of adipocytes.

Calvaria-derived bone cells were exposed to either low-pressure or high-pressure irrigation with normal saline. After 14 days the cells were fixed and the osteoblasts and adipocytes quantified using Oil Red O to stain cytoplasmic lipid droplets (triglycerides) in the cells. Osteoblasts were quantified using a commercially available alkaline-phosphatase staining assay.

A standard quantitative reverse transcription-polymerase chain reaction (RT-PCR) was performed. Messenger RNA levels for osteocalcin, a marker of osteoblasts, and PPARγ2, a marker of adipocytes, were measured. High-pressure lavage resulted in an increase in adipogenesis of 50% when compared with low-pressure lavage.

Our findings suggest that high-pressure lavage may promote differentiation of mesenchymal stem cells towards the adipoctye lineage. This may have clinical significance in the development of delayed and nonunion after treatment of fractures of long bones.
Percutaneous screw fixation for fractures of the sesamoid bones of the hallux
Authors: Blundell C. M. , Nicholson P. , Blackney M. W.
Published: February 2018

Over a period of one year we treated nine fractures of the sesamoid bones of the hallux, five of which were in the medial sesamoid. All patients had symptoms on exercise, but only one had a recent history of injury. The mean age of the patients was 27 years (17 to 45) and there were six men. The mean duration of symptoms was nine months (1.5 to 48). The diagnosis was based on clinical and radiological investigations. We describe a new surgical technique for percutaneous screw fixation for these fractures using a Barouk screw.

All the patients were assessed before and after surgery using the American Orthopaedic Foot and Ankle Society Hallux Score (AOFAS). There was a statistically significant improvement in the mean score from 46.9 to 80.7 (p = 0.0003) after fixation of the fracture with a rapid resolution of symptoms. All patients returned to their previous level of activity by three months.

We believe that this relatively simple technique is an excellent method of treatment in appropriately selected patients.
Failure of active extension after traumatic cubitus varus
Authors: Smith I. J. , Williams C. P.
Published: February 2018

In children cubitus varus is common after malunion of a supracondylar fracture of the humerus. Later problems such as tardy ulnar nerve palsy, snapping of the lateral triceps tendon or ulnar nerve and posterolateral rotatory instability are well documented. We present a case of anteromedial dislocation of the entire triceps tendon with loss of extensor power and describe the method of treatment.
Ischaemic preconditioning of skeletal muscle
Authors: Bushell A. J. , Klenerman L. , Taylor S. , Davies H. , Grierson I. , Helliwell T. R. , Jackson M. J.
Published: February 2018

Ischaemic preconditioning is a process by which exposure of a tissue to a short period of non-damaging ischaemic stress leads to resistance to the deleterious effects of a subsequent prolonged ischaemic stress. It has been extensively described in the heart, but few studies have examined the possibility that it can occur in skeletal muscle. We have used a rat model of ischaemia of one limb to examine this possibility. Exposure of the hind limb to a period of ischaemia of five minutes and reperfusion for five minutes significantly protected the tibialis anterior muscle against the structural damage induced by a subsequent period of limb ischaemia for four hours and reperfusion for one hour. This protection was evident on examination of the muscle by both light and electron microscopy. Longer or shorter times of prior ischaemia had no effect.
In vivo physiological changes in the synovial membrane of the knee during reperfusion after arthroscopy
Authors: Felländer-Tsai L. , Högberg E. , Wredmark T , Arner P.
Published: February 2018

We have used in vivo microdialysis to monitor postoperative physiological events in the synovial membrane after arthroscopy. The levels of lactate were significantly higher in the synovial membrane than in the reference tissue (subcutaneous fat) and there was a significant increase in lactate after operation. Blood flow, measured as the ethanol ratio, was stable in both tissues.

Our findings show that there was an increase in the local production of lactate since the levels of lactate in blood and the reference tissue were comparable and did not show a significant increase. There was also a consumption of glucose in the synovial membrane which was not observed in the reference tissue. The levels of pyruvate were higher in the synovial membrane.

A state of reperfusion occurs in the synovial membrane after moderate trauma such as standard arthroscopy of the knee. Microdialysis should be further evaluated in studies of the in vivo physiology of the synovial membrane.
The pathogenesis of Schmorl’s nodes
Authors: Peng B. , Wu W. , Hou S. , Shang W. , Wang X. , Yang Y.
Published: February 2018

We examined the pathogenesis of Schmorl’s nodes, correlating the histological findings from 12 lumbar vertebrae with the corresponding conventional radiographs, tomographs, MR images and CT scans. The last revealed round, often multiple cystic lesions with indistinct sclerotic margins beneath the cartilaginous endplate. The appearances are similar to the typical CT changes of osteonecrosis. Histological examination of en-bloc slices through Schmorl’s nodes gave clear evidence of subchondral osteonecrosis. Beneath the cartilage endplate, we found fibrosis within the marrow cavities with the disappearance of fat cells. Osteocytes within bone trabeculae were either dead or had disappeared. We suggest that Schmorl’s nodes are the end result of ischaemic necrosis beneath the cartilaginous endplate and that herniation into the body of the vertebra is secondary.
Primary and revision lumbar discectomy
Authors: Morgan-Hough C. V. J. , Jones P. W. , Eisenstein S. M.
Published: February 2018

We present a review of 553 patients who underwent surgery for intractable sciatica ascribed to prolapsed lumbar intervertebral disc. One surgeon in one institution undertook or supervised all the operations over a period of 16 years.

The total number of primary discectomies included in the study was 531, of which 42 subsequently required a second operation for recurrent sciatica, giving a revision rate of 7.9%. Factors associated with reoperation were analysed. A contained disc protrusion was almost three times more likely to need revision surgery, compared with extruded or sequestrated discs. Patients with primary protrusions had a significantly greater straight-leg raise and reduced incidence of positive neurological findings compared with those with extruded or sequestrated discs. These patients should therefore be selected out clinically and treated by a more enthusiastic conservative programme, since they are three times more likely to require revision surgery.
Femoral impaction grafting with cement in revision total hip replacement
Authors: Halliday B. R. , English H. W. , Timperley A. J. , Gie G. A. , Ling R. S. M.
Published: February 2018

We report the results of cancellous femoral impaction grafting with cement in revision hip arthroplasty in all patients from one centre who had undergone surgery more than five years previously. A total of 32 surgeons undertook femoral impaction grafting in 207 patients (226 hips). There were no deaths attributable to the revision surgery; 33 patients with 35 functioning hips died with less than five years’ follow-up. One patient was lost to follow-up. Two hips (1%) developed early postoperative infection. Of the 12 stems which underwent a further surgical procedure for aseptic failure, ten were for femoral fracture and two for loosening.

Survivorship with any further femoral operation as the endpoint was 90.5% (confidence intervals, 82 to 98) and using femoral reoperation for symptomatic aseptic loosening as the endpoint, the survivorship was 99.1% (confidence intervals, 96 to 100) at 10 to 11 years. As a consequence of the experience in this series, we have modified our technique with an increased use of longer stems with impacted allograft. Long stems are indicated when the host bone around the tip of a short stem is compromised, in patients with major loss of bone stock, or when a femoral fracture occurs.
The rhomboid flap: a simple technique to cover the skin defect produced by excision of a mucous cyst of a digit
Authors: Imran D. , Koukkou C. , Bainbridge L. C.
Published: February 2018

Rhomboid flaps were used rather than rotation flaps for skin cover after excision of mucous cysts of the finger in six patients. The rhomboid flap is a safe, reliable technique which is more easily taught and applied than the rotation flap.
Traumatic dislocation of the atlanto-occipital joint
Authors: Govender S. , Vlok G. J. , Fisher-Jeffes N. , Du Preez C. P.
Published: February 2018

We present four patients who had sustained a traumatic dislocation of the atlanto-occipital joint. The diagnosis was initially missed in two patients. One patient, who was neurologically intact, was treated non-operatively. The remaining three recovered neurologically after an occipitocervical fusion. Early recognition of the injury, especially in multiply-injured patients with head injuries, and timely management may improve survival and neurological recovery.
Outcome of calf deep-vein thrombosis after total knee arthroplasty
Authors: Wang C.-J. , Wang J.-W. , Weng L.-H. , Hsu C.-C. , Lo C.-F.
Published: February 2018

We investigated the outcome of deep-vein thrombosis (DVT) in the calf after total knee arthroplasty (TKA) in 48 patients (45 women and three men) by clinical assessment and venographic study between three and four years after surgery. The mean age of the patients was 67.2 ± 7.7 years (52 to 85) and the mean follow-up was 42.6 ± 2.7 months (38 to 48). The diagnosis was osteoarthritis in 47 patients and rheumatoid arthritis in one patient. There were 44 calf thrombi, four popliteal thrombi but no thrombi in the femoral or iliac regions. Of the 48 patients, 24 were clinically symptomatic and 24 were asymptomatic. Clinical examination was carried out on 41 patients, of whom 37 underwent ascending venography. Seven were evaluated by telephone interview.

No patient had the symptoms or signs of recurrent DVT, venous insufficiency in the affected leg, or a history of pulmonary embolism. No patient had been treated for complications of their DVT. Thirty-six of the 37 venographic studies were negative for either old or new DVT in the affected leg. One patient had residual thrombi in the muscular branches of the veins.

Our study shows that deep-vein thromboses in the calf after TKA disappear spontaneously with time. No patient developed a recurrent DVT, proximal propagation or embolisation. Treatment of DVT in the calf after TKA should be based on the severity of the symptoms during the immediate postoperative period.
Sensory dysfunction in the great toe in hallux valgus
Authors: Herron M. L. , Kar S. , Beard D. , Binfield P.
Published: February 2018

Injury to the dorsomedial cutaneous nerve in the foot may occur after operations for hallux valgus. Pressure neuropathy before operation is also described but remains largely unexplored. We have investigated the incidence of sensory deficit in the great toe before operating for hallux valgus and examined to what extent any deficit was related to the degree of angulation of the joint.

Forty-three patients with a total of 61 great toes with hallux valgus presenting for consideration of surgical correction had their sensation tested in pre-designated zones using a five-filament set of Semmes-Weinstein monofilaments. These allowed good inter-observer reliability with an intra-class correlation coefficient of 0.84.

Sensory symptoms were noted by only 21% of the patients, a measurable reduction in sensation by one monofilament grade or more was found in an additional 44%. No relationship was found between the degree of sensory loss and the degree of angulation.

Patients with symptomatic hallux valgus may have sensory loss in the toe without being aware of it. Normal subjective sensation does not reliably predict normal sensory function. Given the potentially high rates of nerve damage following operations for hallux valgus, we recommend objective sensory testing as part of routine assessment before surgery.
Treatment of anaemia after joint replacement
Authors: Sutton P. M. , Cresswell T. , Livesey J. P. , Speed K. , Bagga T.
Published: February 2018

After total hip and knee replacement arthoplasty, patients may become anaemic and may be prescribed oral iron. There is, however, no published evidence that this is of benefit when used postoperatively. We treated 72 patients who were anaemic after primary total hip and knee arthroplasty by randomly allocating them to receive six weeks of either oral ferrous sulphate (35 patients) or a placebo (37 patients). Both groups of patients were similar in all aspects except for the treatment given. There was no statistically significant difference in the change of haemoglobin levels between the two groups. We therefore believe that the prescription of iron to all anaemic patients postoperatively should be avoided. The level of serum ferritin should be monitored at preoperative assessment.
Hidden blood loss following hip and knee arthroplasty
Authors: Sehat K. R. , Evans R. L. , Newman J. H.
Published: February 2018

Following total hip arthroplasty (THA) and total knee arthroplasty (TKR) only the ‘visible’ measured blood loss is usually known. This underestimates the ‘true’ total loss, as some loss is ‘hidden’. Correct management of blood loss should take hidden loss into account.

We studied 101 THAs and 101 TKAs (with re-infusion of drained blood). Following THA, the mean total loss was 1510 ml and the hidden loss 471 ml (26%). Following TKA, the mean total loss was 1498 ml. The hidden loss was 765 ml (49%). Obesity made no difference with either operation.

THA involves a small hidden loss, the total loss being 1.3 times that measured. However, following TKA, there may be substantial hidden blood loss due to bleeding into the tissues and residual blood in the joint. The true total loss can be determined by doubling the measured loss.
Distal radio-ulnar joint subluxation following intramedullary nailing of the radius in a child
Authors: Kapoor V. , Theruvil B. , Warwick D. J. , Uglow M. G.
Published: February 2018

We describe a patient with fractures of both bones of the forearm in whom flexible intramedullary nail fixation of the radius alone led to ulnar malunion and a symptomatic distal radio-ulnar joint subluxation. This was successfully treated by ulnar osteotomy.
Geo-inspired model: Agents vectors naturals inspired by the environmental management (AVNG) of water tributaries
Authors: Millán Rojas Edwin Eduardo , Pérez Castillo José Nelson , Verástegui González Fredy Antonio
Published: February 2018

Contexto: La gestión para cuidar el medio ambiente y la Tierra (geo) puede ser una fuente de inspiración para desarrollar modelos que permitan abordar problemas de complejidad; el objetivo de esta investigación fue desarrollar un aspecto adicional de los modelos inspirados. El modelo geoinspirado tiene dos características, la primera cubre aspectos relacionados con la gestión ambiental y el comportamiento de los recursos naturales, y la segunda tiene un componente de ubicación espacial asociado con objetos existentes en la superficie de la Tierra.Método: El enfoque desarrollado en la investigación es descriptivo y su principal objetivo es la representación o caracterización de un estudio de caso dentro de un contexto particular.Resultados: El resultado fue el diseño de un modelo para emular el comportamiento natural de los afluentes del agua de las estribaciones del Amazonas, con el fin de ampliar la aplicación de los modelos inspirados y permitir el uso de elementos como la georreferenciación y la gestión ambiental. El modelo de geoinspiración propuesto se denomina "agentes de vectores naturales inspirados en la gestión ambiental".Conclusiones: Los agentes vectores naturales geoisnpirados son elementos poliformados que pueden asumir el comportamiento de las entidades ambientales, lo que permite avanzar en otros campos de gestión ambiental (uso del suelo, clima, flora, fauna) y vincular las cuestiones ambientales con la estructura del proyecto modelo.
Diseño y construcción de una interfaz háptica de seis grados de libertad
Authors: Vivas Alban Oscar Andres , Piamba Mamián Marco Fidel , Otaya Bravo Yamid Estiven
Published: February 2018

Contexto: Múltiples aplicaciones tecnológicas están empezando a incluir dispositivos de realimentación háptica, los cuales envían al usuario algún tipo de realimentación que a su vez se traduce en sensación. Este trabajo incursiona en la construcción de uno de estos dispositivos hápticos.Método: El presente trabajo muestra el procedimiento de diseño y posterior construcción de una interfaz háptica que permite seis grados de movimiento independiente con su respectiva realimentación.Resultados: Se obtuvo una interfaz háptica de seis grados de libertad, la cual permite el movimiento de un cursor en un ambiente virtual constituido por un cubo dentro del computador. Dicha interfaz envía al usuario una realimentación de fuerza cuando el cursor virtual toca alguno de los lados del cubo virtual.Conclusiones: La interfaz háptica construida proporciona una adecuada sensación háptica en el ambiente virtual construido. Dicha interfaz podrá ser probada y utilizada en diversos proyectos que pretendan ofrecer mayor percepción al usuario.
KARAKTER KIMIA KECAP IKAN DARI VISCERA IKAN MANYUNG (Arius sp.) YANG DIFERMENTASI DENGAN KADAR GARAM YANG BERBEDA Chemical characteristic of fish sauce from sea cat fish (Arius sp.) viscera fermented with different salt concentration
Authors: Rianingsih Laras , Ibrahim Ratna , Anggo Apri Dwi
Published: February 2018

ABSTRAK   Salah satu kelemahan dari fermentasi tradisional adalah waktu fermentasi yang lama, untuk produk kecap ikan memerlukan waktu berbulan-bulan atau bahkan mencapai 2 tahun. Untuk menanggulangi masalah diatas dilakukan penelitian dengan menurunkan kadar garam untuk mempercepat proses hidrolisis protein pada produksi kecap ikan. Pengaruh dari perbedaan garam (15%, 20% dan 25% b/b) pada karakteristik kimia (total nitrogen, TVB, TMA dan amoniak) kecap ikan yang dibuat dari viscera Ikan Manyung (Arius sp.) diamati setelah 45 hari fermentasi. Produk kecap ikan dari viscera Ikan Manyung (Arius sp.) mengandung total N yang lebih rendah, TVBN, TMA dan ammonia dengan bertambahnya garam. Hasil terbaik adalah pada perlakuan kadar garam 20% karena telah mampu memenuhi standar kecap ikan dari Codex Allimentarius pada parameter total N, serta kadar TVBN, TMA dan amoniak yang relatif rendah.   Kata kunci: Kecap ikan; viscera ikan manyung, garam, karakter kimia     ABSTRACT   One of the drawbacks of traditional fermentation is a relatively long incubation. To overcome the problem above can be done by decreased levels of salt to accelerate hydrolysis in fish sauce production. The effect of different concentration salt (15%, 20% and 25% w/w )on the chemical characteristic(total nitrogen, TVB, TMA, dan ammonia) in fish sauce made from cat fish (Arius sp.) viscera were monitored after 45 days fermentation period. Fish sauce product from cat fish (Arius sp.) viccera contain lower total nitrogen, TVBN, TMA, ammonia with the increasing of salt. The best result was in the 20 % salt addition that could meet the Codex Allimentarius standard in total nitrogen content, and the value of TVB, TMA and ammonia was relative low compared to the other treatment.  Keywords: Fish sauce, cat fish viscera, salt, chemical characteristic
ANALISIS BAHAN ORGANIK DENGAN KUALITAS TANAH TERHADAPUKURAN DAUN BAKAU (Rhizopora mucronata Lamk) DI HUTAN MANGROVE DESA MOJO, ULUJAMI, PEMALANG (Analisis of Organic Matter and Soil Quality on the Size of Mangrove Leaf at Mojo Village, Ulujami Pemalang)
Authors: Ismoyo Untung , Hendrarto Boedi , Suryanti Suryanti
Published: February 2018

ABSTRAK Bakau (Rhizopora mucronata) merupakan salah satu jenis mangrove yang terdapat pada kawasan rehabilitasi hutan mangrove Desa Mojo, Kabupaten Pemalang.Jenis mangrove ini ditanam karena bibitnya mudah diperoleh dan disemai sehingga mendominasi pada kawasan tersebut.Untuk mengetahui faktor-faktor yang berkaitan dengan pertumbuhan mangrove, maka telah dilakukanpenelitian tentang hubungan antara kualitas tanahdengan luasan helai daun mangrove.Jumlah sampel yang digunakan adalah405helai daun yang dipilih dengan kondisi yang sama dan berasal dari 9 stasiun penelitian. Dalam stasion yangsama dilakukan pula pengambilan sampel tanah sampai kedalaman 50 cm, untuk dianalisis kandungan bahan organik dan sifat fisik-kimia.  Sampel daun yang diperoleh kemudian diproses dalam photo studio mini buatan untuk diambil gambarnya menggunakan kamera digital beresolusi tinggi dalam jarak 30 cm dan dihitung luasannya denganperangkat lunak komputer Corel Draw X7.Analisis data menggunakan PCA dan hasilnya menunjukkan, bahwa dari semua variabel yang diukur dari tanah, maka hanya faktorbahan organik saja yang memiliki korelasi positif tinggi dengan luasan daunR. mucronata. Kata kunci: Pohon Bakau, Luasan Daun, Hutan Mangrove Desa Mojo ABSTRACT Mangrove (Rhizopora mucronata) is one of the mangrove species found in the rehabilitation area of mangrove forest of Mojo Village, Pemalang Regency. This type of mangrove is grown because the seeds are easy to obtain and sowing so as to dominate in the area. To know the factors related to the growth of mangroves, so has been conducted research on the relationship between soil quality with the extent of mangrove leaves. The number of samples used is 405 leaf blades selected under the same conditions and derived from 9 research stations. In the same station, soil sampling is done up to 50 cm depth, to analyze organic material content and physical-chemical properties. The leaf samples were then processed in an artificial mini studio photo to be photographed using a high resolution digital camera within 30 cm and calculated the extent of Corel Draw X7 computer software. Analysis of data using PCA and the results show, that of all variables measured from the soil, then only the factor of organic material alone has a high positive correlation with the leaf area of R. mucronata. Keywords: Mangrove, Leaf Extents, Mojo Village’s Mangrove Forest
Hubungan pola konsumsi minuman beralkohol terhadap kejadian hipertensi pada tenaga kerja pariwisata di Kelurahan Legian
Authors: Jayanti I Gusti Ayu Ninik , Wiradnyani Ni Ketut , Ariyasa I Gede
Published: February 2018

Background:  The shift in lifestyle in tourism environment in Legian Village triggers alcohol consumption. Excessive consumption of alcoholic beverages will have an impact on long-term health of one of them increased levels of cortisol in the blood so that the activity of rennin-angiotensin aldesterol system (RAAS) increases and causes blood pressure to rise.Objectives: To determine the correlation between consumption patterns of alcoholic beverage with incidence of tourism labor hypertension in Legian. Methods: Design of crossectional study with sample of 87 tourism worker. Blood pressure measurement using Sphygmomanometer and stethoscope. The consumption pattern of alcoholic beverages is obtained by using the form of SQ-FFQ (Semi Quantitative Food Frequency Qualitiative).Results: The most common type of alcoholic beverage is beer with a percentage of 40.2%. A total of 48.3% of respondents consumed alcoholic beverages with a mild amount and as much as 56.3% of respondents often consumed alcoholic beverages. There was a significant correlation between beverage type and hypertension (rs = 0.433), total consumption and hypertension (rs = 0.566).Conclusion: There was a significant correlation between consumption pattern of alcoholic beverages with incidence of hypertension in tourism labor in Legian Village
On the History of the Exhibition
Authors: Heesen Anke Te
Published: February 2018

This comment on The Object as Ambassador forum provides the basis for a deeper understanding of the history of exhibitions through its historical analysis of the terms museum, collection, and exhibition.
A Short History of the Picture as Box
Authors: Powell Amy Knight
Published: February 2018

In “The Crisis of the Easel Picture” (1948), Clement Greenberg compares the easel picture, disparagingly, to a box-like cavity cut into the wall. In this essay, I argue that late medieval panel paintings—which indeed often took the form of boxes—show Greenberg to be justified in making this comparison, if not in doing so disparagingly. But what Greenberg failed to fully acknowledge is that the easel picture had already long tried to escape this condition through the opening of the metaphor of the window. Failing to recognize this earlier effort to escape the material conditions of the box, many modernists and postmodernists, like Greenberg, attempting to move beyond the easel picture in the name of an art undivided from life, have unintentionally upheld the easel picture’s own escapist ideology.
Functional Redundancy of DICER Cofactors TARBP2 and PRKRA During Murine Embryogenesis Does Not Involve miRNA Biogenesis
Authors: Pullagura Sri Ramulu N , Buaas Bill , Gray Nichelle , Krening Lindsey C , Srivastava Anuj , Braun Robert E
Published: February 2018

Several in vitro studies have suggested that canonical microRNA (miRNA) biogenesis requires the DICER cofactors TARBP2 and PRKRA for processing of pre-miRNAs to mature miRNAs. To investigate the roles of TARBP2 and PRKRA in miRNA biogenesis in vivo, and to determine possible functional redundancy, we first compared the phenotypes of Tarbp2 and Prkra single and double mutants. In contrast to Dicer −/− embryos, which die by embryonic day 7.5 (E7.5), single Tarbp2 −/− and Prkra −/− mice survive beyond E7.5 and either die perinatally or survive and exhibit cranial/facial abnormalities, respectively. In contrast, only a few Tarbp2 −/−; Prkra −/− double mutants survived beyond E12.5, suggesting genetic redundancy between Tarbp2 and Prkra during embryonic development. Sequencing of miRNAs from single-mutant embryos at E15.5 revealed changes in abundance and isomiR type in Tarbp2 −/−, but not Prkra −/−, embryos, demonstrating that TARBP2, but not PRKRA, functions in miRNA biogenesis of a subclass of miRNAs, and suggesting that functional redundancy between TARBP2 and PRKRA does not involve miRNA biogenesis.
De portador de conocimiento a mediador de saberes disciplinares: el perfil del profesor de bibliotecología-archivística y ciencia de la información
Authors: Jaramillo Orlanda
Published: February 2018

El texto presenta un panorama sobre el perfil del profesor de bibliotecología-archivística y ciencia de la información, el cual depende tanto de las características del plan de estudios (proyecto pedagógico, modelo educativo) como de las características del profesor. Los resultados se presentan en dos apartados: uno relacionado con la búsqueda documental, en el cual se expone mapas de ideas, agrupados en cuatro áreas (fundamentación teórica, organización y representación de la información y el conocimiento, gerencias y TIC); el otro corresponde a las características propias de los profesores adscritos a las universidades colombianas que imparten formación en el área.
Una secuencia didáctica para favorecer la conversión de representaciones semióticas de curvas y regiones del plano complejo
Authors: Aznar María-Andrea , Distéfano María-Laura , Moler Emilce , Pesa Marta
Published: February 2018

En este trabajo se presentan la descripción, y los resultados de la implementación de una secuencia didáctica orientada a favorecer la habilidad de efectuar conversiones de representaciones de curvas y regiones del plano complejo, desde el registro gráfico al registro algebraico. Se detallan las variables de conversión que regulan los niveles de complejidad en estas actividades cognitivas, que determinaron la estructura de la secuencia didáctica presentada. Esta fue implementada con un grupo de estudiantes de la asignatura Álgebra de primer año de la Facultad de Ingeniería de la Universidad Nacional de Mar del Plata, Argentina. Se evaluó el impacto de la intervención didáctica realizada y se obtuvieron resultados satisfactorios, no solo sobre las conversiones a las que buscó específicamente contribuir, sino también en prácticas matemáticas que requieren otras actividades semióticas vinculadas a representaciones de números complejos en los dos registros considerados.
The Comparison of Soundness Level of Islamic Banks in Indonesia and Malaysia
Authors: Hosen Muhamad Nadratuzaman , Muhari Syafaat
Published: February 2018

This study was conducted to analyze the soundness comparison of Islamic banks in Indonesia and Malaysia to measure the readiness of Islamic banks in both countries In facing of financial integration in the ASEAN Economic Community (AEC) by 2020. The study uses data of annual financial statements in 10 Islamic banks in each country in period 2012-2014 using CAMEL Method. The results of this study indicate that Islamic banks in Malaysia are relatively better prepared compared to Islamic banks in Indonesia. Islamic Banks in Malaysia tend to be more soundness than Islamic Banks in Indonesia during periods of 2012 to 2014.  The implication based on finding indicated that the Islamic banks in Indonesia need improvement in the product diversification both on financing or funding to compete in ASEAN Region.DOI: 10.15408/etk.v17i1.6711
Foreign Direct Investment or External Debt and Domestic Saving: Which has Greater Impact on Growth
Authors: Djulius Horas
Published: February 2018

The choice taken by developing countries in meeting the lack of development funds has a varying effect. This study clarifies the role of foreign direct investment (FDI) compared to foreign loans and domestic savings in short- and long-term economic growth of Indonesia. Data were obtained from World Bank and Bank Indonesia and used in error correction model to explain the linkage between predictors and economic growth. We show that in the short run, the three explanatory variables significantly affect economic growth. In the long run, compared to FDI and foreign loans, domestic savings positively and significantly affect economic growth. This study emphasizes the importance of sustaining domestic savings to maintain the stability of economic fundamentals in the long term.DOI: 10.15408/etk.v17i1.7120