Proximal humeral fractures : outcome of treatment with shoulder arthroplasty

Introduction: Proximal humerus fractures are a common injury, particularly in the elderly and especially in women. The preferred treatment approach is usually nonsurgical, with surgery reserved for cases that meet specific fracture patterns and patient-specific criteria. The aim of this thesis was to study the use of arthroplasty as a treatment option for proximal humeral fractures. Study I: Revision after shoulder replacement for acute fracture of the proximal humerus. A Nordic registry-based study of 6,756 cases: The aim was to investigate revision rates and reasons for revision after shoulder arthroplasty for acute fractures of the proximal humerus. Common data sets were collected from the Danish, Norwegian, and Swedish registries which conducted shoulder arthroplasty after acute fractures. The number and proportion of reverse total shoulder arthroplasties (rTSA) performed during the study period increased steadily. Of the 222 arthroplasties revised between 2004 and 2013, infection was the most common reason. The relative risk of revision due to infection was higher for rTSA than for shoulder hemiarthroplasties (SHA). In addition, patients younger than 75 years had a higher relative risk of revision, and survival with SHA was worse in younger patients than in older patients. Conclusion: Both SHA and rTSA have similar survival rates. However, the factors leading to a revision decision are not fully known, and reported survival rates may not reflect patients' functional outcomes. Patients with acute fractures often have comorbidities and are less amenable to revision surgery. Inclusion of patient reports in the data set would provide important information. The risk of infection was higher after rTSA than after SHA, and differences in revision rates between systematic reviews and national registries may be due to inclusion criteria. Comparisons between SHA and rTSA should be made with caution. Study II: Western Ontario Osteoarthritis of the Shoulder Index (WOOS) - a validation for use in proximal humerus fractures treated with arthroplasty: The objective was to validate the Western Ontario Osteoarthritis of the Shoulder Index (WOOS) as a patient-reported outcome measures (PROM) for use in proximal humeral fractures treated with arthroplasty. Patients from Swedish Shoulder Arthroplasty registry (SSAR) who underwent surgery after PHF with SHA and had surgery Karolinska hospital and Danderyd hospital were selected. Those who accepted performed shoulder-specific PROM and WOOS retest, and the necessary clinical examinations, Constant score (CS) and American shoulder and elbow Society (ASES), were performed at Danderyd Hospital. The validity of the WOOS has excellent correlation with all shoulder-specific scores and good correlation with EQ -5D. Test-retest reliability of WOOS overall and in subgroups also shows excellent correlation. Cronbach's alpha supports the construct of WOOS, and no floor or ceiling effects were observed. Conclusion: WOOS is a reliable tool for assessing patients with SHA after PHF. Our study supports the continued use of WOOS in SSAR and further studies with WOOS and arthroplasty after proximal humerus fractures. Study III: Reverse total shoulder arthroplasty provides better shoulder function than hemiarthroplasty for displaced 3- and 4-part proximal humeral fractures in patients aged 70 years or older: a multicenter randomized controlled trial: The aim was to compare the outcomes of 3–4-part fractures of the proximal humerus treated with reverse total shoulder arthroplasty (rTSA) and hemiarthroplasty (SHA) in patients aged ≥70 years in a multicenter randomized controlled trial. An RCT multicenter study was conducted, and eight hospitals recruited patients for the study. The rTSA group had a higher mean Constant score (58.7) compared with SHA (47.7), with a mean difference of 11.1 points (95% CI, 3.0–18.9). Patients who underwent rTSA reported greater satisfaction with their shoulders on average and had better range of motion. However, no differences were noted in WOOS, EQ -5D or pain at VAS. We noted three adverse events in the rTSA group and four in the SHA group. Conclusion: Our study showed that the rTSA group had better shoulder function as measured by the Constant score compared with SHA. This could explain why rTSA patients were more satisfied with their shoulder function. The main difference could be explained by a better range of motion in the rTSA group. Study IV: Timing of surgery for proximal humeral fracture treated with shoulder hemiarthroplasty, best results with surgery within 2 weeks: The aim was to evaluate the validity of the national recommendation "surgery with arthroplasty within 2 weeks" by investigating the timing to surgery in patients operated on with shoulder arthroplasty after proximal humerus fractures. Data was collected from SSAR. In addition, the date of fracture was collected from the hospitals that could provide that information. Preoperative delay had a negative impact on WOOS, EQ -5D, and patient satisfaction scores. The best outcomes, as measured by the WOOS score at a follow-up of at least 1 year, were observed when surgery was performed within 6-10 days of the reported fracture date. A delay of more than 10 days was associated with a worse outcome. Conclusion: The current recommendation in Sweden to perform shoulder hemiarthroplasty within two weeks after proximal humerus fracture is considered valid

A new entomopathogenic nematode species for Turkey, Heterorhabditis megidis Poinar, Jackson & Klein 1987 (Rhabditida: Heterorhabditidae)

During a survey on the occurrence of entomopathogenic nematodes (EPNs) in the Eastern Black Sea region of Turkey, a heterorhabditid species was isolated using the Galleria-baiting technique. Based on morphology and morphometrics, the isolate was identified as Heterorhabditis megidis. Sequences of the ITS region of its rDNA confirmed this identification. The species is recorded for the first time from Turkey. A more intensive survey to determine the distribution of this species, covering all parts of the Black Sea region of Turkey, is currently underway

The Krylov-proportionate normalized least mean fourth approach: Formulation and performance analysis

Cataloged from PDF version of article.We propose novel adaptive filtering algorithms based on the mean-fourth error objective while providing further improvements on the convergence performance through proportionate update. We exploit the sparsity of the system in the mean-fourth error framework through the proportionate normalized least mean fourth (PNLMF) algorithm. In order to broaden the applicability of the PNLMF algorithm to dispersive (non-sparse) systems, we introduce the Krylov-proportionate normalized least mean fourth (KPNLMF) algorithm using the Krylov subspace projection technique. We propose the Krylov-proportionate normalized least mean mixed norm (KPNLMMN) algorithm combining the mean-square and mean-fourth error objectives in order to enhance the performance of the constituent filters. Additionally, we propose the stable-PNLMF and stable-KPNLMF algorithms overcoming the stability issues induced due to the usage of the mean fourth error framework. Finally, we provide a complete performance analysis, i.e., the transient and the steady-state analyses, for the proportionate update based algorithms, e.g., the PNLMF, the KPNLMF algorithms and their variants; and analyze their tracking performance in a non-stationary environment. Through the numerical examples, we demonstrate the match of the theoretical and ensemble averaged results and show the superior performance of the introduced algorithms in different scenarios. (C) 2014 Elsevier B.V. All rights reserved

CYCLIC SEDIMENTATION ACROSS THE PERMIAN – TRIASSIC BOUNDARY (CENTRAL TAURIDES, TURKEY)

The best preserved Permian-Triassic boundary beds in Turkey are found in the Hadim region of the central Taurides. The succession is exposed in one of the allochthonous units of the Tauride Belt, the Aladag Unit, whose stratigraphy includes beds ranging from the Devonian to the Cretaceous systems. In the Aladag Unit, the Permian-Triassic boundary beds are entirely composed of carbonates. The Permian portion of these beds belongs to the Paradagmarita Zone, whereas the lowermost Triassic contains the Lower Griesbachian marker Rectocornuspira kalhori. The uppermost Permian carbonates, composed of meter-scale upward shallowing subtidal cycles, are characterized by oolitic limestones of regressive character at the top and are overlain sharply by Lower Triassic stromatolites. Cyclic Upper Permian carbonates are interpreted as highstand sytems tract deposits of the last third-order sequence of the Permian System. The Permian-Triassic boundary is an unconformity corresponding to both erosional and non-depositional hiatuses. The gap at the Permian-Triassic boundary partially corresponds to the shelf-margin systems tract and partly to the transgressive systems tract of the overlying third-order sequence. Stromatolites are interpreted as transgressive systems tract deposits. Special issueInternational Conference on Paleozoic Foraminifera, Paleoforams 2001Edited by Demir Altiner (Guest Editor

Strategic Planning Process And It's Importance For Organizations

Küreselleşme ve sonucunda rekabetin olduğu tüm alanlarda stratejik planlama kavramı önem kazanmıştır. Ne yazık ki birçok ülkede stratejik planlama büyük işletmelerin bir parçasıdır ve küçük işletmelerin çoğunun stratejik bir planı yoktur. Stratejik planlama geleceğin belirsizliklerini minimize etmek ve sürdürülebilir rekabet üstünlüğü sağlamak açısından oldukça önemlidir. Bu çalışmada, stratejik planlama süreci ve bunun örgütler açısından önemi tartışılmaktadır.AbstractAs a result of globalization and competition has gained in importance in all areas of strategic planning concepts. Unfortunately, strategic planning is a part of large enterprises in many countries; most of small enterprises do not have any strategic plan. Strategic planning is very important to minimize the uncertainty of future and to provide sustainable competitive advantages. In this study, strategic planning process and its importance fort he organizations are discussed

The effects of iron deficiency anemia on p wave duration and dispersion

OBJECTIVES: The association between P wave dispersion and iron deficiency anemia has not been documented in the literature. In this study, we evaluated P wave dispersion in patients with iron deficiency anemia and the possible relationships between P wave dispersion and other echocardiographic parameters. INTRODUCTION: The iron status of an individual may play an important role in cardiovascular health. Anemia is an independent risk factor for adverse cardiovascular outcomes. P wave dispersion is a simple electrocardiographic marker that has a predictive value for the development of atrial fibrillation. Apart from cardiovascular diseases, several conditions, such as seasonal variation, alcohol intake and caffeine ingestion, have been demonstrated to affect P wave dispersion. METHODS: The study included 97 patients who had iron deficiency anemia and 50 healthy subjects. The cases were evaluated with a clinical examination and diagnostic tests that included 12-lead electrocardiography and transthoracic echocardiography. RESULTS: Compared to the control group, patients with iron deficiency anemia showed significantly longer maximum P wave duration (Pmax) (91.1±18.0 vs. 85.8±6.7 msec, p=0.054), P wave dispersion (PWD) (48.1±7.7 vs. 40.9±5.6 msec,

THE EFFECTS OF FACE MASK USE DURING COVID-19 ON SPEECH COMPREHENSION IN GERIATRIC PATIENTS WITH HEARING LOSS WHO USE LIP-READING FOR COMMUNICATION: A PROSPECTIVE CROSS-SECTIONAL STUDY

Objective: Communication difficulties are considered the most significant consequence of hearing loss. This study aimed to determine whether surgical face masks, which have been mandatory throughout the COVID-19 pandemic, have an effect on speech comprehension scores in geriatric lip-reading patients with hearing loss and to raise awareness of the need for solutions to this problem. Materials and Method: Patients with moderate and higher sensorineural or mixed bilateral symmetrical hearing loss who stated that they lip-read to better understand during communication were included in the study. The patients’ speech comprehension scores were gathered while the audiologist wore a surgical mask and then a transparent mask, respectively. Results: Twelve (33,3%) of the patients were female, and 24 (66.7%) were male. The mean age of the patients was 66.64±1.53 years. The mean speech comprehension scores of the patients when the audiologist was wearing a surgical mask (38.25±14.33) and a transparent mask (67.81 ± 14.30), respectively, were compared. The surgical mask significantly affected speech comprehension scores, and the Cohen d value of the effect size was 2.06. As such, the surgical face mask had a great effect on these patients’ speech comprehension scores. Conclusions: In elderly lip-reading patients who suffer from hearing loss, seeing the lip movements of the speaker, especially in hospital applications, promotes more effective communication. Transparent face masks can be considered a solution. © 2022, Geriatrics Society. All rights reserved

Revision after shoulder replacement for acute fracture of the proximal humerus

Background and purpose — For more than half a century, stemmed hemiarthroplasty (SHA) has been used in the treatment of comminuted and displaced fractures of the proximal humerus. Reverse shoulder arthroplasty (RSA) has been increasingly popular in cases where it is difficult to obtain satisfactory fixation of the tuberosities. We report revision rates and reasons for revision after shoulder arthroplasty for acute fractures of the proximal humerus. Patients and methods — This study was based on a common dataset from the Nordic Arthroplasty Register Association (NARA), which includes data reported to the national shoulder arthroplasty registries in Denmark, Sweden, and Norway. We included 6,756 shoulder arthroplasties performed for acute fractures between 2004 and 2013. Results — There were 6,112 SHAs (90%) and 565 RSAs (8.4%). The cumulative arthroplasty survival rate after 5 years was 0.96 for both SHA and RSA. The relative risk of revision of RSA was 1.4 (95% CI: 0.9–2.2) with SHA as reference. For both types of arthroplasty, the most common reason for revision was infection (SHA 0.8%, RSA 2.1%). The relative risk of revision due to infection was 3.1 (95% CI: 1.6–5.9) for RSA with SHA as reference. The relative risk of revision for patients who were less than 75 years of age was 2.8 (95% CI: 2.0–3.8) compared to older patients. Interpretation — Revision after shoulder arthroplasty for acute fractures was rare. Survival rates were similar between SHA and RSA, but RSA had a statistically significant and clinically relevant higher risk of revision because of infection