Minimum 10-Year Clinical Outcome of Lateral Collagen Meniscal Implants for the Replacement of Partial Lateral Meniscal Defects: Further Results From a Prospective Multicenter Study

Background: The collagen meniscal implant (CMI) is a biologic scaffold aimed at replacing partial meniscal defects. The long-term results of lateral meniscal replacement have never been investigated. Purpose: To document the clinical outcomes and failures of lateral CMI implantation for partial lateral meniscal defect at a minimum 10-year follow-up. Study Design: Case series; Level of evidence, 4, Methods: This study included 24 consecutive patients who underwent lateral CMI implantation for partial lateral meniscal defects between April 2006 and September 2009 and who were part of a previous study with a 2-year follow-up. Outcome measures at the latest follow-up included the Lysholm score, Knee injury and Osteoarthritis Outcome Score, visual analog scale (VAS) for pain, Tegner activity level, and EuroQol 5-Dimensions score. Data regarding complications and failures were collected, and patients were asked about their satisfaction with the procedure. Results: Included in the final analysis were 19 patients (16 male, 3 female) with a mean age at surgery of 37.1 ± 12.6 years and a mean follow-up of 12.4 ± 1.5 years (range, 10-14 years). Five failures (26%) were reported: 1 CMI removal because of implant breakage and 4 joint replacements (2 unicompartmental knee arthroplasties and 2 total knee arthroplasties). The implant survival rate was 96% at 2 years, 85% at 5 years, 85% at 10 years, 77% at 12 years, and 64% at 14 years. Lysholm scores at the final follow-up were rated as “excellent” in 36% (5 of 14 nonfailures), “good” in 43% (6 of 14), and “fair” in 21% (3 of 14). The VAS score was 3.1 ± 3.1, with only 16% (3 of 19 patients) reporting that they were pain-free; the median Tegner score was 3 (interquartile range, 2-5). All clinical scores decreased from the 2-year follow-up; however, with the exception of the Tegner score, they remained significantly higher compared with the preoperative status. Overall, 79% of patients were willing to undergo the same procedure. Conclusion: Lateral CMI implantation for partial lateral meniscal defects provided good long-term results, with a 10-year survival rate of 85% and a 14-year survival rate of 64%. At the final follow-up, 58% of the patients had “good” or “excellent” Lysholm scores. However, there was a general decrease in outcome scores between the short- and the long-term follow-up

Sirolimus Therapy for Patients With Lymphangioleiomyomatosis Leads to Loss of Chylous Ascites and Circulating LAM Cells

A young woman received a diagnosis of abdominal, sporadic lymphangioleiomyomatosis (LAM) and multiple abdominal lymphangioleiomyomas and was referred for recurrent chylous ascites responding only to a fat-free diet. On admission, pulmonary function test (PFT) results showed a moderate reduction in the transfer factor for carbon monoxide with normal exercise performance. The serum vascular endothelial growth factor D (VEGF-D) level was 2,209 pg/mL. DNA sequences, amplified at loci kg8, D16S3395, D16S3024, D16S521, and D16S291 on chromosome 16p13.3, showed a loss of heterozygosity (LOH) only for kg8. Fat-free total parenteral nutrition in association with sirolimus (2 mg po daily) was initiated. Serum sirolimus levels were maintained at concentrations between 5 and 15 ng/mL. After 1 month, reintroduction of a low-fat oral feeding was achieved without recurrence of ascites. PFT results were stable. Interestingly, clinical improvement was associated with a reduction in the VEGF-D serum level (1,558 pg/mL). LOH at the kg8 biomarker in blood LAM cells was no longer detected

The SMILING project : prevention of falls by a mechatronic training device

Ageing is characterized by functional changes that can create gait and balance disturbances, which are the main risk factors of falling. Elderly people at risk of falling can be considered to be suffering from an involuntary motor behaviour that restricts their participation in society. One method to overcome such a situation is to activate a new learning process to train for real life tasks, which represents innovation. The SMILING system is intended to challenge the elderly to solve new problems in real time by inducing variable environments that need active response and problem solving. Variable environments induced by perturbations will weaken stiff motor behaviour(s), induce flexibility and thus enable effective training and improve mobility in real life environments. The SMILING solution provides a changeable yet safe environment that needs active response and problem solving by the user. It consists of a wearable non-invasive computer-controlled system that applies chaotic perturbations to the lower extremities during walking through small alterations of the height and slope of weight-bearing surfaces. The complete system consists of 3 modules: i) a complete walking analysis system; ii) a pair of motorised training shoes; iii) a user friendly portable control unit

Performance of the EUDET-type beam telescopes

Test beam measurements at the test beam facilities of DESY have been conducted to characterise the performance of the EUDET-type beam telescopes originally developed within the EUDET project. The beam telescopes are equipped with six sensor planes using MIMOSA26 monolithic active pixel devices. A programmable Trigger Logic Unit provides trigger logic and time stamp information on particle passage. Both data acquisition framework and offline reconstruction software packages are available. User devices are easily integrable into the data acquisition framework via predefined interfaces. The biased residual distribution is studied as a function of the beam energy, plane spacing and sensor threshold. Its standard deviation at the two centre pixel planes using all six planes for tracking in a 6\,GeV electron/positron-beam is measured to be (2.88\,\pm\,0.08)\,\upmu\meter.Iterative track fits using the formalism of General Broken Lines are performed to estimate the intrinsic resolution of the individual pixel planes. The mean intrinsic resolution over the six sensors used is found to be (3.24\,\pm\,0.09)\,\upmu\meter.With a 5\,GeV electron/positron beam, the track resolution halfway between the two inner pixel planes using an equidistant plane spacing of 20\,mm is estimated to (1.83\,\pm\,0.03)\,\upmu\meter assuming the measured intrinsic resolution. Towards lower beam energies the track resolution deteriorates due to increasing multiple scattering. Threshold studies show an optimal working point of the MIMOSA26 sensors at a sensor threshold of between five and six times their RMS noise. Measurements at different plane spacings are used to calibrate the amount of multiple scattering in the material traversed and allow for corrections to the predicted angular scattering for electron beams

Effect of surgery, delivery device and head position on sinus irrigant penetration in a cadaver model

AbstractObjectiveThe extent of surgery, the type of device used and head position may influence nasal irrigation. The aim of this study was to determine the effectiveness of topical irrigant delivery to the paranasal sinuses according to these factors.MethodFour cadaveric heads underwent four stepwise endoscopic dissections. Irrigations were evaluated after every stage using different delivery devices (squeeze-bottle, gravity-dependent device and syringe) in two head positions (nose-to-sink and vertex down). Irrigant penetration into each sinus was estimated using a four-point scale.ResultsA significant positive effect of surgery was demonstrated for each sinus as well as for the delivery device. High-volume irrigant devices are more effective, and the head position plays a significant role in irrigant distribution to the frontal sinus.ConclusionThis study further confirms the efficacy of high-volume irrigant devices. A vertex down position during the irrigation could improve delivery to the frontal sinus, and the widening of the ostia increases irrigant access to the sinuses

Flexible control of movement in plants

Although plants are essentially sessile in nature, these organisms are very much in tune with their environment and are capable of a variety of movements. This may come as a surprise to many non-botanists, but not to Charles Darwin, who reported that plants do produce movements. Following Darwin\u2019s specific interest on climbing plants, this paper will focus on the attachment mechanisms by the tendrils. We draw attention to an unsolved problem in available literature: whether during the approach phase the tendrils of climbing plants consider the structure of the support they intend to grasp and plan the movement accordingly ahead of time. Here we report the first empirical evidence that this might be the case. The three-dimensional (3D) kinematic analysis of a climbing plant (Pisum sativum L.) demonstrates that the plant not only perceives the support, but it scales the kinematics of tendrils\u2019 aperture according to its thickness. When the same support is represented in two-dimensions (2D), and thus unclimbable, there is no evidence for such scaling. In these circumstances the tendrils\u2019 kinematics resemble those observed for the condition in which no support was offered. We discuss these data in light of the evidence suggesting that plants are equipped with sensory mechanisms able to provide the necessary information to plan and control a movement

Mobile Phone and Wearable Sensor-Based mHealth Approach for Psychiatric Disorders and Symptoms : Systematic Review and Link to the m-RESIST Project

Background: Mobile Therapeutic Attention for Patients with Treatment-Resistant Schizophrenia (m-RESIST) is an EU Horizon 2020-funded project aimed at designing and validating an innovative therapeutic program for treatment-resistant schizophrenia. The program exploits information from mobile phones and wearable sensors for behavioral tracking to support intervention administration. Objective: To systematically review original studies on sensor-based mHealth apps aimed at uncovering associations between sensor data and symptoms of psychiatric disorders in order to support the m-RESIST approach to assess effectiveness of behavioral monitoring in therapy. Methods: A systematic review of the English-language literature, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed through Scopus, PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials databases. Studies published between September 1, 2009, and September 30, 2018, were selected. Boolean search operators with an iterative combination of search terms were applied. Results: Studies reporting quantitative information on data collected from mobile use and/or wearable sensors, and where that information was associated with clinical outcomes, were included. A total of 35 studies were identified; most of them investigated bipolar disorders, depression, depression symptoms, stress, and symptoms of stress, while only a few studies addressed persons with schizophrenia. The data from sensors were associated with symptoms of schizophrenia, bipolar disorders, and depression. Conclusions: Although the data from sensors demonstrated an association with the symptoms of schizophrenia, bipolar disorders, and depression, their usability in clinical settings to support therapeutic intervention is not yet fully assessed and needs to be scrutinized more thoroughly.Peer reviewe

Efficacy and tolerability of multiple drug therapy in HIV-infected children

Objectives To characterize the efficacy and tolerability of multiple drug therapy (MDT) among heavily pre-treated HIV-infected children. Methods An observational study of seven children treated with 4\u20137 antiretroviral agents. MDT regimens were chosen with regard to past antiretroviral exposure and genotypic resistance data. Five children received MDT once, one child twice and one child four times. All patients had AIDS and severe CD4+ depletion and failed >2 PI-based HAART regimens. Results Virologic response, defined as a 65log10 decrease in plasma HIV-1 RNA at week 24, was achieved in 7/11 MDT. Successful MDT kept a sustained viral suppression (<50 copies/ml) at longest follow-up (72\u201396 weeks). Successful MDT obtained a great immune recovery: the median rise in absolute and percentage of CD4+ cells was 261 and 4 at week 24 and it reached 480 and 16 at 72\u201396 weeks. Adverse events were common but generally manageable. Mild/moderate gastrointestinal complaints and laboratory abnormalities were detected in 5/11 and 8/11 MDT. Grade 2 severity pancreatitis occurred in one case with chronic active hepatitis C. Pancreatitis resolved within 30 days of MDT interruption. Conclusions MDT may be a therapeutic option in children who failed to respond to most standard HAART regimens

Risk of obstructive sleep apnea with daytime sleepiness is associated with liver damage in non-morbidly obese patients with nonalcoholic Fatty liver disease

BACKGROUND: A high prevalence of obstructive sleep apnea syndrome (OSAS) has been reported in severely obese patients with nonalcoholic fatty liver disease (NAFLD), but few studies have evaluated OSAS in non-morbidly obese NAFLD patients. AIMS: To determine the prevalence of risk for OSAS with or without daytime sleepiness in non-morbidly obese patients with NAFLD and evaluate the association with the severity of liver damage. METHODS: We considered 159 consecutive patients with histological NAFLD and body mass index (BMI) <35 Kg/m2, and 80 controls without ultrasonographic steatosis matched for age, sex, and BMI. OSAS risk was determined by positivity for Berlin questionnaire (BQ), and daytime sleepiness by the Sleepness Epworth Scale (ESS). Liver damage was evaluated according to the NAFLD activity score. RESULTS: In NAFLD patients, BQ alone was positive in 39 (25%), ESS in 8 (5%), and both in 13 (8%, OSAS with sleepines); p\u200a=\u200ans vs. controls without steatosis. In NAFLD patients at risk for OSAS with (but not in those without) sleepiness, we observed a higher prevalence of nonalcoholic steatohepatitis (NASH; 11/13, 85% vs. 72/146, 49%; p\u200a=\u200a0.018), and of clinically significant fibrosis (stage>1; 9/13, 69% vs. 39/146, 27%; p\u200a=\u200a0.003). At multivariate logistic regression analysis, OSAS with sleepiness was strongly associated with NASH and fibrosis>1 independently of known clinical risk factors such as age, gender, BMI, diabetes, and ALT levels (OR 7.1, 95% c.i. 1.7-51, p\u200a=\u200a0.005 and OR 14.0, 95% c.i. 3.5-70, p\u200a=\u200a0.0002, respectively). CONCLUSIONS: A proportion of NAFLD patients without severe obesity is at risk for OSAS with daytime sleepiness, which is associated with the severity of liver damage independently of body mass and other cofactors

Infrastructure for Detector Research and Development towards the International Linear Collider

The EUDET-project was launched to create an infrastructure for developing and testing new and advanced detector technologies to be used at a future linear collider. The aim was to make possible experimentation and analysis of data for institutes, which otherwise could not be realized due to lack of resources. The infrastructure comprised an analysis and software network, and instrumentation infrastructures for tracking detectors as well as for calorimetry.Comment: 54 pages, 48 picture