Evidence Based Development of a Novel Lateral Fibula Plate (VariAx Fibula) Using a Real CT Bone Data Based Optimization Process During Device Development

Development of novel implants in orthopaedic trauma surgery is based on limited datasets of cadaver trials or artificial bone models. A method has been developed whereby implants can be constructed in an evidence based method founded on a large anatomic database consisting of more than 2.000 datasets of bones extracted from CT scans. The aim of this study was the development and clinical application of an anatomically pre-contoured plate for the treatment of distal fibular fractures based on the anatomical database

Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease

OBJECTIVE: Cardiac disease is the leading cause of indirect maternal mortality. The aim of this study was to analyse to what extent socioeconomic factors influence the outcome of pregnancy in women with heart disease.  METHODS: The Registry of Pregnancy and Cardiac disease is a global prospective registry. For this analysis, countries that enrolled ≥10 patients were included. A combined cardiac endpoint included maternal cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, hospitalisation for cardiac reason or intervention. Associations between patient characteristics, country characteristics (income inequality expressed as Gini coefficient, health expenditure, schooling, gross domestic product, birth rate and hospital beds) and cardiac endpoints were checked in a three-level model (patient-centre-country).  RESULTS: A total of 30 countries enrolled 2924 patients from 89 centres. At least one endpoint occurred in 645 women (22.1%). Maternal age, New York Heart Association classification and modified WHO risk classification were associated with the combined endpoint and explained 37% of variance in outcome. Gini coefficient and country-specific birth rate explained an additional 4%. There were large differences between the individual countries, but the need for multilevel modelling to account for these differences disappeared after adjustment for patient characteristics, Gini and country-specific birth rate.  CONCLUSION: While there are definite interregional differences in pregnancy outcome in women with cardiac disease, these differences seem to be mainly driven by individual patient characteristics. Adjustment for country characteristics refined the results to a limited extent, but maternal condition seems to be the main determinant of outcome

Regression of nodular liver lesions in Wilson's disease

WOS: 000240235700004PubMed ID: 16950693Long-term follow-up abdominal imaging studies have not been reported previously in patients with the hepatic form of Wilson's disease (WD). This paper reports the case of a 35-year-old woman with symptoms dating back several months and with multiple, nodular liver lesions. The lesions were hyperdense on non-enhanced computed tomography and hypointense on T2-weighted magnetic resonance (MR) images. A diagnosis of WD was established several weeks after her admission to hospital, and chelating treatment was commenced promptly. No abnormalities were found on follow-up MR examinations of the abdomen and brain 4.5 years later. These imaging features suggest that so long as WD is diagnosed in the initial stages, liver nodules can regress with time and complete healing can be achieved with continuous decoppering treatment

Morpho-functional response of the elbow extension muscles to twelve week, self-perceived maximal resistance training

The aim of this study was to determine morphological and functional changes of the elbow extensor muscles in response to a 12-week self-perceived maximal resistance training (MRT). Twenty-one healthy sedentary young men were engaged in elbow extensor training using isoacceleration dynamometry for 12 weeks with a frequency of five sessions per week (five sets of ten maximal voluntarily contractions, 1-min rest period between each set). Prior to, at 6 weeks and after the training, a series of cross-sectional magnetic resonance images of the upper arm were obtained and muscle volumes were calculated. Maximal and endurance strength increased (P<0·01) by 15% and 45% at 6 weeks, and by 29% and 70% after 12 weeks compared with baseline values, while fatigue rate of the elbow extensors decreased by 67%. The volume of triceps brachii increased in both arms (P<0·01) by 4% at 6 weeks, and by 8% after 12 weeks compared with baseline values (right arm – from 487·4 ± 72·8 cm3 to 505·8 ± 72·3 cm3 after 6 weeks and 525·3 ± 73·7 cm3 after 12 weeks; left arm – from 475·3 ± 79·1 cm3 to 493·2 ± 72·7 cm3 after 6 weeks and 511·3 ± 77·0 cm3 after 12 weeks). A high correlation was found between maximal muscle strength and muscle volume prior (r2 = 0·62) and after (r2 = 0·69) the training (P≤0·05). A self-perceived MRT resulted in an increase in maximal and endurance strength. Morphological adaptation changes of triceps brachii as a result of 12-week specific strength training can explain only up to 26% of strength gain

Changes of functional status and volume of triceps brachii measured by magnetic resonance imaging after maximal resistance training

Purpose To evaluate the effect of 6-week self-perceived maximal resistance training on muscle volume utilizing magnetic resonance imaging and maximal, average, and endurance strength of the elbow extensors and to assess the relationship between muscle strength and volume before and after the training. Materials and Methods This was a prospective blinded study. A total of 15 healthy untrained men, aged 22.5 ± 3.7 years (mean ± SD), were engaged in elbow extensor training using isoacceleration dynamometry for 6 weeks with a frequency of five sessions per week (five sets of 10 maximal voluntary contractions, 1-minute rest period between each set). Prior to and after the training, cross-sectional magnetic resonance images of the upper arm were obtained and muscle volumes were calculated using the truncated cone formula. Results Average, maximal, and endurance strength of the upper arm extensors increased significantly by 43%, 15%, and 56%, respectively. The volume of triceps brachii increased in both arms (P < 0.05): right from 456.9 ± 113.8 cm3 to 475.8 ± 100.9 cm3 and left from 444.3 ± 121.9 cm3 to 468.4 ± 110.4 cm3, or 5%. Maximal and average strength correlated significantly with muscle volume before and after the training. Conclusion A specific 6-week resistance training protocol resulted in muscle strength improvement, together with increase in triceps brachii muscle volume, as demonstrated by volumetric imaging. J. Magn. Reson. Imaging 2009;29:671–676. © 2009 Wiley-Liss, Inc

Population-Based Design of Mandibular Plates Based on Bone Quality and Morphology

In this paper we present a new population-based implant design methodology, which advances the state-of-the-art approaches by combining shape and bone quality information into the design strategy. The method enhances the mechanical stability of the fixation and reduces the intra-operative in-plane bending which might impede the functionality of the locking mechanism. The method is presented for the case of mandibular locking fixation plates, where the mandibular angle and the bone quality at screw locations are taken into account. Using computational anatomy techniques, the method automatically derives, from a set of computed tomography images, the mandibular angle and the bone thickness and intensity values at the path of every screw. An optimisation strategy is then used to optimise the two parameters of plate angle and screw position. Results for the new design are presented along with a comparison with a commercially available mandibular locking fixation plate. A statistically highly significant improvement was observed. Our experiments allowed us to conclude that an angle of 126° and a screw separation of 8mm is a more suitable design than the standard 120° and 9mm