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Significant time and resources are devoted to conducting orthopaedic biomechanics research; however, it is not known how these studies relate to their subsequent clinical studies. The purpose of the present study was to determine whether biomechanically superior treatments were associated with improved clinical outcomes as determined by analogous randomized controlled trials (RCTs). A systematic review was conducted to find RCTs that tested a research question based on a prior biomechanical study. PubMed and SCOPUS databases were queried for orthopaedic randomized controlled trials, and full text articles were reviewed to find RCTs which cited biomechanical studies with analogous comparison groups. A random-effects multi-level logistic regression model was conducted examining the association between RCT outcome and biomechanics outcome, adjusting for multiple outcomes nested within study. In total, 20,261 articles were reviewed yielding 21 RCTs citing a total of 43 analogous biomechanical studies. In 7 instances (16.2%), the RCT and a cited biomechanical study showed concordant results (i.e. the superior treatment in the RCT was also the superior construct in the biomechanical study). RCT outcome was not associated with biomechanical outcome (β = −1.50, standard error = 0.78, p = .05). This study assessed 21 orthopaedic RCTs with 43 corresponding biomechanical studies and found no association between superior biomechanical properties of a given orthopaedic treatment and improved clinical outcomes. Favourable biomechanical properties alone should not be the primary reason for selecting one treatment over another. Furthermore, RCTs based on biomechanical studies should be carefully designed to maximize the chance of providing clinically relevant insights.

BACKGROUND CONTEXT Smoking is detrimental to obtaining a solid spinal fusion mass with previous studies demonstrating its association with pseudoarthrosis in patients undergoing spinal fusion. Varenicline is a pharmacologic adjunct used in smoking cessation which acts as a partial agonist of the same nicotinic receptors activated during tobacco use. However, no clinical or basic science studies to date have characterized if varenicline has negative effects on spinal fusion and bone healing by itself. PURPOSE Our study’s aim was to elucidate whether varenicline affects the frequency or quality of posterolateral spinal fusion in a rodent model at an endpoint of 12 weeks. STUDY DESIGN Randomized control trial. PATIENT SAMPLE Fourteen male Lewis rats randomly separated into two experimental groups. OUTCOME MEASURES Manual palpation of fusion segment, radiography, μCT imaging, and four-point bend. METHODS Fourteen male Lewis rats were randomly separated into two experimental groups undergoing L4–L5 posterior spinal fusion procedure followed by daily subcutaneous injections of human dose varenicline or saline (control) for 12 weeks postsurgery. Spine samples were explanted, and fusion was determined via manual palpation of segments by two independent observers. High-resolution radiographs were obtained to evaluate bridging fusion mass. μCT imaging was performed to characterize fusion mass and consolidation. Lumbar spinal fusion units were tested in four-point bending to evaluate stiffness and peak load. Study funding sources include $5000 OREF Grant. There were no applicable financial relationships or conflicts of interest. RESULTS At 3 months postsurgery, 12 out of 14 rats demonstrated lumbar spine fusion (86% fused) with no difference in fusion frequency between the varenicline and control groups as detected by manual palpation. High-resolution radiography revealed six out of seven rats (86%) having complete fusion in both groups. μCT showed no significant difference in bone mineral density or bone fraction volume between groups in the region of interest. Biomechanical testing demonstrated no significant different in the average stiffness or peak loads at the fusion site of the varenicline and control groups. CONCLUSION Based on the results of our rat study, there is no indication that varenicline itself has a detrimental effect on the frequency and quality of spinal fusion.

Aims A number of methods have been described to remove a well-fixed humeral implant as part of revision shoulder arthroplasty. These include the use of cortical windows and humeral osteotomies. The router bit extraction technique uses a high-speed router bit to disrupt the bone-implant interface. The implant is then struck in a retrograde fashion with a square-tip impactor and mallet. The purpose of this study was to determine the characteristics and frequency of the different techniques needed for the removal of a well-fixed humeral stem in revision shoulder arthroplasty. Patients and Methods Between 2010 and 2018, 288 revision shoulder arthroplasty procedures requiring removal of a well-fixed humeral component were carried out at a tertiary referral centre by a single surgeon. The patient demographics, indications for surgery, and method of extraction were collected. Results Of the 288 revisions, 284 humeral stems (98.6%) were removed using the router bit extraction technique alone. Four humeral stems (1.39%) required an additional cortical window. Humeral osteotomy was not necessary in any procedure. Most of the humeral stems removed (78.8%) were cementless. Of the four humeral stems that required a cortical window, three involved removal of a hemiarthroplasty. Two were cemented and two were cementless. Conclusion The router bit extraction technique removed a well-fixed humeral component in a very high proportion of patients (98.6%). This method allows surgeons to avoid more invasive approaches involving a cortical window or humeral osteotomy, and their associated complications. Cite this article: Bone Joint J 2019;101-B:1280–1284

Background The early results of reverse shoulder arthroplasty (RSA) were influenced to some extent by the use of first-generation implants and surgeons’ learning curves, resulting in relatively high reoperation rates. The purpose of this study was to quantify the burden of and identify the indications for reoperation after primary RSA using contemporary implants and techniques. Methods A retrospective review of 1649 primary RSAs implanted consecutively between 2009 and 2015 at a single institution was conducted. All arthroplasties were performed by 5 fellowship-trained shoulder surgeons at a tertiary referral center. Demographic characteristics, indications for primary RSA, and reoperations were analyzed and categorized for trends associated with each type of reoperation performed. Results A total of 39 reoperations (2.37%) were performed for a variety of indications. Overall, only a few patients with infection or instability required reoperation (0.55%). The most common indications for reoperation were related to the humeral component (1.03%); the majority of humeral component complications were related to a specific design flaw of 1 implant system. RSAs performed for proximal humeral fracture sequelae more commonly underwent reoperation owing to instability or humeral component–related issues; all 4 cases of aseptic humeral stem loosening occurred in the setting of proximal humeral fracture sequela treatment. Only 0.36% of all primary RSAs required reoperation because of glenoid complications. Conclusions Primary RSA performed with contemporary implants and surgical techniques seems to be associated with a very low rate of reoperation. The most common reasons for reoperation were humeral component fracture for 1 particular implant, humeral loosening, dislocation, infection, and glenoid failure, each occurring at a rate under 1%.

BackgroundThe role of completion lymph node dissection (CLND) in patients with sentinel lymph node (SLN)-positive melanoma continues to be debated. This systematic review and meta-analysis evaluated survival and recurrence rate in these patients who underwent CLND, compared with observation.MethodsA comprehensive MEDLINE and Embase database search was performed for cohort studies and RCTs published between January 2000 and June 2017 that assessed the outcomes of CLND compared with observation in patients with SLN-positive melanoma. The primary outcome was survival and the secondary outcome was recurrence rate. Studies were assessed for quality using the Cochrane risk-of-bias tool for RCTs and Newcastle–Ottawa Scale for cohort studies. Pooled relative risk or hazard ratio with 95 per cent confidence intervals were calculated for each outcome. The extent of heterogeneity between studies was assessed with the I2 test. The protocol was registered in PROSPERO (CRD42017070152).ResultsFifteen studies (13 cohort studies with 7868 patients and 2 RCTs with 2228 patients) were identified for qualitative synthesis. Thirteen studies remained for quantitative meta-analysis. Survival was similar in patients who underwent CLND and those who were observed (risk ratio (RR) for death 0·85, 95 per cent c.i. 0·71 to 1·02). The recurrence rate was also similar (RR 0·91, 0·79 to 1·05).ConclusionPatients with SLN-positive melanoma do not have a significant benefit in survival or recurrence rate if they undergo CLND rather than observation.

Arthroscopic shoulder stabilization is the most commonly used technique to treat shoulder instability; however, recurrence rates have been shown to be high in our literature. Optimizing treating of glenohumeral instability is crucial to improve patient outcomes. This chapter will provide a basic review of the key steps in the evaluation and management of patients with shoulder instability with minimal bone loss.

The general design process starts with defining problems or understanding the target audience. The world is moving toward a more technology-driven society that is pushed by machine learning and artificial intelligence which is also called the 4th wave of the industrial revolution. From this, questions arise regarding how to prepare design students for this changing paradigm in their future careers. Creativity, critical thinking in decision making, and complex problem-solving skills are becoming essential in the era of the 4th wave of the industrial revolution. This paper presents personal perspectives based on the author’s experience in the graphic design process over the last 30 years, starting with questioning the design process and methods that have been used in the design disciplines. The ultimate goal of this study is to open a dialogue, through a case study, on how to prepare students in this rapidly changing world and discuss the future direction in design education.

Oral mucosal melanoma (OMM) is notorious for having a poor prognosis. Recognition of the early features of OMM by both clinicians and pathologists can play an important role in improving survival. Therefore, the purpose of this report is to increase awareness of the early features of OMM, by presenting 2 cases with longitudinal clinical and histopathologic documentation showing progression of OMM from a deceptively bland premalignant (noninvasive) oral melanocytic lesion (POML). By analyzing the clinical and histopathologic features of POML in our cases, and those in the literature, we found that the concerning features are (1) clinically, a pigmented lesion violating the ABCDE criteria or showing multiple recurrences; and (2) histologically, a melanocytic proliferation, in either a lentiginous or pagetoid pattern with or without cellular atypia. Making a diagnosis of POML prospectively is often challenging. Increasing awareness of the clinical and histopathologic features and complete surgical excision of POML are emphasized.

Dissection of bilateral recurrent laryngeal nerve (RLN) nodes is a technically demanding procedure, but robotic systems have been useful for RLN node dissection. This retrospective study investigated the learning curve for bilateral RLN node dissection in esophageal-cancer patients using a robotic system for esophageal cancer. We retrospectively reviewed 33 consecutive patients who received a robotic esophagectomy and total lymphadenectomy by single surgeon. The patients were divided into either group 1 (initial 20 cases) or group 2 (later 13 cases). The mean patient age was 61.88 ± 9.03 years and 28 (84.8%) patients were male. Most cases were pathologically diagnosed as squamous cell carcinoma. The lesion locations included 3 (9.1%) in the upper esophagus, 12 (63.6%) in the mid esophagus, and 9 (27.3%) in the lower esophagus. Eleven (33.3%) cases were stage I, 7 (21.2%) were stage II, and 15 (45.5%) were stage III. One case in group 2 (3%) suffered operative mortality. Operation time, robot console time, and blood loss were similar between the two groups. The timing of right and left RLN node dissection, the number of total dissected lymph nodes, and the percentage of dissected right and left RLN nodes were also comparable. However, the incidence of vocal cord palsy was significantly lower in group 2 (55% vs. 0%, p= 0.02). The incidence of other operative complications did not vary between the two groups. Even though operative outcomes and incidence of other complications were comparable between the two groups, the incidence of vocal cord palsy decreased significantly after 20 cases. Thus, we conclude that a minimum of 20 cases is required before a surgeon is experienced enough to perform safe dissection of bilateral RLN nodes.

Aims Transfusion long after percutaneous coronary intervention (PCI) may pose a significant risk but is not sufficiently understood. We investigated the long-term patterns and impact of transfusion on the clinical outcome of patients undergoing PCI. Methods and results Five-year clinical outcomes of all Korean undergoing PCI using stent in year 2011 (n=48786) were investigated. Primary outcome was the incidence density of transfusion. The association of transfusion with major adverse clinical event (MACE) consisting all-cause death, revascularization, critically ill cardiovascular status, or stroke was assessed after reflecting the propensity of each patient for transfusion and adjusting transfusion frequency and intervals. The 5-year incidence density of transfusion was 4.74 (95% confidence interval [CI] = 4.70–4.79) per 100 person-year. Patients who received transfusion were older, were more often women, and had overall higher frequency of clinical risk factors (p Year of transfusion and outcome Conclusions One out of every 4 Koreans undergoing PCI received transfusion within 5 years, and had 3-fold higher risk of MACE compared to patients without transfusion. These observational findings may warrant the establishment of transfusion strategies for patients undergoing PCI.

Cement is the most commonly used method of achieving fixation of total elbow arthroplasty components. The goal of cementing is to achieve immediate and definitive component fixation. Cementing technique has the potential to impact the short- and long-term outcomes of patients undergoing total elbow arthroplasty. This chapter will review the key technical considerations in cemented total elbow arthroplasty.

There is considerable potential to decarbonise household energy consumption through the electrification of heating systems which can absorb excess renewable power and mitigate power network constraints through intelligent control. However, current standards discourage low carbon electricity sources through outdated assumptions; predicated upon a traditional electricity network which had higher emissions. Consequently, the implementation of product Energy labelling across Europe is biased against electric space and water heating systems in favour of gas. This paper examines the impact of this bias through a case study of the European Union's product labelling directive for domestic hot water systems. Laboratory testing of a market leading electric water tank and an A rated instantaneous gas boiler has demonstrated efficiencies of 87.4% and 72.9% respectively. In spite of this, the labelling directive assigns a C rating to the tank. This is due to a conversion coefficient (CC) within the directive's calculation based on an average electricity generation efficiency of 40% without a similar coefficient for gas. This paper advocates the removal of the CC factor from the directive to normalise the comparison, thus promoting a technology uniquely suited towards absorbing intermittent renewable energy sources with negligible costs.

Contains fulltext : 172380.pdf (Publisher’s version ) (Open Access)

Lack of communication methods due to older adults’ physical and mental decline produce a significant communication gap with friends and family, which creates social and mental distance with them. Also, relatively few studies have been dedicated to developing social media technologies that are older-adult-friendly. The main goals of this initial study were (1) to develop a prototype of story-based communication application based on a touch-based tablet application; and (2) to assess the prototype design using a mixed-method approach. Although anecdotal stereotypes suggest that technology is harder for older adults to learn, this research found that older adults are willing to learn and use communication applications. Results also suggested that intuitive visual cues might play an important role in enabling older adults to grasp and understand the structure of an application. Therefore, this paper tries to expand the scope of designers’ knowledge for the development of tablet-based applications for older adults and find the possibilities of data usage for the related gerontology areas of study.

Mucoceles of the paranasal sinuses are benign, chronic, expanding lesions that characteristically develop because of obstruction of the sinus ostium. The frontal sinus is the most common sinus to be affected by a mucocele, which usually results from trauma or inflammatory processes. Patients with these lesions frequently present with visual complaints of decreased visual acuity, visual field abnormalities, proptosis, ptosis, displacement of the globe, or restricted ocular movements secondary to erosion through the thin bone of the superior orbit and compression on the globe. Often, intracranial extension of frontal sinus mucoceles is also present from erosion through the posterior table of the frontal sinus. Very rarely, they will present as a subcutaneous forehead mass or swelling. To the best of our knowledge, only 5 cases of a frontal sinus mucocele presenting as a forehead subcutaneous mass has been previously reported. We report the case of an 80-year-old woman with a history of remote forehead trauma who presented with a frontal sinus mucopyocele manifesting as a subcutaneous forehead mass eroding through the skin.

Solitary fibrous tumors are an uncommon slow growing benign neoplasm originally described as a pleural neoplasm but can also be found in the lung, mediastinum, peritoneum, or any other sites including the head and neck. Malignant solitary fibrous tumors (MSFT) are extremely rare and only few cases have been published in the literature. There have been 19 cases reported of MSFT in the head and neck, but there are no reports of MSFT located within the scalp in the English language literature. We present a case of MSFT arising in the scalp and describe our experience with the clinical presentation, surgical management, and outcome in this pathological condition.

Background Journal clubs play an important role in the education of orthopaedic surgery residents; however, there are sparse data available on the characteristics that make journal clubs effective. Objective The primary goal of this study was to determine the characteristics of effective journal clubs as identified by orthopaedic residents and faculty. We sought to compare the opinions of residents and faculty in order to identify areas that may benefit from future research and discussion. Design Orthopaedic surgery residents and faculty at residency programs around the country were surveyed anonymously. The survey was designed to determine the contribution of various journal club characteristics on the effectiveness of journal club. Nonparametric statistics were used to test for goodness-of-fit, and to compare responses between faculty and residents. Results A total of 204 individuals participated. The most important goals of journal clubs were teaching the skillset of evaluating scientific papers (2.0 ± 1.2 [mean rank ± standard deviation, on a scale of 6, with 1 being most important]), encouraging participants to read current orthopaedic literature, (2.4 ± 1.1), and instilling career-long habits of reading the orthopaedic literature among residents (3.1 ± 1.3). Mandatory attendance (71.8%), monthly journal clubs (80.9%), resident presentation of articles (86.7%), and discussion of 3 to 5 papers (78.7%) were thought to lead to more effective clubs. The most clinically relevant articles published within the last year (63.8%), and classic articles that have influenced practice (68.1%) were preferred. Participation and attendance (2.4 ± 1.5) and paper selection (2.6 ± 1.5) were the most important characteristics overall. Conclusions In orthopaedics, journal clubs fulfill the role of encouraging reading of the literature, as well as educating residents and faculty. There are many possible club formats, but some are clearly felt to be more effective. Particular attention should be paid to attendance, participation, and paper selection.

Introduction: Several studies have examined tracking pattern of lipid profile level during long follow-up periods in Western countries. However, there have been few such studies in East Asia. Hypothesis: We assessed the hypothesis that there exists tracking pattern of lipid profile level from adolescence to adulthood, and lipid measurements in adolescence can predict adult dyslipidemia in South Korea. Methods: The Kangwha Study was a community-based prospective cohort study that started in 1986 in Kangwha County, South Korea . A total of 400 participants (54% women) whose serum total cholesterol, triglyceride, and high density lipoprotein (HDL) cholesterol level were measured at least once during adolescence (1992-1996), and repeatedly measured at least once during adulthood (2005-2015) were enrolled in our study. Body mass index, waist circumstance, and blood pressure were measured at all measurements. Family history of cardiovascular disease, smoking history, and presence of adult dyslipidemia were checked at adulthood. The tracking pattern of lipid profile level was determined by tracking coefficients (low: Results: The presence of adult dyslipidemia was 26.3% (105 of 400). Mean age of study participants at enrollment is 13.8 years (SD, 1.6 years), and that at adulthood is 30.1 years (SD, 3.7 years). When adjusted for age, body mass index, waist circumstance, and blood pressure, the tracking coefficient of total cholesterol was 0.59 (95% confidence interval (CI), 0.54-0.63), that of triglyceride was 0.39 (95% CI, 0.28-0.49), and that of HDL cholesterol was 0.51 (95% CI, 0.46-0.55). The AUC value of our multiple logistic regression model on adult dyslipidemia without lipid profile levels at adolescence was 0.77 (95% CI, 0.72-0.83), and that with lipid profile levels at adolescence was 0.80 (95% CI, 0.75-0.85). P value for AUC comparison was significant (p=0.02). In additional analyses, using the average lipid profile levels in multiple lipid measurements at adolescence did not significantly improve the AUC value (p>0.09). Conclusion: In conclusion, moderate tracking patterns of serum lipid profile level were shown in this study. Serum lipid profile measurements at adolescence could help the prediction of adult dyslipidemia. The results of this study supported the need of lipid profile screening at adolescence.

Massive irreparable rotator cuff tears cause significant shoulder pain and dysfunction. Physical therapy (PT), arthroscopic debridement with biceps tenotomy (AD-BT), and hemiarthroplasty (HA) are treatments shown to reduce pain and improve quality of life. Reverse total shoulder arthroplasty (RTSA) is a newer surgical treatment option that may offer improved function. A cost-effectiveness analysis of these interventions has never been performed, and no head-to-head comparative effectiveness trials currently exist. A Markov decision analytic model was used to compare RTSA, HA, AD-BT, and PT as treatments for elderly patients with massive irreparable rotator cuff tears. Probabilities for complications, perioperative death, conversion procedures, and reoperations were derived from the literature, and costs were determined by average Medicare reimbursement rates from 2011. Reverse total shoulder arthroplasty yielded the most quality-adjusted life years (QALY) with 7.69, but greater benefits came at higher costs compared with other treatments. Sensitivity analyses showed that PT was the most cost-effective intervention at a health utility of 0.75 or greater (QALY 7.35). The health utility of RTSA was 0.72 or less (QALY 7.48) or RTSA probability of no complications was 0.83 or less (QALY 7.48 at cost of $23,830). Reverse total shoulder arthroplasty yielded benefits at a cost considered good value for money compared with other treatments. Reverse total shoulder arthroplasty is the preferred and most cost-effective treatment option for elderly patients with massive irreparable rotator cuff tears. For patients seeking pain relief without functional gains, AD-BT can be considered a cost-effective and cheaper alternative. The cost-effectiveness analysis approach can help guide clinical practice as well as the policies of health care systems and insurers. [ Orthopedics. 2017; 40(1):e65–e76.]

The aim of this study was to evaluate the expression of surface molecules in splenic dendritic cells (DC) in multiple-organ dysfunction syndrome (MODS) mice and their effects on the immunosuppression of sepsis and MODS. One hundred thirty C57BL/6 mice were divided into 7 groups: 6, 12, 24, 48 h, 5-7 days, 10-12 days, and the normal control group. The sepsis-MODS mouse model was established by zymson injection into the peritoneal cavity. Histopathological changes in the spleen were evaluated by hematoxylin and eosin (HE) staining. After enrichment with BDTM IMag, the expressions of PD-1, PD-L1, MHC-II (I-A(b)), and CD86 in splenic DCs were examined by flow cytometry, and their relationship with sepsis development and MODS was analyzed. The histological structures of the spleen were damaged in the 24-, 48-h, and 10-12-day groups. PD-L1 expression increased 6 h after zymosan injection, decreased to normal levels at 24 and 48 h, and increased at 5-7 days, peaking at 10-12 days. The change in PD-1 expression roughly paralleled that of PD-L1. MHC-II and CD86 increased at 6 and 12 h, and dropped to normal levels at 10-12 days. In the early stage of injury, splenic DCs were mainly activated, whereas in the later stage, the expressions of the negative co-stimulatory molecules, PD-L1 and PD- 1, were upregulated, similar to tolerogenic DCs. Splenic DCs might suppress the stimulation of T lymphocytes in MODS mice through the PD-L1/PD-1 pathway, which would induce immunosuppression and the pathogenesis of MODS.

BACKGROUND CONTEXT Smoking is detrimental to obtaining a solid spinal fusion mass with previous studies demonstrating that tobacco use is associated with pseudoarthrosis in patients undergoing spinal fusions. Additionally, smoking is an important predictor of increased dissatisfaction, decreased walking ability, increased pain medication use, and poorer quality of life scores in patients after spine surgery when compared to nonsmokers. Accordingly, physicians make significant efforts toward helping patients discontinue their use of nicotine products. Varenicline is a nonscheduled prescription medication that works as a partial agonist of nicotinic acetylcholine receptors, the same receptors activated during smoking and tobacco use, and is used as a pharmacologic adjunct to aid patients in smoking cessation. However, no clinical or basic science studies to date have characterized if varenicline has the same negative effects as nicotine on spinal fusion, consolidation, and bone healing. PURPOSE As a partial agonist of nicotine receptors, our study aimed to elucidate whether varenicline affects the rate or quality of spinal fusion. STUDY DESIGN/SETTING Manual, radiographic, and biomechanical testing. PATIENT SAMPLE A total of 14 Lewis rats undergoing L4-5 lumbar spinal fusion. OUTCOME MEASURES Gross motion, radiographic density, peak load, and stiffness of fusion mass METHODS According to our IACUC approved protocol, fourteen male Lewis rats underwent tail amputation to create an autogenous bone graft from the tailbone followed by a lumbar L4-5 posterior spinal fusion procedure. Postsurgery, rats were randomly separated into two experimental groups receiving either daily subcutaneous injections of human dose (1mg/kg daily in saline) varenicline or saline (placebo) for 12 weeks postsurgery. Spine samples were then explanted and fusion was determined via manual palpation of segments by two independent blinded observers. Radiographic analysis of fusion was performed via high-resolution radiographs evaluating bridging fusion mass. Rat lumbar spinal fusion units were then tested in 4-point bending to evaluate stiffness and peak load before failure. Comparisons were made between groups (significance at p RESULTS At three months postsurgery, twelve out of fourteen rats demonstrated lumbar spine fusion (86% fused) with no difference in fusion rate between the varenicline and control groups (6/7, 86%). Fusion rate as detected by manual palpation indicated no motion in the desired fusion segment. Findings were further supported with faxitron radiography demonstrating six out of seven rats (86%) having complete fusion consisting of contiguous transverse processes bilaterally at a single level in each of the varenicline and placebo control groups. Of the six successfully fused specimens, five from each group underwent successful biomechanical testing. The average stiffness at the fusion site of the varenicline group and control group was 49.2±17.5N/mm and 69.1±32.6N/mm, respectively (p=.271). The average peak load at the fusion site of the varenicline group and control group was 51.9±25.2N and 60.5±20.4N, respectively (p=.574). CONCLUSIONS Varenicline has no significant effect on the rate and quality of spinal fusions and remains an appropriate pharmaceutical adjunct for tobacco cessation in individuals undergoing spinal fusion.

Purpose This study examined a palmar beak fracture model to determine which thumb carpometacarpal (CMC) joint ligament is the primary ligament relevant to the pattern of injury. Methods Six fresh-frozen cadaveric wrists were used. The radius, ulna, and first metacarpal were secured and tested with a materials testing system, holding the wrist in 20° extension, 20° ulnar deviation, and 30° palmar abduction of the first metacarpal. Testing consisted of preconditioning cycles followed by compressive loading at 100 mm/s. We confirmed fractures with fluoroscopy and dissected the specimens to examine the CMC joint ligaments. The metacarpal was stressed through a range of motion to determine which maneuvers reduced or displaced the fractures. Results Our model successfully created palmar beak fractures in all cadaveric specimens. All fractures were displaced and intra-articular. The anterior oblique ligament (AOL) was thin and partially attached to the palmar beak fracture fragment. The ulnar collateral ligament was attached in its entirety to the fracture fragment and represented a thicker, more robust ligament compared with the AOL. Radial abduction and pronation of the metacarpal reduced fracture displacement. Extension of the CMC joint or tensioning the AOL did not decrease fracture displacement. Conclusions This model successfully created a reproducible and clinically relevant palmar beak fracture in a biomechanical setting. The primary ligament attached to the palmar beak fracture fragment was the ulnar collateral ligament, and not the AOL as previously described. These findings suggest that the AOL may not be a substantial contributor to palmar beak fracture morphology. Clinical relevance A refined description of the ligamentous anatomy of the palmar break fracture enhances opportunities for improved reduction and treatment of this common hand injury.

Since using LDL level alone is insufficient as a method to identify individuals with incident coronary artery disease (CAD), other factors may be implicated in the pathogenesis of CAD. Additionally, controversy still remains regarding whether there is an age-related increase in circulating cytokines in healthy individuals. We investigated the influence of age on atherogenicity of LDL and inflammatory markers in healthy women.Two thousand nine hundred forty four healthy women form 30-79 years old (23.3 ± 0.05 kg/m²) were categorized into 5 age groups: 30-39, 40-49, 50-59, 60-69 and 70-79 years. BMI, smoking, drinking, and metabolic syndrome prevalence adjusted mean values of total-cholesterol progressively increased from the group age 30-39 years to the group age 40-49 and 50-59 years and thereafter decreased in the group age 60-69 and 70-79 years. Serum concentrations of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were higher in women aged 60-79 years than women aged 30-59 years. Plasma ox-LDL levels increased in the group age 50-59 years compared with the group age 30-39 and 40-49 years and further increased in the group age 60-69 and 70-79 years. Mean values of LDL particle size were smaller in women aged 60-79 years than those in women aged 30-59 years. After adjustment for BMI, smoking, drinking, and metabolic syndrome status, age was positively correlated with LDL-cholesterol (r = 0.095, P0.001), oxidized LDL (r = 0.305, P0.001), hs-CRP (r = 0.150, P0.001), TNF-α (r = 0.171, P0.001) and IL-6 (r = 0.294, P0.001) and negatively with LDL particle size (r = -0.239, P0.001).Our results indicate that LDL atherogenicity and inflammatory mediators can be better markers of CAD risk than known risk factors such as elevated concentrations of total- and LDL-cholesterol, decreased HDL-cholesterol levels and smoking in old healthy women.

Purpose To evaluate the 7-hole angle plate for open reduction, internal fixation of mandibular angle fractures when the Champy technique is inadequate and more rigid or semirigid fixation is beneficial and to provide rational indications for the choice of the 7-hole angle plate. Patients and Methods Retrospective evaluation of 10 patients selected at Parkland Memorial Hospital over a 2-year period when the 7-hole angle plate stabilized their angle fracture. Patients were evaluated for postoperative complications including pain, malocclusion, and infection. Results All 10 patients had sufficient follow-up for inclusion in this retrospective study. Correct placement of the 7-hole angle plate, easily accomplished with adequate assistance, produced no reportable postoperative complications. Conclusion The 7-hole angle plate is a good first option when more rigid or semirigid fixation is required, and the best fallback when the Champy technique is ineffective.

A method is presented for predicting the energy loss for a 2D turbine cascade blade operating in subsonic regions where the exit Mach number ≤ 0.8. A prediction method based on entropy creation was used to analyze the cascade profile loss mechanism. The basic profile loss model was introduced from the isentropic Mach number distribution along the blade surface and the trailing edge loss model was introduced from available test data, CFD results and available loss models. In addition, the Reynolds number correction curve was applied from previous research. Linear cascade test datasets which represent hub, mid-span and tip sections were used to validate this loss model.

Background: Amplification of the human epidermal growth factor receptor 2 (HER2) gene and concomitant protein overexpression are present in 20-25% of breast cancers. HER2 overexpression and/or gene amplification is associated with a worse clinical outcome and an important predictive marker for sensitivity to anthracycline-based chemotherapy and HER2- targeted therapy. In Korea, the HER2 status has usually been assessed by immunohistochemistry (IHC) in the laboratories. To verify the preanalytic, analytic, and postanalytic factors of IHC in multi-institutions, we assessed the interlaboratory variability of HER2 IHC by comparing the local IHC with the central IHC and SISH results, as a first step toward building a nationwide quality assurance program. Methods: The Breast Pathology Study Group of Korean Society of Pathologists collected 1,198 breast carcinoma samples from 7 university-based hospitals and constructed 56 tissue microarray (TMA) blocks with triplicate of 1 mm cores. Local IHC results for HER2 were obtained from 1,130 patients. We performed IHC (PATHWAY anti-HER2/neu (4B5) rabbit monoclonal antibody, Ventana Medical Systems) and SISH (INFORM HER2 DNA Probe Kit, Ventana Medical Systems) for HER2 on the TMA sections using the automated Benchmark platform (Ventana Medical Systems). We interpreted the results according to the American Society of Clinical Oncology/College of American Pathologists guidelines. Results from local IHC were compared with central IHC and SISH. The concordant rates between central IHC and SISH results were also calculated. Results: The total percentage of cases in each category of local IHC score was: 0/1+, 70.4%; 2+, 8.8% (range among hospitals, 0-36%); and 3+, 20.8% (10.8-28.8%). The percentage of central IHC results (1,110 patients) in each category was: 0/1+, 79.7%; 2+, 3.6% (1.1-8.3%); and 3+, 16.7% (13.1-18.8%). SISH results were obtained from 1,033 patients: negative, 79.5%; equivocal, 0.2% (0-1.6%); and positive, 20.3% (19.2-22.6%). SISH amplifications in each local IHC category were observed as follows: 0/1+, 4.3% (0.6-10%); 2+, 18.8% (5.6-66.7%); and 3+, 71.2% (50-97.3%). When considering the central SISH as gold standard, 3% of cases (30/995) were false negative and 6.3% (63/995) were false positive in local IHC. In central lab, the concordance rates between IHC 3+ and SISH-positive, and IHC 0/1+ and SISH-negative were 95.5% and 98%, respectively. Conclusions: The results of central IHC and SISH markedly decreased the interlaboratory variability of HER2 status. The measurement of HER2 gene amplification by SISH was less affected by the preanalytic factors than the measurement of overexpression of HER2 protein by IHC. Because the rate of false positivity is higher than that of false negativity in the local IHC, the quality assurance program needs to be focused on decreasing not only the false negativity, but also the false positivity of HER2 IHC in local laboratories Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-08-05.

During the routine dissection course, we found a rare variation of the incomplete coeliac trunk in an 87-year-old Korean male cadaver. The left gastric artery, the splenic artery and the hepatomesenteric trunk arose independently from the abdominal aorta. The detailed branching pattern of this case could not be classified by classic classification systems, but belongs to type III' of Morita's classification. The accurate embryological knowledge on the arterial variations is important both to anatomists and to clinicians.

This study is dedicated to the design of a ball-type balancer system installed on the high-speed disk drive in order to reduce radial vibrations of rotors caused by eccentricities of disk's center of gravity and circular runway of the ball balancer. The ball balancer is a promising candidate due to its low cost and capability to completely eliminate radial vibrations under the conditions that runway eccentricity, damping and friction are not present. A mathematical model was established first for the analysis of the dynamics of a rotor–balancer system. The influence of concerned parameters, e.g., runway eccentricity and rolling resistance, on residual vibrations was then explored through solving the equations for steady state solutions. The results were used to evaluate the performance of balancers in terms of vibration reduction. The design guidelines for minimizing the vibrations by controlling the aforementioned concerned parameters were provided based on the parametric analysis conducted. Finally, experimental study was orchestrated and performed to verify the validity of the mathematical model and demonstrate balancer capability for reduction of radial vibrations.

Macroglossia is a rare condition, but can severely affect the oral and maxillofacial region. Angioedema is a condition resulting from multiple mechanisms, all of which can result in macroglossia. This report describes an unusual case of acquired macroglossia in an adult resulting from chronic edema secondary to angioedema in the setting of stroke. The patient had a morbidly enlarged tongue and presented with clinical signs and symptoms consistent with massive macroglossia. She required surgical intervention for acute management of her symptoms and definitive treatment of her macroglossia.

International audience; The smart electricity meter (SEM) is one of the most critical elements of smart grids. The billing function of SEM is one of its most important functions to its operators and end-users. Because the SEM devices need to be highly reliable, in this study we conduct accelerated degradation tests (ADTs) for the prediction of SEM reliability with respect to the billing function. For designing the ADTs, we have identified five key modules and their components, two performance indicators, and three possible degradation stressors. Six ADTs are conducted under different configurations of the stressors. The test data are then used to fit degradation paths by linear regression models. Extrapolation to the failure threshold allows the prediction of the Time-to-Failure of SEM. Finally, the reliable lifetime of the SEM is predicted by an accelerated degradation function which is obtained by fitting a Weibull failure time distribution.

Background The immunopathological mechanism for occupational asthma induced by toluene diisocyanate (TDI) remains to be further clarified. There have been few reports suggesting involvement of neutrophils in inducing bronchoconstriction after TDI inhalation. Objectives To further understand the role of neutrophils in the pathogenesis of TDI-induced asthma. Materials and methods Eight TDI-induced asthmatic subjects were classified as group I, and five exposed workers who had complained of work-related symptoms and worked in the same workplace, but showed negative bronchial challenges were enrolled as controls (group II). Serum neutrophil chemotactic activity during TDI bronchial challenge test was measured by the Boyden chamber method. Induced sputum was collected before and after the TDI bronchial challenge test. The myeloperoxidase (MPO) and interleukin (IL) -8 levels in the sputum were measured using RIA and ELISA. Result Serum neutrophil chemotactic activity significantly increased at 10 min (P = 0.01), then decreased at 60 min (P = 0.02) and remained unchanged for up to 420 min (P = 0.07) in group I subjects, while no significant changes were found in group II subjects (P > 0.05). MPO and IL-8 were abundantly present in the sputum of all the TDI-induced asthmatic subjects and they increased significantly at 420 min after the bronchial challenges (P = 0.02, P = 0.03, respectively), while no significant changes were noted in group II subjects (P > 0.05). Conclusion These findings support the view that activated neutrophils may contribute to bronchoconstriction induced by TDI which may be associated with IL-8 release.

Background The pathogenic mechanism of grain dust (GD)-induced occupational asthma (OA) remains unclear. Objective To understand further the mechanism of GD-induced OA. Methods Fifteen employees working in a same GD industry, complaining of work-related respiratory symptoms, were enrolled and were divided into two groups according to the GD-bronchoprovocation test (BPT) result: six positive responders were grouped as group III, nine negative responders as group II and five healthy controls as group I. Serum GD-specific immunoglobulin (Ig)E (sIgE), specific IgG (sIgG) and specific IgG4 (sIgG4) antibodies were detected by enzyme-linked immunosorbent assay. Basophil histamine release was measured by the autofluorometric method, and changes of serum neutrophil chemotactic activity were observed by the Boyden chamber method. Results For clinical parameters such as degree of airway hyperresponsiveness to methacholine, duration of respiratory symptoms, exposure duration, and prevalences of serum sIgE, sIgG and sIgG4 antibodies, there were no significant differences between group II and III (P > 0.05, respectively). Serum neutrophil chemotactic activity increased significantly at 30 min and decreased at 240 min after the GD-BPT in group III subjects (P 0.05). Basophil histamine release induced by GD was significantly higher in group III than those of group I or group II (P

Background There is a growing body of evidence to support the effectiveness of education programs for patients with arthritis. However, there has been little investigation into education strategies for patients with axial spondyloarthritis (axSpA). A number of studies examining education strategies for patients with arthritis have involved an interdisciplinary approach and found positive impact on disease activity, function and overall health (1). Furthermore, the use of electronic formats for education are preferred over other formats for patients with axSpA (2). As such, the Toronto Western Hospital Spondylitis Program developed a novel e-Learning education module for patients with axSpA with input from patients and an interdisciplinary team of health care professionals. The module consists of an interactive web-based platform covering evidence-based topics including diagnosis, treatment and self-management for axSpA. Objectives To measure the effect of the axSpA e-Learning patient education module with respect to: 1) chronic disease self-efficacy; 2) knowledge of axSpA, and 3) exercise behaviour. Methods Fifty-four adult patients with axSpA attending a tertiary academic spondylitis clinic were randomly assigned to one of two groups: 1) e-Learning intervention, where patients were emailed a link to the web-based patient education module and were asked to complete the module at their leisure; or, 2) usual care. All patients completed baseline and follow-up questionnaires that included: the Ankylosing Spondylitis (AS): “what do you know” knowledge questionnaire; Stanford Chronic Disease Self-Efficacy Scale (CDSE), and, the Stanford questionnaire for Exercise Behaviours. Results Twenty-one patients with axSpA completed the e-Learning module and 33 patients continued with usual care. Overall, mean (SD) age was 42.6 (13.2) years, 70% were male, mean (SD) disease duration was 19.3 (10.1) years and 85% had a post-secondary education. There were no statistically significant differences in the above outcome measures between the two groups at baseline or follow-up. However there was significant improvement from baseline to follow-up in patients that completed the e-Learning module with respect to their AS knowledge mean score (SD) 19.0 (4.1) vs 19.9 (5.0) (p=0.0002) and CDSE sub-scale “manage disease in general” mean score (SD) regarding when to visit a doctor and ability to manage health condition 7.5 (1.8) vs. 7.9 (1.9) (p=0.02) and 7.3 (1.8) vs. 7.9 (2.1) (p=0.02) respectively. Conclusions The above demonstrates an increase in overall disease knowledge and improved self-efficacy through the implementation of a novel e-Learning patient education module. This e-Learning module has the potential to provide benefit to patients with axSpA who have limited access to specialized care, ultimately optimizing outcomes in this patient population. References Vliet Vlieland TP. Multidisciplinary team care and outcomes in rheumatoid arthritis. Curr Opin Rheumatol 2004;16(2):153–6 Utilization of an informational needs assessment to develop an education program for patients with ankylosing spondylitis and related axial spondyloarthritis R. Kang1, L. Passalent, R. Morton, C. Hawke, J. Blair4, A. Lake2, M. Doucet5, D. MacGarvie2, K. Wong6, R. Inman Annals of the Rheumatic Diseases 2014; 72(Suppl 3):A1037-A1038. Disclosure of Interest None declared

In addressing failed surgery for compressive neuropathies about the arm, it is important to distinguish between what would truly be called recurrence vs. those who have a failure to improve in their symptoms. Evaluation of these patients does require some time in both obtaining a thorough history as well as performing a detailed clinical exam. Electromyographic and neural conduction velocity testing is helpful. In these cases, the surgeon needs to think both proximal and distal; that is, could the symptoms be coming from the neck or could there be areas of further compression proximally or distally about the peripheral nerve? Reoperating on previously operated nerve tissue can be quite stressful as the nerve tissue is frequently less forgiving than other soft tissue structures commonly encountered in the scar bed. The use of a microscope can sometimes be helpful in visualizing the tissue planes and/or nerve tissue. If mechanical reasons are found to explain the patient’s continued symptoms, then these points of compression can be surgically addressed if the patient is willing to accept the potential risks of nerve injury and further scarring, which sometimes precludes the patient from improving as much as both doctor and patient were hoping.

Major peripheral nerve injuries are often associated with devastating functional deficits. Current management techniques fail to achieve adequate functional neural regeneration, and the development of adjunct therapies is necessary to improve outcomes. Recent efforts at enhancing the regeneration rate of peripheral nerves and developing axonal guidance channels or conduits have had limited success. The neuromuscular junction serves as the interface between the peripheral nerves and muscle. This critical area undergoes significant changes following peripheral nerve injury and induces end-organ atrophy after denervation, which limits the chance of true functional regeneration. Stabilization of the neuromuscular junction may be an important adjunct in peripheral nerve repair and should be explored as a method of managing major nerve injuries.

The Shopping Cart Interactive Program (SCIP) application was designed to improve shoppers' connection with the grocery retail environment. Nutrition is central to human life. Eating the right foods can significantly impact one's quality of life. With the capabilities of the SCIP application to provide an interface that can display readable health information on a mobile device and tailor to the specific dietary restrictions of its users, it will enable shoppers to have a less frustrating experience when shopping for food.

Excerpt A digital color image is a multidimensional entity. It is sampled in a 2D plane with width and length, having quantized values in the third dimension to indicate the intensities of three or more channels (trichromatic or multispectral) for describing color attributes. The smallest unit in the 2D image plane is called the picture element (pixel or pel), constituted by the pixel size (width and length) and depth (the number of tone levels). However, the appearance of a color image is much more intriguing than a few physical measurements; there are psychological and psychophysical attributes that cannot be measured by any existing instruments—only by human vision. Therefore, the most important factor in color-image analysis is human vision because a human being is the ultimate judge of image quality. Human vision provides the fundamental guidance to digital-imaging design, analysis, and interpretation. Because human vision is subjective and instrumentation is objective, there is a need for establishing the correlation between them. This makes digital color imaging a very interesting and complex process, involving human vision, color appearance phenomena, imaging technology, device characteristics, and media properties. With rapid advances in color science and technology that resulted in a better understanding of color images in the forms of human visual system (HVS) and color appearance model (CAM) on the one hand, and the developments of various color-imaging technologies and computation approaches on the other, it is now possible to address the color-image reproduction at the system level in a quantitative manner and to produce good image quality across all media involved. To achieve these goals, cross-media color-image reproduction consists of four core elements: device characteristics and calibration, color appearance modeling, image processing, and gamut mapping. This chapter describes the scope and complexity of the digital color imaging at the system level and provides the sRGB⇆CIELAB conversions as examples to illustrate the modular architecture and technical requirements for a successful implementation.

Color Errors of Reconstructed CRI Spectra with Respect to Measured Values Using Tristimulus Inputs

This chapter presents the applications of the matrix R theory for spectrum decomposition and reconstruction. We apply the method to spectra of seven illuminants and fourteen spectra used in the color rendering index (CRI) under the CIE 1931 or CIE 1964 standard observer. The common characteristics are derived and discussed. Based on these characteristics, we develop two methods for deriving two basis vectors that can be used to reconstruct various illuminants to some degree of accuracy. The first method uses the intuitive approach of averaging to generate basis vectors. The second method uses input tristimulus values to obtain the fundamental metamer via orthogonal projection, and the metameric black is obtained from a set of coefficients to scale the average metameric black. The coefficients are derived from ratios of input tristimulus values to average tristimulus values. These methods are applied to reconstruct 7 illuminants and 14 CRI spectra. The application of the metameric spectral reconstruction to the estimation of the fundamental metamer from an RGB or XYZ color scanner for accessing skin-tone reproducibility is also discussed.

This appendix contains the conversion matrices for various RGB primary sets to ITU-R.BT.709/RGB under illuminant D65.

Most device-dependent color spaces are creations for the convenience of practical usage, digital representation, and computation. They do not relate to the objective definition or the way humans see color. They are used to encode device-specific digital data at the device-control level. Device-dependent color spaces fall into two main classes: €”additive and subtractive spaces. Additive spaces include RGB spaces and any spaces derived from Device∕RGB space, such as HSV and HLS spaces. Subtractive spaces include CMY, CMYK, and Hi-Fi spaces that have five or more primary colorants. In this chapter, the color gamut of device-dependent color spaces is discussed. The gamut computation of ideal block dyes is given in detail. The process of determining a color gamut boundary of a real imaging device, which includes the test target, device gamut model, interpolation method, and color gamut descriptor, is given. Finally, we discuss color gamut mapping for cross-media rendition because of the gamut mismatch among real imaging devices. 7.1 Red-Green-Blue (RGB) Color Space RGB color space defines colors within a unit cube by the additive color-mixing model. Additive color mixing means that a color stimulus for which the radiant power in any wavelength interval, small or large, in any part of the spectrum is equal to the sum of the powers in the same interval of the constituents of the mixture, constituents that are assumed to be optically incoherent. As shown in Fig. 7.1, red, green, and blue are additive primaries represented by the three axes of the cube that defines the color gamut boundary of the RGB space; all colors are located within the cube. Each color in the cube can be represented as a triplet (R, G, B) where values for R, G, and B are assigned in the range from 0 to 1 (or from 0 to the bit depth of the device). In an ideal case, the mixture of two additive primaries produces a subtractive primary; thus, the mixture of the red (1, 0, 0) and green (0, 1, 0) is yellow (1, 1, 0), the mixture of the red (1, 0, 0) and blue (0, 0, 1) is magenta (1, 0, 1), and the mixture of the green (0, 1, 0) and blue (0, 0, 1) is cyan (0, 1, 1). A white (1, 1, 1) is obtained when all three primaries are added together and the black (0, 0, 0) is located at the origin of the cube. Shades of gray are located along the diagonal line that connects the black and white points.

Excerpt The Kubelka-Munk (K-M) theory is based on light absorption and partial scattering. Kubelka and Munk formulated this theory to model the resultant light emerging from translucent and opaque media, assuming that there are only two light channels traveling in opposite directions. The light is being absorbed and scattered in only two directions: an upward beam J and a downward beam I, as shown in Fig. 16.1. A background is presented at the bottom of the medium to provide the upward light reflection. This chapter presents the fundamentals of the K-M theory, spectral extension, cellular extension, and a unified global theory.