10-year survival of total ankle arthroplasties: A report on 780 cases from the Swedish Ankle Register

Background and purpose There is an ongoing need to review large series of total ankle replacements (TARs) for monitoring of changes in practice and their outcome. 4 national registries, including the Swedish Ankle Register, have previously reported their 5-year results. We now present an extended series with a longer follow-up, and with a 10-year survival analysis. Patients and methods Records of uncemented 3-component TARs were retrospectively reviewed, determining risk factors such as age, sex, and diagnosis. Prosthetic survival rates were calculated with exchange or removal of components as endpoint-excluding incidental exchange of the polyethylene meniscus. Results Of the 780 prostheses implanted since 1993, 168 (22%) had been revised by June 15, 2010. The overall survival rate fell from 0.81 (95% CI: 0.79-0.83) at 5 years to 0.69 (95% CI: 0.67-0.71) at 10 years. The survival rate was higher, although not statistically significantly so, during the latter part of the period investigated. Excluding the STAR prosthesis, the survival rate for all the remaining designs was 0.78 at 10 years. Women below the age of 60 with osteoarthritis were at a higher risk of revision, but age did not influence the outcome in men or women with rheumatoid arthritis. Revisions due to technical mistakes at the index surgery and instability were undertaken earlier than revisions for other reasons. Interpretation The results have slowly improved during the 18-year period investigated. However, we do not believe that the survival rates of ankle replacements in the near future will approach those of hip and knee replacements-even though improved instrumentation and design of the prostheses, together with better patient selection, will presumably give better results

Фотодинамическая терапия экспериментального острого холецистита

фотохимиотерапияхолецистит /те

Radioactivity Exploration from the Arctic to the Antarctic. Part 1: Introduction

This book is dedicated to professor emeritus Bengt Forkman (Nuclear Physics, Lund University) who in 1979 took the initiative to arrange an environmental radioactivity research program for the Ymer-80 expedition. He engaged his old friend Bertil Persson whom he during the 1960th inspired to university studies in Lund who just been promoted to professor of Radioecology at the Swedish University of Agricultural Sciences in Uppsala. Bertil Persson was tutor for Elis Holm at Lund University, who for his thesis was engaged in radiochemical analysis of plutonium isotopes in the environment. Elis Holm became deeply involved in management of Ymer-80 and all the following expeditions as well. We found a superior talent for the logistics in Kjell-Åke Carlsson (who was mechanical engineer at the department of radiation physics at Lund University). Without him, we would not have been able to solve all the thousands of practical issues and contacts with authorities and sponsors. He also contributed with the diaries extensive photographic and video documentation of all the expeditions. We have together compiled this book although several others were partly engaged in the various expeditions to whom we are deeply thankful for their contributions. They will appear as contributors in the separate parts of this book: 1. Ymer-80 (Bengt Forkman, Boel Forkman, Lars Ahlgren (diseased) 2. Swedarp 1988-1989 (Per Roos, Birgitta Roos) 3. Arctic Ocean 1991 4. Tundra Expedition 5. Arctic Ocean 1996 (Dan Josefsson, Mats Ericsson

Observational manifestations of solar magneto-convection -- center-to-limb variation

We present the first center-to-limb G-band images synthesized from high resolution simulations of solar magneto-convection. Towards the limb the simulations show "hilly" granulation with dark bands on the far side, bright granulation walls and striated faculae, similar to observations. At disk center G-band bright points are flanked by dark lanes. The increased brightness in magnetic elements is due to their lower density compared with the surrounding intergranular medium. One thus sees deeper layers where the temperature is higher. At a given geometric height, the magnetic elements are cooler than the surrounding medium. In the G-band, the contrast is further increased by the destruction of CH in the low density magnetic elements. The optical depth unity surface is very corrugated. Bright granules have their continuum optical depth unity 80 km above the mean surface, the magnetic elements 200-300 km below. The horizontal temperature gradient is especially large next to flux concentrations. When viewed at an angle, the deep magnetic elements optical surface is hidden by the granules and the bright points are no longer visible, except where the "magnetic valleys" are aligned with the line of sight. Towards the limb, the low density in the strong magnetic elements causes unit line-of-sight optical depth to occur deeper in the granule walls behind than for rays not going through magnetic elements and variations in the field strength produce a striated appearance in the bright granule walls.Comment: To appear in ApJL. 6 pages 4 figure

Bilateral Arthrodesis of the Ankle Joint : Self-Reported Outcomes in 35 Patients From the Swedish Ankle Registry

Bilateral ankle arthrodesis is seldom performed, and results concerning the outcome and satisfaction can only sparsely be found in published studies. We analyzed the data from 35 patients who had undergone bilateral ankle arthrodesis in the Swedish Ankle Registry using patient-reported generic and region-specific outcome measures. Of 36 talocrural arthrodeses and 34 tibio-talar-calcaneal arthrodeses, 6 ankles (9%) had undergone repeat arthrodesis because of nonunion. After a mean follow-up period of 47 ± 5 (range 12 to 194) months, the mean scores were as follows: self-reported foot and ankle score, 33 ± 10 (range 4 to 48); the EuroQol Group's EQ-5D™ score, 0.67 ± 0.28 (range −0.11 to 1), the EuroQol Group's visual analog scale score, 70 ± 19 (range 20 to 95), 36-item Short Form Health Survey (SF-36) physical domain, 39 ± 11 (range 16 to 58); and SF-36 mental domain, 54 ± 14 (range 17 to 71). Patients with rheumatoid arthritis seemed to have similar self-reported foot and ankle scores but possibly lower EQ-5D™ and SF-36 scores. Those with talocrural arthrodeses scored higher than did those with tibio-talar-calcaneal arthrodeses on the EQ5D™ and SF-36 questionnaires (p = .03 and p = .04). In 64 of 70 ankles (91%), the patients were satisfied or very satisfied with the outcome. In conclusion, we consider bilateral ankle arthrodesis to be a reasonable treatment for symptomatic hindfoot arthritis, with high postoperative mid-term satisfaction and satisfactory scores on the patient-reported generic and region-specific outcome measures, when no other treatment option is available

Valence-Electron Resonances in Alkali-Metal Overlayers Observed via Photoemission Line-Shape Changes

Valence-electron resonances for Na overlayers on Ag(111) and Cu(111) are observed by photoemission via line-shape changes for the substrate s,p-band emission in a narrow range of photon energies. The effect is ascribed to interfering contributions to the photoelectron wave from the substrate and the vacuum barrier

Catastrophic failure of an uncemented acetabular component due to high wear and osteolysis: An analysis of 154 Omnifit prostheses with mean 6-year follow-up

Background The purposes of this study were (1) to evaluate the wear pattern of the hydroxyapatite-coated "Dual Radius" Omnifit cup, (2) to investigate whether wear is correlated to any demographic or prosthesis-related factors, and (3) to describe micromotion of both the cup and the stem. Patients and methods 154 hips were implanted between 1990 and 1996 and followed for an average of 6 years. Wear was measured according to the "Charnley-duo" method and, in 79 hips, with radiostereometry (RSA). RSA was also used to evaluate micromotion. We analyzed the femoral heads using scanning electron microscopy, energy dispersive X-ray spectroscopy and an atomic force microscope. Result 66 cups were revised and had a mean annual wear of 0.32 mm compared to 0.12 mm in hips not revised. Osteolytic processes were observed in 35 hips but at revision osteolysis was present in 51 cases. 43/66 sockets were loose. Micromotion evaluated by RSA, weight, age, side, size of cup, screws, polyethylene thickness or shelf-life of the polyethylene did not correlate to wear, whereas male gender did. Interpretation It is still unclear why about half of our cases had an abnormal wear rate. Annual wear exceeding 0.2 mm is prognostic of late failure and should be considered a warning sign

Poor prosthesis survival and function after component exchange of total ankle prostheses

BACKGROUND AND PURPOSE: In failed total ankle replacements (TARs), fusion is often the procedure of preference; the outcome after exchanging prosthetic components is debated. We analyzed prosthetic survival, self-reported function, and patient satisfaction after component exchange. Patients and methods We identified patients in the Swedish Ankle Registry who underwent exchange of a tibial and/or talar component between January 1, 1993 and July 1, 2013 and estimated prosthetic survival by Kaplan-Meier analysis. We evaluated the patient-reported outcome measures (PROMs) SEFAS, EQ-5D, EQ-VAS, SF-36, and patient satisfaction by direct questions.RESULTS: 69 patients underwent revision TAR median 22 (0-110) months after the primary procedure. 24 of these failed again after median 26 (1-110) months. Survival analysis of revision TAR showed a 5-year survival rate of 76% and a 10-year survival of 55%. 29 patients with first revision TAR in situ answered the PROMs at mean 8 (1-17) years after revision and had the following mean scores: SEFAS 22, SF-36 physical 37 and mental 49, EQ-5D index 0.6, and EQ-VAS 64. 15 of the patients were satisfied, 5 were neither satisfied nor dissatisfied, and 9 were dissatisfied.INTERPRETATION: Revision TAR had a 10-year survival of 55%, which is lower than the 10-year survival of 74% for primary TAR reported from the same registry. Only half of the patients were satisfied. Future studies should show which, if any, patients benefit from revision TAR and which patients should rather be fused directly

Radioactivity Exploration from the Arctic to Antarctica. Part 5: The Tundra-94 expedition

The joint Swedish-Russian “Tundra Ecology-94” expedition during 1994 used the large Russian ice-breaking research vessel R/V Akademik Fedorov a platform and went along a coastline of 3500 km-from the Kola Peninsula 10°E to Kolyuchinskaya Bay 173°E. Radioactivity in air, seawater and sediment was explored at various locations along the route. The average of 7Be activity concentration in air over the Arctic Ocean was found to be only about 0.6 mBq.m-3, in air close to the Siberian coast-line, however, it was as high as 11 mBq.m-3. The activity concentration of 210Pb in the air over the Arctic Ocean varies between 37 – 176 micro-Bq.m-3. In the air close to the Siberian coastline 71oN 84oE, however, the activity concentration of 210Pb in the air was much higher, about 2500 micro.Bq.m-3. Anthropogenic radioactivity in the Arctic originate from nuclear weapons fallout, release from nuclear fuel reprocessing plant, and from the Chernobyl accident. The minimum values of the 137Cs activity concentration water along the route of the Tundra were found in South-eastern Barents Sea: 5.3 Bq.m-3 of surface-water, and of bottom-water 6.4 Bq.m-3. Maximum values were found in the Western Laptevsea: 12.8 Bq.m-3 of surface-water, and of bottom-water 5.1 Bq.m-3. East of 150 oE the 134Cs / 137Cs ratios are less than 0.003, indicating that less than 6% of the 137Cs originated from the Chernobyl accident. 137Cs levels are reduced to values of about 1.4 Bq.m-3 in the low salinity water near the mouths of the Ob and Yenisey Rivers. The 134Cs / 137Cs activity ratio of 0.014 in the freshwater indicates that the Chernobyl component in the river systems is the same (30%) as in the marine waters west of 150 oE. In surface water the 90Sr activity concentration range from 2 to 4 Bq.m-3, Maximuim values about 3.5 Bq.m-3 were found between 100-140 oE. But east of 150 oE the values decreased to about 0.5 Bq.m-3 at 170 oE. In bottom water the 90Sr activity concentration range from 1.5 at 40 oE to maximum values about 4 Bq.m-3 between 100-120 oE. . The measured 90Sr/137Cs ratios in surface water close to a value of 0.14 over a wide range of stations from the Barents to the Laptev Seas. The 129I concentration in sea-water along the route of the Tundra expedition decrease from about 20·1011 atoms.l-1 at 40 oE, to about 1·1011 atoms.l-1 east of 160 oE. The 239+240Pu activity concentration in surface seawater decrease from about 10 mBq.m-3 to about 1 mBq.m-3 east of 160 oE. In bottom seawater it is more evenly distributed between 10-4 mBq.m-3, with minimum at 60-80 oE and maxima at 40oE and 160 oE. Measured 238Pu/239,240Pu activity ratios in the water column yield no evidence of any leakage of plutonium from dumped nuclear wastes in the Kara and Barents Seas