Intraoperative Complications and Mid-Term Follow-Up of Large-Diameter Head Metal-on-Metal Total Hip Arthroplasty and Hip Resurfacing Arthroplasty

Background and Aims: Large-diameter head total hip arthroplasty and hip resurfacing arthroplasty were popular in Finland from 2000 to 2012 for the treatment of hip osteoarthritis. The aim of this retrospective study was to investigate the mid-term survival of large-diameter head total hip arthroplasty patients operated on in three university hospitals and to compare these results to the survival of hip resurfacing arthroplasty patients. Material and Methods: A total of 3860 hip arthroplasties (3029 large-diameter head total hip arthroplasties in 2734 patients and 831 hip resurfacing arthroplasties in 757 patients) were operated on between January 2004 and December 2009. The mean follow-up was 4.3years (range: 0.3-8.0years) in the total hip arthroplasty group and 5.1years (range: 1.7-7.9years) in the hip resurfacing arthroplasty group. Cox multiple regression model and Kaplan-Meier survival analysis were used to study the survival of the total hip arthroplasties and the hip resurfacing arthroplasties. Intraoperative complications and reasons for revisions were also evaluated. Results: In Cox regression analysis, the hazard ratio for revision of hip resurfacing arthroplasty was 1.5 compared with large-diameter head total hip arthroplasty (95% confidence interval: 1.0-2.2) (p=0.029). The cumulative Kaplan-Meier survival rate was 90.7% at 7.7years for the large-diameter head total hip arthroplasty (95% confidence interval: 86.8-94.6) and 92.2% at 7.6years for hip resurfacing arthroplasty (95% confidence interval: 89.9-94.6). There were a total of 166/3029 (5.5%) intraoperative complications in the large-diameter head total hip arthroplasty group and 20/831 (2.4%) in the hip resurfacing arthroplasty group (p=0.001). Revision for any reason was performed on 137/3029 (4.5%) of the arthroplasties in the large-diameter head total hip arthroplasty group and 52/831 (6.3%) in the hip resurfacing arthroplasty group (p=0.04). Conclusion: The mid-term survival of both of these devices was poor, and revisions due to adverse reactions to metal debris will most likely rise at longer follow-up. There were more intraoperative complications in the large-diameter head total hip arthroplasty group than in the hip resurfacing arthroplasty group.Peer reviewe

Bundling up carbon nanotubes through Wigner defects

We show, using ab initio total energy density functional theory, that the so-called Wigner defects, an interstitial carbon atom right besides a vacancy, which are present in irradiated graphite can also exist in bundles of carbon nanotubes. Due to the geometrical structure of a nanotube, however, this defect has a rather low formation energy, lower than the vacancy itself, suggesting that it may be one of the most important defects that are created after electron or ion irradiation. Moreover, they form a strong link between the nanotubes in bundles, increasing their shear modulus by a sizeable amount, clearly indicating its importance for the mechanical properties of nanotube bundles.Comment: 5 pages and 4 figure

UJIAN NASIONAL MENGKEBIRI KEDAULATAN GURU

Stardisasi telah menjadi pilihan Kebijakan pendidikan di Indonesia, sebagai memenuhi dari pentingnya lokal, nasional dan global. ISO 9000 adalah sebagai standardisasi internasional kualitas pendidikan yang telah dikompromikan oleh banyak negara di dunia telah memberikan pelayanan terbaik dan memberikan harapan konsumen pendidikan. Standarisasi kelulusan siswa di Indonesia adalah Ujian Nasional, oleh karena pelaksanaan ini telah kehilangan nilai kejujuran, kebaikan dan karakter pendidikan kita . Karena alasan pengguna standardisasi Ujian Nasional tidak sebagai salah satu di semua ukuran fundamental sukses nasional pendidikan di Indonesia. Ujian Nasional telah kehilangan kedaulatan guru karena tidak memberikan autoritas sama sekali untuk guru untuk memberikan nilai kepada siswa mereka. Pemerintah perlu mengambil kebijakan lain untuk mengubah Ujian Nasional yang satu dapat menciptakan kreativitas siswa dan guru untuk tidak membunuh demokrasi kitaStardisasi telah menjadi pilihan Kebijakan pendidikan di Indonesia, sebagai memenuhi dari pentingnya lokal, nasional dan global. ISO 9000 adalah sebagai standardisasi internasional kualitas pendidikan yang telah dikompromikan oleh banyak negara di dunia telah memberikan pelayanan terbaik dan memberikan harapan konsumen pendidikan. Standarisasi kelulusan siswa di Indonesia adalah Ujian Nasional, oleh karena pelaksanaan ini telah kehilangan nilai kejujuran, kebaikan dan karakter pendidikan kita . Karena alasan pengguna standardisasi Ujian Nasional tidak sebagai salah satu di semua ukuran fundamental sukses nasional pendidikan di Indonesia. Ujian Nasional telah kehilangan kedaulatan guru karena tidak memberikan autoritas sama sekali untuk guru untuk memberikan nilai kepada siswa mereka. Pemerintah perlu mengambil kebijakan lain untuk mengubah Ujian Nasional yang satu dapat menciptakan kreativitas siswa dan guru untuk tidak membunuh demokrasi kit

Surgical and oncological results after rectal resections with or without previous treatment for prostate cancer

IntroductionPrevious treatment for prostate cancer (PC) may potentially affect the surgical and oncological outcomes of subsequent rectal cancer surgery, but there are only a few studies regarding this particular group. In this study, we present the 3-year surgical and oncological results of rectal cancer patients who had received previous treatment for PC at a single Finnish tertiary referral centre.Material and methodsData regarding all male patients diagnosed with rectal cancer and treated at Tampere University Hospital (TAUH) between 1997 and 2016 were gathered from medical records. In total, this study included 553 rectal cancer patients who underwent curative surgery, and 54 of them (9.8%) had a prior history of treatment for prostate cancer.ResultsPatients in the PC group were older and had more comorbidities compared with those in the non-PC group. The PC patients had a significantly higher risk of permanent stoma compared with the non-PC patients (61.5% vs. 45.2%, respectively, p = 0.025). The PC patients seemed to have lower tumours than the non-PC patients (87% vs. 75%, respectively, p = 0.05). Overall, the 3-year overall survival (OS) for the PC and non-PC patients was 74.1% and 80.6%, respectively. No significant differences were observed between the study groups even in the age-adjusted comparison [hazard ratio (HR): 1.07, confidence interval (CI) 95%: 0.60–1.89]. In the univariable analysis, radically operated patients without a history of PC exhibited an improved overall survival, (HR: 2.46, 95% CI: 1.34–4.53, p = 0.004). However, only a higher age-adjusted Charlson comorbidity index (CCI) and a low tumour location (<10 cm) were found to have an independent prognostic impact on worse OS in the multivariable analysis (HR: 1.57, 95% CI: 1.36–1.82, p < 0.001 and HR: 2.74, 95% CI: 1.32–5.70, p = 0.007, respectively). No significant differences were observed between the groups in terms of disease-free or local recurrence-free survival.ConclusionRectal cancer is more frequently found in the middle or lower part of the rectum in patients who have previously received treatment for prostate cancer. These patients also have a higher likelihood of requiring a permanent stoma. In radically operated rectal cancer, the PC group had a worse OS rate, according to the univariable analysis. However, the only independent prognostic factors for a worse OS that were highlighted in the multivariable analysis included a higher CCI and a low tumour location

Distinct pathways in the over-expression of matrix metalloproteinases in human fibroblasts by relaxation of mechanical tension.

peer reviewedaudience: researcherThe aim of the work was to analyze, on a comparative basis, the signaling pathways operating in the regulation of a panel of matrix metalloproteinases (MMP) expressed by human dermal fibroblasts submitted to mechanical stress relaxation by cytochalasin D (CD) and in a retracting collagen gel (RCG). The mRNA steady-state level of MMPs was measured by a quantitative RT-PCR procedure using a synthetic RNA as internal standard. In monolayer, most MMPs were barely detected, except MMP-2. Disruption of the actin stress fibers by CD induced a moderate increase of MMP-2 mRNA and a much larger stimulation of MMP-3, -9, -13 and -14 mRNAs. In RCG, a significant up-regulation of these MMPs was also observed although to a lower extent than in CD-treated monolayers. Among the investigated MMPs, the MMP-8 and -11 were not reproducibly detected. MMP-2 was processed to its active form both by CD and in RCG. The CD-induced up-regulation of gene expression was largely repressed by blocking protein synthesis by cycloheximide for all the MMPs, by inhibiting the tyrosine-kinases of the src family by herbimycin A for all MMPs, except MMP-2, and by inhibiting the TPA-inducible PKC isoforms by bisindoyl maleimide for all MMPs, except MMP-14. The up-regulation induced by stress relaxation in RCG was protein synthesis-dependent for MMP-2 and MMP-13, tyrosine kinases-dependent for MMP-3 and MMP-13, as previously described for MMP-1. Inhibiting TPA-inducible PKC did not affect any MMP in RCG except MMP-13, which was strongly induced. The processing of MMP-2 was tyrosine kinases-dependent but PKC-independent. Inhibitors of the ERK1,2 and p38 MAP kinases pathways diversely affected the MMPs expression. Inhibiting the Rho-kinase activity by Y-27632 was inactive. These results point to the potent regulation operated by the status of the cytoskeleton on the cell phenotype, and to distinct regulatory pathways involved in the control of different MMPs expression

Fermionic microstates within Painlev\'e-Gullstrand black hole

We consider the quantum vacuum of fermionic field in the presence of a black-hole background as a possible candidate for the stabilized black hole. The stable vacuum state (as well as thermal equilibrium states with arbitrary temperature) can exist if we use the Painlev\'e-Gullstrand description of the black hole, and the superluminal dispersion of the particle spectrum at high energy, which is introduced in the free-falling frame. Such choice is inspired by the analogy between the quantum vacuum and the ground state of quantum liquid, in which the event horizon for the low-energy fermionic quasiparticles also can arise. The quantum vacuum is characterized by the Fermi surface, which appears behind the event horizon. We do not consider the back reaction, and thus there is no guarantee that the stable black hole exists. But if it does exist, the Fermi surface behind the horizon would be the necessary attribute of its vacuum state. We also consider exact discrete spectrum of fermions inside the horizon which allows us to discuss the problem of fermion zero modes.Comment: LaTeX, 20 pages, 2 figure

Fatal Outcome in Bacteremia is Characterized by High Plasma Cell Free DNA Concentration and Apoptotic DNA Fragmentation: A Prospective Cohort Study

INTRODUCTION: Recent studies have shown that apoptosis plays a critical role in the pathogenesis of sepsis. High plasma cell free DNA (cf-DNA) concentrations have been shown to be associated with sepsis outcome. The origin of cf-DNA is unclear. METHODS: Total plasma cf-DNA was quantified directly in plasma and the amplifiable cf-DNA assessed using quantitative PCR in 132 patients with bacteremia caused by Staphylococcus aureus, Streptococcus pneumoniae, ß-hemolytic streptococcae or Escherichia coli. The quality of cf-DNA was analyzed with a DNA Chip assay performed on 8 survivors and 8 nonsurvivors. Values were measured on days 1-4 after positive blood culture, on day 5-17 and on recovery. RESULTS: The maximum cf-DNA values on days 1-4 (n = 132) were markedly higher in nonsurvivors compared to survivors (2.03 vs 1.26 ug/ml, p<0.001) and the AUCROC in the prediction of case fatality was 0.81 (95% CI 0.69-0.94). cf-DNA at a cut-off level of 1.52 ug/ml showed 83% sensitivity and 79% specificity for fatal disease. High cf-DNA (>1.52 ug/ml) remained an independent risk factor for case fatality in a logistic regression model. Qualitative analysis of cf-DNA showed that cf-DNA displayed a predominating low-molecular-weight cf-DNA band (150-200 bp) in nonsurvivors, corresponding to the size of the apoptotic nucleosomal DNA. cf-DNA concentration showed a significant positive correlation with visually graded apoptotic band intensity (R = 0.822, p<0.001). CONCLUSIONS: Plasma cf-DNA concentration proved to be a specific independent prognostic biomarker in bacteremia. cf-DNA displayed a predominating low-molecular-weight cf-DNA band in nonsurvivors corresponding to the size of apoptotic nucleosomal DNA

Access Control for Data Integration in Presence of Data Dependencies

International audienceDefining access control policies in a data integration scenario is a challenging task. In such a scenario typically each source specifies its local access control policy and cannot anticipate data inferences that can arise when data is integrated at the mediator level. Inferences, e.g., using functional dependencies, can allow malicious users to obtain, at the mediator level, prohibited information by linking multiple queries and thus violating the local policies. In this paper, we propose a framework, i.e., a methodology and a set of algorithms, to prevent such violations. First, we use a graph-based approach to identify sets of queries, called violating transactions, and then we propose an approach to forbid the execution of those transactions by identifying additional access control rules that should be added to the mediator. We also state the complexity of the algorithms and discuss a set of experiments we conducted by using both real and synthetic datasets. Tests also confirm the complexity and upper bounds in worst-case scenarios of the proposed algorithms