471 research outputs found
PRELIMINARY FINDINGS OF A POTENZIATED PIEZOSURGERGICAL DEVICE AT THE RABBIT SKULL
The number of available ultrasonic osteotomes has remarkably increased. In vitro and in vivo studies
have revealed differences between conventional osteotomes, such as rotating or sawing devices, and
ultrasound-supported osteotomes (Piezosurgery®) regarding the micromorphology and roughness
values of osteotomized bone surfaces.
Objective: the present study compares the micro-morphologies and roughness values of
osteotomized bone surfaces after the application of rotating and sawing devices, Piezosurgery
Medical® and Piezosurgery Medical New Generation Powerful Handpiece.
Methods: Fresh, standard-sized bony samples were taken from a rabbit skull using the following
osteotomes: rotating and sawing devices, Piezosurgery Medical® and a Piezosurgery Medical New
Generation Powerful Handpiece. The required duration of time for each osteotomy was recorded.
Micromorphologies and roughness values to characterize the bone surfaces following the different
osteotomy methods were described. The prepared surfaces were examined via light microscopy,
environmental surface electron microscopy (ESEM), transmission electron microscopy (TEM), confocal
laser scanning microscopy (CLSM) and atomic force microscopy. The selective cutting of mineralized
tissues while preserving adjacent soft tissue (dura mater and nervous tissue) was studied. Bone
necrosis of the osteotomy sites and the vitality of the osteocytes near the sectional plane were
investigated, as well as the proportion of apoptosis or cell degeneration.
Results and Conclusions: The potential positive effects on bone healing and reossification
associated with different devices were evaluated and the comparative analysis among the different
devices used was performed, in order to determine the best osteotomes to be employed during
cranio-facial surgery
Functional Design and Analysis of a Linked Shoulder Prosthesis
Persistent shoulder instability following joint arthroplasty remains a concern with mixed outcomes following clinical and surgical intervention. Thus, a linked universal joint implant was developed and functionally analyzed. A virtual model of the linked implant was developed and implanted in a 3D bony specimen to measure the available circumduction range of motion. Stresses in the implant were estimated using finite element analysis based on joint loads during activities of daily life. The glenoid fixation stress was evaluated using finite element analysis.
The implant was capable of restoring normal range of motion, and withstanding expected joint loads without yield or fatigue failure. Bone fixation stress remains a concern, depending on the implant configuration and aggressive joint loading
An investigation into the effects of commencing haemodialysis in the critically ill
<b>Introduction:</b>
We have aimed to describe haemodynamic changes when haemodialysis is instituted in the critically ill. 3
hypotheses are tested: 1)The initial session is associated with cardiovascular instability, 2)The initial session is
associated with more cardiovascular instability compared to subsequent sessions, and 3)Looking at unstable
sessions alone, there will be a greater proportion of potentially harmful changes in the initial sessions compared
to subsequent ones.
<b>Methods:</b>
Data was collected for 209 patients, identifying 1605 dialysis sessions. Analysis was performed on hourly
records, classifying sessions as stable/unstable by a cutoff of >+/-20% change in baseline physiology
(HR/MAP). Data from 3 hours prior, and 4 hours after dialysis was included, and average and minimum values
derived. 3 time comparisons were made (pre-HD:during, during HD:post, pre-HD:post). Initial sessions were
analysed separately from subsequent sessions to derive 2 groups. If a session was identified as being unstable,
then the nature of instability was examined by recording whether changes crossed defined physiological ranges.
The changes seen in unstable sessions could be described as to their effects: being harmful/potentially harmful,
or beneficial/potentially beneficial.
<b>Results:</b>
Discarding incomplete data, 181 initial and 1382 subsequent sessions were analysed. A session was deemed to
be stable if there was no significant change (>+/-20%) in the time-averaged or minimum MAP/HR across time
comparisons. By this definition 85/181 initial sessions were unstable (47%, 95% CI SEM 39.8-54.2). Therefore
Hypothesis 1 is accepted. This compares to 44% of subsequent sessions (95% CI 41.1-46.3). Comparing these
proportions and their respective CI gives a 95% CI for the standard error of the difference of -4% to 10%.
Therefore Hypothesis 2 is rejected. In initial sessions there were 92/1020 harmful changes. This gives a
proportion of 9.0% (95% CI SEM 7.4-10.9). In the subsequent sessions there were 712/7248 harmful changes.
This gives a proportion of 9.8% (95% CI SEM 9.1-10.5). Comparing the two unpaired proportions gives a
difference of -0.08% with a 95% CI of the SE of the difference of -2.5 to +1.2. Hypothesis 3 is rejected. Fisher’s
exact test gives a result of p=0.68, reinforcing the lack of significant variance.
<b>Conclusions:</b>
Our results reject the claims that using haemodialysis is an inherently unstable choice of therapy. Although
proportionally more of the initial sessions are classed as unstable, the majority of MAP and HR changes are
beneficial in nature
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