CT scan evaluation of glenoid component fixation: a prospective study of 27 minimally cemented shoulder arthroplasties

BACKGROUND: Glenoid component failure is the most common complication of total shoulder arthroplasty. It can be correlated with failure of the component itself to resist wear and deformation, failure of fixation or failure of the glenoid bone. Anchor Peg Glenoid component (Depuy(®)) seems to have a higher bone fixation in biomechanical canine model: it is a all-polyethylene, concave component with one circumferentially fluted, central, interference-fit peg and three small cemented peripheral pegs. MATERIALS AND METHODS: We realized a prospective study of Anchor Peg total shoulder arthroplasty, included 27 patients suffering from primary arthrosis or arthritis, without rotator cuff tear. A clinical and radiographic evaluation was performed at 3 months, 1 and 2 years; a CT scan was made in postoperative and analyzed central peg’s bone integration 1 year later. RESULTS: Improvement of postoperative Constant score and radiographic good results were correlated with satisfactory subjective results reported by patients. We observed radiolucent lines under glenoid component in 3 cases. Twenty-six CT scans were available at 1 year: it showed complete bone integration around the central peg in 21 cases and partial peripheral bone integration in four cases. Only one patient had any tissue integration around the peg, probably because of his implantation near cortical bone of scapular spine. DISCUSSION/CONCLUSION: Long-term result of arthroplasty is correlated with glenoid durable fixation to underlying bone: this study shows higher fixation of glenoid component with bone integration of central peg. However, these results will have to be confirmed in a later revision

Pathogenesis of adolescent idiopathic scoliosis in girls - a double neuro-osseous theory involving disharmony between two nervous systems, somatic and autonomic expressed in the spine and trunk: possible dependency on sympathetic nervous system and hormones with implications for medical therapy

Anthropometric data from three groups of adolescent girls - preoperative adolescent idiopathic scoliosis (AIS), screened for scoliosis and normals were analysed by comparing skeletal data between higher and lower body mass index subsets. Unexpected findings for each of skeletal maturation, asymmetries and overgrowth are not explained by prevailing theories of AIS pathogenesis. A speculative pathogenetic theory for girls is formulated after surveying evidence including: (1) the thoracospinal concept for right thoracic AIS in girls; (2) the new neuroskeletal biology relating the sympathetic nervous system to bone formation/resorption and bone growth; (3) white adipose tissue storing triglycerides and the adiposity hormone leptin which functions as satiety hormone and sentinel of energy balance to the hypothalamus for long-term adiposity; and (4) central leptin resistance in obesity and possibly in healthy females. The new theory states that AIS in girls results from developmental disharmony expressed in spine and trunk between autonomic and somatic nervous systems. The autonomic component of this double neuro-osseous theory for AIS pathogenesis in girls involves selectively increased sensitivity of the hypothalamus to circulating leptin (genetically-determined up-regulation possibly involving inhibitory or sensitizing intracellular molecules, such as SOC3, PTP-1B and SH2B1 respectively), with asymmetry as an adverse response (hormesis); this asymmetry is routed bilaterally via the sympathetic nervous system to the growing axial skeleton where it may initiate the scoliosis deformity (leptin-hypothalamic-sympathetic nervous system concept = LHS concept). In some younger preoperative AIS girls, the hypothalamic up-regulation to circulating leptin also involves the somatotropic (growth hormone/IGF) axis which exaggerates the sympathetically-induced asymmetric skeletal effects and contributes to curve progression, a concept with therapeutic implications. In the somatic nervous system, dysfunction of a postural mechanism involving the CNS body schema fails to control, or may induce, the spinal deformity of AIS in girls (escalator concept). Biomechanical factors affecting ribs and/or vertebrae and spinal cord during growth may localize AIS to the thoracic spine and contribute to sagittal spinal shape alterations. The developmental disharmony in spine and trunk is compounded by any osteopenia, biomechanical spinal growth modulation, disc degeneration and platelet calmodulin dysfunction. Methods for testing the theory are outlined. Implications are discussed for neuroendocrine dysfunctions, osteopontin, sympathoactivation, medical therapy, Rett and Prader-Willi syndromes, infantile idiopathic scoliosis, and human evolution. AIS pathogenesis in girls is predicated on two putative normal mechanisms involved in trunk growth, each acquired in evolution and unique to humans

Le Néolithique de la Collection Vernet et de la Station de Borne (Haute-Loire)

Crémillieux A., Aulanier M., Vidil A. Le Néolithique de la Collection Vernet et de la Station de Borne (Haute-Loire). In: Revue archéologique du Centre de la France, tome 16, fascicule 3-4, 1977. pp. 281-293

Nanoporous Thermosets with Percolating Pores from Block Polymers Chemically Fixed above the Order–Disorder Transition

A lamellar diblock polymer combining a cross-linkable segment with a chemically etchable segment was cross-linked above its order–disorder temperature (<i>T</i>_ODT) to kinetically trap the morphology associated with the fluctuating disordered state. After removal of the etchable block, evaluation of the resulting porous thermoset allows for an unprecedented experimental characterization of the trapped disordered phase. Through a combination of small-angle X-ray scattering, nitrogen sorption, scanning electron microscopy, and electron tomography experiments we demonstrate that the nanoporous structure exhibits a narrow pore size distribution and a high surface to volume ratio and is bicontinuous over a large sample area. Together with the processability of the polymeric starting material, the proposed system combines attractive attributes for many advanced applications. In particular, it was used to design new composite membranes for the ultrafiltration of water