37,126 research outputs found

    EXOGEN ultrasound bone healing system for long bone fractures with non-union or delayed healing: a NICE medical technology guidance

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    Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.This article has been made available through the Brunel Open Access Publishing Fund.A routine part of the process for developing National Institute for Health and Care Excellence (NICE) medical technologies guidance is a submission of clinical and economic evidence by the technology manufacturer. The Birmingham and Brunel Consortium External Assessment Centre (EAC; a consortium of the University of Birmingham and Brunel University) independently appraised the submission on the EXOGEN bone healing system for long bone fractures with non-union or delayed healing. This article is an overview of the original evidence submitted, the EAC’s findings, and the final NICE guidance issued.The Birmingham and Brunel Consortium is funded by NICE to act as an External Assessment Centre for the Medical Technologies Evaluation Programme

    Dnmt3b ablation impairs fracture repair through upregulation of Notch pathway

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    We previously established that DNA methyltransferase 3b (Dnmt3b) is the sole Dnmt responsive to fracture repair and that Dnmt3b expression is induced in progenitor cells during fracture repair. In the current study, we confirmed that Dnmt3b ablation in mesenchymal progenitor cells (MPCs) resulted in impaired endochondral ossification, delayed fracture repair, and reduced mechanical strength of the newly formed bone in Prx1-Cre;Dnmt3bf/f (Dnmt3bPrx1) mice. Mechanistically, deletion of Dnmt3b in MPCs led to reduced chondrogenic and osteogenic differentiation in vitro. We further identified Rbpjκ as a downstream target of Dnmt3b in MPCs. In fact, we located 2 Dnmt3b binding sites in the murine proximal Rbpjκ promoter and gene body and confirmed Dnmt3b interaction with the 2 binding sites by ChIP assays. Luciferase assays showed functional utilization of the Dnmt3b binding sites in murine C3H10T1/2 cells. Importantly, we showed that the MPC differentiation defect observed in Dnmt3b deficiency cells was due to the upregulation of Rbpjκ, evident by restored MPC differentiation upon Rbpjκ inhibition. Consistent with in vitro findings, Rbpjκ blockage via dual antiplatelet therapy reversed the differentiation defect and accelerated fracture repair in Dnmt3bPrx1 mice. Collectively, our data suggest that Dnmt3b suppresses Notch signaling during MPC differentiation and is necessary for normal fracture repair

    Mechanoregulation of bone remodeling and healing as inspiration for self-repair in materials

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    The material bone has attracted the attention of material scientists due to its fracture resistance and ability to self-repair. A mechanoregulated exchange of damaged bone using newly synthesized material avoids the accumulation of fatigue damage. This remodeling process is also the basis for structural adaptation to common loading conditions, thereby reducing the probability of material failure. In the case of fracture, an initial step of tissue formation is followed by a mechanobiological controlled restoration of the pre-fracture state. The present perspective focuses on these mechanobiological aspects of bone remodeling and healing. Specifically, the role of the control function is considered, which describes mechanoregulation as a link between mechanical stimulation and the local response of the material through changes in structure or material properties. Mechanical forces propagate over large distances leading to a complex non-local feedback between mechanical stimulation and material response. To better understand such phenomena, computer models are often employed. As expected from control theory, negative and positive feedback loops lead to entirely different time evolutions, corresponding to stable and unstable states of the material system. After some background information about bone remodeling and healing, we describe a few representative models, the corresponding control functions, and their consequences. The results are then discussed with respect to the potential design of synthetic materials with specific self-repair properties

    Interfacial strength development in thermoplastic resins and fiber-reinforced thermoplastic composites

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    An experimental program to develop test methods to be used to characterize interfacial (autohesive) strength development in polysulfone thermoplastic resin and graphite-polysulfone prepreg during processing is reported. Two test methods were used to examine interfacial strength development in neat resin samples. These included an interfacial tension test and a compact tension (CT) fracture toughness test. The interfacial tensile test proved to be very difficult to perform with a considerable amount of data scatter. Thus, the interfacial test was discarded in favor of the fracture toughness test. Interfacial strength development was observed by measuring the refracture toughness of precracked compact tension specimens that were rehealed at a given temperature and contact time. The measured refracture toughness was correlated with temperature and contact time. Interfacial strength development in graphite-polysulfone unidirectional composites was measured using a double cantilever beam (DCB) interlaminar fracture toughness test. The critical strain energy release rate of refractured composite specimens was measured as a function of healing temperature and contact time

    Hip fracture. Preliminary results supporting significative correlations between the psychological wellbeing of patients and their relative caregivers

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    Background and aim. Hip fracture is one of the major causes of loss of self-sufficiency in older patients. The associated caregiving rehabilitation task often falls to the lot of a member of the patient’s family. Our study aims at assessing the relationship between the psychological well-being of patients with hip fracture and their caregivers. Methods. The study was carried-out on 53 elderly patients with hip fracture and their primary caregivers. The Mini Mental State Examination (patient), Activities of Daily Living (patient), Instrumental Activities of Daily Living (patient), Geriatric Depression Scale (patient), Psychological General Well-Being Index (patient/caregiver) and the Caregiver Burden Inventory (caregiver) were administered to each participant. Results. The results revealed significant correlations between stress levels and the psychological well-being of hip-fracture patients and relative caregivers. In particular, the Caregiver Burden Inventory’s total score was negatively related to the patient’s Psychological General Well-Being Index score (p < 0.05) and with Anxiety (p < 0.05), Depressed Mood (p < 0.01), Positive Well-being (p < 0.05) and General Health (p < 0.05) subscale scores, as well as with the patient’s Activities of Daily Living (p < 0.05) score. Patients’ Psychological General Well-Being Index scores were related to the caregivers’ General Health subscale (p < 0.01), and negatively related to Caregiver Burden Inventory Time Dependence (p < 0.05) and Social Burden (p < 0.05) subscales, as well as with the Geriatric Depression Scale score (p < 0.05). Conclusion. A mutual relationship seems to exist between a patient’s psychological well-being and his/her caregiver’s burden. These findings highlight the importance of a bio-psychosocial approach to both patients and caregivers

    Sliding wear of self-mated Al2O3-SiC whisker reinforced composites at 23-1200 C

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    Microstructural changes occurring during sliding wear of self-mated Al2O3-SiC whisker reinforced composites were studied using optical, scanning electron microscopy, and transmission electron microscopy. Pin-on-disk specimens were slid in air at 2.7 m/sec sliding velocity under a 26.5 N load for 1 hr. Wear tests were conducted at 23, 600, 800, and 1200 C. Mild wear with a wear factor of 2.4 times 10(exp -7) to 1.5 times 10(exp -6) cu mm/Nm was experienced at all test temperatures. The composite shows evidence of wear by fatigue mechanisms at 800 C and below. Tribochemical reaction (SiC oxidation and reaction of SiO2 and Al2O3) leads to intergranular failure at 1200 C. Distinct microstructural differences existing at each test temperature are reported

    Roll a Hard Six: Losing Your Noodle in Raymond Federman’s Double or Nothing

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    Raymond Federman’s Double or Nothing is a convoluted representation of the mentallyunstable mind existing as a series of six characters that are at once separate and conjoined: the horrors and traumatic events of the narrative past dismantle the unified subject into a series of schizophrenic sub-personalities, parts of the destabilized Author’s psyche, existing as separate fragments that eventually collide. Further, the imaginary room emerges as the Fifth Person, promising, but failing, to be a central stabilizer of the other fractured selves. Finally, the design of the text echoes the patterns of the traumatized mind, illustrating the inability of a narrative to construct a stable, unified subject and demonstrating the inadequacy of traditional narrative forms. The text, with its obliterations, cropped phrases, and pictorial manifestations, becomes the Sixth Person. However, in the end, the text shows that the past cannot be erased, explained, or reversed; neither can the experimental nature of the novel reach beyond the traumatized, schizoid subject to represent the horrors of the past that caused the Author’s psychotic breach. Federman has rolled a hard six that will repeatedly fragment and unite, just as the traumatic past continues to repeat itself as one that defies representation

    Transport efficiency and dynamics of hydraulic fracture networks

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    Acknowledgments This study is carried out within the framework of DGMK (German Society for Petroleum and Coal Science and Technology) research project 718 “Mineral Vein Dynamics Modeling,” which is funded by the companies ExxonMobil Production Deutschland GmbH, GDF SUEZ E&P Deutschland GmbH, RWE Dea AG and Wintershall Holding GmbH, within the basic research programme of the WEG Wirtschaftsverband Erdöl- und Erdgasgewinnung e.V. We thank the companies for their financial support and their permission to publish our results. We further acknowledge support by Deutsche Forschungsgemeinschaft and Open Access Publishing Fund of University of Tübingen.Peer reviewedPublisher PD
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