The effect of pathological shoulder rhythm on muscle and joint forces after reverse shoulder arthroplasty, a numerical analysis.

BACKGROUND Compromised abduction ability after reverse shoulder arthroplasty is primarily linked to limited glenohumeral range of motion while scapulothoracic mobility can typically be maintained. Glenohumeral joint forces strongly depend on the resulting scapulohumeral rhythm, however, an association between the acting muscle and joint forces and the subject-specific scapulohumeral rhythm after reverse shoulder arthroplasty has not been established. METHODS Eleven reverse shoulder arthroplasty patients were divided into groups of poor and excellent abduction ability. Subject-specific models were developed and scaled for each patient using existing motion capture data in AnyBody™. Shoulder muscle and joint forces were obtained using inverse dynamics calculations during shoulder abduction to 100° in the scapula plane. The scapulohumeral rhythm, the resting abduction angle and internal body forces between the outcome groups were compared using a Mann Whitney U test. FINDINGS The mean glenohumeral and scapulothoracic contribution to overall shoulder abduction for the excellent group was on average 9.7% higher and 21.4% lower, respectively, compared to the mean of the poor group. For shoulder abduction angles between 30° and 60°, the excellent group demonstrated on average 25% higher muscle forces in the anterior deltoid which was significantly higher compared to the poor outcome patients. Scapulothoracic muscle activity did not differ significantly between the two functional groups. INTERPRETATION Accordingly, rehabilitation strategies focusing on strengthening the anterior part of the deltoid in particular may improve clinical outcomes

The Non-Affected Muscle Volume Compensates for the Partial Loss of Strength after Injection of Botulinum Toxin A

Local botulinum toxin (BTX-A, Botox®) injection in overactive muscles is a standard treatment in patients with cerebral palsy. The effect is markedly reduced in children above the age of 6 to 7. One possible reason for this is the muscle volume affected by the drug. Nine patients (aged 11.5; 8.7–14.5 years) with cerebral palsy GMFCS I were treated with BTX-A for equinus gait at the gastrocnemii and soleus muscles. BTX-A was administered at one or two injection sites per muscle belly and with a maximum of 50 U per injection site. Physical examination, instrumented gait analysis, and musculoskeletal modelling were used to assess standard muscle parameters, kinematics, and kinetics during gait. Magnetic resonance imaging (MRI) was used to detect the affected muscle volume. All the measurements were carried out pre-, 6 weeks post-, and 12 weeks post-BTX-A. Between 9 and 15% of the muscle volume was affected by BTX-A. There was no effect on gait kinematics and kinetics after BTX-A injection, indicating that the overall kinetic demand placed on the plantar flexor muscles remained unchanged. BTX-A is an effective drug for inducing muscle weakness. However, in our patient cohort, the volume of the affected muscle section was limited, and the remaining non-affected parts were able to compensate for the weakened part of the muscle by taking over the kinetic demands associated with gait, thus not enabling a net functional effect in older children. We recommend distributing the drug over the whole muscle belly through multiple injection sites

Microwave and Millimeter-Wave GaN HEMTs: Impact of Epitaxial Structure on Short-Channel Effects, Electron Trapping, and Reliability

Application of gallium nitride high-electron-mobility transistors (GaN HEMTs) to millimeter-wave power amplifiers requires gate length scaling below 150 nm: in order to control short-channel effects, the gate-to-channel distance must be decreased, and the device epitaxial structure has to be completely redesigned. A high 2-D electron gas (2DEG) carrier density can be preserved even with a very thin top barrier layer by substituting AlGaN with AlN, InAl(Ga)N, or ScAlN. Moreover, to prevent interaction of hot electrons with compensating impurities and defects in the doped GaN buffer, the latter has to be separated from the channel by a back barrier. Other device designs consist in adopting a graded channel (which controls the electric field) or to adopt nitrogen-polar (N-polar) GaN growth (which decreases the distance between gate and channel, thus attenuating short-channel effects). The aim of this article is to review the various options for controlling short-channel effects, improve off-state characteristics, and reduce drain–source leakage current. Advantages and potential drawbacks of each proposed solution are analyzed in terms of current collapse (CC), dispersion effects, and reliability

Nutrição e manejo do solo em fruteiras de caroço em regiões de clima temperado

The agronomic techniques adopted for stone fruit trees cultivation should be ecologically and economically sustainable. This implies that production processes, apart from improving fruit yield and quality, mantain or increase the value of natural resources, guaranteeng satisfactory incomes to growers. The paper discusses fertilization and soil management aspects for peach, species largely investigated, and other stone fruit species, with emphasis on the Italian fruit industry. As técnicas adotadas no cultivo das frutas de caroço ou drupáceas devem ser definidas com uma visão de sustentabilidade ecológica e econômica. Tal visão sugere que os aspectos produtivos, voltados ao aumento da qualidade, sejam compatíveis com o ambiente, mantendo e, se possível, aumentando a qualidade dos recursos ambientais e garantindo, ao mesmo tempo, um adequado retorno econômico aos fruticultores. No presente trabalho são discutidos aspectos da fertilização e manejo do solo das drupáceas, assumindo como modelo o pessegueiro, espécie mais estudada, sendo evidenciados alguns resultados obtidos recentemente em outras espécies do grupo, com ênfase na Itália, mas que podem ser aplicados, na maioria dos casos, em qualquer situação

Nutrição e manejo do solo em fruteiras de caroço em regiões de clima temperado

The agronomic techniques adopted for stone fruit trees cultivation should be ecologically and economically sustainable. This implies that production processes, apart from improving fruit yield and quality, mantain or increase the value of natural resources, guaranteeng satisfactory incomes to growers. The paper discusses fertilization and soil management aspects for peach, species largely investigated, and other stone fruit species, with emphasis on the Italian fruit industry. As técnicas adotadas no cultivo das frutas de caroço ou drupáceas devem ser definidas com uma visão de sustentabilidade ecológica e econômica. Tal visão sugere que os aspectos produtivos, voltados ao aumento da qualidade, sejam compatíveis com o ambiente, mantendo e, se possível, aumentando a qualidade dos recursos ambientais e garantindo, ao mesmo tempo, um adequado retorno econômico aos fruticultores. No presente trabalho são discutidos aspectos da fertilização e manejo do solo das drupáceas, assumindo como modelo o pessegueiro, espécie mais estudada, sendo evidenciados alguns resultados obtidos recentemente em outras espécies do grupo, com ênfase na Itália, mas que podem ser aplicados, na maioria dos casos, em qualquer situação

Load-induced blood marker kinetics in patients with medial knee compartment osteoarthritis are associated with accumulated load and patient reported outcome measures [version 2; peer review: 1 approved, 2 approved with reservations]

Background This study aimed to quantify the mechanoresponse of 10 blood marker candidates for joint metabolism to a walking stress test in patients with knee osteoarthritis and to determine the association among marker kinetics and with accumulated load and patient reported outcomes. Methods 24 patients with knee osteoarthritis completed questionnaires, and a 30-minute walking stress test with six blood serum samples and gait analysis. Concentrations of cartilage oligomeric matrix protein (COMP), matrix metalloproteinases (MMP)-1, -3, and -9, epitope resulting from cleavage of type II collagen by collagenases (C2C), type II procollagen (CPII), interleukin (IL)-6, proteoglycan (PRG)-4, A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)-4, and resistin were determined by enzyme-linked immunosorbent assays, Joint load (moments and compartmental forces) was estimated using musculoskeletal modeling using gait analysis data. Results COMP and MMP-3 showed an immediate increase after the walking stress followed by a decrease. MMP-9 and resistin showed a delayed decrease below pre-stress levels. ∆COMP correlated with ∆MMP-3 for most time points. ∆MMP-9 correlated with ∆resistin for most time points. The load-induced increase in blood marker levels correlated among blood markers and time points. C2C and resistin correlated positively and C2C/CPII and MMP2 correlated negatively with load during gait. Immediate relative ∆CPII and ∆MMP1 and delayed relative ∆COMP, ∆IL6, ∆C2C, ∆CPII, ∆MMP1 and ∆MMP3 correlated with the load accumulated during the walking stress. Baseline C2C levels correlated with Knee Osteoarthritis Outcome Score (KOOS) subscales and load-induced changes in MMP-3 with KOOS and Short Form 36 quality of life subscores (P<0.05). Conclusions The distinct and differentiated physiological response to the walking stress depends on accumulated load and appears relevant for patient reported osteoarthritis outcome and quality of life and warrants further investigation in the context of disease progression. ClinicalTrials.gov registration: NCT0262220

Current Preclinical Testing of New Hip Arthroplasty Technologies Does Not Reflect Real-World Loadings: Capturing Patient-Specific and Activity-Related Variation in Hip Contact Forces

Background: Total hip replacement (THR) implants are routinely tested for their tribological performance through regulatory pre-clinical wear testing (e.g. ISO-14242). The standardized loading conditions defined in these tests consist of simplified waveforms, which do not specifically represent in vivo loads in different groups of patients. The aim of this study was to investigate, through musculoskeletal modelling, patient-specific and activity-related variation in hip contact forces (HCFs) in a large cohort of THR patients during common activities of daily living (ADLs). Methods: 132 THR patients participated in a motion-capture analysis while performing different ADLs, including walk, fast walk, stair ascent and descent (locomotor); sit-to-stand, stand-to-sit, squat and lunge (non-locomotor). HCFs were then calculated using the AnyBody Modelling System and qualitatively compared across all activities. The influence of gender on HCFs was analysed through statistical parametric mapping (SPM) analysis. Results: Systematic differences were found in HCF magnitudes and individual components in both locomotor and non-locomotor ADLs. The qualitative analysis of the ADLs revealed a large range and a large variability of forces experienced at the hip during different activities. Significant differences in the three-dimensional loading patterns were observed between males and females across most activities. Conclusions: THR patients present a large variability in the forces experienced at the hip joint during their daily life. The inter-patient variation might partially explain the heterogeneity observed in implant survival rates. A more extensive pre-clinical implant testing standard, under clinically relevant loading conditions has been advocated to better predict and avoid clinical wear problems

ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio