Is the pull-out force of the Meniscus Arrow in bone affected by the inward curling of the barbs during biodegradation? An in vitro study

Background: Inward curling of the barbs of Meniscus Arrows during degradation was observed in a previous study, in which swelling, distention, and water uptake by Meniscus Arrows was evaluated. This change of configuration could have consequences with respect to anchorage capacity in bone. Material/Methods: Eight non-degraded Meniscus Arrows in the original configuration were pulled out of thawed, fresh-frozen human femoral condyle, and pull-out force was measured and compared with that of 6 Meniscus Arrows after 31 days of degradation under controlled conditions. Results: No significant difference was found between the 2 groups with respect to the required pull-out force (t test), the distribution of the data, or the interaction between degradation and location, as evaluated by mann-Whitney test, and no significant difference was found between the 2 groups with respect to the degradation state or position in the coudyles, as evaluated by 2-way analysis of variance. Conclusions: Our results indicate that the decrease in barb-barb diameter during the first month of degradation of the Meniscus Arrows has no significant effect on the tensile pull-out force required for removal from human femur condyle. Further research should be undertaken to examine whether the same is true for other biodegradable devices with barbs

Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma.

Sentinel-lymph-node biopsy is associated with increased melanoma-specific survival (i.e., survival until death from melanoma) among patients with node-positive intermediate-thickness melanomas (1.2 to 3.5 mm). The value of completion lymph-node dissection for patients with sentinel-node metastases is not clear. In an international trial, we randomly assigned patients with sentinel-node metastases detected by means of standard pathological assessment or a multimarker molecular assay to immediate completion lymph-node dissection (dissection group) or nodal observation with ultrasonography (observation group). The primary end point was melanoma-specific survival. Secondary end points included disease-free survival and the cumulative rate of nonsentinel-node metastasis. Immediate completion lymph-node dissection was not associated with increased melanoma-specific survival among 1934 patients with data that could be evaluated in an intention-to-treat analysis or among 1755 patients in the per-protocol analysis. In the per-protocol analysis, the mean (±SE) 3-year rate of melanoma-specific survival was similar in the dissection group and the observation group (86±1.3% and 86±1.2%, respectively; P=0.42 by the log-rank test) at a median follow-up of 43 months. The rate of disease-free survival was slightly higher in the dissection group than in the observation group (68±1.7% and 63±1.7%, respectively; P=0.05 by the log-rank test) at 3 years, based on an increased rate of disease control in the regional nodes at 3 years (92±1.0% vs. 77±1.5%; P<0.001 by the log-rank test); these results must be interpreted with caution. Nonsentinel-node metastases, identified in 11.5% of the patients in the dissection group, were a strong, independent prognostic factor for recurrence (hazard ratio, 1.78; P=0.005). Lymphedema was observed in 24.1% of the patients in the dissection group and in 6.3% of those in the observation group. Immediate completion lymph-node dissection increased the rate of regional disease control and provided prognostic information but did not increase melanoma-specific survival among patients with melanoma and sentinel-node metastases. (Funded by the National Cancer Institute and others; MSLT-II ClinicalTrials.gov number, NCT00297895 .)

Fixation of osteochondral fragments in the human knee using Meniscus Arrows

The aim of this study is to compare the hold in bone of Meniscus Arrows and Smart Nails, followed by the report of the results of the clinical application of Meniscus Arrows as fixation devices. First, pull-out tests were performed to analyse the holdfast of both nails in bone. Statistical analysis showed no significant difference; therefore, the thinner Meniscus Arrow was chosen as fixation device in the patient series of two patients with a symptomatic Osteochondritis dissecans fragment and three patients with an osteochondral fracture of a femur condyle. The cartilage margins were glued with Tissuecoll. All fragments consolidated. Second look arthroscopy in three patients showed fixed fragments with stable, congruent cartilage edges. At an average follow-up period of 5 years no pain, effusion, locking, restricted range of motion or signs of osteoarthritis were reported. Based on the results of the pull-out tests and available clinical studies, Meniscus Arrows and Smart Nails are both likely to perform adequately as fixation devices in the treatment of Osteochondritis dissecans and osteochondral fractures in the knee. They both provide the advantage of one stage surgery. However, based on their smaller diameter, the Meniscus Arrows should be preferred for this indication

Design of a compact transmission line transformer for high voltage nanosecond pulses

The area of pulsed-power technology covers a broad range of powers (up to 1014 W), voltages (up to 106-107 V), currents (as high as 106 A or higher) and pulse durations (below 10-8 s). State of the art systems have voltages up to a few hundred kilovolts at pulse lengths down to the nanosecond range. Special applications require extreme field strengths in the range of 1 GV/m. The design of a compact source, meeting the above requirement aims for 1 MV, 1 ns pulses. In this paper, we present a novel compact TLT (transmission line transformer). The TLT consists of 10 coaxial transmission lines which are connected in parallel at the input and in series at the output. To verify the theoretical analysis a model of the transmission line transformer has been simulated by a time domain electromagnetic field solver. An optimized transmission line transformer has been built and first measurements have been performed. The equivalent circuit model and the simulations agree with the experimental results. The effect of secondary mode suppression by means of ferrite has been investigated. Both simulations and experiments showed that ferromagnetic cores around each individual transmissions line in our design can be omitted

Design of compact transmission line transformer for high voltage nanosecond pulses

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