The push-through total femoral prosthesis offers a functional alternative to total femoral replacement:a case series

PURPOSE: Oncologic resections or complications of segmental femoral prostheses can result in severe bone loss of the femur for which a total femoral prosthesis (TFP) is required. This study assesses whether the loss of stability and function caused by the loss of muscle attachments can be improved by using a push-through total femoral endoprosthesis (PTTF), because it saves parts of the femur and its muscle attachments. METHODS: In this retrospective case series, ten patients aged 25-77 (mean 54) who received a PTTF between 2005 and 2014 were included for baseline, complications and survival analysis with a mean follow-up of 5.3 (1.1-9.6) years. Functional outcome was assessed in six patients using the Musculoskeletal Tumor Society (MSTS) score, WHO performance scale, Toronto Extremity Salvage Score (TESS), SF36, EQ-5D, NRS pain score, fatigue score and satisfaction score. RESULTS: The mean MSTS score was 64% (23-93%). Five patients had a WHO performance scale of 1, one patient of 3. Mean TESS was 69% (13-90%). SF36 was most notably limited by physical functioning (mean 48), vitality (68) and general health (67). NRS score was 1.9, 1.8 and 8.3 for pain, fatigue and satisfaction, respectively. There were four failures: two infections (one resulting in amputation and one in a minor revision) and two mechanical failures (which required one revision to a TFP and one minor revision). Patient survival was 100%, limb survival 90%, and prosthesis survival 80%. CONCLUSION: The push-through total femoral endoprosthesis allows preservation of muscle attachments and offers a good alternative to total femoral prostheses

The Prevalence of Previously Undiagnosed Leprosy in the General Population of Northwest Bangladesh

In order to estimate the level of leprosy in an area with many leprosy patients, we determined the prevalence of previously undiagnosed leprosy in the general population and compared this with the registered (or known) number of leprosy patients. We also compared it with the known prevalence of leprosy in contacts of leprosy patients. We examined 20 randomly selected geographical clusters of 1,000 persons each in two districts of Bangladesh, with over 4 million population. Physical examination was performed on all individuals. The number of newly found leprosy cases among 17,862 people above 5 years of age from the clusters was 27, giving a rate of previously undiagnosed leprosy of 15.1 per 10,000. This rate is six times higher than the registered prevalence, but three times lower than the rate in the most distant subgroup of contacts (neighbour of neighbour and social contacts) of leprosy patients in the same area. We conclude that in areas where leprosy is common, it may be preferable to do full village or neighbourhood surveys when a new leprosy patient is found, rather than to limit contact surveys to close contacts only, such as household members

Histone 3.3 hotspot mutations in conventional osteosarcomas: a comprehensive clinical and molecular characterization of six H3F3A mutated cases

Background: Histone 3.3 (H3.3) hotspot mutations in bone tumors occur in the vast majority of giant cell tumors of bone (GCTBs; 96%), chondroblastomas (95%) and in a few cases of osteosarcomas. However, clinical presentation, histopathological features, and additional molecular characteristics of H3.3 mutant osteosarcomas are largely unknown. Methods: In this multicentre, retrospective study, a total of 106 conventional high-grade osteosarcomas, across all age groups were re-examined for hotspot mutations in the H3.3 coding genes H3F3A and H3F3B. H3.3 mutant osteosarcomas were re-evaluated in a multidisciplinary manner and analyzed for genome-wide DNA-methylation patterns and DNA copy number aberrations alongside H3.3 wild-type osteosarcomas and H3F3A G34W/L mutant GCTBs. Results: Six osteosarcomas (6/106) carried H3F3A hotspot mutations. No mutations were found in H3F3B. All patients with H3F3A mutant osteosarcoma were older than 30 years with a median age of 65 years. Copy number aberrations that are commonly encountered in high-grade osteosarcomas also occurred in H3F3A mutant osteosarcomas. Unlike a single osteosarcoma with a H3F3A K27M mutation, the DNA methylation profiles of H3F3A G34W/R mutant osteosarcomas were clearly different from H3.3 wild-type osteosarcomas, but more closely related to GCTBs. The most differentially methylated promoters between H3F3A G34W/R mutant and H3.3 wild-type osteosarcomas were in KLLN/PTEN (p < 0.00005) and HIST1H2BB (p < 0.0005). Conclusions: H3.3 mutations in osteosarcomas may occur in H3F3A at mutational hotspots. They are overall rare, but become more frequent in osteosarcoma patients older than 30 years. Osteosarcomas carrying H3F3A G34W/R mutations are associated with epigenetic dysregulation of KLLN/PTEN and HIST1H2BB

Can Orthopedic Oncologists Predict Functional Outcome in Patients with Sarcoma after Limb Salvage Surgery in the Lower Limb? A Nationwide Study

Accurate predictions of functional outcome after limb salvage surgery (LSS) in the lower limb are important for several reasons, including informing the patient preoperatively and, in some cases, deciding between amputation and LSS. This study aimed to elucidate the correlation between surgeon-predicted and patient-reported functional outcome of LSS in the Netherlands. Twentythree patients (between six months and ten years after surgery) and five independent orthopedic oncologists completed the Toronto Extremity Salvage Score (TESS) and the RAND-36 physical functioning subscale (RAND-36 PFS). The orthopedic oncologists made their predictions based on case descriptions (including MRI scans) that reflected the preoperative status. The correlation between patient-reported and surgeon-predicted functional outcome was &quot;very poor&quot; to &quot;poor&quot; on both scores ( 2 values ranged from 0.014 to 0.354). Patient-reported functional outcome was generally underestimated, by 8.7% on the TESS and 8.3% on the RAND-36 PFS. The most difficult and least difficult tasks on the RAND-36 PFS were also the most difficult and least difficult to predict, respectively. Most questions had a &quot;poor&quot; intersurgeon agreement. It was difficult to accurately predict the patient-reported functional outcome of LSS. Surgeons&apos; ability to predict functional scores can be improved the most by focusing on accurately predicting more demanding tasks

Predicting neuropathy and reactions in leprosy at diagnosis and before incident events. Results from the INFIR cohort study

BackgroundLeprosy is a disease of skin and peripheral nerves. The process of nerve injury occurs gradually through the course of the disease as well as acutely in association with reactions. The INFIR (ILEP Nerve Function Impairment and Reactions) Cohort was established to identify clinically relevant neurological and immunological predictors for nerve injury and reactions.Methodology/Principal FindingsThe study, in two centres in India, recruited 188 new, previously untreated patients with multi-bacillary leprosy who had no recent nerve damage. These patients underwent a series of novel blood tests and nerve function testing including motor and sensory nerve conduction, warm and cold detection thresholds, vibrometry, dynamometry, monofilament sensory testing and voluntary muscle testing at diagnosis and at monthly follow up for the first year and every second month for the second year. During the 2 year follow up a total of 74 incident events were detected. Sub-clinical changes to nerve function at diagnosis and during follow-up predicted these new nerve events. Serological assays at baseline and immediately before an event were not predictive; however, change in TNF alpha before an event was a statistically significant predictor of that event.Conclusions/SignificanceThese findings increase our understanding of the processes of nerve damage in leprosy showing that nerve function impairment is more widespread than previously appreciated. Any nerve involvement, including sub-clinical changes, is predictive of further nerve function impairment. These new factors could be used to identify patients at high risk of developing impairment and disability

The aspect of labour in hybrid and in-situ concrete construction in South Africa

Thesis (MEng)--Stellenbosch University, 2015.ENGLISH ABSTRACT: Hybrid concrete construction (HCC) is a construction technique that makes use of both in-situ and pre-fabricated concrete products by making optimum use of the advantages of both these methods in the same project. Although the advantages of this construction method is well recognised throughout the world, and a feasibility study has illustrated that HCC is a suitable construction method in South Africa, it remains under-utilised in this country. Labour has been identified as one of the aspects of the decision-making process between in-situ and HCC. The construction industry is ranked as the employer with the 5thhighest number of employees in South Africa, which is currently experiencing a 25.4% unemployment rate. This highlights the importance of the construction industry as an employer in South Africa. Labour is considered as one of the areas of highest concern in the South African construction industry. This concern is intensified when the shortage of skilled labour in the industry is taken into account. In the light of these realities, the objective of this research study was to investigate the utilization of labour in both the in-situ and HCC environments, and the effect of the use of HCC on labour and its socio-economic aspects. The first step of this process necessitated the identification of the most important labour-related concerns in the South African construction industry. A previous investigation into this industry identified low productivity of labourers and the use of unskilled labour as the most significant areas of concern, whilst another study identified socio-economic issues as important factors to consider when deciding between in-situ and HCC. These socio-economic issues were quantified through literature to be job creation, job security, skills development and a suitable working environment. Interviews and surveys with experienced managers in different divisions of the South African civil construction industry were used to investigate the effect of the use of HCC on the identified labour-related factors. A case study was used to support the qualitative opinions of the interviewees. Lastly, a risk analysis was conducted, which identified the importance of labour-related risks in both considered environments. The research study showed that the labour force is applied to greater effect when using HCC than when using the in-situ construction method. The use of HCC also serves as partial mitigation of the shortage of skilled labour in South Africa, due to its ability to effectively utilize low-skilled labour. The construction environment of HCC also proves to be more labour-friendly, and management of labourers are easier and more effective in this environment. However, in-situ construction creates more employment opportunities, whilst HCC has a quicker turnover, thus shortening the employment period. Therefore it should be considered that labourers in the HCC environment are released earlier and could sooner be employed for new projects, countering the effect of less employment opportunities in this environment.AFRIKAANSE OPSOMMING: Hibriede betonkonstruksie (HBK) is ‟n tegniek waarby beide voorafvervaardigde beton-elemente en in-situ beton in dieselfde projek gebruik word ten einde voordeel uit beide metodes te trek. Alhoewel die voordele van dié konstruksietegniek welbekend is in talle lande van die wêreld en ‟n uitvoerbaarheidsanalise getoon het dat HBK ‟n voordelige konstruksiemetode vir Suid-Afrika is, word dit tans onderbenut in die plaaslike sektor. Arbeid is geïdentifiseer as een van die faktore in die besluitnemingsproses tussen in-situ en HBK. Die konstruksiebedryf word beskou as die bedryf met die 5de hoogste indiensnemingsyfer in Suid-Afrika, wat tans „n 25.4% werkloosheidsyfer ervaar. Dit beklemtoon die belangrikheid van die konstruksiebedryf as 'n werkgewer in Suid-Afrika. Arbeid word ook beskou as grootste probleem-area in die Suid-Afrikaanse konstruksiebedryf. Hierdie probleme word versterk deur die huidige tekort aan geskoolde arbeid in die konstruksiebedryf. In die lig van hierdie gegewens was die doel van hierdie navorsingstudie om die gebruik van arbeid in beide omgewings te bestudeer, asook die uitwerking van beide konstruksiemetodes op die arbeiders en die sosio-ekonomiese aspekte aangaande arbeid. Die eerste stap van hierdie proses was die identifisering van die belangrikste arbeidsverwante probleme in die Suid-Afrikaanse konstruksiebedryf. In 'n vorige studie aangaande die Suid-Afrikaanse konstruksiebedryf, is lae arbeidsproduktiwiteit en die gebruik van ongeskoolde arbeid geïdentifiseer as die probleem-areas in hierdie bedryf. 'n Ander studie aangaande die gebruik van HBK in Suid-Afrika het sosio-ekonomiese kwessies as 'n belangrike faktor beskou om te oorweeg in die keuse tussen in-situ en HBK. Hierdie sosio-ekonomiese kwessies is gekwantifiseer deur middel van „n literatuurstudie oor: werkskepping, werksekerheid, die ontwikkeling van arbeidsvaardighede en die mees geskikte werksomgewing vir arbeiders. Onderhoude en opnames met ervare bestuurders van verskillende afdelings in die Suid-Afrikaanse siviele konstruksiebedryf is gebruik om die effek wat die gebruik van HBK op die geïdentifiseerde arbeidsverwante faktore het, te ondersoek en te bepaal. „n Gevallestudie is gebruik om hierdie kwalitatiewe menings kwantitatief te ondersteun. „n Risiko-analise is ook uitgevoer om die invloed van arbeiders op die produktiwiteit van beide die in-situ konstruksie-omgewing en die voorafvervaardigde omgewing te bepaal. Hierdie navorsingstudie het getoon dat die arbeidsmag meer effektief gebruik word in HBK as in die in-situ konstruksiemetode. Hierdie metode (HBK) is ook in staat is om laag-geskoolde arbeiders effektief aan te wend. Die konstruksie-omgewing met betrekking tot HBK is ook meer arbeidsvriendelik, en die bestuur van arbeiders in hierdie omgewing is makliker en meer effektief. Alhoewel, wanneer werkskepping oorweeg word, word in-situ konstruksie egter as die doeltreffender metode beskou. Dit moet egter in ag geneem word dat HBK projekte „n korter konstruksieperiode het as in-situ konstruksie, dus het arbeiders in die HBK omgewing gouer die geleentheid om met „n nuwe projek te begin

Die rol van die takseersentrum in die identifisering en ontwikkeling van onderwysleierkundighede by onderrigleiers

Proefskrif (D. Ed.) -- Universiteit van Stellenbosch, 1989.Full text to be digitised and attached to bibliographic record

Die opleiding van sekondereskoolonderwysers in Engeland en Wallis, en Kaapland : 'n vergelykende studie

Proefskrif (M. Ed.) -- Universiteit van Stellenbosch, 1982.Full text to be digitised and attached to bibliographic record

Die opleiding van sekondereskoolonderwysers in Engeland en Wallis, en Kaapland : 'n vergelykende studie

Proefskrif (M. Ed.) -- Universiteit van Stellenbosch, 1982.Full text to be digitised and attached to bibliographic record

Epidemiologic trends of leprosy for the 21st century

Major gaps still exist in the knowledge about leprosy, particularly with regard to how it spreads. Leprosy epidemiology remains complicated due to the specific characteristics of Mycobacterium leprae. To describe epidemiologic trends for the 21st century, the first part of this paper gives an overview of the epidemiology of leprosy, followed by past trends and the present situation of new-case detection as a proxy of the incidence. The third part, regarding predicted epidemiologic trends for the 21st century, elaborates on the main topic of this paper. With limited diagnostic tools to detect infection with M leprae, other methods are necessary to estimate trends in incidence and transmission. A computer program has been developed for modeling the transmission and control of leprosy (SIMLEP). The effect of failure to sustain early case detection beyond 2005 on leprosy incidence and case detection is shown. Important unanswered questions are whether the incubation period is contagious and how rapid close contacts of leprosy patients are infected. As long as such key questions remain unanswered, it will be difficult to estimate the impact of control strategies on the transmission of M leprae on resulting disease incidence. In the meantime we can expect that the global new-case detection trends will stay more or less stable or only decrease slightly for many years to come. There is a need of new preventive interventions to change this situation and reduce the incidence of leprosy in the 21st century. (C) 2016 Elsevier Inc. All rights reserved