A nanostructured look of collagen apatite porosity into human mineralized collagen fibril

Bone tissue is a hierarchical material characterized at nanoscale by the mineralized collagen fibril, a recurring structure mainly composed of apatite minerals, collagen and water. Bone nanostructure has a fundamental role in determining the mechanical behavior of the tissue and its mass transport properties. Diffusion phenomenon allows to maintain an adequate supply of metabolites in the mechanisms of bone remodeling, adaptation and repair. Several analytical and computational models have been developed to analyze and predict bone tissue behavior. However, the fine replication of the natural tissue still represents a challenge. Insights on the structural organization at nanoscale and on the influence of apatite mineral crystals on the diffusion coefficient lead to outline the functional conditions for the development of biomimetic strategies for bone tissue engineering. Thorough understanding of bone nanostructure is essential to improve longevity of bioscaffolds and to decrease the risk of failure by controlling their mechanical and biological performance

A Three-Dimensional Study of the Morphology and Topography of Pericytes in the Microvascular Bed of Skeletal Muscle

Digested tissue specimens and corrosion casts of rat soleus and tibialis anterior muscles were employed for this Scanning Electron Microscopy (SEM) study. The shape, morphology, and position of pericytes were compared to corresponding imprints on the cast surfaces. Pericytes, observed in digested tissue specimens, showed a typical morphological pattern: a central body with two primary processes that run along the capillary in opposite directions. From these primary processes, secondary ones arise and often encircle the vessel almost completely. On the surface of corrosion casts, roundish imprints were found in the microvascular tree at the same level where digested tissue specimens showed the presence of pericyte bodies. Along and around the cast surface, shallow grooves reproduced the course of the primary and secondary processes. The peculiar tridimensional arrangement of pericytes at the level of capillary bifurcations underlines their role in red cell flow regulation. However, if the mechanical linkage of the pericytes to the endothelium and their contractability is taken into account, additional roles of these perivascular cells may be hypothesized

Restablecimiento de una nueva normalidad biomecánica en las graves deformidades de la rodilla

En las graves alteraciones morfo-estructurales de la rodilla, con inestabilidad en varusvalgus, las prótesis vinculadas a bisagra simple, tendían a fallar. El presente trabajo se propone evidenciar que, en tales situaciones, la prótesis vinculada a rotación representa la solución más idónea para el restablecimiento de una nueva normalidad. 18 pacientes (13 mujeres y 5 hombres) con edad media de 68 años han sido sometidos a intervención para colocar prótesis de rodilla. Ha sido utilizado el implante Endo-Model® de Waldemar Link®, prótesis vinculada a rotación. El follow-up medio es de 19 meses con controles a 2, 3, 6 y 12 meses y después anuales. Los resultados han sido: óptimo para 17 pacientes y bueno para 1 paciente, en el cual se ha verificado la ruptura post-operatoria del tendón cuadricipital. Nuestra casuística muestra resultados comparables a los de otros autores. No hemos tenido movilizaciones asépticas o sépticas, ni complicaciones médicas intraoperatorias y post-operatorias. Consideramos que, en presencia de la correcta indicación clínica, la utilización de la prótesis vinculada a rotación es preferible a la de deslizamiento porque disminuye el riesgo de una movilización precoz del implante y del desgaste anormal de los componentes protésicos, restableciendo una nueva normalidad biomecánica.Peer Reviewe

Muscle Oxygen Delivery in the Forearm and in the Vastus Lateralis Muscles in Response to Resistance Exercise: A Comparison Between Nepalese Porters and Italian Trekkers

Altitude ascending represents an intriguing experimental model reproducing physiological and pathophysiological conditions sharing hypoxemia as the denominator. The aim of the present study was to investigate fractional oxygen extraction and blood dynamics in response to hypobaric hypoxia and to acute resistance exercises, taking into account several factors including different ethnic origin and muscle groups. As part of the “Kanchenjunga Exploration & Physiology” project, six Italian trekkers and six Nepalese porters took part in a high altitude trek in the Himalayas. The measurements were carried out at low (1,450 m) and high altitude (HA; 4,780 m). Near-infrared spectroscopy (NIRS)-derived parameters, i.e., Tot-Hb and tissue saturation index (TSI), were gathered at rest and after bouts of 3-min resistive exercise, both in the quadriceps and in the forearm muscles. TSI decreased with altitude, particularly in forearm muscles (from 66.9 to 57.3%), whereas the decrement was less in the quadriceps (from 62.5 to 57.2%); Nepalese porters were characterized by greater values in thigh TSI than Italian trekkers. Tot-Hb was increased after exercise. At altitude, such increase appeared to be higher in the quadriceps. This effect might be a consequence of the long-term adaptive memory due to the frequent exposures to altitude. Although speculative, we suggest a long-term adaptation of the Nepalese porters due to improved oxygenation of muscles frequently undergoing hypoxic exercise. Muscle structure, individual factors, and altitude exposure time should be taken into account to move on the knowledge of oxygen delivery and utilization at altitude

Modular versus monoblock stem in revision total hip arthroplasty: a systematic review and meta-analysis

Background: Total hip arthroplasty (THA) is estimated to grow in the following decades with a consequent increase of THA revisions (rTHA). This systematic review and meta-analysis aims to compare modular and monoblock stem in rTHA surgery, focusing on clinical and radiological outcomes and complication rates. Methods: A literature search was performed using the following search strategy: ((Modular stem) OR (monolithic stem)) AND (hip review) on PubMed, Scopus, and Cochrane. Randomized controlled trials (RCTs) and observational studies (OS) compared clinical and radiological outcomes, and complication rates for monoblock and modular revision femoral stem were included. The risk of bias was assessed through the Methodological Index for Non-Randomized Studies (MINORS) score. The Review Manager (RevMan) software was used for the meta-analysis. The rate of complications was assessed using odds ratio (OR) with 95% confidence intervals (CIs). Results: The authors included 11 OS and one RCT with 3,671 participants (mean age: 68.4 years old). The mean follow-up was 46.9 months. There was no prevalence of subsidence for one type of stem. Mean subsidence was from 0.92 to 10 mm for modular stem and from 1 to 15 mm for monoblock stem. Postoperative Harris Hip Score (HHS) showed better results with modular stems without statistical significance [mean difference (MD) =1.32; 95% CI: −1.62 to 4.27; P=0.38]. No statistically significant difference was found for dislocations (OR =2.48; 95% CI: 0.67 to 9.14; P=0.17), infections (OR =1.07; 95% CI: 0.51 to 2.23; P=0.86), intraoperative fractures (OR =1.62; 95% CI: 0.42 to 6.21; P=0.48), and postoperative fractures (OR =1.60; 95% CI: 0.55 to 4.64; P=0.39). Conclusions: Modular and monoblock stems show comparable and satisfactory clinical and radiological outcomes for rTHA. Both stems are valid and effective options for managing femoral bone deficit in hip revision surgery. The main limitation of this study is the small number and low quality of enclosed studies that compared the two stems. Moreover, the modular stem is usually used for more complex cases with lower quality femoral bone stock

Visuomotor Integration for Coupled Hand Movements in Healthy Subjects and Patients With Stroke

Many studies have investigated the bilateral upper limb coordination during movements under different motor and visual conditions. Bilateral training has also been proposed as an effective rehabilitative protocol for patients with stroke. However, the factors influencing in-phase vs. anti-phase coupling have not yet been fully explored. In this study, we used a motion capture device based on two infrared distance sensors to assess whether the up and down oscillation of the less functional hand (the non-dominant one in healthy younger and older subjects and the paretic one in patients with stroke) could be influenced by in-phase or anti-phase coupling of the more functional hand and by visual feedback. Similar patterns were found between single hand movements and in-phase coupled movements, whereas anti-phase coupled movements were less ample, less sinusoidal, but more frequent. These features were particularly evident for patients with stroke who showed a reduced waveform similarity of bilateral movements in all conditions but especially for anti-phase movements under visual control. These results indicate that visuomotor integration in patients with stroke could be less effective than in healthy subjects, probably because of the attentional overload required when moving the two limbs in an alternating fashion

Status of the High Field Cable Test Facility at Fermilab

Fermi National Accelerator Laboratory (FNAL) and Lawrence Berkeley National Laboratory (LBNL) are building a new High Field Vertical Magnet Test Facility (HFVMTF) for testing superconducting cables in high magnetic field. The background magnetic field of 15 T in the HFVMTF will be produced by a magnet provided by LBNL. The HFVMTF is jointly funded by the US DOE Offices of Science, High Energy Physics (HEP), and Fusion Energy Sciences (FES), and will serve as a superconducting cable test facility in high magnetic fields and a wide range of temperatures for HEP and FES communities. This facility will also be used to test high-field superconducting magnet models and demonstrators, including hybrid magnets, produced by the US Magnet Development Program (MDP). The paper describes the status of the facility, including construction, cryostat designs, top and lambda plates, and systems for powering, and quench protection and monitoring

On unsupervised methods for medical image segmentation: Investigating classic approaches in breast cancer dce-mri

Unsupervised segmentation techniques, which do not require labeled data for training and can be more easily integrated into the clinical routine, represent a valid solution especially from a clinical feasibility perspective. Indeed, large-scale annotated datasets are not always available, undermining their immediate implementation and use in the clinic. Breast cancer is the most common cause of cancer death in women worldwide. In this study, breast lesion delineation in Dynamic Contrast Enhanced MRI (DCE-MRI) series was addressed by means of four popular unsupervised segmentation approaches: Split-and-Merge combined with Region Growing (SMRG), k-means, Fuzzy C-Means (FCM), and spatial FCM (sFCM). They represent well-established pattern recognition techniques that are still widely used in clinical research. Starting from the basic versions of these segmentation approaches, during our analysis, we identified the shortcomings of each of them, proposing improved versions, as well as developing ad hoc pre- and post-processing steps. The obtained experimental results, in terms of area-based—namely, Dice Index (DI), Jaccard Index (JI), Sensitivity, Specificity, False Positive Ratio (FPR), False Negative Ratio (FNR)—and distance-based metrics—Mean Absolute Distance (MAD), Maximum Distance (MaxD), Hausdorff Distance (HD)—encourage the use of unsupervised machine learning techniques in medical image segmentation. In particular, fuzzy clustering approaches (namely, FCM and sFCM) achieved the best performance. In fact, for area-based metrics, they obtained DI = 78.23% ± 6.50 (sFCM), JI = 65.90% ± 8.14 (sFCM), sensitivity = 77.84% ± 8.72 (FCM), specificity = 87.10% ± 8.24 (sFCM), FPR = 0.14 ± 0.12 (sFCM), and FNR = 0.22 ± 0.09 (sFCM). Concerning distance-based metrics, they obtained MAD = 1.37 ± 0.90 (sFCM), MaxD = 4.04 ± 2.87 (sFCM), and HD = 2.21 ± 0.43 (FCM). These experimental findings suggest that further research would be useful for advanced fuzzy logic techniques specifically tailored to medical image segmentation.</jats:p

Validity, reliability, and responsiveness of a self-reported foot and ankle score (SEFAS)

Background and purpose A questionnaire was introduced by the New Zealand Arthroplasty Registry for use when evaluating the outcome of total ankle replacement surgery. We evaluated the reliability, validity, and responsiveness of the modified Swedish version of the questionnaire (SEFAS) in patients with osteoarthritis or inflammatory arthritis before and/or after their ankle was replaced or fused. Patients and methods The questionnaire was translated into Swedish and cross-culturally adapted according to a standardized procedure. It was sent to 135 patients with ankle arthritis who were scheduled for or had undergone surgery, together with the foot and ankle outcome score (FAOS), the short form 36 (SF-36) score, and the EuroQol (EQ-5D) score. Construct validity was evaluated with Spearman's correlation coefficient when comparing SEFAS with FAOS, SF-36, and EQ-5D, content validity by calculating floor and ceiling effects, test-retest reliability with intraclass correlation coefficient (ICC), internal consistency with Cronbach's alpha (n = 62), agreement by Bland-Altman plot, and responsiveness by effect size and standardized response mean (n = 37). Results For construct validity, we correlated SEFAS with the other scores and 70% or more of our predefined hypotheses concerning correlations could be confirmed. There were no floor or ceiling effects. ICC was 0.92 (CI 95%: 0.88-0.95), Cronbach's alpha 0.96, effect size was 1.44, and the standardized response mean was 1.00. Interpretation SEFAS is a self-reported foot and ankle score with good validity, reliability and responsiveness, indicating that the score can be used to evaluate patients with osteoarthritis or inflammatory arthritis of the ankle and outcome of surgery

3D pelvimetry and biometric measurements: a surgical perspective for colorectal resections

Purpose: Male sex, high BMI, narrow pelvis, and bulky mesorectum were acknowledged as clinical variables correlated with a difficult pelvic dissection in colorectal surgery. This paper aimed at comparing pelvic biometric measurements in female and male patients and at providing a perspective on how pelvimetry segmentation may help in visualizing mesorectal distribution. Methods: A 3D software was used for segmentation of DICOM data of consecutive patients aged 60&nbsp;years, who underwent elective abdominal CT scan. The following measurements were estimated: pelvic inlet, outlet, and depth; pubic tubercle height; distances from the promontory to the coccyx and to S3/S4; distance from S3/S4 to coccyx\u2019s tip; ischial spines distance; pelvic tilt; offset angle; pelvic inlet angle; angle between the inlet/sacral promontory/coccyx; angle between the promontory/coccyx/pelvic outlet; S3 angle; and pelvic inlet to pelvic depth ratio. The measurements were compared in males and females using statistical analyses. Results: Two-hundred patients (M/F 1:1) were analyzed. Out of 21 pelvimetry measurements, 19 of them documented a significant mean difference between groups. Specifically, female patients had a significantly wider pelvic inlet and outlet but a shorter pelvic depth, and promontory/sacral/coccyx distances, resulting in an augmented inlet/depth ratio when comparing with males (p &lt; 0.0001). The sole exceptions were the straight conjugate (p = 0.06) and S3 angle (p = 0.17). 3D segmentation provided a perspective of the mesorectum distribution according to the pelvic shape. Conclusion: Significant differences in the structure of pelvis exist in males and females. Surgeons must be aware of the pelvic shape when approaching the rectum