Evaluation of the accuracy of a patient-specific instrumentation

Patient-specific instruments (PSI) has been introduced with the aim to reduce the overall costs of the implants, minimizing the size and number of instruments required, and also reducing surgery time. The aim of this study was to perform a review of the current literature, as well as to report about our personal experience, to assess reliability and accuracy of patient specific instrument system in total knee arthroplasty (TKA). A literature review was conducted of PSI system reviewing articles related to coronal alignment, clinical knee and function scores, cost, patient satisfaction and complications. Studies have reported incidences of coronal alignment ≥3° from neutral in TKAs performed with patient-specific cutting guides ranging from 6% to 31%. PSI seem not to be able to result in the same degree of accuracy as for the CAS system, while comparing well with standard manual technique with respect to component positioning and overall lower axis, in particular in the sagittal plane. In cases in which custom-made cutting jigs were used, we recommend performing an accurate control of the alignment before and after any cuts and in any further step of the procedure, in order to avoid possible outliers

Treatment of a Femur Nonunion with Microsurgical Corticoperiosteal Pedicled Flap from the Medial Femoral Condyle

Introduction.Te vascularized corticoperiosteal fap is harvested from the medial femoral condyle and it is nourished by the articular branch of the descending genicular artery and the superomedial genicular artery. Tis fap is usually harvested as a free fap for the reconstruction of bone defects at forearm, distal radius, carpus, hand, and recently at lower limb too. Case Report. A 50-year-old Caucasian man referred to our department for hypertrophic nonunion of the distal femur, refractory to the conservative treatments. Te frst surgical choice was the revision of the nail and the bone reconstruction with a corticoperiosteal pedicled fap from the medial femoral condyle. We considered union to have occurred 3.5 months afer surgery when radiographs showed bridging of at least three of the four bony cortices and clinically the patient was able to walk with full weight bearing without any pain. At the last follow-up (25 months), the patient was completely satisfed with the procedure. Discussion. Te corticoperiosteal fap allows a faster healing of fractures with a minimal morbidity at the donor site. We suggest that the corticoperiosteal pedicled fap graf is a reliable and efective treatment for distal femur nonunion

Extra-articular tenodesis combined with an anterior cruciate ligament reconstruction in acute anterior cruciate ligament tear in elite female football players

PURPOSE: The growing popularity of elite soccer among female participants has led to increased incidents of anterior cruciate ligament (ACL) ruptures. Many authors underline a positive glide after ACL reconstruction (ACLR), especially in women. In fact, an isolated intra-articular ACLR may be inadequate to control rotational instability after a combined injury of the ACL and the peripheral structures of the knee. Extra-articular procedures are sometimes used in primary cases displaying excessive antero-lateral rotatory instability. The purpose of this case series was to report subjective and objective outcomes after combined ACL and lateral extra-articular tenodesis (LET) with a minimum 4-year follow-up in a selected high-risk population of elite female football players. METHODS: Between January 2007 and December 2010, 16 elite Italian female football players were included in the study. All patients underwent the same surgical technique: anatomical ACLR with autogenous semitendinosus and gracilis tendons. After the intra-articular reconstruction was performed, an additional extra-articular MacIntosh modified Coker-Arnold procedure was carried out. Patients were assessed pre- and post-operatively with the subjective and objective International Knee Documentation Committee (IKDC) evaluation form, Tegner activity scale (TAS) and Lysholm score. Joint laxity was assessed with KT-1000 by measuring the side-to-side (S/S) differences in displacement at manual maximum (mm) testing. RESULTS: At a mean follow-up of 72.6 ± 8.1 months, two independent examiners reviewed all players. All of the patients had a fully recovered range of motion. Lachman test was negative in all patients (100 %). The evaluation of joint laxity and clinical evaluation showed a statistically significant improvement. No patients experienced complication or a re-rupture. DISCUSSION: The rationale of combining extra-articular procedures with ACLR is to restrict the internal rotation of the reconstructed knee, taking advantage of its long lever arm and thus providing more stability in the rotational axis and preventing the ACL graft from undergoing further excessive strain. CONCLUSIONS: The combination of an LET with ACLR in elite female football players demonstrated excellent results in terms of subjective scales, post-operative residual laxity and re-rupture rate with no complication, and a complete return to sport activity

Natural semi-direct gauge mediation and D-branes at singularities

We consider semi-direct gauge mediation models of supersymmetry breaking where the messengers are composite fields and their supersymmetric mass is naturally generated through quartic superpotential couplings. We show that such composite messenger models can be easily embedded in quiver gauge theories arising from D-branes at Calabi-Yau singularities, and argue that semi-direct gauge mediation is in fact a very natural option for supersymmetry breaking in D-brane models. We provide several explicit examples and discuss their salient phenomenological properties.Comment: 20 pages, 5 figures. V2: Typos corrected and a note about putative unsuppressed gaugino mass adde

Donor and acceptor levels of organic photovoltaic compounds from first principles

Accurate and efficient approaches to predict the optical properties of organic semiconducting compounds could accelerate the search for efficient organic photovoltaic materials. Nevertheless, predicting the optical properties of organic semiconductors has been plagued by the inaccuracy or computational cost of conventional first-principles calculations. In this work, we demonstrate that orbital-dependent density-functional theory based upon Koopmans' condition [Phys. Rev. B 82, 115121 (2010)] is apt at describing donor and acceptor levels for a wide variety of organic molecules, clusters, and oligomers within a few tenths of an electron-volt relative to experiment, which is comparable to the predictive performance of many-body perturbation theory methods at a fraction of the computational cost.Comment: 13 pages, 11 figure

Can the outside-in half-tunnel technique reduce femoral tunnel widening in anterior cruciate ligament reconstruction? A CT study

There are different techniques for drilling the femoral tunnel in the anterior cruciate ligament reconstruction (ACLR), but their influence in the bone tunnel enlargement in unknown. The purpose of this study was to compare two different surgical techniques for evaluating femoral tunnel enlargement in ACLR. The hypothesis was that tunnel placement using the outside-in technique leads to less tunnel enlargement compared to the transtibial technique. METHODS: Forty-four patients treated for ACLR between March 2013 and March 2014 were prospectively enrolled in this study. According to the surgical technique, subjects were assigned to Group A (Out-in) or Group B (Transtibial). All patients underwent CT examination in order to evaluate the femoral tunnel enlargement at four different levels. Moreover, all patients were evaluated with the Lachman test and pivot shift test, and the KT1000 arthrometer was used to measure the anterior laxity of the knee. A subjective evaluation was performed using the 2000 International Knee Documentation Committee Subjective Knee score, Lysholm knee score and Tegner activity scale. All patients were assessed after 24 months of follow-up. RESULTS: At the final follow-up, there were statistically significant differences (p 0.05). CONCLUSIONS: In ACLR with a suspension system, the outside-in technique leads to less enlargement of the femoral tunnel lower than the transtibial technique. KEYWORDS: Anterior cruciate ligament reconstruction; CT imaging; Drilling technique; Femoral tunnel enlargement PMID: 28389757 DOI: 10.1007/s00590-017-1950-8 Share on FacebookShare on TwitterShare on Google+ LinkOut - more resource

La dimensione linguistica nell’apprendimento della matematica: un esempio di attività laboratoriale

Nel presente contributo si propongono riflessioni circa l’importanza dell’educazione linguistica nell’apprendimento della matematica. Il ruolo fondamentale della lingua nell’apprendimento della matematica è messo in luce nelle indicazioni curricolari ministeriali e nei principali documenti nazionali e internazionali in campo educativo. A partire da alcuni dei principali risultati di ricerca, si presentano alcune delle fasi del laboratorio svolto durante il percorso di ricerca-formazione sul tema

Analysis of the Tribological Behaviour of the Lubricated Contacts of a Connecting Rod Equipped with a Direct Pin Oiling Gallery

This paper describes a methodology for identifying a suitable design of a Direct-Pin-Oiling (DPO) gallery, drilled through the conrod shank of a high-performance internal combustion engine, to directly supply pressurized lubricant to the piston pin/small-end interface. Initially, a multibody elastohydrodynamic model is set up to analyse the tribological behaviour of conrod bearings, when considering a standard configuration employing a passive lubricating hole drilled on the top of the small-end. Then, a preliminary DPO gallery is introduced to examine how it affects the oil flows at lubricated interfaces and their tribological behaviour. The numerical results and parallel experimental evidence underline the need to modify the initial configuration of the DPO gallery and a more performing gallery design is proposed

Exploring the Combined Effects of Different Nitrogen Sources and Chabazite Zeolite-Tuff on Nitrogen Dynamics in an Acidic Sandy-Loam Soil

Volcanic tuffs rich in chabazite zeolites have been extensively examined for their potential to enhance soil properties and increase fertilizer efficiency, both in their natural state and when enriched with nitrogen (N). However, there is a scarcity of data regarding their utilization in acidic sandy soil, particularly when used alongside organic fertilizers. This paper presents the findings of a 50-day laboratory incubation study that investigated the dynamics of N pools in an acidic sandy-loam agricultural soil treated with various N sources. These sources included urea, N-enriched chabazite zeolite tuff, and pelleted composted manure applied at a rate of 170 kg N/ha. Additionally, the N sources were tested in combination with chabazite zeolite tuff mixed into the soil to assess its role as a soil conditioner. The results revealed distinct behaviours among the tested N sources, primarily impacting soil pH and N dynamics. Soil fertilized with manure exhibited slow N mineralization, whereas N-enriched zeolite displayed a more balanced behaviour concerning net NO3−-N production and NH4+-N consumption. Both N-enriched zeolite and urea temporarily altered the soil pH, resembling a “liming” effect, while pelleted manure facilitated a prolonged shift towards neutral pH values. Considering the water adsorption capacity of zeolite minerals, caution is advised when adjusting water content and employing combustion methods to measure soil organic matter in zeolite treated soil to avoid potential inaccuracies. In summary, N-enriched chabazite zeolite tuff emerged as a valuable N source in acidic sandy-loam soil, offering a promising alternative to synthetic fertilizers and showcasing a sustainable means of N recycling

Single harvesting in the all-inside graft-link technique. is the graft length crucial for success? A biomechanical study

Background: The all-inside graft-link technique for anterior cruciate ligament reconstruction is performed with two cortical suspension devices with adjustable loops on both femur and tibia. This technique requires meticulous graft preparation. The aim of this study was to biomechanically test three different graft configurations resulting from differences in initial graft length. Materials and methods: Thirty bovine digital extensor tendons were arranged in three different ways: “half-quadrupled”, “tripled” and “quadrupled”. The final graft length was 65–75 mm. The specimens were fixed vertical to the loading axis of a tensile testing machine. After a static pre-conditioning of 50 N for 5 min, a load to failure test was performed and data regarding the ultimate failure load (UFL), the stiffness and mode of failure were recorded. Results: The evaluation of UFL showed a significant differences between group means as determined by one-way analysis of variance (F = 21.92, p = 0.002). Post hoc comparisons showed a significantly better UFL of “tripled” (p = 0.007) and “quadrupled” preparations (p = 0.014) compared to the “half-quadrupled” configuration, with no significant differences between “tripled” and “quadrupled” grafts (p = 0.061). No significant differences were found when evaluating the stiffness between the groups. Failure occurred by tendon slippage across the suture in all specimens. Conclusion: The “quadrupled” tendon achieved the best UFL, with even the “tripled” configuration having sufficient biomechanical characteristics to withstand the loads experienced during early rehabilitation. For this reason, with a total semitendinosus length of less than 260 mm it could be better to “triple” instead of “half-quadruple” it to achieve better performance of the graft