Comparative study of intraoperative knee flexion with three different TKR designs

SummaryIntroductionSubstantial flexion after total knee arthroplasty (TKA) is required for certain categories of patients who wish to squat or kneel in their daily life. Many factors influence this postoperative flexion, including the prosthesis design. It is therefore valuable to in vivo analyze these factors on three knee prosthesis designs through a study of their intraoperative flexion.HypothesisThe posterior-stabilized (PS) knee prostheses provide better intraoperative flexion than the ultracongruent (UC) model. Of the currently available PS models, the high-flexion ones have better intraoperative flexion than standard models. Our main focus endpoint was the intraoperative flexion achieved, before soft-tissues closure, during TKA surgical procedure.Patients and methodsThis was a controlled study. Seventy-two osteoarthritic knees requiring TKA were included to compare three selected prosthesis models: the SAL ultracongruent and two PS models (the standard LPS and the LPS Flex). This was a single-operator study, with patients divided into three homogenous, comparable groups, in which intraoperative measurement of flexion was performed using computer-assisted navigation. Statistical analysis allowed comparison of the three models.ResultsIntraoperatively, after prosthesis implantation, before soft-tissues closure, the mean flexion of the LPS-Flex was 134° versus 124° for the SAL (p=0.0004); the mean flexion of the standard LPS model was 130° versus 124° for the SAL (p=0.14); the PS Flex model showed no significant difference (p=0.26) in flexion (134°) compared to the standard model (130°). The SAL ultracongruent model seemed to be a factor reducing the intraoperative flexion by 8° compared to the PS models (p<10−4).DiscussionIn this study, the PS designs (standard or Flex) provided better intraoperative flexion than the SAL ultracongruent design. However, the LPS Prosthesis did not demonstrate superiority over the standard LPS Prosthesis.Level of evidenceLevel III, low-power prospective study

Un modèle d'interaction réaliste pour la simulation de marchés financiers

Dans les modèles de marché multi-agents utilisés habituellement, la structure du marché est presque toujours réduite à une équation qui aggrège les décisions des agents de façon synchrone pour mettre à jour le prix de l'action à chaque pas de temps. Sur les marchés réels, ce processus est totalement différent : le prix de l'action émerge d'interactions survenant de manière asynchrone entre les acheteurs et les vendeurs. Dans cet article, nous introduisons un modèle de marché artificiel conçu pour être le plus proche possible de la structure des marchés réels. Ce modèle est basé sur un carnet d'ordres à travers lequel les agents échangent des actions de manière asynchrone. Nous montrons que, sans émettre d'hypothèses particulières sur le comportement des agents, ce modèle exhibe de nombreuses propriétés statistiques des marchés réels. Nous soutenons que la plupart de ces propriétés proviennent de la manière dont les agents interagissent plutôt que de leurs comportements. Ce résutat expérimental est validé et renforcé grâce à l'utilisation de nombreux tests statistiques utilisés par les économistes pour caractériser les propriétés des marchés réels. Nous finissons par quelques perspectives ouvertes par les avantages de l'utilisation de tels modèles pour le développement, le test et la validation d'automates d'investissement. In usual multi-agent stock market models, market structure is mostly reduced to an equation matching supply and demand, which synchronously aggregates agents decisions to update stock price at each time steps. On real markets, the process is however very different: stock price emerges from one-to one asynchronous interactions between buyers and sellers at various time step. In this article, we introduce an artificial stock market model designed to be close to real market structure. The model is based on a centralized orderbook through which agents exchange stocks asynchronously.We show that, without making any strong assumption on agents behaviors, this model exhibits many statistical properties of real stock markets. We argue that most of market features are implied by the exchange process more than by agents behaviors. This experimental result is validated and strengthen using several tests used by economists to characterize real market. We finally put in perspective the advantages of such a realistic model to develop, test and validate behavior of automated trading agents

Rotational positioning of the tibial tray in total knee arthroplasty: A CT evaluation

SummaryIntroductionVarious surgical techniques have been described to set the rotational alignment of the tibial baseplate during total knee arthroplasty. The self-positioning method (“self-adjustment”) aligns the tibial implant according to the rotational alignment of the femoral component which is used as a reference after performing repeated knee flexion/extension cycles. Postoperative computed tomography scanning produces accurate measurements of the tibial baseplate rotational alignment with respect to the femoral component.HypothesisThe rotational positioning of the tibial baseplate matches the rotation of the femoral component with parallel alignment to the prosthetic posterior bicondylar axis.Patients and methodsA 3-month follow-up CT scan was carried out after primary total knee arthroplasty implanted in osteoarthritic patients with a mean 7.8° varus deformity of the knee in 50 cases and a mean 8.7° valgus deformity of the knee in 44 cases. The NexGen LPS Flex (Zimmer) fixed-bearing knee prosthesis was used in all cases. An independant examiner (not part of the operating team) measured different variables: the angle between the anatomic transepicondylar axis and the posterior bicondylar axis of the femoral prosthesis (prosthetic posterior condylar angle), the angle between the posterior bicondylar axis and the posterior marginal axis of the tibial prosthesis, the angle between the posterior marginal axis of the tibial prosthesis and the posterior marginal axis of the tibial bone and finally the angle between the anatomic transepicondylar axis and the posterior marginal axis of the tibial prosthesis.ResultsFor the genu varum and genu valgum subgroups, the mean posterior condylar axis of the femoral prosthesis was 3.1° (SD: 1.91; extremes 0° to 17.5°) and 4.7° (SD: 2.7; extremes 0° to 11°) respectively. The tibial baseplate was placed in external rotation with respect to the femoral component: 0.7° (SD : 4.45; extremes –9.5° to 9.8°) and 0.9° (SD: 4.53; extremes –10.8° to 9.5°), but also to the native tibia: 6.1° (SD: 5.85; extremes –4.6° to 22.5°) and 12.5° (SD: 8.6; extremes –10° to 28.9°). The tibial component was placed in internal rotation relative to the anatomic transepicondylar axis: 1.9° (SD : 4.93; extremes –13.6° to 7°) and 3° (SD : 4.38; extremes –16.2° to 4.8°).DiscussionThe tibial component is aligned parallel to the femoral component whatever the initial frontal deformity (P≅0.7). However, a difference was observed between the rotational alignment of the tibial baseplate and the native tibia depending on the initial deformity and could be attributed to the morphological variations of the bony tibial plateau in case of genu valgum.ConclusionThe self-positioning method is a reproducible option when using this type of implant since it allows the tibial component to be positioned parallel to the posterior border of the femur.Level of evidenceLevel III. Observational prospective study

Stability of dark solitons in three dimensional dipolar Bose-Einstein condensates

The dynamical stability of dark solitons in dipolar Bose-Einstein condensates is studied. For standard short-range interacting condensates dark solitons are unstable against transverse excitations in two and three dimensions. On the contrary, due to its non local character, the dipolar interaction allows for stable 3D stationary dark solitons, opening a qualitatively novel scenario in nonlinear atom optics. We discuss in detail the conditions to achieve this stability, which demand the use of an additional optical lattice, and the stability regimes.Comment: 4 pages, 3 eps figure

Complex lithium ion dynamics in simulated LiPO3 glass studied by means of multi-time correlation functions

Molecular dynamics simulations are performed to study the lithium jumps in LiPO3 glass. In particular, we calculate higher-order correlation functions that probe the positions of single lithium ions at several times. Three-time correlation functions show that the non-exponential relaxation of the lithium ions results from both correlated back-and-forth jumps and the existence of dynamical heterogeneities, i.e., the presence of a broad distribution of jump rates. A quantitative analysis yields that the contribution of the dynamical heterogeneities to the non-exponential depopulation of the lithium sites increases upon cooling. Further, correlated back-and-forth jumps between neighboring sites are observed for the fast ions of the distribution, but not for the slow ions and, hence, the back-jump probability depends on the dynamical state. Four-time correlation functions indicate that an exchange between fast and slow ions takes place on the timescale of the jumps themselves, i.e., the dynamical heterogeneities are short-lived. Hence, sites featuring fast and slow lithium dynamics, respectively, are intimately mixed. In addition, a backward correlation beyond the first neighbor shell for highly mobile ions and the presence of long-range dynamical heterogeneities suggest that fast ion migration occurs along preferential pathways in the glassy matrix. In the melt, we find no evidence for correlated back-and-forth motions and dynamical heterogeneities on the length scale of the next-neighbor distance.Comment: 12 pages, 13 figure

Development of a Series of Kynurenine 3-Monooxygenase Inhibitors Leading to a Clinical Candidate for the Treatment of Acute Pancreatitis

Recently, we reported a novel role for KMO in the pathogenesis of acute pancreatitis (AP). A number of inhibitors of kynurenine 3-monooxygenase (KMO) have previously been described as potential treatments for neurodegenerative conditions and particularly for Huntington’s disease. However, the inhibitors reported to date have insufficient aqueous solubility relative to their cellular potency to be compatible with the intravenous (iv) dosing route required in AP. We have identified and optimized a novel series of high affinity KMO inhibitors with favorable physicochemical properties. The leading example is exquisitely selective, has low clearance in two species, prevents lung and kidney damage in a rat model of acute pancreatitis, and is progressing into preclinical development

The Clinical Variability of Maternally Inherited Diabetes and Deafness Is Associated with the Degree of Heteroplasmy in Blood Leukocytes

Context: Maternally inherited diabetes and deafness (MIDD) is a rare form of diabetes with a matrilineal transmission, sensorineural hearing loss, and macular pattern dystrophy due to an A to G transition at position 3243 of mitochondrial DNA (mtDNA) (m.3243A&gt;G). The phenotypic heterogeneity of MIDD may be the consequence of different levels of mutated mtDNA among mitochondria in a given tissue. Objective: The aim of the present study was thus to ascertain the correlation between the severity of the phenotype in patients with MIDD and the level of heteroplasmy in the blood leukocytes. Participants: The GEDIAM prospective multicenter register was initiated in 1995. Eighty-nine Europid patients from this register, with MIDD and the mtDNA 3243A&gt;G mutation, were included. Patients with MELAS (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes) or with mitochondrial diabetes related to other mutations or to deletions of mtDNA were excluded. Results: A significant negative correlation was found between levels of heteroplasmy and age of the patients at the time of sampling for molecular analysis, age at the diagnosis of diabetes, and body mass index. After adjustment for age at sampling for molecular study and gender, the correlation between heteroplasmy levels and age at the diagnosis of diabetes was no more significant. The two other correlations remained significant. A significant positive correlation between levels of heteroplasmy and HbA1c was also found and remained significant after adjustment for age at molecular sampling and gender. Conclusions: These results support the hypothesis that heteroplasmy levels are at least one of the determinants of the severity of the phenotype in MIDD. Heteroplasmy levels are at least one of the determinants of the severity of the phenotype of maternally inherited diabetes and deafness