Early results with the Delta Xtend shoulder arthroplasty as primary treatment or proximal humerus reoperation

Reverse total shoulder arthroplasty (RTSA) has established itself as the standard of care for the treatment of rotator cuff arthropathy (RCA). Gradually, its share increased in relation to all used shoulder arthroplasties mainly in cases of complex proximal humeral fractures (PHFx). Method: From November 2019 to December 2021, 39 patients at mean age of 72.8 years were operated via RTSA Delta Xtend by one surgeon in our clinic. 32 of them were followed for a period between 12 ÷ 30 months. At postoperative visits, function and pain were assessed using the Constant-Murley score (CMS), DASH score and recorded range of motion (ROM). Level of satisfaction was assessed using the visual analogue scale (VAS). Results: The mean CMS recorded at the last visit was 82.6, and the relative one 90.8%. The achieved anterior elevation 145.9° and lateral elevation 136.6°. A significantly lower mean value of external rotation (39.8°) was found compared to the inner one (50.6°). Conclusion: This study confirms those described by other authors promising early results with Delta Xtend RTSA. Longer follow-up is needed with a view to assessment of the dynamics of registered results, possible late complications and revision interventions

The role of the domain interface in the stability, folding and function of CLIC1

Chloride intracellular channel protein 1 (CLIC1) is a dual-state protein existing in both soluble monomeric conformation as well as integral-membrane form. The role of the domain interface in the conversion between these species was investigated. Bioinformatics-based analysis was undertaken to compare and contrast the domain interfaces of dimeric GSTs with their monomeric homologues CLIC1 and CLIC4. The mutants CLIC1-M32A and CLIC1-E81M were used as experimental case studies on the role of domain-domain interactions in the stability and folding of CLIC family proteins. A consensus interface was revealed with the prominent interaction being a conserved inter-domain lock-and-key type motif previously studied in class Alpha GSTs (Wallace et al., 2000). A number of domain-interface interactions were found to be unique to the CLIC family and as such thought to play a role in the conversion of these proteins from their soluble form to an integral membrane form. Overall the domain interfaces of monomeric CLIC1 and CLIC4 did not differ significantly from the domain interfaces of dimeric GSTs. The removal of the unique CLIC family salt-bridges between Arg29 and Glu81 and the cavity forming domain interface mutation Met32Ala did not induce significant changes in the conformational flexibility of the native state. The true role of the Arg29-Glu81 salt-bridges was masked by the introduction of stabilizing hydrophobic contacts. Removal of the inter-domain lock-and-key interaction destabilized CLIC1 significantly with concomitant loss in cooperative folding that resulted in the stabilization of a molten globule-like species. This intermediate state was less stable and less structured than the equilibrium intermediate of wtCLIC1 at pH 5.5. However the bulk of the structures found to unfold during intermediate-species formation was the same in mutant and wild-type proteins. It was concluded that formation of the membrane-competent form of CLIC1 involves re-structuring of the N-terminal thioredoxin domain that takes place after destabilization of the salt bridges connecting h1 and h3 and uncoupling of the inter-domain lock-and-key motif

A Novel Technique for Treatment of Metaphyseal Voids in Proximal Humerus Fractures in Elderly Patients

Background and Objectives: The treatment of proximal humerus fractures in elderly patients is challenging, with reported high complication rates mostly related to implant failure involving screw cut-out and penetration. Metaphyseal defects are common in osteoporotic bone and weaken the osteosynthesis construct. A novel technique for augmentation with polymethylmethacrylate (PMMA) bone cement was developed for the treatment of patients in advanced age with complex proximal humerus fractures and metaphyseal voids, whereby the cement was allowed to partially cure for 5-7 min after mixing to achieve medium viscosity, and then it was manually placed into the defect through the traumatic lateral window with a volume of 4-6 mL per patient. The aim of this retrospective clinical study was to assess this technique versus autologous bone graft augmentation and no augmentation. Materials and Methods: The outcomes of 120 patients with plated Neer three- and four-part fractures, assigned to groups of 63 cases with no augmentation, 28 with bone graft augmentation and 29 with cement augmentation, were assessed in this study. DASH, CS, pain scores and range of motion were analyzed at 3, 6 and 12 months. Statistical analysis was performed with factors for treatment and age groups, Neer fracture types and follow-up periods, and with the consideration of age as a covariate. Results: DASH and CS improved following cement augmentation at three and six months compared to bone grafting, being significant when correcting for age as a covariate (p ≤ 0.007). While the age group had a significant effect on both these scores with worsened values at a higher age for non-augmented and grafted patients (p ≤ 0.044), this was not the case for cement augmented patients (p ≥ 0.128). Cement augmentation demonstrated good clinical results at 12 months with a mean DASH of 10.21 and mean CS percentage of 84.83% versus the contralateral side, not being significantly different among the techniques (p ≥ 0.372), despite the cement augmented group representing the older population with more four-part fractures. There were no concerning adverse events specifically related to the novel technique. Conclusions: This study has detailed a novel technique for the treatment of metaphyseal defects with PMMA cement augmentation in elderly patients with complex proximal humerus fractures and follow-up to one year, whereby the cement was allowed to partially cure to achieve medium viscosity, and then it was manually placed into the defect through the traumatic lateral window. The results demonstrate clinically equivalent short-term results to 6 months compared to augmentation with bone graft or no augmentation-despite the patient group being older and with a higher rate of more severe fracture patterns. The technique appears to be safe with no specifically related adverse events and can be added in the surgeon's armamentarium for the treatment of these difficult to manage fractures

Review of Kaon Physics at CERN and in Europe

The Kaon physics program at CERN and in Europe will be presented. I will first give a short review of recent results form the NA48/2 and NA62 experiments, with special emphasis to the measurement of RK , the ratio of Kaon leptonic decays rates, K → eν and K → μν, using the full minimum bias data sample collected in 2007-2008. The main subject of the talk will be the study of the highly suppressed decay K → πνν. While its rate can be predicted with minimal theoretical uncertainty in the Standard Model (BR ∼ 8 × 10−11), the smallness of BR and the challenging experimental signature make it very difficult to measure. The branching ratio for this decay is thus a sensitive probe of the flavour sector of the SM. The aim of NA62 is the measurement of the K → πνν BR with ∼ 10% precision in two years of data taking. This will require the observation of 10K decays in the experiment's fiducial volume, as well as the use of high-performance systems for precision tracking, particle identification, and photon vetoing. These aspects of the experiment will also allow NA62 to carry out a rich program of searches for lepton flavour and/or number violating K decays. Data taking will start in October 2014. The physics prospects and the status of the construction and commissioning of the NA62 experiment will be presented. In the last part of the talk I will report on Kaon physics results and prospects from other experiments at CERN (e.g. LHCb) and in Europe (e.g. KLOE and KLOE-2) and briefly mention the status in US

Early results with the Delta Xtend shoulder arthroplasty as primary treatment or proximal humerus reoperation

Reverse total shoulder arthroplasty (RTSA) has established itself as the standard of care for the treatment of rotator cuff arthropathy (RCA). Gradually, its share increased in relation to all used shoulder arthroplasties mainly in cases of complex proximal humeral fractures (PHFx). Method: From November 2019 to December 2021, 39 patients at mean age of 72.8 years were operated via RTSA Delta Xtend by one surgeon in our clinic. 32 of them were followed for a period between 12 ÷ 30 months. At postoperative visits, function and pain were assessed using the Constant-Murley score (CMS), DASH score and recorded range of motion (ROM). Level of satisfaction was assessed using the visual analogue scale (VAS). Results: The mean CMS recorded at the last visit was 82.6, and the relative one 90.8%. The achieved anterior elevation 145.9° and lateral elevation 136.6°. A significantly lower mean value of external rotation (39.8°) was found compared to the inner one (50.6°). Conclusion: This study confirms those described by other authors promising early results with Delta Xtend RTSA. Longer follow-up is needed with a view to assessment of the dynamics of registered results, possible late complications and revision interventions

Management of Complex Acetabular Fractures by Using 3D Printed Models

Background and Objectives: Using 3D printed models in orthopaedics and traumatology contributes to a better understanding of injury patterns regarding surgical approaches, reduction techniques, and fracture fixation methods. The aim of this study is to evaluate the effectiveness of a novel technique implementing 3D printed models to facilitate the optimal preoperative planning of the surgical treatment of complex acetabular fractures. Materials and Methods: Patients with complex acetabular fractures were assigned to two groups: (1) conventional group (n = 12) and (2) 3D printed group (n = 10). Both groups included participants with either a posterior column plus posterior wall fracture, a transverse plus posterior wall fracture, or a both-column acetabular fracture. Datasets from CT scanning were segmented and converted to STL format, with separated bones and fragments for 3D printing in different colors. Comparison between the two groups was performed in terms of quality of fracture reduction (good: equal to, or less than 2 mm displacement, and fair: larger than 2 mm displacement), functional assessment, operative time, blood loss, and number of intraoperative x-rays. Results: A significant decrease in operative time, blood loss, and number of intraoperative x-rays was registered in the 3D printed group versus the conventional one (p Conclusions: The 3D printing technique can be considered a highly efficient and patient-specific approach for management of complex acetabular fractures, helping to restore patient′s individual anatomy after surgery

Optimizing the WPI Assistive Technology Resource Center: Operation and Management

The Assistive Technology Resource Center at WPI originated with the intent to fill the need for a regional assistive technology hub. Over time, the Center has expanded and has aided many individuals by creating new solutions to disability-related issues that were not addressed in the past. After ten years in existence, it became necessary to re-evaluate the operation of the Center and to remedy some of the potential weaknesses that may have kept it from operating at its full potential. - This project concentrates on identifying these issues and creating physical solutions for them, such as re-organizing the Rehabilitation Engineering Laboratory, creating a digital project database, and updating the ATRC website

Hierarchical Learning Management System for the Insurance Industry

This paper describes a model of a Hierarchical Learning Management System (HLMS) for the insurance industry. The problem is that LMSs are widely used, but not suitable for each educational environment and domain. The existing LMSs are with the general purpose and do not reflect the specific needs of different domains. The proposed LMS is a specific hierarchic system specially created for the insurance industry. The model uses a hierarchic approach to share, organize and present the learning content. It allows for building an LMS specific for the insurance industry which is reliable, efficient, fast, and easy to use by the insurance professionals

A SURVEY REGARDING THE AWARENESS OF THERMOPLASTIC RESINS AMONG BULGARIAN DENTISTS AND DENTAL TECHNICIANS

Thermoplastic materials (TMs) are used more than a century in dentistry worldwide, but in Bulgaria, there is limited information about their properties and indications. These materials let the specialists widen the application of full and partial dentures even in difficult clinical cases. Objective: A survey regarding the awareness of the properties, the drawbacks and the indications of the thermoplastic materials for dental purposes in Bulgaria. Material and method: Inquiry ranged from April 2016 until October 2016. The participants were 289 dentist and dental technicians in Bulgaria. The questions regard area of expertise, gender, age, years of experience; awareness of the types of TMs, members and working protocol; properties of the materials, personal observations of the participants. Results: Most of the participants work in a private practice, and half of them are familiar with the TMs in general. Conclusion: This study shows that 52% of the participants are aware of have some information about TM, 82% of them know the polyamides, 25% the thermoplastic acrylic resins, 15% polyoxymethylene, 4% polyolefin and only 1,5% Polyan. 42% use these materials in their practice and are familiar with the technological and working protocol and only 36% report that they are aware of their properties, disadvantages and indications