The use of computer-assisted orthopedic surgery for total knee replacement in daily practice: a survey among ESSKA/SGO-SSO members

Computer-assisted orthopedic surgery (CAOS) for total knee arthroplasty is an emerging surgical tool, yet little is known about how it is being used in everyday orthopedic centers. We sought to better understand physicians' current practices and beliefs on this topic through performing a Web-based survey. Between December 2006 and January 2007, a 24-question survey was emailed to 3,330 members of the European Society of Sports Traumatology Knee Surgery and Arthroscopy (ESSKA) and the Swiss Orthopedic Society (SGO-SSO), with 389 (11.7%) agreeing to participate. Of this group, 202 (51.9%) reported that their center was equipped with a navigation system, which was an image-free based system for most (83.2%) and was primarily used for total knee arthroplasty (61.4%). In terms of the proportion of use, 50.5% of respondents used their navigation system in less than 25% of cases, 16.3% in 25-50% of cases, 7.4% in 51-75% of cases, and 25.7% in more than 75% of cases. The potential for improving the alignment of prosthesis was the most strongly cited reason for using a navigation system, while the potential for increasing operation times and the risk of infections were the most strongly cited reasons for not using a navigation system. Approximately half of respondents surveyed believed navigation systems were a real innovation contributing to the improvement of total knee implantation. However, heavy usage of computer-assisted navigation (≥51% of cases) was observed in only 33.1% of respondents, with only a quarter using it at rates that could be considered frequent (>75% of cases). Forty-eight percent of respondents said they will use a navigation system in more cases and 39.1% that their usage will stay the same. These findings indicate that CAOS is being used only moderately in current practices, though respondents generally had a positive opinion of its potential benefits. Physicians may be awaiting more data before adopting the use of these systems, though survey responses also suggest a projected increase in their use in the coming year

Analyse der Veränderungen von Wavelet-transformierten elektromyographischen Signalen, wie sie beim Tragen einer Kniebandage entstehen

Der Vergleich von diversen Elektromyogrammen stellt eine wesentliche Anforderung an die Datenanalyse dar. Das Ziel der vorliegenden Arbeit ist es, eine Methode mit geringem mathematischem Aufwand vorzustellen, mit der kleine Veränderungen am Bewegungsapparat durch Auswertung des EMG-Signals einfach und mit einer hohen Sensitivität ermittelt und dargestellt werden können. Die Wavelettransformierten Elektromyogramme bilden Intensitätsbilder, die in einem Bildraum als Punkte dargestellt werden können. Die Distanz-analyse der Bildpunkte im Bildraum erlaubt es festzustellen, ob zwei Gruppen von Elektromyogrammen - im vorliegenden Falle diejenigen, die beim Gehen mit und ohne Kniebandage gemessen wurden - sich im Mittel signifikant unterscheiden. Die Methode definiert eine Distanz-Winkel-Darstellung und Differenz-Intensitätsbilder, die es erlauben, die Auftrennung optisch zu beurteilen. Es ist zu erwarten, daβ bei gröβeren Interventionen die Unterschiede deutlicher erscheinen werden. The comparison of electromyograms represents a challenge for data analysis. The aim of the project was to present a method that uses a minimal computational effort to resolve small but significant changes in the muscular activity that occur while walking with and without a knee brace. The wavelet transformed electromyograms were represented as intensity patterns that resolve the power of the signal in time and frequency. The intensity pattern of each electromyogram defines single points in a pattern space. The distance between these points in pattern space were used to detect and show the separation between the groups of electromyograms that were recorded while walking with and without a knee brace. The method proposes a distance versus angle representation to visually discriminate the intensity patterns. Once it has been shown that the differences are statistically significant, one can visualize the result in a difference intensity pattern that indicates at what time and at what frequency the electromyograms vary between the two conditions tested. It is to be expected that interventions that are more intrusive than a knee brace will reveal even more distinct difference

Multicenter-study of operative treatment of intraligamentous tears of the anterior cruciate ligament in children and adolescents: Comparison of four different techniques

Tears of the anterior cruciate ligament in skeletally immature patients were operated with four different methods and their outcome compared to each other. Sixty-eight patients (33 males, 35 females), mean 12.5years, were treated in four different centers from 1984 to 2001. Twenty-eight patients underwent the ACL-reconstruction with hamstring grafts, 16 patients with bone-patella-bone autografts, 12 patients with quadriceps grafts and 12 patients with facia lata. The mean follow-up was 32months. Postoperative evaluation included radiographs, KT-1000/2000 stability measurements, Lysholm score, The Tegner activity scale and IKDC score. Neither leg length discrepancy nor angular deformities were noted. Mean KT-1000 difference was 2.1mm, mean postoperative Lysholm knee score 93.3, IKDC 87% normal or nearly normal. The Tegner index decreased from 6.6 to 5.7. In total, six patients developed instability due to an adequate trauma 1year after the index operation. Two patients showed mild arthrotic changes. All but two patients were able to return to the same level of preoperative sports participation. None of the four methods studied showed major differences in outcome compared to the other. No growth disturbance could be note

Toward Design of Novel Materials for Organic Electronics

Materials for organic electronics are presently used in prominent applications, such as displays in mobile devices, while being intensely researched for other purposes, such as organic photovoltaics, large-area devices, and thin-film transistors. Many of the challenges to improve and optimize these applications are material related and there is a nearly infinite chemical space that needs to be explored to identify the most suitable material candidates. Established experimental approaches struggle with the size and complexity of this chemical space. Herein, the development of simulation methods is addressed, with a particular emphasis on predictive multiscale protocols, to complement experimental research in the identification of novel materials and illustrate the potential of these methods with a few prominent recent applications. Finally, the potential of machine learning and methods based on artificial intelligence is discussed to further accelerate the search for new materials

Changes in axonal excitability of primary sensory afferents with general anaesthesia in humans

BACKGROUND: Intraoperative monitoring of neuronal function is important in a variety of surgeries. The type of general anaesthetic used can affect the interpretation and quality of such recordings. Although the principal effects of general anaesthetics are synaptically mediated, the extent to which they affect excitability of the peripheral afferent nervous system is unclear. METHODS: Forty subjects were randomized in a stratified manner into two groups, anaesthetized with either propofol or sevoflurane. The threshold tracking technique (QTRAC(®)) was used to measure nerve excitability parameters of the sensory action potential of the median nerve before and after induction of general anaesthesia. RESULTS: Several parameters of peripheral sensory afferent nerve excitability changed after induction of general anaesthesia, which were similar for both propofol and sevoflurane. The maximum amplitude of the sensory nerve action potential decreased in both groups (propofol: 25.3%; sevoflurane: 29.5%; both P<0.01). The relative refractory period [mean (sd)] also decreased similarly in both groups [propofol: -0.6 (0.7) ms; sevoflurane: -0.3 (0.5) ms; both P<0.01]. Skin temperature at the stimulation site increased significantly in both groups [propofol: +1.2 (1.0)°C; sevoflurane: +1.7 (1.4)°C; both P<0.01]. CONCLUSIONS: Small changes in excitability of primary sensory afferents after the induction of anaesthesia with propofol or sevoflurane were detected. These effects, which were non-specific and are possibly explained by changes observed in temperature, demonstrate possible anaesthetic effects on intraoperative neuromonitoring

Effect of laser pulse duration on ablation efficiency of hard bone in microseconds regime

The aim of the present study is to investigate the effect of laser pulse duration on ablation efficiency of hard bones. The bones were ablated using a microsecond pulsed Er-YAG laser. The laser wavelength was 2.94 μm and the repetition rate was 10Hz. Three samples of porcine femur were used and several areas were ablated with a fixed pulse energy of 280mJ and different pulse durations. The ablation procedure was applied during five seconds for all the experiments, therefore, the same amount of energy (14 J) was deposited in each trial. The ablation efficiency was determined by measuring the ablated volume per second for each experiment

Effect of ibandronate on spontaneous osteonecrosis of the knee: a randomized, double-blind, placebo-controlled trial

Summary: Based on this double-blind, placebo-controlled study, ibandronate has no beneficial effect on clinical and radiological outcome in patients with spontaneous osteonecrosis of the knee over and above anti-inflammatory medication. Introduction: Observational studies suggest beneficial effects of bisphosphonates in spontaneous osteonecrosis (ON) of the knee. We investigated whether ibandronate would improve clinical and radiological outcome in newly diagnosed ON. Methods: In this randomized, double-blind, placebo-controlled trial, 30 patients (mean age, 57.3 ± 10.7years) with ON of the knee were assigned to receive either ibandronate (cumulative dose, 13.5mg) or placebo intravenously (divided into five doses 12weeks). All subjects received additional treatment with oral diclofenac (70mg) and supplementation with calcium carbonate (500mg) and vitamin D (400IU) to be taken daily for 12weeks. Patients were followed for 48weeks. The primary outcome was the change in pain score after 12weeks. Secondary endpoints included changes in pain score, mobility, and radiological outcome (MRI) after 48weeks. Results: At baseline, both treatment groups (IBN, n = 14; placebo, n = 16) were comparable in relation to pain score and radiological grading (bone marrow edema, ON). After 12weeks, mean pain score was reduced in both ibandronate- (mean change, −2.98; 95% CI, −4.34 to −1.62) and placebo- (−3.59; 95% CI, −5.07 to −2.12) treated subjects (between-group comparison adjusted for age, sex, and osteonecrosis type, p = ns). Except for significant decrease in bone resorption marker (CTX) in ibandronate-treated subjects (p < 0.01), adjusted mean changes in all functional and radiological outcome measures were comparable between treatment groups after 24 and 48weeks. Conclusions: In patients with spontaneous osteonecrosis of the knee, bisphosphonate treatment (i.e., IV ibandronate) has no beneficial effect over and above anti-inflammatory medication

Pathogenic variants in SQOR encoding sulfide:quinone oxidoreductase are a potentially treatable cause of Leigh disease

Hydrogen sulfide, a signaling molecule formed mainly from cysteine, is catabolized by sulfide:quinone oxidoreductase (gene SQOR). Toxic hydrogen sulfide exposure inhibits complex IV. We describe children of two families with pathogenic variants in SQOR. Exome sequencing identified variants; SQOR enzyme activity was measured spectrophotometrically, protein levels evaluated by western blotting, and mitochondrial function was assayed. In family A, following a brief illness, a 4- year- old girl presented comatose with lactic acidosis and multiorgan failure. After stabilization, she remained comatose, hypotonic, had neurostorming episodes, elevated lactate, and Leigh- like lesions on brain imaging. She died shortly after. Her 8- year- old sister presented with a rapidly fatal episode of coma with lactic acidosis, and lesions in the basal ganglia and left cortex. Muscle and liver tissue had isolated decreased complex IV activity, but normal complex IV protein levels and complex formation. Both patients were homozygous for c.637G- >- A, which we identified as a founder mutation in the Lehrerleut Hutterite with a carrier frequency of 1 in 13. The resulting p.Glu213Lys change disrupts hydrogen bonding with neighboring residues, resulting in severely reduced SQOR protein and enzyme activity, whereas sulfide generating enzyme levels were unchanged. In family B, a boy had episodes of encephalopathy and basal ganglia lesions. He was homozygous for c.446delT and had severely reduced fibroblast SQOR enzyme activity and protein levels. SQOR dysfunction can result in hydrogen sulfide accumulation, which, consistent with its known toxicity, inhibits complex IV resulting in energy failure. In conclusion, SQOR deficiency represents a new, potentially treatable, cause of Leigh disease.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162807/2/jimd12232.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162807/1/jimd12232_am.pd

Decline of genetic diversity in ancient domestic stallions in Europe.

Present-day domestic horses are immensely diverse in their maternally inherited mitochondrial DNA, yet they show very little variation on their paternally inherited Y chromosome. Although it has recently been shown that Y chromosomal diversity in domestic horses was higher at least until the Iron Age, when and why this diversity disappeared remain controversial questions. We genotyped 16 recently discovered Y chromosomal single-nucleotide polymorphisms in 96 ancient Eurasian stallions spanning the early domestication stages (Copper and Bronze Age) to the Middle Ages. Using this Y chromosomal time series, which covers nearly the entire history of horse domestication, we reveal how Y chromosomal diversity changed over time. Our results also show that the lack of multiple stallion lineages in the extant domestic population is caused by neither a founder effect nor random demographic effects but instead is the result of artificial selection-initially during the Iron Age by nomadic people from the Eurasian steppes and later during the Roman period. Moreover, the modern domestic haplotype probably derived from another, already advantageous, haplotype, most likely after the beginning of the domestication. In line with recent findings indicating that the Przewalski and domestic horse lineages remained connected by gene flow after they diverged about 45,000 years ago, we present evidence for Y chromosomal introgression of Przewalski horses into the gene pool of European domestic horses at least until medieval times

Physicochemical analysis of rotavirus segment 11 supports a 'modified panhandle' structure and not the predicted alternative tRNA-like structure (TRLS)

.Rotaviruses are a major cause of acute gastroenteritis, which is often fatal in infants. The viral genome consists of 11 double-stranded RNA segments, but little is known about their cis-acting sequences and structural elements. Covariation studies and phylogenetic analysis exploring the potential structure of RNA11 of rotaviruses suggested that, besides the previously predicted "modified panhandle" structure, the 5' and 3' termini of one of the isoforms of the bovine rotavirus UKtc strain may interact to form a tRNA-like structure (TRLS). Such TRLSs have been identified in RNAs of plant viruses, where they are important for enhancing replication and packaging. However, using tRNA mimicry assays (in vitro aminoacylation and 3'- adenylation), we found no biochemical evidence for tRNA-like functions of RNA11. Capping, synthetic 3' adenylation and manipulation of divalent cation concentrations did not change this finding. NMR studies on a 5'- and 3'-deletion construct of RNA11 containing the putative intra-strand complementary sequences supported a predominant panhandle structure and did not conform to a cloverleaf fold despite the strong evidence for a predicted structure in this conserved region of the viral RNA. Additional viral or cellular factors may be needed to stabilise it into a form with tRNA-like properties