Patient-oriented and performance-based outcomes after knee autologous chondrocyte implantation: a timeline for the first year of recovery

It is well established that autologous chondrocyte implantation (ACI) can require extended recovery postoperatively; however, little information exists to provide clinicians and patients with a timeline for anticipated function during the first year after ACI. Objective: To document the recovery of functional performance of activities of daily living after ACI. Patients: ACI patients (n = 48, 29 male 35.1 ± 8.0 y). Intervention: All patients completed functional tests (weight-bearing squat, walk-across, sit-to-stand, step-up/over, and forward lunge) using the NeuroCom long force plate (Clackamas, OR) and completed patient-reported outcome measures (International Knee Documentation Committee Subjective Knee Evaluation Form, Lysholm, Western Ontario and McMaster Osteoarthritis Index WOMAC, and 36-Item Short-Form Health Survey) preoperatively and 3, 6, and 12 mo postoperatively. Main Outcome Measures: A covariance pattern model was used to compare performance and self-reported outcome across time and provide a timeline for functional recovery after ACI. Results: Participants demonstrated significant improvement in walk-across stride length from baseline (42.0% ± 8.9% height) at 6 (46.8% ± 8.1%) and 12 mo (46.6% ± 7.6%). Weight bearing on the involved limb during squatting at 30°, 60°, and 90° was significantly less at 3 mo than presurgery. Step-up/over time was significantly slower at 3 mo (1.67 ± 0.69 s) than at baseline (1.49 ± 0.33 s), 6 mo (1.51 ± 0.36 s), and 12 mo (1.40 ± 0.26 s). Step-up/over lift-up index was increased from baseline (41.0% ± 11.3% body weight BW) at 3 (45.0% ± 11.7% BW), 6 (47.0% ± 11.3% BW), and 12 mo (47.3% ± 11.6% BW). Forward-lunge time was decreased at 3 mo (1.51 ± 0.44 s) compared with baseline (1.39 ± 0.43 s), 6 mo (1.32 ± 0.05 s), and 12 mo (1.27 ± 0.06). Similarly, forward-lunge impact force was decreased at 3 mo (22.2% ± 1.4% BW) compared with baseline (25.4% ± 1.5% BW). The WOMAC demonstrated significant improvements at 3 mo. All patient-reported outcomes were improved from baseline at 6 and 12 mo postsurgery. Conclusions: Patients' perceptions of improvements may outpace physical changes in function. Decreased function for at least the first 3 mo after ACI should be anticipated, and improvement in performance of tasks requiring weight-bearing knee flexion, such as squatting, going down stairs, or lunging, may not occur for a year or more after surgery

Binary Central Stars of Planetary Nebulae Discovered Through Photometric Variability III: The Central Star of Abell 65

A growing number of close binary stars are being discovered among central stars of planetary nebulae. Recent and ongoing surveys are finding new systems and contributing to our knowledge of the evolution of close binary systems. The push to find more systems was largely based on early discoveries which suggested that 10 to 15% of all central stars are close binaries. One goal of this series of papers is confirmation and classification of these systems as close binaries and determination of binary system parameters. Here we provide time-resolved multi-wavelength photometry of the central star of Abell 65 as well as further analysis of the nebula and discussion of possible binary--nebula connections. Our results for Abell 65 confirm recent work showing that it has a close, cool binary companion, though several of our model parameters disagree with the recently published values. With our longer time baseline of photometric observations from 1989--2009 we also provide a more precise orbital period of 1.0037577 days.Comment: Accepted for publication in the Astronomical Journa

Millimeter-wave diode-grid phase shifters

Monolithic diode grids have been fabricated on 2-cm square gallium-arsenide wafers with 1600 Schottky-barrier varactor diodes. Shorted diodes are detected with a liquid-crystal technique, and the bad diodes are removed with an ultrasonic probe. A small-aperture reflectometer that uses wavefront division interference was developed to measure the reflection coefficient of the grids. A Phase shift of 70° with a 7-dB loss was obtained at 93 GHz when the bias on the diode grid was changed from -3 V to 1 V. A simple transmission-line grid model, together with the measured low-frequency parameters for the diodes, was shown to predict the measured performance over the entire capacitive bias range of the diodes, as well as over the complete reactive tuning range provided by a reflector behind the grid, and over a wide range of frequencies form 33 GHz to 141 GHz. This shows that the transmission-line model and the measured low-frequency diode parameters can be used to design an electronic beam-steering array and to predict its performance. An electronic beam-steering array made of a pair of grids using state-of-the-art diodes with 5-Ω series resistances would have a loss of 1.4 dB at 90 GHz

The value of the follow-through derives from motor learning depending on future actions.

In ball sports, we are taught to follow through, despite the inability of events after contact or release to influence the outcome [1, 2]. Here we show that the specific motor memory active at any given moment critically depends on the movement that will be made in the near future. We demonstrate that associating a different follow-through movement with two motor skills that normally interfere [3-7] allows them to be learned simultaneously, suggesting that distinct future actions activate separate motor memories. This implies that when learning a skill, a variable follow-through would activate multiple motor memories across practice, whereas a consistent follow-through would activate a single motor memory, resulting in faster learning. We confirm this prediction and show that such follow-through effects influence adaptation over time periods associated with real-world skill learning. Overall, our results indicate that movements made in the immediate future influence the current active motor memory. This suggests that there is a critical time period both before [8] and after the current movement that determines motor memory activation and controls learning.This is the final published version. The article was originally published in Current Biology, Volume 25, Issue 3, p397–401, 2 February 2015, DOI: 10.1016/j.cub.2014.12.03

Millimeter-Wave Diode-Grid Frequency Doubler

Monolithic diode grid were fabricated on 2-cm^2 gallium-arsenide wafers in a proof-of-principle test of a quasi-optical varactor millimeter-wave frequency multiplier array concept. An equivalent circuit model based on a transmission-line analysis of plane wave illumination was applied to predict the array performance. The doubler experiments were performed under far-field illumination conditions. A second-harmonic conversion efficiency of 9.5% and output powers of 0.5 W were achieved at 66 GHz when the diode grid was pumped with a pulsed source at 33 GHz. This grid had 760 Schottky-barrier varactor diodes. The average series resistance was 27 Ω, the minimum capacitance was 18 fF at a reverse breakdown voltage of -3 V. The measurements indicate that the diode grid is a feasible device for generating watt-level powers at millimeter frequencies and that substantial improvement is possible by improving the diode breakdown voltage

Introduction to and Screening Visit Results of the Multicenter Pediatric Crohn's Disease Growth Study.

BackgroundStatural growth impairment is more common in males with Crohn's disease (CD). We assessed sex differences in height Z score differences and bone age (BA) Z scores and characterized age of menarche in a novel contemporary cohort of pediatric CD patients undergoing screening for enrollment in the multicenter longitudinal Growth Study.MethodsCrohn's disease patients (females with chronological age [CA] 5 years and older and younger than 14 years; males with CA 6 years and older and younger than 16 years) participated in a screening visit for the Growth Study. Height BA-Z scores are height Z scores calculated based on BA. Height CA-Z scores are height Z scores calculated based on CA. The height Z score difference equals height CA-Z score minus height BA-Z score.ResultsOne hundred seventy-one patients (60% male) qualified for this analysis. Mean CA was 12.2 years. Mean height CA-Z score was -0.4, and mean height BA-Z score was 0.4 in females. Mean height CA-Z score was -0.1, and mean height BA-Z score was 0.2 in males. The absolute value of the mean height Z score difference was significantly greater in females (0.8) than males (0.3; P = 0.005). The mean BA-Z score in females (-1.0) was significantly lower than in males (-0.2; P = 0.002). The median CA at menarche was 13.6 (95% CI, 12.6-14.6) years.ConclusionsOur screening visit data suggest that standardized height gain is lower in males with skeletal maturation and delayed puberty is common in females in CD. We are investigating these findings in the ongoing Growth Study

The economic implications of HLA matching in cadaveric renal transplantation.

Abstract Background: The potential economic effects of the allocation of cadaveric kidneys on the basis of tissue-matching criteria are controversial. We analyzed the economic costs associated with the transplantation of cadaveric kidneys with various numbers of HLA mismatches and examined the potential economic benefits of a local, as compared with a national, system designed to minimize HLA mismatches between donor and recipient in first cadaveric renal transplantations. Methods: All data were supplied by the U.S. Renal Data System. Data on all payments made by Medicare from 1991 through 1997 for the care of recipients of a first cadaveric renal transplant were analyzed according to the number of HLA-A, B, and DR mismatches between donor and recipient and the duration of cold ischemia before transplantation. Results: Average Medicare payments for renal-transplant recipients in the three years after transplantation increased from $60,436 per patient for fully HLA-matched kidneys (those with no HLA-A, B, or DR mismatches) to$80,807 for kidneys with six HLA mismatches between donor and recipient, a difference of 34 percent (P\u3c0.001). By three years after transplantation, the average Medicare payments were $64,119 for transplantations of kidneys with less than 12 hours of cold-ischemia time and$74,997 for those with more than 36 hours (P\u3c0.001). In simulations, the assignment of cadaveric kidneys to recipients by a method that minimized HLA mismatching within a local geographic area (i.e., within one of the approximately 50 organ-procurement organizations, which cover widely varying geographic areas) produced the largest cost savings ($4,290 per patient over a period of three years) and the largest improvements in the graft-survival rate (2.3 percent) when the potential costs of longer cold-ischemia time were considered. Conclusions: Transplantation of better-matched cadaveric kidneys could have substantial economic advantages. In our simulations, HLA-based allocation of kidneys at the local level produced the largest estimated cost savings, when the duration of cold ischemia was taken into account. No additional savings were estimated to result from a national allocation program, because the additional costs of longer cold-ischemia time were greater than the advantages of optimizing HLA matching