bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiplex Recombinase Polymerase Amplification Assay for Simultaneous Detection of Treponema pallidum and Haemophilus ducreyi in yaws-like lesions
Authors: Frimpong Michael , Simpson Shirley Victoria , Ahor Hubert Senanu , Agbanyo Abigail , Gyabaah Solomon , Agbavor Bernadette , Amanor Ivy Brago , Addo Kennedy Kwasi , Böhlken-Fascher Susanne , Kissenkötter Jonas , Wahed Ahmed Abd El , Phillips Richard Odame
Published: August 2020

Yaws is a skin debilitating disease caused by Treponema pallidum subspecies pertenue with most cases reported in children. World Health Organization (WHO) aims at total eradication of this disease through mass treatment of suspected cases followed by an intensive follow-up program. However, effective diagnosis is pivotal in the successful implementation of this control program. Recombinase polymerase amplification (RPA), an isothermal nucleic acid amplification technique offers a wider range of differentiation of pathogens including those isolated from chronic skin ulcers with similar characteristics such as Haemophilus ducreyi (H. ducreyi). We have developed a duplex RPA assay for the simultaneous detection of Treponema pallidum (T. pallidum) and H. ducreyi (TPHD-RPA). TPHD-RPA assay demonstrated no cross-reaction with other pathogens and enable detection of T. pallidum and H. ducreyi within 15 minutes at 42 oC. The duplex RPA assay was validated with 49 clinical samples from individuals confirmed to have yaws by serological tests. Compared with commercial multiplex real-time PCR, the TPHD-RPA assay demonstrated 94-95% sensitivity for T. pallidum and H. ducreyi confirmed samples, respectively and 100% specificity. This simple novel TPHD-RPA assay enables the rapid detection of both T. pallidum and H. ducreyi in yaws-like lesions. This test could support the yaws eradication programs by ensuring effective diagnosis as well as enable monitoring of eradication efforts success or failure and planning of follow-up interventions at the community level.
Validation of Sentinel-3 SAR Level-2 and Level-3 Products in the Baltic Sea and Estonian lakes
Authors: Liibusk Aive , Kall Tarmo , Rikka Sander , Uiboupin Rivo , Suursaar Ülo , Tseng Kuo-Hsin
Published: August 2020

Multimission satellite altimetry (e.g. ERS, Envisat, TOPEX/Poseidon, Jason) data have enabled a synoptic view of ocean variations in the past decades, including sea-level rise and mesoscale circulations. Since 2016, the Sentinel-3 mission has provided better spatial and temporal sampling compared with its predecessors. The Sentinel-3 Ku/C Radar Altimeter (SRAL) is one of the synthetic aperture radar altimeters (SAR Altimeter) which is more precise in coastal and lake observations. In this study, we validate Sentinel-3 Level-2 products in Baltic Sea coastal areas and two lakes in Estonia. Moreover, the Copernicus Marine Environment Monitoring Service (CMEMS) Level-3 sea-level anomaly data and the Nucleus for European Modelling of the Ocean (NEMO) reanalysis model outcomes are compared with measurements from a tide gauge network. A dense in situ water level network deployed along the coast for geodetic observation was utilised to provide ground truths for validating altimetry results. Three validation methods were used for Level-2 data: (i) collocated Sentinel-3 and GNSS ship measurements; (ii) a national geoid model (EST-GEOID2017) with sea-level anomaly correction; (iii) collocated Sentinel-3 and buoy measurements. The validations were carried out in seven Sentinel-3A/B overpasses in 2019. Our results show that the uncertainty of the Sentinel-3 Level-2 altimetry product is below decimetre level on the Estonian coast and the targeted lakes. Results from CMEMS Level-3 showed a correlation of 0.8 (RMSE 0.19 m) and 0.91 (RMSE 0.27 m) when compared against tide gauge measurements and NEMO model, respectively.
Pulsed Telecommunication Signals of Non-ionizing Radiation Affect Amyloid Precursor Protein and α-Synuclein Metabolism in Non-neural Human Cells
Authors: STEFI AIKATERINA , SKOUROLIAKOU KATERINA , MARGARITIS LUKAS , VASSILACOPOULOU DIDO
Published: August 2020

The expanding use of devices emitting Pulsed Telecommunication Signals (PTS) has launched a serious debate over the possible effects of electromagnetic radiation (EMR) on living organisms. Our previous work has indicated that PTS exposure alters Amyloid Precursor Protein (APP) and alpha-synuclein (α-syn) metabolism in human cells of neural origin, providing a possible connection between exposure and neurodegeneration. This investigation aimed to reveal, in vitro in human non-neural cells (HEK293), the aftermath of the same exposure on the processing of APP and α-syn. Data presented here, indicate changes in APP metabolism, acquisition of different cellular topologies of the newly generated APP fragments, changes in monomeric α-syn accumulation and multimerization, indicating that APP and α-syn processing is possibly altered in the periphery by EMR. These effects are accompanied by a substantial increase in the levels of Reactive Oxygen Species (ROS). Further investigation is required in order to provide insights into the interaction of PTS with non-neural cells affecting the peripheral systemic functional stability. This is necessary because nowadays whole body human exposure from various EMR sources is a fact in normal life with the valid estimation that they may be increased in view of the forthcoming 5G telecommunications network implementation.
ПРЕДВАРИТЕЛЬНЫЕ ИТОГИ ИЗУЧЕНИЯ ОСНОВНЫХ ПОКАЗАТЕЛЕЙ ИММУННОЙ СИСТЕМЫ У ПАЦИЕНТОВ С НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИЕЙ COVID-19
Authors: Курлаева Любовь , Степанова Ксения , Степанова Татьяна , Кальгина Галина , Григорьева Светлана , Панина Цахик , Сидоренко Ольга , Сиюткина Ольга , Семенюк Евгения
Published: August 2020

Комплексная оценка основных показателей иммунной системы пациентов с новой коронавирусной инфекцией показала их разнонаправленные изменения. При индивидуальном анализе иммунологических показателей вирусных больных у 24% выявлена лейкопения, у 14 % абсолютная лимфопения, что является проявлением иммунодефицитного состояния. Высокие значения фагоцитарной активности нейтрофилов, уровня миелопероксидазы, концентрации интерлейкина-8 указывают на активацию врожденного иммунитета. Натуральные киллеры как представители неспецифического иммунитета изменяются в противоположном направлении: абсолютное количество NK снижается в 1,9 раза (р>0,05). Это может ослабить иммунную защиту, которую осуществляют основные клетки противовирусного иммунитета.
Quality Measure Public Reporting Is Associated with Improved Outcomes Following Hip and Knee Replacement
Authors: Bozic Kevin , Yu Huihui , Zywiel Michael G. , Li Li , Lin Zhenqiu , Simoes Jaymie L. , Dorsey Sheares Karen , Grady Jacqueline , Bernheim Susannah M. , Suter Lisa G.
Published: August 2020

Background:

Given the inclusion of orthopaedic quality measures in the Centers for Medicare & Medicaid Services national hospital payment programs, the present study sought to assess whether the public reporting of total hip arthroplasty (THA) and total knee arthroplasty (TKA) risk-standardized readmission rates (RSRRs) and complication rates (RSCRs) was temporally associated with a decrease in the rates of these outcomes among Medicare beneficiaries.

Methods:

Annual trends in national observed and hospital-level RSRRs and RSCRs were evaluated for patients who underwent hospital-based inpatient hip and/or knee replacement procedures from fiscal year 2010 to fiscal year 2016. Hospital-level rates were calculated with use of the same measures and methodology that were utilized in public reporting. Annual trends in the distribution of hospital-level outcomes were then examined with use of density plots.

Results:

Complication and readmission rates and variation declined steadily from fiscal year 2010 to fiscal year 2016. Reductions of 33% and 25% were noted in hospital-level RSCRs and RSRRs, respectively. The interquartile range decreased by 18% (relative reduction) for RSCRs and by 34% (relative reduction) for RSRRs. The frequency of risk variables in the complication and readmission models did not systematically change over time, suggesting no evidence of widespread bias or up-coding.

Conclusions:

This study showed that hospital-level complication and readmission rates following THA and TKA and the variation in hospital-level performance declined during a period coinciding with the start of public reporting and financial incentives associated with measurement. The consistently decreasing trend in rates of and variation in outcomes suggests steady improvements and greater consistency among hospitals in clinical outcomes for THA and TKA patients in the 2016 fiscal year compared with the 2010 fiscal year. The interactions between public reporting, payment, and hospital coding practices are complex and require further study.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Risk Factors for Revision of Polished Taper-Slip Cemented Stems for Periprosthetic Femoral Fracture After Primary Total Hip Replacement
Authors: Lamb J.N. , Jain S. , King S.W. , West R.M. , Pandit H.G.
Published: August 2020

Background:

Total hip replacement (THR) with a cemented polished taper-slip (PTS) femoral stem has excellent long-term results but is associated with a higher postoperative periprosthetic femoral fracture (PFF) risk compared with composite beam stems. This study aimed to identify risk factors associated with PFF revision following THR with PTS stems.

Methods:

In a retrospective cohort study, 299,019 primary THRs using PTS stems from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) were included, with a median follow-up of 5.2 years (interquartile range [IQR], 3.1 to 8.2 years). The adjusted hazard ratio (HR) of PFF revision was estimated for each variable using multivariable Cox survival regression analysis.

Results:

Of 299,019 THR cases, 1,055 underwent revision for PFF at a median time of 3.1 years (IQR, 1.0 to 6.1 years). The mean age (and standard deviation) was 72 ± 9.7 years, 64.3% (192,365 patients) were female, and 82.6% (247,126 patients) had an American Society of Anesthesiologists (ASA) class of 1 or 2. Variables associated with increased PFF were increasing age (HR, 1.02 per year), intraoperative fracture (HR, 2.57 [95% confidence interval (CI), 1.42 to 4.66]), ovaloid (HR, 1.96 [95% CI, 1.22 to 3.16]) and round cross-sectional shapes (HR, 9.58 [95% CI, 2.29 to 40.12]), increasing stem offset (HR, 1.07 per millimeter), increasing head size (HR, 1.04 per millimeter), THR performed from 2012 to 2016 (HR, 1.45 [95% CI, 1.18 to 1.78]), cobalt-chromium stem material (HR, 6.7 [95% CI, 3.0 to 15.4]), and cobalt-chromium stems with low-viscosity cement (HR, 22.88 [95% CI, 9.90 to 52.85]). Variables associated with a decreased risk of PFF revision were female sex (HR, 0.52 [95% CI, 0.45 to 0.59]), increasing stem length (HR, 0.97 per millimeter), and a ceramic-on-polyethylene bearing (HR, 0.55 [95% CI, 0.36 to 0.85]).

Conclusions:

Increased risk of PFF revision was associated with PTS stems that are short, have high offset, are used with large femoral heads, are made of cobalt-chromium, or have ovaloid or round cross-sectional shapes. Large increases in PFF risk were associated with cobalt-chromium stems used with low-viscosity cement. Further study is required to confirm causation.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Implications of Aging Population Demographics on the Delivery of Primary Total Joint Arthroplasty in a Bundled Payment System
Authors: Petersen William P. , Teo Greg Michael , Friedlander Scott , Schwarzkopf Ran , Long William J.
Published: August 2020

Background:

The Centers for Medicare & Medicaid Services (CMS)’s Bundled Payments for Care Improvement (BPCI) program provides a set payment for the provision of primary total joint arthroplasty (TJA) care regardless of age and risk factors. Published literature indicates that the cost of care per episode of TJA increases with age. We examined the implication of this relationship and the effect of projected changes of age demographics on our center’s BPCI experience.

Methods:

A retrospective review of prospectively collected data on 1,662 Medicare BPCI patients undergoing primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) from 2013 to 2016 at a single orthopaedic institution was performed. The relationship between age and cost of care was first determined in our analysis of our BPCI experience. We then performed a cost analysis by age group with respect to our institution’s profit or loss per episode of care. A forecast for shifting age demographics in our region, modeled by the U.S. Census Bureau’s Federal-State Cooperative for Population Estimates (FSCPE) and Projections (FSCPP), was used to evaluate the financial implications for our BPCI program.

Results:

Our institution sustains a significant loss of $1,934 (p < 0.001) per case for patients 85 to 99 years of age, which is offset by profits associated with treating patients in younger age groups. This age group (85 to 99 years of age) will double by the year 2040 in our region, whereas the youngest age group (65 to 69 years of age) is projected to marginally increase by 12%. The average cost of care per primary TJA will rise because of the predicted shifting age demographics, compounded by an estimated 3% inflation rate. Utilizing the current BPCI reimbursement rate, we project an inflection point of declining profits after the year 2030 with the given projections for our regional population.

Conclusions:

The regional population served by our institution is aging. This shift will lead to an increased cost of care and diminishing profits for TJA after 2030. The CMS’s BPCI initiative and novel alternative payment models (APMs) should consider age as a modifier for reimbursement to incentivize care for the vulnerable and older age groups.

Clinical Relevance:

The findings of the present study are clinically relevant for decision-making regarding the allocation of resources in the setting of an aging population.
The 3 Sagittal Morphotypes That Define the Normal Cervical Spine
Authors: Virk Sohrab , Lafage Renaud , Elysee Jonathan , Louie Philip , Kim Han Jo , Albert Todd , Lenke Lawrence G. , Schwab Frank , Lafage Virginie
Published: August 2020

Background:

Cervical alignment is vital for maintaining horizontal gaze and sagittal balance. The aims of this study were to summarize previously published descriptions of normative cervical alignment and to analyze a cohort of asymptomatic volunteers in order to identify natural clusters of normal radiographic parameters.

Methods:

We performed a systematic review of the literature on radiographic measurements of asymptomatic volunteers through a search of MEDLINE and ScienceDirect databases. We then performed an analysis of demographic and radiographic parameters of volunteers without back or neck complaints. Only subjects with a chin-brow vertical angle (CBVA) within previously published normal limits were retained for analysis. A 2-step cluster analysis was used to find natural groups of cervical alignment. Differences among groups were investigated with a post hoc analysis of variance (ANOVA).

Results:

We included 37 articles in our analysis. There was a broad spectrum of both C2-C7 lordosis-kyphosis and T1 slope across ages and sexes. Of the 119 asymptomatic volunteers who were available for analysis, 84 (with a mean age [and standard deviation] of 49.0 ± 17.1 years) had a CBVA ranging from −4.7° to 17.7°. The cluster analysis identified 3 alignment groups based on cervical lordosis-kyphosis and T1 slope (silhouette measure of cohesion, >0.6). Twenty-seven volunteers (32.1%) were identified as the “kyphotic curve cohort” (KCC) (mean C2-C7 Cobb angle, −8.6° ± 7.3°; mean T1 slope, 17.4° ± 6.6°), 43 volunteers (51.2%) were identified as the “medium lordosis cohort” (MLC) (mean C2-C7 Cobb angle, 8.7° ± 7.2°; mean T1 slope, 26.6° ± 4.0°), and 14 volunteers (16.7%) were identified as the “large lordosis cohort” (LLC) (mean C2-C7 Cobb angle, 21.2° ± 7.2°, mean T1 slope, 39.5° ± 6.4°) (p < 0.001 for both). Moving from KCC to LLC, there was a significant decrease in C0-C2 lordosis (p = 0.016). Examination of the cervical vertebral orientation demonstrated that C4 had a constant orientation relative to the horizontal (p = 0.665). Correlation analysis between C2-C7 and vertebral orientations again demonstrated that C4 orientation was independent of C2-C7 alignment.

Conclusions:

We have identified 3 morphotypes of the cervical spine based on C2-C7 alignment and T1 slope. These findings demonstrate the broad definition of normal cervical alignment and the range of cervical lordosis-kyphosis that is acceptable.
Microstructural and Mechanical Properties of Grafts Commonly Used for Cruciate Ligament Reconstruction
Authors: Castile Ryan M. , Jenkins Matthew J. , Lake Spencer P. , Brophy Robert H.
Published: August 2020

Background:

Injuries to the anterior cruciate ligament and posterior cruciate ligament are common, and often are treated with reconstruction. Limited quantitative data are available describing material properties of grafts used for reconstructions such as the bone-patellar tendon-bone (BPTB), hamstring tendon (HS), and quadriceps tendon (QT). The purpose of this study was to quantify and compare microstructural and mechanical properties of BPTB, HS, and QT grafts.

Methods:

Forty specimens (13 BPTB, 13 HS, and 14 QT grafts) from 24 donors were used. Specimens were subjected to preconditioning, stress relaxation, and ramp to failure. Mechanical parameters were calculated for each sample, and polarization imaging was used to evaluate the direction and strength of collagen fiber alignment during testing.

Results:

QT had the largest modulus values, and HS had the smallest. BPTB exhibited the least disperse collagen organization, while HS were the least strongly aligned. Microstructural properties showed more strongly aligned collagen with increasing load for all grafts. All tissues showed stress relaxation and subtle microstructural changes during the hold period.

Conclusions:

The mechanical and microstructural properties differed significantly among BPTB, HS, and QT grafts. QT exhibited the largest moduli and greatest strength of collagen alignment, while HS had the smallest moduli and least strongly aligned collagen.

Clinical Relevance:

This study identified mechanical and microstructural differences among common grafts and between these grafts and the cruciate ligaments they replace. Further research is needed to properly interpret the clinical relevance of these differences.
An Update on Cementless Femoral Fixation in Total Hip Arthroplasty
Authors: Kheir Michael M. , Drayer Nicholas J. , Chen Antonia F.
Published: August 2020

➤ Cementless stems can be categorized using the updated classification system.

➤ Short stems were designed as an alternative to conventional stems with the advantage of bone preservation, and they have grown in popularity with promising results; however, long-term outcomes are lacking.

➤ Hydroxyapatite coating appears to have no advantage with respect to stem loosening.

➤ The literature has shown no difference in revision rates between modular and nonmodular stems; however, with the advantages of equalizing limb lengths and offset come the drawbacks of corrosion and junctional fatigue failure of modular implants.

➤ There is increasing use of cementless stems, including in octogenarians, with promising outcomes compared with cemented stems; however, there is a higher risk of periprosthetic fractures with cementless fixation, particularly in elderly female patients.
Blood Management for Elective Orthopaedic Surgery
Authors: Palmer Antony J.R. , Gagné Sylvain , Fergusson Dean A. , Murphy Michael F. , Grammatopoulos George
Published: August 2020

➤ Strategies to conserve blood and reduce exposure to allogeneic blood improve outcomes after orthopaedic surgery.

➤ A multidisciplinary team approach, including surgeons, anesthesiologists, hematologists, and other medical specialties, is required to deliver optimal blood management.

➤ Key steps are to optimize preoperative hemoglobin levels, administer antifibrinolytics, use cell salvage for procedures with high blood loss, and adhere to restrictive transfusion thresholds.
Acetabular Labral Reconstruction with Iliotibial Band Autograft
Authors: Philippon Marc J. , Arner Justin W. , Crawford Matthew D. , Bolia Ioanna K. , Briggs Karen K.
Published: August 2020

Background:

Labral reconstruction has been shown to result in improved patient-reported outcomes (PROs) at mid-term follow-up in patients with a deficient labrum. The purpose of this study was to determine survivorship and PROs at a minimum 10-year follow-up.

Methods:

A retrospective evaluation of a prospectively collected single-surgeon database included 91 hips (89 patients) that underwent arthroscopic labral reconstruction with iliotibial band autograft between 2006 and 2008. The primary PRO was the Hip Outcome Score (HOS)-activities of daily living (ADL). The modified Harris hip score (mHHS), HOS-sports, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and patient satisfaction (on a scale of 1 to 10) were also collected at a 10-year minimum follow-up. Survivorship analysis curves were evaluated.

Results:

Eighty-two hips were evaluated at a 10-year minimum follow-up. Overall survivorship, with revision hip arthroscopy or total hip arthroplasty (THA) as the end point, was 70% at 5 years and 61% at 10 years, and the mean survival time was 9 years (95% confidence interval = 7.6 to 10 years). For the patients who did not undergo subsequent surgery, on average the mHHS increased from 60 preoperatively to 82 at the 10-year follow-up (p = 0.001), the HOS-ADL improved from 69 to 90 (p = 0.004), the HOS-sports improved from 43 to 76 (p = 0.001), and the median patient satisfaction was 10 of 10. Eighty percent of the patients achieved the minimal clinically important difference (MCID) in the HOS-ADL, and 87% obtained a patient acceptable symptom state (PASS).

Conclusions:

Following arthroscopic labral reconstruction with iliotibial band autograft, 9% of the hips underwent revision arthroscopy and 27% underwent THA. At 10 years, the survival rate, with revision hip arthroscopy or THA as the end point, was 61%; however, for those with >2 mm of joint space, the current indication for labral reconstruction, the 10-year survival rate was 90%. Excellent PROs and patient satisfaction were reported by those who did not require revision or THA. With appropriate patient selection and prevention of postoperative adhesions, labral reconstruction results in excellent outcomes and high patient satisfaction that is sustained at a minimum 10-year follow-up.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Hitting the Target: Natural History of the Hip Based on Achieving an Acetabular Safe Zone Following Periacetabular Osteotomy
Authors: Wyles Cody C. , Vargas Juan S. , Heidenreich Mark J. , Mara Kristin C. , Peters Christopher L. , Clohisy John C. , Trousdale Robert T. , Sierra Rafael J.
Published: August 2020

Background:

Periacetabular osteotomy (PAO) remains the gold-standard treatment for acetabular dysplasia in skeletally mature patients with preserved cartilage. The purpose of this multicenter cohort study was to delineate the long-term radiographic natural history of the dysplastic hip following PAO based on the final position of the acetabular fragment.

Methods:

We evaluated patients who underwent PAO performed by 4 hip preservation surgeons to treat acetabular dysplasia with or without concomitant retroversion from 1996 to 2012 at 3 academic institutions. There were 288 patients with a mean clinical and radiographic follow-up of 9 years (range, 5 to 21 years). Postoperative radiographs made at the first clinical visit were used to determine if the acetabular fragment fell into a safe zone according to the absence of retroversion, a lateral center-edge angle (LCEA) of 25° to 40°, an anterior center-edge angle (ACEA) of 25° to 40°, and a Tönnis angle of 0° to 10°. Every available subsequent radiograph was assessed for degenerative changes by the Tönnis classification (grades 0 to 3). The time to progression was analyzed using Cox proportional hazards regression and multistate modeling.

Results:

Only the absence of retroversion was independently associated with a decreased risk of progressing at least 1 Tönnis grade during follow-up: hazard ratio (HR), 0.60 (95% confidence interval [CI], 0.38 to 0.94; p = 0.025). Achieving the ACEA safe zone yielded the greatest time increase for remaining in Tönnis grade 0 or 1 (43 years for having an ACEA in the safe zone compared with 28 years for not having an ACEA in the safe zone), followed by the absence of retroversion (34 years for the absence of retroversion compared with 24 years for the presence of retroversion). However, attaining the Tönnis angle or LCEA safe zones did not delay progression. The achievement of additional safe zones generally increased the length of time that patients spent in Tönnis grade 0 or 1: 25 years for 0 safe zones, 36 years for 1 safe zone, 29 years for 2 safe zones, 37 years for 3 safe zones, and 44 years for 4 safe zones.

Conclusions:

This study demonstrates the importance of achieving appropriate acetabular reorientation to enhance the longevity of the native hip following PAO. Although the LCEA and the Tönnis angle are the most common metrics used to assess appropriate acetabular correction, this study shows that adequately addressing retroversion and the ACEA has a greater impact on improving the natural history.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Hip Resurfacing Compared with 28-mm Metal-on-Metal Total Hip Replacement
Authors: Vendittoli Pascal-André , Shahin Maged , Rivière Charles , Roy Alain Guy , Barry Janie , Lavigne Martin
Published: August 2020

Background:

Bone stock conservation, hip anatomy preservation, and greater stability are among the promoted advantages of hip resurfacing (HR). However, the disappointing failure of some implants nearly led to its abandonment. The aim of this study was to compare clinical scores and revision and complication rates after HR with those after total hip arthroplasty (THA).

Methods:

Two hundred and three hips were randomized to 28-mm metal-on-metal (MoM) THA (99 hips) or to HR (104 hips). Main outcome measures compared between groups were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, the revision rate, and the complication rates. The radiographic findings were also assessed.

Results:

After a mean follow-up of 15 years (range, 14 to 16 years), 9 (4.4%) of the 203 patients were lost to follow-up and 15 (7.4%) had died. The Kaplan-Meier survivorship, with revision for any reason as the end point, was 89.2% (95% confidence interval [CI], 82.3% to 96.1%) for HR and 94.2% (95% CI, 89.3% to 99.1%) for THA (p = 0.292). The reasons for revision included infection (3 patients), recurrent dislocation (1 patient), and adverse reaction to metal debris (ARMD) (1 patient) in the THA group and ARMD (2 patients) and femoral head loosening (7 patients) in the HR group. With aseptic revision as the end point, the Kaplan-Meier survivorship was significantly higher in the THA group (97.4% versus 89.2%; p = 0.033). No dislocation occurred in the HR group compared with 4 in the THA group (p = 0.058). Both groups achieved a similar mean WOMAC score (10.7 in the HR group and 8.8 in the THA group; p = 0.749), Forgotten Joint Score (87.1 and 85.3, respectively; p = 0.410), University of California Los Angeles (UCLA) activity score (6.3 and 6.4, respectively; p = 0.189), and overall joint perception (p = 0.251).

Conclusions:

The specific HR and MoM 28-mm THA implants used in this study showed good long-term survival and function. The overall rates of complications and revisions were similar in both groups but were of different types. As it provides better femoral bone preservation and biomechanical reconstruction, HR may continue to have a role in selected patients when performed by experienced surgeons and using validated implants.

Level of Evidence:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
More Predictable Return of Motor Function with Mepivacaine Versus Bupivacaine Spinal Anesthetic in Total Hip and Total Knee Arthroplasty
Authors: Wyles Cody C. , Pagnano Mark W. , Trousdale Robert T. , Sierra Rafael J. , Taunton Michael J. , Perry Kevin I. , Larson Dirk R. , Amundson Adam W. , Smith Hugh M. , Duncan Christopher M. , Abdel Matthew P.
Published: August 2020

Background:

Spinal anesthesia provides several benefits for patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), but historically comes at the cost of slow and unpredictable return of lower-extremity motor function related to the use of long-acting local anesthetics. In this prospective, double-blinded, randomized clinical trial we sought to determine if an alternative local anesthetic, mepivacaine, would allow more consistent return of motor function compared with low-dose bupivacaine spinal anesthesia during primary THA and TKA.

Methods:

This trial was conducted at a single academic institution. Prior to trial initiation an internal pilot study determined that 154 patients were required to achieve 80% power. Patients were randomized in a 1:1 fashion with use of advanced computerized stratification based on procedure, age group, sex, and body mass index. Following the surgical procedure, motor function was assessed every 15 minutes in the nonoperative lower extremity according to the Bromage scale and discontinued once Bromage 0 was achieved (spontaneous movement at hip, knee, and ankle).

Results:

Return of lower-extremity function was more predictable in patients who received mepivacaine than in those who received low-dose bupivacaine. Among patients who received mepivacaine, 1% achieved motor function return beyond 5 hours compared with 11% of patients who received bupivacaine (p = 0.013). The mean time to return of lower-extremity motor function was 26 minutes quicker in patients who received mepivacaine (185 minutes; 95% confidence interval, 174 to 196 minutes) compared with low-dose bupivacaine (210 minutes; 95% confidence interval, 193 to 228 minutes) (p = 0.016). There were no significant differences in safety outcomes including pain scores, time to participation in physical therapy, incidence of orthostatic hypotension, urinary retention, or transient neurologic symptoms in patients receiving mepivacaine compared with low-dose bupivacaine.

Conclusions:

In patients undergoing primary THA and TKA, spinal anesthesia with mepivacaine allowed more consistent return of lower-extremity motor function compared with low-dose bupivacaine, without a concomitant increase in complications potentially associated with spinal anesthetics. This is particularly of value in an era of short-stay and outpatient surgical procedures.

Level of Evidence:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Risk Factors for Reoperation Following Final Fusion After the Treatment of Early-Onset Scoliosis with Traditional Growing Rods
Authors: Du Jerry Y. , Poe-Kochert Connie , Thompson George H. , Hardesty Christina K. , Pawelek Jeff B. , Flynn John M. , Emans John B. ,   Pediatric Spine Study Group
Published: August 2020

Background:

Although there is a high rate of reoperation after final fusion following the treatment of early-onset scoliosis with use of traditional growing rods, the risk factors for reoperation are unknown. The purpose of the present study was to identify risk factors associated with the need for reoperation after final fusion for the treatment of early-onset scoliosis.

Methods:

A multicenter database for patients with early-onset scoliosis was retrospectively analyzed. Patients managed with traditional growing rods and final fusion were identified (n = 248). The inclusion criteria were ≥1 lengthening procedure with traditional growing rods and ≥2 years of follow-up after final fusion or revision surgery within 2 years after final fusion (167 patients; 67%). Patients requiring reoperation following final fusion were compared with patients who did not require reoperation. The data that were analyzed included demographic characteristics, comorbidities, spinal deformity characteristics, radiographic measurements, perioperative details, and complications during all stages of treatment. A multivariate regression model was used to identify independent risk factors.

Results:

The mean duration of follow-up from the initial visit to the latest visit was 10.7 ± 4.1 years, and the mean duration of follow-up after final fusion was 4.9 ± 3.1 years. Thirty-two (19%) of the 167 patients required reoperation following final fusion. Curve progression requiring revision surgery during lengthening with traditional growing rods (adjusted odds ratio [aOR], 21.137 per event; p = 0.028), the number of levels spanned with traditional growing rods (aOR, 1.378 per level; p = 0.007), and the duration of treatment with traditional growing rods (aOR, 1.220 per year; p = 0.035) were independently associated with revision surgery after final fusion.

Conclusions:

Independent risk factors for curve progression requiring reoperation during lengthening with traditional growing rods that require operative intervention include increasing number of levels spanned with traditional growing rods and longer duration of treatment with traditional growing rods. These findings may help with patient counseling and potentially guide surgeon decision-making.

Level of Evidence:

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
When (Almost) Everyone is Above Average
Authors: Inclan Paul M. , Cooperstein Alisa A. , Powers Alexa , Dy Christopher J. , Klein Sandra E.
Published: August 2020

Introduction:

The American Orthopaedic Association introduced standardized letters of recommendations (SLORs) to improve on traditional letters of recommendations by “providing a global prospective on an applicant.” However, no study has defined the utilization of SLORs, the distribution of applicant ratings in SLORs, or the impact of sex, race, or degree of involvement between the letter writer and applicant on SLOR domain ratings.

Methods:

One-hundred seventy-nine applications were randomly selected from all applicants submitted to a single, academic orthopaedic residency program. A single reviewer extracted both applicant characteristics and SLOR characteristics from applications. Descriptive statistics, chi-square tests, and nonparametric one-way analysis of variance analysis were conducted.

Results:

Six hundred twenty-eight letters of recommendation from 179 applicants were analyzed. Four hundred ninety-seven of 628 (79.1%) letters contained a SLOR. Mean percentile ratings were calculated for all the following domains: patient care (mean ± SD = 86.7 ± 8.7), medical knowledge (87.2 ± 8.6), interpersonal and communication (87.7 ± 9.3), procedural (86.6 ± 8.9), research (88.9 ± 9.0), ability to work within a team (89.6 ± 8.4), professionalism (90.8 ± 7.3), initiative and drive (90.6 ± 7.6), and commitment to orthopaedic surgery (91.1 ± 6.7). Forty-eight percent of applicants were indicated as “ranked to guarantee match.” When compared with male applicants, female applicants demonstrated higher percentile ratings in patient care (88.6 ± 8.2 vs. 86.3 ± 8.7, p = 0.010), interpersonal and communication skills (90.6 ± 7.3 vs. 86.9 ± 9.6, p < 0.001), and ability to work within a team (91.3 ± 6.3 vs. 89.2 ± 8.8, p = 0.045). Higher United States Medical Licensing Examination step 1 (r = 0.08, p = 0.05) and step 2 scores (r = 0.10, p = 0.02) correlated with higher medical knowledge ratings. The number of publications (r = 0.3, p < 0.001) and presentations (r = 0.25, p < 0.001) correlated with research ratings.

Conclusion:

SLORs demonstrated a profound ceiling effect, potentially limiting the utility of the instrument for the comparison of applicants. Future modifications to this instrument may include measures to better delineate between applicants.
Turn To Turn Short Circuit Classification In Induction Motor Stator Windings Caused By Isolation Failure Using Neural Network (NN) Method
Authors: Diah Prahmana karyatanti Iradiratu , Yan Dewantara Belly , Rahmatullah Daeng , Jeihan Irawan Barli
Published: August 2020

Almost all industries use induction motors as production aids, this is due to several reasons, namely, the resulting rotational speed is constant, the induction motor does not have a brush so that the friction loss can be reduced, and easy maintenance. In this study is to detect damage to the stator winding caused by lamination of the windings so that a short circuit occurs in one phase, which is also called a turn fault. The Fast Fourier Transform (FFT) method is used to detect currents with a load of 0%, and 100% which will later be detected for classification on the Neural Network (NN). Categorizing the level of loading and the level of damage experienced by induction motors, namely turn to turn u1, turn to turn u1 and v1, and turn to turn u1, v1 and w1. The reading of the test results conducted on the Neural Network has good prediction results because the Mean Squared Error (MSE) produced does not exceed the specified 5% erracy level.
Design of Monitoring and Control of Energy Use in Multi-storey Buildings based on IoT
Authors: Wisaksono Arief , Purwanti Yanik , Ariyanti Novia , Masruchin Masruchin
Published: August 2020

This study discusses monitoring and control systems. Energy use in buildings or high-rise buildings based on IoT. In general, standard buildings are designed and built without regard to automation with supporting technology, namely a system installed to control and monitor the building services responsible for lighting, cooling, electricity. and others IOT-based energy monitoring and control using two serial communication systems run together which are managed by the Blink application using two micro controllers in one package, one microcontroller for monitoring and detecting how much electrical energy is used continuously with fixed looping and another microcontroller for sensor control, so that the automation system can turn on and turn off the electrical energy that is supplied to each floor. Lined serial communication systems are used to ensure system continuity, by using this communication system the control can be done right The results obtained from the process are monitoring and controlling energy both AC lights or other usage in real time
Quick Diagnostics Of New Infectious Coronavirus
Authors: Murodkhonovich Boboev Muhammadayubkhon , Shahzoda Ramazonova
Published: August 2020

The emergence in December 2019 of diseases caused by the new coronavirus (2019-nCoV) posed difficult challenges for healthcare professionals and doctors related to the rapid diagnosis and clinical management of patients with this infection.
Relationship of HbA1c with Fasting Blood Glucose on Diagnostic Values and Lifestyle in Type II Diabetes Mellitus Patients
Authors: Anggraini Rahayu , Nadatein Ima , Astuti Puji
Published: August 2020

Early diagnosis of DM (Diabetes Mellitus) is very important in reducing complications. HbA1c has been recommended as a diagnosis of diabetes in the guidelines for clinical practice as a determination of type 2 diabetes in 2011 by WHO, but is there a significant relationship between HBA1c and fasting blood glucose levels (GDP) in a person after being diagnosed with Diabetes Mellitus. In this study, the relationship between HbA1c and GDP levels was assessed through observational cross-sectional analytic based studies. The research method uses a large sample selected through the GDP test (> 125 mg / dl) of 17 people (5 men and 12 women). Statistical analysis of the test of the relationship between the HbA1c results and GDP with the Pearson Correlation, Crosstabs, and independent T test to determine the relationship of sex with GDP and HBA1c. The results of the study, there was a significant relationship between levels of GDP with HBA1c with p = 0.002, where the incidence of GDP (> 125 mg / dl) in men was 17.7% and women were 52.9%, while the results of HBA1c (> 6.5 %) in men 23.5% and women 52.9%. In conclusion, the results of HBA1c (> 6.5%) can be used for diagnosis of DM, whereas the level of GDP is only to know that people with diabetes have changed their lifestyle or not, and it is found that women are more easily change lifestyles than men, due to GDP results (<125 mg / dl) of 11.8% higher than the HBA1c yield (<6.5%) of 5.9%.
Caracterización de los conectores SMA de una línea de transmisión a través de sus parámetros S
Authors: Rodríguez-Rojas Santiago Isaac , Sánchez-Choachí Johan Sebastián , Romero-Noguera Jorge Andrés , Saavedra-Melo Miguel Ángel
Published: August 2020

En este documento se presentan el análisis y los resultados relevantes relacionados con la caracterización de los conectores SMA acoplados a una línea de transmisión de 50 Ω. Dicha caracterización se llevó a cabo utilizando un analizador de espectros FSH8 Rohde & Schwarz, con el cual se midieron dos de sus parámetros S y se compararon con el comportamiento en simulación de la línea con y sin los conectores. El error relativo obtenido en cada caso evidencia algunos de los efectos encontrados por la influencia de los conectores y permite realizar un acercamiento al comportamiento esperado en este tipo de implementación. Por otra parte, también se puede concluir que los conectores SMA aportaron un corrimiento en frecuencia de la resonancia de la línea, así como un cambio en su atenuación, también se puede establecer que una calibración adecuada y completa de los puertos del equipo que se utilice en mediciones en altas frecuencias es fundamental para la obtención de resultados correctos y para descartar fuentes de eventuales errores. De igual forma, es viable reproducir desde la simulación los principales efectos que pueden tener los conectores utilizados en una medición de radiofrecuencia. Finalmente, dado que cada conector aporta errores particulares imposibles de predecir con certeza, es necesario el uso de técnicas de procesamiento adicionales que permitan minimizar estos errores.
An assessment of Antimicrobial Activity of Three Endodontic Sealers on Enterococcus faecalis, Candida albicans and Staphylococcus aureus by a Direct Contact Test: An In Vitro Study
Authors: Chakraborty Trishnika , Taneja Sonali
Published: August 2020

For successful endodontic treatment, the antimicrobial property of endodontic filling is mandatory. Hence, the aim of this in vitro study was to assess the antibacterial efficacy of three endodontic sealers on Enterococcus faecalis, Candida albicans and Staphylococcus aureus by direct contact test (DCT).Materials and MethodsThe antimicrobial efficacy of three different sealers, AH Plus, MTA Fillapex and Endo Sequence BC, was tested against Enterococcus faecalis ATCC 29212, Candida albicans ATCC 10231 and Staphylococcus aureus ATCC 25923 by DCT. Freshly mixed sealers were placed in flat bottom test tubes incubated at 37°C. Thereafter, 10 μL of suspension was drawn and spread over culture plates to determine the colony count using a digital colony counter. Readings were taken at 1 hr (fresh specimen), and then at 24 hrs (after setting). The results were tabulated, and statistical analysis was performed using one-way ANOVA and Tukey’s HSD test.ResultsDCT showed a significant decrease in microbial count in AH Plus, MTA Fillapex and Endoseq BC at both time intervals. Group 3 (Endosequence BC) showed minimum microbial count followed by Group 2 (MTA Fillapex) and maximum microbial count for Group 1 (AH Plus) for both time intervals (1 hour and 24 hours).ConclusionEndosequence BC showed maximum antimicrobial efficacy against all the tested microorganisms for both time intervals, followed by MTA Fillapex and AH Plus.
Comparison of Out-of-Pocket Expenditure and Catastrophic Health Expenditure for Severe Disease by Health Security System: based on End-stage Renal Disease in South Korea
Authors: Shin Sun Mi , Lee Hee Woo
Published: August 2020

Background: Korea's health security system named National Health Insurance and Medical Aid has revolutionized the nation's mandatory health insurance and continues to reduce excessive copayments. However, few have been studied on healthcare utilization and expenditure according to the health security system in case of severe disease. This study looked at reverse discrimination within end-stage renal disease between National Health Insurance and Medical Aid. Methods: Subjects were a total of 305 diagnosed with end-stage renal disease in Korea Health Panel from 2008 to 2013. Chi-square, t-test, and ANCOVA were conducted to identify healthcare utilization rate, out-of-pocket expenditure, and prevalence of catastrophic expenditure. Mixed effect panel analysis was used to evaluate total out-of-pocket expenditure over a 6-year trend by National Health Insurance and Medical Aid. Results: There were no significant differences in healthcare utilization rate in emergency-room visits, admission, or out-patient department visits between National Health Insurance and Medical Aid because healthcare service was essential for a serious disease such as End-stage Renal Disease.Meanwhile, each out-of-pocket expenditure for admission and out-patient department in National Health Insurance was 2.6 and 3.1 times higher than Medical Aid (P<0.05). A total of out-of-pocket expenditure including emergency-room visits, admission, out-patient department visits, and prescribed drug expenditure was 2.9 times higher in National Health Insurance than those of Medical Aid (P<0.001). Over a 6-year trend for a total of out-of-pocket expenditure, subjects with National Health Insurance spent more than those of Medical Aid (P<0.01). If total household income decile was less than the median and subjects were covered by National Health Insurance, the catastrophic health expenditure rate was 92.2%, but 58.8% in Medical Aid (P<0.001). Conclusion: Serious disease such as end-stage renal disease can result in reverse discrimination depending on the type of health security system. It is necessary to consider those who belong to National Health Insurance but are still poor.