Management of metal-on-metal hip implant patients: Who, when and how to revise?

The debate on how best to manage patients with metal-on-metal (MOM) hip implants continues. With over 1 million patients affected worldwide, the impact is far reaching. The majority of the aggressive failures of MOM hip implants have been dealt with by revision hip surgery, leaving patients with a much more indolent pattern of failure of devices that have been in situ for more than 10 years. The longer-term outcome for such patients remains unknown, and much debate exists on how best to manage these patients. Regulatory guidance is available but remains open to interpretation due to the lack of current evidence and long-term studies. Metal ion thresholds for concern have been suggested at 7 ppb for hip resurfacing arthroplasty and below this level for large diameter total hip arthroplasties. Soft tissue changes including pseudotumours and muscle atrophy have been shown to progress, but this is not consistent. New advanced imaging techniques are helping to diagnose complications with metal hips and the reasons for failure, however these are not widely available. This has led to some centres to tackle difficult cases through multidisciplinary collaboration, for both surgical management decisions and also follow-up decisions. We summarise current evidence and consider who is at risk, when revision should be undertaken and how patients should be managed

Interplay between structure and magnetism in Mo12S9I9Mo_{12} S_9 I_9 nanowires

We investigate the equilibrium geometry and electronic structure of Mo$_{12}$S$_{9}$I$_{9}$ nanowires using ab initio Density Functional calculations. The skeleton of these unusually stable nanowires consists of rigid, functionalized Mo octahedra, connected by flexible, bi-stable sulphur bridges. This structural flexibility translates into a capability to stretch up to approximate 20% at almost no energy cost. The nanowires change from conductors to narrow-gap magnetic semiconductors in one of their structural isomers.Comment: 4 pages with PRL standards and 3 figure

Surface Functionalization of Carbon Nanotubes for Energy Applications

Carbon nanotubes (CNTs) are receiving a great deal of attention as a catalyst support for different energy applications, due to their high surface area and high conductivity. Recent literature studies have shown that the application of CNTs mainly depends on their surface functionalization process. Typically, pristine CNTs (as produced) have no functional groups, which is usually considered as an obstacle to their widespread application. In this chapter, we highlight the different techniques used to functionalize the surface of CNTs, including physical and chemical functionalization processes. We show the advantages and the drawbacks of the different functionalization processes. Additionally, we explain in detail the different techniques used to characterize the CNTs before and after functionalization processes. Furthermore, we focus on polymer wrapping techniques of CNTs to create active nanocomposite materials for energy applications, in particular the applications in the agriculture field to fight pollution and make farming activity easier and more efficient

Facilitating the driver detection of road surface type by selective manipulation of the steering-wheel acceleration signal

Copyright @ 2012 by Institution of Mechanical Engineers.Previous research has investigated the possibility of facilitating the driver detection of road surface type by means of selective manipulation of the steering-wheel acceleration signal. In previous studies a selective increase in acceleration amplitude has been found to facilitate road-surface-type detection, as has selective manipulation of the individual transient events which are present in the signal. The previous research results have been collected into a first guideline for the optimization of the steering-wheel acceleration signal, and the guideline has been tested in the current study. The test stimuli used in the current study were ten steering-wheel acceleration-time histories which were selected from an extensive database of road test measurements performed by the research group. The time histories, which were all from midsized European automobiles and European roads, were selected such that the widest possible operating envelope could be achieved in terms of the r.m.s. value of the steering acceleration, the kurtosis, the power spectral density function, and the number of transient events present in the signal. The time histories were manipulated by means of the mildly non-stationary mission synthesis algorithm in order to increase, by a factor of 2, both the number and the size of the transient events contained within the frequency interval from 20 Hz to 60Hz. The ensemble, composed of both the unmanipulated and the manipulated time histories, was used to perform a laboratory-based detection task with 15 participants, who were presented the individual stimuli in random order. The participants were asked to state, by answering 'yes' or 'no', whether each stimulus was considered to be from the road surface that was displayed in front of them by means of a large photograph on a board. The results suggest that the selectively manipulated steering-wheel acceleration stimuli produced improved detection for eight of the ten road surface types which were tested, with a maximum improvement of 14 per cent in the case of the broken road surface. The selective manipulation did lead, however, to some degradation in detection for the motorway road stimulus and for the noise road stimulus, thus suggesting that the current guideline is not universally optimal for all road surfaces

Factors Associated With Trunnionosis in the Metal-on-Metal Pinnacle Hip

BACKGROUND: Trunnionosis of the tapered head-stem junction of total hip arthroplasties, either through corrosion or mechanical wear, has been implicated in early implant failure. Retrieval analysis of large numbers of failed implants can help us better understand the factors that influence damage at this interface. METHODS: In this study, we examined 120 retrieved total hip arthroplasties of one bearing design, the 36-mm diameter metal-on-metal, DePuy Pinnacle, that had been paired with 3 different stems. We measured material loss of the bearing and head-trunnion taper surfaces and collected clinical and component data for each case. We then used multiple linear regression analysis to determine which factors influenced the rate of taper material loss. RESULTS: We found 4 significant variables: (1) longer time to revision (P = .004), (2) the use of a 12/14 taper for the head-trunnion junction (P < .001), (3) decreased bearing surface wear (P = .003), and (4) vertical femoral offset (P = .05). These together explained 29% of the variability in taper material loss. CONCLUSION: Our most important finding is the effect of trunnion design. Of the 3 types studied, we found that S-ROM design was the most successful at minimizing trunnionosis

Muscle atrophy and metal-on-metal hip implants

Background and purpose — Muscle atrophy is seen in patients with metal-on-metal (MOM) hip implants, probably because of inflammatory destruction of the musculo-tendon junction. However, like pseudotumors, it is unclear when atrophy occurs and whether it progresses with time. Our objective was to determine whether muscle atrophy associated with MOM hip implants progresses with time. Patients and methods — We retrospectively reviewed 74 hips in 56 patients (32 of them women) using serial MRI. Median age was 59 (23–83) years. The median time post-implantation was 83 (35–142) months, and the median interval between scans was 11 months. Hip muscles were scored using the Pfirrmann system. The mean scores for muscle atrophy were compared between the first and second MRI scans. Blood cobalt and chromium concentrations were determined. Results — The median blood cobalt was 6.84 (0.24–90) ppb and median chromium level was 4.42 (0.20–45) ppb. The median Oxford hip score was 34 (5–48). The change in the gluteus minimus mean atrophy score between first and second MRI was 0.12 (p = 0.002). Mean change in the gluteus medius posterior portion (unaffected by surgical approach) was 0.08 (p = 0.01) and mean change in the inferior portion was 0.10 (p = 0.05). Mean pseudotumor grade increased by 0.18 (p = 0.02). Interpretation — Worsening muscle atrophy and worsening pseudotumor grade occur over a 1-year period in a substantial proportion of patients with MOM hip implants. Serial MRI helps to identify those patients who are at risk of developing worsening soft-tissue pathology. These patients should be considered for revision surgery before irreversible muscle destruction occurs

Composição da comunidade bacteriana do solo sob sistemas integrados na região norte de Mato Grosso.

Os sistemas integrados de produção agrícola estão sendo estudados como uma alternativa aos monocultivos tradicionais no intuíto de tornar a atividade agrícola sustentável, particulamente no estado do Mato Grosso. Entretanto, ainda não se conhece como essa atividade afeta as propriedades microbiológicas do solo. Assim, o objetivo deste trabalho foi avaliar e comparar os efeitos de sistemas integrados na composição da comunidade bacteriana do solo com diferentes monocultivos tendo como área referência uma mata nativa do bioma de transição Cerrado e Amazônia. O local de estudo está localizado na Embrapa Agrossilvipastoril no município de Sinop/MT e foram avaliados sete tratamentos (1-mata nativa, 2-lavoura, 3-pecuária, 4-eucalipto, 5-integração eucalipto lavoura (iEL), 6-integração eucalipto pecuária (iEP), 7-integração eucalipto lavoura pecuária (iELP)) dispostos em quatro blocos casualizados, os quais foram conduzidos segundo as recomendações agronômicas das espécies cultivadas. As amostras de solo foram coletadas nas épocas de chuva e estiagem em 2012 com o auxílio de trado holandês na profundidade de 0-10 cm, considerando 20 pontos aleatórios com caminhamento zigue-zague para fazer uma composta de cada tratamento. A extração de DNA total do solo foi realizada com o kit MoBio UltraClean? Soil DNA (MoBio Laboratories, Carlsbad, CA., EUA) conforme protocolo descrito pelo fabricante e sequenciado pela tecnologia Illumina (Illumina, Inc., CA, USA) com a plataforma MiSeq na Universidade da Florida (Gainesville, EUA). Por meio de ferramentas de bioinformática 2.957.127 sequencias do gene 16S rRNA com alta qualidade foram obtidas, sendo que 2.172.432 de OTUs (Operational Taxonomic Units) foram classificados para o domínio Bacteria, 3.564 Archaea e 262.994 não foram classificados. A composição bacteriana do solo com abundancia relativa &#8805; 10 % a nível de filo apresentou três táxons, porém Firmicutes e Proteobacteria apresentaram padrão de comportamento de maior abundancia na estiagem em relação a chuva para mata nativa e iELP e para a lavoura o padrão foi o oposto . A nível de classe, dentre cinco filos apenas Actinobacteria variou o comportamento para iELP e mata nativa com menor abundância na estiagem e maior na chuva, tendo a lavoura o comportamento inverso e para Clostridia ocorreu o mesmo padrão porém ao contrário para os respectivos tratamentos. Analisando a diferença entre os tratamentos por meio da dissimiliradidade a nível de filo, corte de abundância relativa &#8805; 0.05 % (18 filos na estiagem e 21 na chuva), o dendrograma baseado na distância euclidiana agrupou mata nativa e iELP como os mais semelhantes e lavoura o mais dissimilar dentre todos os tratamentos. Podemos concluir, que o sistema integrado eucalipto lavoura pecuária apresentou maior semelhança na sua composição bacteriana do solo com a da mata nativa em comparação com os demais tratamentos avaliados, como também manteve o padrão do comportamento da abundancia relativa parecido na época de estiagem, assim demonstrando indício de sustentabilidade

Electronic Structure of Disclinated Graphene in an Uniform Magnetic Field

The electronic structure in the vicinity of the 1-heptagonal and 1-pentagonal defects in the carbon graphene plane is investigated. Using a continuum gauge field-theory model the local density of states around the Fermi energy is calculated for both cases. In this model, the disclination is represented by an SO(2) gauge vortex and corresponding metric follows from the elasticity properties of the graphene membrane. To enhance the interval of energies, a self-consistent perturbation scheme is used. The Landau states are investigated and compared with the predicted values.Comment: keywords: graphene, heptagonal defect, elasticity, carbon nanohorns, 13 page

Detection of metallic cobalt and chromium liver deposition following failed hip replacement using T2* and R2 magnetic resonance

BACKGROUND: Failed hip prostheses can cause elevated circulating cobalt and chromium levels, with rare reports of fatal systemic organ deposition, including cobalt cardiomyopathy. Although blood cobalt and chromium levels are easily measured, organ deposition is difficult to detect without invasive biopsy. The T2* magnetic resonance (MR) method is used to quantify tissue iron deposition, and plays an important role in the management of iron-loading conditions. Cobalt and chromium, like iron, also affect magnetism and are proposed MR contrast agents. CASE PRESENTATION: We describe a case of a 44-year-old male with a failed hip implant and very elevated blood cobalt and chromium levels. Despite normal cardiac MR findings, liver T2* and R2 values were abnormal, triggering tissue biopsy. Liver tissue analysis, including X-ray fluorescence, demonstrated heavy elemental cobalt and chromium deposition in macrophages, and no detectable iron. CONCLUSIONS: Our case demonstrates T2* and R2 quantification of liver metal deposition in a patient with a failed hip implant. Further work is needed to investigate the role of T2* and R2 MR in the detection of metal deposition from metal on metal hip prostheses