Medial-lateral loading and wear in TKA

Pre-clinical wear testing of Total Knee Arthroplasty has traditionally been carried out in a physical experiment [Fisher, 2002]. Recent computational models have been shown to have sufficient accuracy to be considered alongside these experiments [Knight, 2007]. These computational models use a relationship of wear volume proportional to the product of contact pressure, sliding distance and cross shear [Maxian, 1996]. Instrumented knees have recently shown that medial-lateral (ML) loads may be of similar magnitudes to that of the anterior-posterior (AP) load. The AP load is known to have a significant effect on the kinematics of the total knee replacement and so it is reasonable to assume that application of an ML load may have a similar degree of influence on kinematics. The effect of the ML load is hypothesised to increase the cross shear and hence the wear rate. At present, the ISO standard for testing TKA contains no provision for a ML load

Characterization and computational modelling of acrylic bone cement polymerisation

Total joint replacement is one of the most successful surgical procedures and is a proven treatment for arthritis. Despite low failure rates, the wide application of the treatment means that large numbers of prostheses fail and must be revised. Improved pre-clinical testing methods for these orthopaedic devices may assist in developing new prostheses with improved clinical results. Computational modelling of biological systems is becoming increasingly accurate and is a much quicker and cheaper alternative to physical testing, but continued development is necessary to ensure computational models produce accurate and reliable predictions of implant behaviour. Acrylic bone cements have been used as a method of fixation for over 50 years but despite improvements in cement handling techniques and numerous attempts to improve the mechanical properties of the cement in other ways, the cement is often highlighted as the weak link in the joint replacement system. Aseptic loosening is cited as the cause for the majority of revision operations and cement degradation has been shown to be a contributor to the loosening process. In-vivo, cement is subject to cyclic loads and these are the primary cause of cement damage. Residual stresses generated during the polymerisation of the cement are now thought to play a significant role in cement failure. This thesis examines the development of residual stresses as a result of thermal and chemical changes during polymerisation of the cement. Experimental techniques for characterising the evolution of materials properties during the polymerisation reaction are discussed. Differential scanning calorimetry was used to measure the reaction variables such as the activation energy of polymerisation. The development of an ultrasonic rheometry technique for monitoring the mechanical property evolution within a bone cement specimen is discussed. Computational models were generated to predict the reaction behaviour of the cement in terms of the heat produced and the evolution of the physical properties of the curing mass. Some advantages and disadvantages of candidate mathematical models have been evaluated and are discussed, along with applications in several implant fixation scenarios.. The model compared well with experimental data and was used to predict thermal necrosis in the bone surrounding both a hip resurfacing implant and a knee replacement. Using the output reaction path produced by the thermal model a mechanical model was also produced simulating the shrinkage and mechanical property evolution exhibited by the polymerising cement. Two material models were compared with and without the effects of plasticity. Residual stress magnitudes were assessed in comparison with published values and showed better agreement when plasticity was included. Peak stresses were observed to occur during polymerisation. The location of the peak stresses were compared with experimental data on pre-load crack locations in the literature and showed good agreement

Does a PEEK femoral TKA implant preserve intact femoral surface strains compared with CoCr? A preliminary laboratory study

BACKGROUND: Both the material and geometry of a total knee arthroplasty (TKA) component influence the induced periprosthetic bone strain field. Strain, a measure of the local relative deformation in a structure, corresponds to the mechanical stimulus that governs bone remodeling and is therefore a useful in vitro biomechanical measure for assessing the response of bone to new implant designs and materials. A polyetheretherketone (PEEK) femoral implant has the potential to promote bone strains closer to that of natural bone as a result of its low elastic modulus compared with cobalt-chromium (CoCr).QUESTIONS/PURPOSES: In the present study, we used a Digital Image Correlation (DIC) technique to answer the following question: Does a PEEK TKA femoral component induce a more physiologically normal bone strain distribution than a CoCr component? To achieve this, a DIC test protocol was developed for periprosthetic bone strain assessment using an analog model; the protocol aimed to minimize errors in strain assessment through the selection of appropriate analysis parameters.METHODS: Three synthetic bone femurs were used in this experiment. One was implanted with a CoCr femoral component and one with a PEEK femoral component. The third (unimplanted) femur was intact and used as the physiological reference (control) model. All models were subjected to standing loads on the corresponding polyethylene (ultrahigh-molecular-weight polyethylene) tibial component, and speckle image data were acquired for surface strain analysis using DIC in six repeat tests. The strain in 16 regions of interest on the lateral surface of each of the implanted bone models was plotted for comparison with the corresponding strains in the intact case. A Wilcoxon signed-rank test was used to test for difference at the 5% significance level.RESULTS: Surface analog bone strain after CoCr implantation indicated strain shielding (R2 = 0.6178 with slope, ? = 0.4314) and was lower than the intact case (p = 0.014). The strain after implantation with the PEEK implant deviated less from the intact case (R2 = 0.7972 with slope ? = 0.939) with no difference (p = 0.231).CONCLUSIONS: The strain shielding observed with the contemporary CoCr implant, consistent with clinical bone mineral density change data reported by others, may be reduced by using a PEEK implant.CLINICAL RELEVANCE: This bone analog in vitro study suggests that a PEEK femoral component could transfer more physiologically normal bone strains with a potentially reduced stress shielding effect, which may improve long-term bone preservation. Additional studies including paired cadaver tests are necessary to test the hypothesis further

Laying the foundations of international careers research

As an editorial to the special issue ‘new avenues in international careers research’ this paper discusses the roots of the international careers research stream, which sits at the intersection between career studies, HRM and international management. In order to support future studies in this emerging area of enquiry, we then attempt to lay down the foundations of a research agenda based around what we see as the three core areas of interest: contextualised careers research, comparative careers research, and careers research in internationally operating organisations. After providing some suggestions for the kinds of theoretical, methodological and research collaboration tools that will be required to build on these foundations, we introduce the five empirical papers that comprise this special issue

Th2 cells are essential for modulation of vascular repair by allogeneic endothelial cells

Author Manuscript 2011 April 1.Background: Endothelial cells (ECs) embedded within 3-dimensional matrices (MEEC) control lumenal inflammation and intimal hyperplasia when placed in the vascular adventitia. Matrix embedding alters endothelial immunogenicity in vitro. T-helper (Th) cell-driven host immunity is an impediment of allogeneic grafts. We aimed to identify if modulation of Th balance would affect immune compatibility and endothelial regulation of vascular repair in vivo. Methods: Pigs (n = 4/group) underwent carotid artery balloon injury and were left untreated (Group 1) or received perivascular porcine MEEC implants (Group 2), 12 days of cyclosporine A (CsA; Group 3), or MEEC and CsA (Group 4). Host immune reactivity was analyzed after 28 and 90 days. Results: MEEC treatment induced formation of EC-specific immunoglobulin (Ig) G1 antibodies (41 ± 6 mean fluorescence intensity [MFI]) and differentiation of host splenocytes into Th2, but not Th1, cytokine-producing cells (interleukin [IL]-4, 242 ± 102; IL-10, 273 ± 114 number of spots). Concomitant CsA therapy reduced IgG1 antibody frequency (25 ± 2 MFI; p < 0.02) and Th2-cytokine producing splenocytes upon MEEC treatment (IL-4, 157 ± 19; IL-10, 124 ± 26 number of spots; p < 0.05). MEECs inhibited luminal occlusion 28 and 90 days after balloon injury (12 ± 7%) vs untreated controls (68 ± 14%; p < 0.001) but to a lesser extent with concomitant CsA treatment (34 ± 13%; p < 0.02 vs Group 2). Conclusions: MEECs do not induce a significant Th1-driven immune response but do enhance differentiation of splenocytes into cells producing Th2 cytokine. Reduction in this Th2 response reduces the vasoregulatory effects of allogeneic ECs after injury

Factors that influence the administration of tranexamic acid (TXA) to trauma patients in prehospital settings: A systematic review

OBJECTIVE: In the UK there are around 5400 deaths annually from injury. Tranexamic acid (TXA) prevents bleeding and has been shown to reduce trauma mortality. However, only 5% of UK major trauma patients who are at risk of haemorrhage receive prehospital TXA. This review aims to examine the evidence regarding factors influencing the prehospital administration of TXA to trauma patients. DESIGN: Systematic literature review. DATA SOURCES: AMED, CENTRAL, CINAHL, Cochrane Database of Systematic Reviews, Conference Proceedings Citation Index-Science, Embase and MEDLINE were searched from January 2010 to 2020; searches were updated in June 2022. CLINICALTRIALS: gov and OpenGrey were also searched and forward and backwards citation chasing performed. ELIGIBILITY CRITERIA: All primary research reporting factors influencing TXA administration to trauma patients in the prehospital setting was included. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers performed the selection process, quality assessment and data extraction. Data were tabulated, grouped by setting and influencing factor and synthesised narratively. RESULTS: Twenty papers (278 249 participants in total) were included in the final synthesis; 13 papers from civilian and 7 from military settings. Thirteen studies were rated as 'moderate' using the Effective Public Health Practice Project Quality Assessment Tool. Several common factors were identified: knowledge and skills; consequences and social influences; injury type (severity, injury site and mechanism); protocols; resources; priorities; patient age; patient sex. CONCLUSIONS: This review highlights an absence of high-quality research. Preliminary evidence suggests a host of system and individual-level factors that may be important in determining whether TXA is administered to trauma patients in the prehospital setting. FUNDING AND REGISTRATION: This review was supported by Research Capability Funding from the South Western Ambulance Service NHS Foundation Trust and the National Institute for Health Research Applied Research Collaboration South West Peninsula. PROSPERO REGISTRATION NUMBER: CRD42020162943

Careers in context: An international study of career goals as mesostructure between societies’ career-related human potential and proactive career behavior

Careers exist in a societal context that offers both constraints and opportunities for career actors. Whereas most studies focus on proximal individual and/or organisational‐level variables, we provide insights into how career goals and behaviours are understood and embedded in the more distal societal context. More specifically, we operationalise societal context using the career‐related human potential composite and aim to understand if and why career goals and behaviours vary between countries. Drawing on a model of career structuration and using multilevel mediation modelling, we draw on a survey of 17,986 employees from 27 countries, covering nine of GLOBE's 10 cultural clusters, and national statistical data to examine the relationship between societal context (macrostructure building the career‐opportunity structure) and actors' career goals (career mesostructure) and career behaviour (actions). We show that societal context in terms of societies' career‐related human potential composite is negatively associated with the importance given to financial achievements as a specific career mesostructure in a society that is positively related to individuals' proactive career behaviour. Our career mesostructure fully mediates the relationship between societal context and individuals' proactive career behaviour. In this way, we expand career theory's scope beyond occupation‐ and organisation‐related factors

Kualitas Hidup Pasien Diabetes Melitus Tipe 2 di Puskesmas Se Kota Kupang

Diabetes Mellitus is well known as a chronic disease which can lead to a decrease in quality of life in all domains. The study aims to explore the diabetic type 2 patient\u27s quality of life and find out the factors affecting in type 2 diabetic mellitus patients. The cross-sectional study design is used that included 65 patient with type 2 diabetes mellitus, in 11 public health centers of Kupang City. Data were collected by using Short Form Survey (SF-36) that assessed 8-scale health profile. Independent sample t-test is used to analyze the correlation between the factors affecting and the quality of life. the study showed that the QoL of DM patients decreased in all 8- health profile including physical functioning, social functioning, mental health, general health, pain, change in the role due to physical problems and emotional problems. The Study also showed there was a relationship between gender, duration of suffering from Diabetes mellitus, and complications to the quality of life. Male perceived a better quality of life than female