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Background: For 20 years, authors have predicted an expansion in total knee arthroplasty (TKA) and total hip arthroplasty (THA) utilization. Over this same period, the introduction of biological disease-modifying antirheumatic drugs has dramatically altered the treatment of rheumatoid arthritis (RA) with hopes of preventing articular damage and obviating the need for prosthetic replacement. The goal of our investigation was to evaluate TKA and THA utilization in young patients with RA (

Qiuju Liu,1 Brittny Major,2 Jennifer Le-Rademacher,2 Aref A Al-Kali,3 Hassan Alkhateeb,3 Kebede Begna,3 Michelle A Elliott,3 Naseema Gangat,3 William J Hogan,3 C Christopher Hook,3 Scott H Kaufmann,3 Animesh Pardanani,3 Mrinal S Patnaik,3 Ayalew Tefferi,3 Alexandra P Wolanskyj-Spinner,3 Wei Wei,4 Mark R Litzow3 1Department of Cancer Center, Division of Hematology, Jilin University, Changchun, Jilin, People’s Republic of China; 2Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA; 3Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA; 4Department of Urology, Second Division, Jilin University, Changchun, Jilin, People’s Republic of ChinaCorrespondence: Mark R LitzowDivision of Hematology, Mayo Clinic, 200 First St, Rochester, MN 55902, USATel +1 507-284-2511Email litzow.mark@mayo.eduIntroduction: Obesity is a worldwide problem that is related to cardiac disease, thrombosis and cancer. However, little is known about the impact of obesity on the outcomes of adult acute lymphoblastic leukemia (ALL) patients.Methods: We retrospectively evaluated a cohort of 154 newly diagnosed adult ALL patients between 1994 and 2011 at Mayo Clinic (Rochester). According to the World Health Organization (WHO) international BMI classification, patients were stratified as underweight, normal weight, overweight, and obese. For some analyses, patients were also stratified according to a two-sided non-obese or obese classification.Results: The median follow-up time was 8.37 years. Obese patients were more likely to be women (p=0.024) and ≥ 60 years old (p=0.003). Five-year mortality rates were higher in obese patients than non-obese [HR 95% CI: 1.60 (1.03– 2.50) p=0.035]. This was also the case in subgroup analysis among T-cell patients although the number of patients was small [HR 95% CI: 5.42 (1.84– 15.98) p< 0.001]. There was no difference in mortality among the B-cell patients. After adjusting for baseline variables, the difference in mortality remained in several models. There was no difference in EFS or cumulative incidence of relapse rates between obese and non-obese patients among the overall population.Discussion: In conclusion, our study suggests that adult ALL patients with obesity have lower survival rates, especially in T-cell ALL.Keywords: acute lymphoblastic leukemia, obesity, overweight, B cell, T cell

Study Design: This was a systematic review of the literature and meta-analysis. Objective: The objective of this study was to evaluate the current literature regarding the risk factors contributing to reoperation due to adjacent segment disease (ASD). Summary of Background Data: ASD is a broad term referring to a variety of complications which might require reoperation. Revision spine surgery is known to be associated with poor clinical outcomes and high rate of complications. Unplanned reoperation has been suggested as a quality marker for the hospitals. Materials and Methods: An electronic search was conducted using PubMed. A total of 2467 articles were reviewed. Of these, 55 studies met our inclusion criteria and included an aggregate of 1940 patients. Data were collected pertaining to risk factors including age, sex, fusion length, lumbar lordosis, body mass index, pelvic incidence, sacral slope, pelvis tilt, initial pathology, type of fusion procedure, floating versus sacral or pelvic fusion, presence of preoperative facet or disc degeneration at the junctional segment, and sagittal orientation of the facets at the junctional segment. Analysis of the data was performed using Comprehensive Meta-Analysis software (Biostat, Inc.). Results: The overall pooled incidence rate of reoperation due to ASD from all included studies was 0.08 (confidence interval: 0.065–0.098). Meta-regression analysis demonstrated no significant interaction between age and reoperation rate (P = 0.48). A comparison of the event rates between males and females demonstrated no significant difference between male and female reoperation rates (P = 0.58). There was a significantly higher rate of ASD in patients with longer fusion constructs (P = 0.0001). Conclusions: We found that 8% of patients in our included studies required reoperation due to ASD. Our analysis also revealed that longer fusion constructs correlated with a higher rate of subsequent revision surgery. Therefore, the surgeon should limit the number of fusion levels if possible to reduce the risk of future reoperation due to ASD. Level of evidence: IV

Research studies on bio-tribological protective coatings of titanium, chromium and carbon based have been performed. Thin films were fabricated by hybrid PLD technique (PLD supported by magnetron sputtering). Coatings consisted of two parts; the inner part (first from the substrate) in each case was formed by titanium or chromium/titanium nitride or chromium nitride (Ti/TiN or Cr/Cr2N). The outer part was formed by pure DLC or multilayer DLC/Ti or Cr. No delamination was found at the interface. Titanium or chromium metallic layer was deposited as a first layer directly on the metallic substrate to avoid delamination. All individual layers were built of columnar nano-crystallites. Mechanisms of the mechanical wear of analyzed systems were presented, focusing on the cracking propagation in ball-on-disc tests using an 1 N and 5 N applied loads for 5 000 cycles. Complex microstructure analysis of presented nano-multilayer coatings, before and after mechanical tests, were performed by means of transmission electron microscopy (TEM). The highest stress concentration during mechanical uploading was moved through the multilayer coating by breaking only one layer at the time. The microstructure characterization revealed that cracking propagating in the outer part of the coating was stopped at the interface. In the case of the inner part of the coating Ti/TiN; Cr/Cr2N, ceramic layers showed brittle cracking, while metallic (Ti or Cr) ones deformed plastically. Fabricated coatings were subjected under the analysis in the biomechanical system optimized to test for the direct contact with a human whole blood. The study considered physiological conditions mainly related to the temperature and humidity and the frequency of cyclic deformation of the artificial vessel into which the tested sample was introduced.

The work is a review of the methods of the surface modification performed by the authors dedicated for for cardiac support system. It presents the evolution of designing the surface dedicated to direct contact with blood. Initially thin and ultrathin coatings were developed. They were designed as a blood-polymer barrier. The pneumatic heart assist devices are made of a medical grade polyurethane. A major milestone was to create advanced ceramic thin films expressing the flexible effects deposited by physical techniques. Coatings have evolved. Another milestone was the surface reproducing the microenvironment to capture progenitor cells from the bloodstream. Thin coatings were prepared, using methods of ion been, controlled residual stresses were introduced. Wrinkles appeared without cracking. This enabled taking control over the process of cell differentiation. Alternatively, the tissue inspired structure resulted of the coating in the form of extracellular matrix. The outer surface was modified with synthetic materials. This enabled the effective proteins docking to induce cell growth, recreating the luminal side of the blood vessel. Coagulation processes have been slowed down. In addition, it was found pro-angiogenic effect.

Achieving fast and strong adhesion to jawbone is essential for dental implants. Thin deposited films may improve osseointegration, but they are prone to cohesive and adhesive fracture due to high stresses while screwing the implant into the bone, leading to bared, less osteoconductive substrate surfaces and nano- and micro-particles in the bone. Aim of this work is the investigation of the cohesion and adhesion failure stresses of osteoconductive tantalum, titanium, silicon, zirconium and aluminium oxide and diamond-like carbon films. The tribological behaviour under dry and lubricated conditions (Ringer solution) reveals best results for diamond-like carbon, while cohesion and adhesion of zirconium oxide films is highest.

Goal of this work is the investigation of roughness influences on the abrasive wear behaviour of magnetron sputtered multi-layered, low-friction coatings on carbon-fibre reinforced polymers (CFRP). Higher coating roughness at similar CFRP quality was realized by higher deposition rates, leading to increased heat flux to the substrates during deposition. Thermal expansion of the epoxy matrix on the micro scale results in a wavy, wrinkled surface topography. Both in scratch and reciprocal sliding testing against alumina, the friction coefficients are lower for the smooth coatings, but their wear rate is higher due to low-cycle fatigue caused abrasion.

Although higher social class carries mental and physical health benefits, these advantages are less robust among members of racial and ethnic minority groups than among European Americans. We explore whether differential reactions to discrimination may be a factor in explaining why. Working-class and middle-class Latino American women engaged in an evaluative interaction with a European American woman who rejected them and held either prejudiced or unprejudiced attitudes. We examined how participants responded to this rejection by measuring neuroendocrine reactivity, executive functioning, and the affective content of their verbal responses during the interaction. Among middle-class Latinas, rejection from a prejudiced, compared to unprejudiced, out-group member was associated with less adaptive stress responses, greater cognitive depletion, and more feelings of uncertainty. In contrast, among working-class Latinas, neuroendocrine, cognitive, and affective responses were similar across the two sources of rejection. Results suggest that social class is an important moderator of responses to discrimination. © The Author(s) 2013.

Open burning poses a significant threat to human health and the environment by releasing hazardous chemicals and exacerbating plastic pollution. Urgent action is required to address its pervasive impact and the substantial release of gaseous pollutants. Limited research has explored the demographic aspect of open burning behavior, with none specifically conducted in Kentucky. An analysis of open burning complaints reported to the Kentucky Division for Air Quality in 2015, 2019, and 2021 revealed no significant differences in reported incidents by month and county. Binary logistic regression analyses identified the urban vs rural divide as significant predictors of open burning incidents, while violations were influenced by both urban and rural factors and average household income. Unemployment rates and the percentage of individuals with less than a high school diploma did not significantly predict open burning violations. Targeted interventions at the state and local level, focusing on rural areas and economically disadvantaged communities, can effectively address and mitigate open burning issues.

Reports findings from a study of searching behavior by over 200,000 users of the Excite search engine. Analysis of over one million queries revealed most people use few search terms, few modified queries, view few Web pages, and rarely use advanced search features. Concludes that Web searching by the public differs significantly from searching of other information retrieval systems. (Contains 16 references.) (AEF)

As a result of loading with an external force during the wear process, coating deforms uniformly. After a certain limit load is exceeded, coating deformation is localised through the formation of the so‐called shear bands. It has been showed experimentally the process of shear bands formation. The microstructural characterisation before and after the mechanical tests was performed using scanning and transmission electron microscopy (SEM and TEM) on cross‐sections of the samples. The analysis indicated that in the case of multilayer coatings where the ratio of the metallic to the ceramic phase is 1:1, the shear bands are formed at an angle of 45°. With a greater proportion of the ceramic phase to metallic (ratio 1:2), the shear band changed the shear angle from ∼45° to ∼90°. Mechanical in situ tests were carried out in the chambers of SEM and TEM. The scratch tests in the SEM were done with the simultaneous observation of the phenomena occurring on the surface of the tested materials showed that at a scratch force of 0.04 N, the additional outer a‐C:H layer was damaged, which was shown in the form of a fault in the force–displacement diagram, and in the form of splits visible in the SEM image. However, the application of this additional layer had a positive effect on the wear mechanism of the entire coating structure. The test also indicated that in the case of coatings with phases ratio 1:2 and 1:4 (metallic to ceramic), the characteristics of the brittle material were demonstrated, unlike the coating with a 1:1 phase ratio, where plastic properties predominated. However, for the 1:2 phase ratio coating, the chip was more ductile than for the chip formed when testing a 1:4 phase ratio coating. For in situ mechanical testing in the TEM, a straining holder was used. The test showed that the shear band angle for a 1:1 ratio coating has changed from 45° to 90° due to the different direction of force interaction. [ABSTRACT FROM AUTHOR]