Thresholds for the Oxford Hip Score after total hip replacement surgery:a novel approach to postoperative evaluation

Abstract Background This is a prospective cohort study to define the thresholds to distinguish patients with a satisfactory or unsatisfactory outcome after total hip replacement (THR) based on patient-reported outcome measures (PROMs) including the Oxford Hip Score (OHS), and using patient satisfaction and patient-perceived function as global transition items. The thresholds are intended to be used as a tool in the process of determining which patients are in need of postoperative outpatient evaluation. Methods One hundred and three THR patients who had completed a preoperative questionnaire containing the OHS questionnaire were invited to complete the same questionnaire and supplementary questions at a mean of 6 (4–9) months after surgery. Correlations between outcome measures and anchors were calculated using Pearson’s correlation coefficient. Thresholds were established by receiver operating characteristic (ROC) analysis, using multiple anchors. Results Significant correlations were found between outcome measures and anchors. Thresholds were determined for outcome measures coupled with satisfaction, patient-perceived function and a combination thereof using a cut-off of 50 and 70. Conclusions We have established a set of thresholds for Oxford scores that may help determine which THR patients are in need of postoperative evaluation. These thresholds can be implemented in clinical practice. Level of evidence Level 3

Mirroring everyday clinical practice in clinical trial design: a new concept to improve the external validity of randomized double-blind placebo-controlled trials in the pharmacological treatment of major depression

Background: Randomized, double-blind, placebo-controlled trials constitute the gold standard in clinical research when testing the efficacy of new psychopharmacological interventions in the treatment of major depression. However, the blinded use of placebo has been found to influence clinical trial outcomes and may bias patient selection. Discussion: To improve clinical trial design in major depression so as to reflect clinical practice more closely we propose to present patients with a balanced view of the benefits of study participation irrespective of their assignment to placebo or active treatment. In addition every participant should be given the option to finally receive the active medication. A research agenda is outlined to evaluate the impact of the proposed changes on the efficacy of the drug to be evaluated and on the demographic and clinical characteristics of the enrollment fraction with regard to its representativeness of the eligible population. Summary: We propose a list of measures to be taken to improve the external validity of double-blind, placebocontrolled trials in major depression. The recommended changes to clinical trial design may also be relevant for other psychiatric as well as medical disorders in which expectations regarding treatment outcome may affect the outcome itself

Ultrasensitive force and displacement detection using trapped ions

The ability to detect extremely small forces is vital for a variety of disciplines including precision spin-resonance imaging, microscopy, and tests of fundamental physical phenomena. Current force-detection sensitivity limits have surpassed 1 $aN/\sqrt{Hz}$ (atto $=10^{-18}$) through coupling of micro or nanofabricated mechanical resonators to a variety of physical systems including single-electron transistors, superconducting microwave cavities, and individual spins. These experiments have allowed for probing studies of a variety of phenomena, but sensitivity requirements are ever-increasing as new regimes of physical interactions are considered. Here we show that trapped atomic ions are exquisitely sensitive force detectors, with a measured sensitivity more than three orders of magnitude better than existing reports. We demonstrate detection of forces as small as 174 $yN$ (yocto $=10^{-24}$), with a sensitivity 390$\pm150$ $yN/\sqrt{Hz}$ using crystals of $n=60$ $^{9}$Be$^{+}$ ions in a Penning trap. Our technique is based on the excitation of normal motional modes in an ion trap by externally applied electric fields, detection via and phase-coherent Doppler velocimetry, which allows for the discrimination of ion motion with amplitudes on the scale of nanometers. These experimental results and extracted force-detection sensitivities in the single-ion limit validate proposals suggesting that trapped atomic ions are capable of detecting of forces with sensitivity approaching 1 $yN/\sqrt{Hz}$. We anticipate that this demonstration will be strongly motivational for the development of a new class of deployable trapped-ion-based sensors, and will permit scientists to access new regimes in materials science.Comment: Expanded introduction and analysis. Methods section added. Subject to press embarg

A sleeping phantom leg awakened following hemicolectomy, thrombosis, and chemotherapy: a case report

INTRODUCTION: We describe the case of a patient who experienced phantom pain that began 42 years after right above-the-knee amputation. Immediately prior to phantom pain onset, this long-term amputee had experienced, in rapid succession, cancer, hemicolectomy, chemotherapy, and thrombotic occlusion. Very little has been published to date on the association between chemotherapy and exacerbation of neuropathic pain in amputees, let alone the phenomenon of bringing about pain in amputees who have been pain-free for many decades. While this patient presented with a unique profile following a rare sequence of medical events, his case should be recognized considering the frequent co-occurrence of osteomyelitis, chemotherapy, and amputation. CASE PRESENTATION: A 68-year-old Australian Caucasian man presented 42 years after right above-the-knee amputation with phantom pain immediately following hemicolectomy, thrombotic occlusion in the amputated leg, and chemotherapy treatment with leucovorin and 5-fluorouracil. He exhibited probable hyperalgesia with a reduced pinprick threshold and increased stump sensitivity, indicating likely peripheral and central sensitization. CONCLUSION: Our patient, who had long-term nerve injury due to amputation, together with recent ischemic nerve and tissue injury due to thrombosis, exhibited likely chemotherapy-induced neuropathy. While he presented with unique treatment needs, cases such as this one may actually be quite common considering that osteosarcoma can frequently lead to amputation and be followed by chemotherapy. The increased susceptibility of amputees to developing potentially intractable chemotherapy-induced neuropathic pain should be taken into consideration throughout the course of chemotherapy treatment. Patients in whom chronic phantom pain then develops, perhaps together with mobility issues, inevitably place greater demands on healthcare service providers that require treatment by various clinical specialists, including oncologists, neurologists, prosthetists, and, most frequently, general practitioners

Chandra spectroscopy of the hot star beta Crucis and the discovery of a pre-main-sequence companion

In order to test the O star wind-shock scenario for X-ray production in less luminous stars with weaker winds, we made a pointed 74 ks observation of the nearby early B giant, beta Cru (B0.5 III), with the Chandra HETGS. We find that the X-ray spectrum is quite soft, with a dominant thermal component near 3 million K, and that the emission lines are resolved but quite narrow, with half-widths of 150 km/s. The forbidden-to-intercombination line ratios of Ne IX and Mg XI indicate that the hot plasma is distributed in the wind, rather than confined near the photosphere. It is difficult to understand the X-ray data in the context of the standard wind-shock paradigm for OB stars, primarily because of the narrow lines, but also because of the high X-ray production efficiency. A scenario in which the bulk of the outer wind is shock heated is broadly consistent with the data, but not very well motivated theoretically. It is possible that magnetic channeling could explain the X-ray properties, although no field has been detected on beta Cru. We detected periodic variability in the hard (hnu > 1 keV) X-rays, modulated on the known optical period of 4.58 hours, which is the period of the primary beta Cep pulsation mode for this star. We also have detected, for the first time, an apparent companion to beta Cru at a projected separation of 4 arcsec. This companion was likely never seen in optical images because of the presumed very high contrast between it and beta Cru in the optical. However, the brightness contrast in the X-ray is only 3:1, which is consistent with the companion being an X-ray active low-mass pre-main-sequence star. The companion's X-ray spectrum is relatively hard and variable, as would be expected from a post T Tauri star.Comment: Accepted for publication in MNRAS; 19 pages, 15 figures, some in color; version with higher-resolution figures available at http://astro.swarthmore.edu/~cohen/papers/bcru_mnras2008.pd

From START to FINISH : the influence of osmotic stress on the cell cycle

Peer reviewedPublisher PD

Rotator Cuff Deficient Arthritis of the Glenohumeral Joint

Rotator cuff deficient arthritis of the glenohumeral joint, especially cuff tear arthropathy, has proved a challenging clinical entity for orthopaedic surgeons ever since Charles Neer originally detailed the problem in 1983. Understanding has improved regarding the pathophysiology and pathomechanics underlying cuff tear arthropathy. Surgical reconstruction options can lead to excellent outcomes for patients afflicted with these painful and functionally limited shoulders. Humeral hemiarthroplasty and reverse total shoulder arthroplasty have jumped to the forefront in the treatment of cuff tear arthropathy. As studies continue to look at the results of these procedures in cuff tear arthropathy, existing indications and treatment algorithms will be further refined. In this article the history and pathophysiology of cuff tear arthropathy are reviewed. Additionally, the clinical findings and results of surgical reconstruction are discussed

A self-consistent quantum master equation approach to molecular transport

We propose a self-consistent generalized quantum master equation (GQME) to describe electron transport through molecular junctions. In a previous study [M.Esposito and M.Galperin. Phys. Rev. B 79, 205303 (2009)], we derived a time-nonlocal GQME to cure the lack of broadening effects in Redfield theory. To do so, the free evolution used in the Born-Markov approximation to close the Redfield equation was replaced by a standard Redfield evolution. In the present paper, we propose a backward Redfield evolution leading to a time-local GQME which allows for a self-consistent procedure of the GQME generator. This approach is approximate but properly reproduces the nonequilibrium steady state density matrix and the currents of an exactly solvable model. The approach is less accurate for higher moments such as the noise.Comment: 9 pages, 4 figure