Pre-operative Planning and Intra-operative Guidance for Shoulder Replacement Surgery

Shoulder joint replacement, or arthroplasty, is indicated in cases where arthritis or trauma has resulted in severe joint damage that in turn causes increased pain and decreased function. However, shoulder arthroplasty is less successful than hip and knee replacement, mostly due to the complexity of the shoulder joint and the resultant complexity of the replacement operation. In this paper we present a complete visualization-oriented pre-operative planning and intra-operative guidance approach for shoulder joint replacement. Our system assists the surgeon by allowing a virtual arthroplasty procedure whilst giving feedback, primarily via patient- and procedure-specific joint range of motion (ROM) simulation and visualization. After a successful planning, our system automatically generates a 3D model of a patient-specific mechanical guidance device that is then produced by a rapid prototyping machine and can be used during the operation. In this way, a computer-based guidance system is not required in the operating room

LED belichting en Het Nieuwe Telen bj tomaat: Proof of Principle

In dit Proof of Principle project is een belichte tomatenteelt geteeld met als doel 30% energiebesparing bij een gelijke productie. De LEDs hingen in 2 rijen: op ca. 40 cm boven de onderste bladeren en de tweede streng op 40 of op 70 cm hoogte daarboven. Bij de start van de teelt is zoveel licht gebruikt als het gewas aankon, en omdat het gewas zich goed ontwikkelde, is er al relatief vroeg besloten tot het verhogen van de stengeldichtheid. Dit heeft geleid tot een té hoge plantbelasting relatief vroeg in de teelt, terwijl er eigenlijk onvoldoende licht beschikbaar was om het aan te kunnen in de winter met weinig zonlicht. In het 192 cm rijafstanden systeem zijn de planten té dicht bij elkaar komen te staan. In vergelijking met een referentieteelt met 79 kg m-2 tomaten, is er onder productie LEDs 75 kg m-2 tomaten geproduceerd, en 80 kg m-2 bij de interlighting LEDs, vnl. omdat laatst genoemde LEDs langer brandde in de zomer

Het Nieuwe Belichten onder Diffuus glas

Het Nieuwe Belichten combineert Het Nieuwe Telen met een belichtingsstrategie om het gewas gericht te sturen en energie te besparen. Samen met een diffuus kasdek werden deze elementen samengebracht om energie te besparen en de productie te kunnen sturen. Tomaten van het ras Komeett werden belicht met twee belichtingssystemen, een afdeling met SON-T belichting, en twee afdelingen met een hybride belichtingssysteem (SON-T en LED-tussenbelichting), waarvan één met diffuus glas. Onder diffuus glas leek het gewas vaak energie over te hebben en meer assimilaten in de vruchten te brengen, waardoor het mogelijk lijkt om met een hogere plantbelasting onder diffuus glas te telen. In deze proef resulteerde de hybridebelichting in een productiestijging van 1.6% t.o.v. SON-T belichting terwijl diffuus glas leverde een productiestijging van 4.9% op. Diffuus glas heeft zijn voordelen nu weer bewezen in een belichte teelt, en ook tijdens de wintermaanden. Er is 83 tot 89 kg tomaten m-2 geproduceerd, met gebruikt van maar 30 kg m-2 CO2. Tijdens de wintermaanden waren er teveel bladrandjes geconstateerd, vooral bij Dir SON-T maar vooral door gebruik van het middel Luna Privilege, is Botrytis goed onder controle gebleven. Voor wat betreft de warmtevraag zijn de energiedoelstellingen gehaald te zijn (21 m3 gas tijdens de teelt), maar het schatten besparing op elektra werd bemoeilijkt door het ontbreken van een referentie. Omdat er eerder in het najaar is begonnen met belichten, zijn er ca. 600 branduren meer zijn gemaakt dan in een praktijkteelt. Next Generation Lighting combines Next Generation Cultivation with a lighting strategy, aimed to steer the crop and save energy. These elements were combined with a diffuse greenhouse for the cultivation of Komeett tomatoes, illuminated with two lighting systems, HPS as reference, and two greenhouses with a hybrid lighting system (SON-T and LED interlighting), one with diffuse glass. The crop often seemed to have extra energy under diffuse glass, bringing more assimilates to the fruits, so that it appears possible to maintain a higher fruit load under diffuse glass. In this trial hybrid lighting resulted in a production increase of 1.6 % compared to HPS lighting, compared to a 4.9% production increase for the same hybrid lighting under diffuse glass. The advantage of diffuse glass is partly due to its, but also because more light is brought into the crop. The crops produced 83 to 89 kg of tomatoes per m2, using only 30 kg CO2 per m2. Too many leaf edges were observed during the winter months, especially under HPS lighting but Botrytis remained well under control due to the use of Luna Privilege. As far as the heat component is concerned, the energy target appears to been well achieved (21 m3 gas during cultivation). The savings in electricity is a more difficult aspect because due to the early planting date, consequently realising 600 more assimilation lighting hours in autumn compared to a commercial crop planted in October

The accuracy and precision of radiostereometric analysis in monitoring tibial plateau fractures

Background and purpose: The application of radiostereometric analysis (RSA) to monitor stability of tibial plateau fractures during healing is both limited and yet to be validated. We therefore evaluated the accuracy and precision of RSA in a tibial plateau fracture model. Methods: Combinations of 3, 6, and 9 markers in a lateral condyle fracture were evaluated with reference to 6 proximal tibial arrangements. Translation and rotation accuracy was assessed with displacement-controlled stages, while precision was assessed with dynamic double examinations. A comparison of error according to marker number and arrangement was completed with 2-way ANOVA models. Results: The results were improved using more tantalum markers in each segment. In the fracture fragment, marker scatter in all axes was achieved by a circumferential arrangement (medial, anterior, and lateral) of the tantalum markers above the fixation devices. Markers placed on either side of the tibial tuberosity and in the medial aspect of the fracture split represented the proximal tibial reference segment best. Using 6 markers with this distribution in each segment, the translation accuracy (root mean square error) was less than 37 μm in all axes. The precision (95% confidence interval) was less than ± 16 μm in all axes in vitro. Rotation, tested around the x-axis, had an accuracy of less than 0.123° and a precision of ± 0.024°. Interpretation: RSA is highly accurate and precise in the assessment of lateral tibial plateau fracture fragment movement. The validation of our center's RSA system provides evidence to support future clinical RSA fracture studies.Lucian B Solomon, Aaron W Stevenson, Stuart A Callary, Thomas R Sullivan, Donald W Howie, and Mellick J Chehad

Fixation of the fully hydroxyapatite-coated Corail stem implanted due to femoral neck fracture: 38 patients followed for 2 years with RSA and DEXA

Background Today, dislocated femoral neck fractures are commonly treated with a cemented hip arthroplasty. However, cementing of the femoral component may lead to adverse effects and even death. Uncemented stems may lower these risks and hydroxyapatite (HA) coating may enhance integration, but prosthetic stability and clinical outcome in patients with osteoporotic bone have not been fully explored. We therefore studied fixation and clinical outcome in patients who had had a femoral neck fracture and who had received a fully HA-coated stem prosthesis. Patients and methods 50 patients with a dislocated femoral neck fracture were operated with the fully HA-coated Corail total or hemiarthroplasty. 38 patients, mean age 81 (70-96) years, were followed for 24 months with conventional radiographs, RSA, DEXA, and for clinical outcome. Results 31 of the 38 implants moved statistically significantly up to 3 months, mainly distally, mean 2.7 mm (max. 20 mm (SD 4.3)), and rotated into retroversion mean 3.3 (-1.8 to 17) (SD 4.3) and then appeared to stabilize. Distal stem migration was more pronounced if the stem was deemed to be too small. There was no correlation between BMD and stem migration. The migration did not result in any clinically adverse effects. Interpretation The fully hydroxyapatite-coated Corail stem migrates during the first 3 months, but clinical outcome appears to be good, without any adverse events

Cemented versus cementless Oxford unicompartmental knee arthroplasty using radiostereometric analysis:A randomised controlled trial

Optimising joint reconstruction management in arthritis and bone tumour patient

Mucopolysaccharidosis type IIIB may predominantly present with an attenuated clinical phenotype

Mucopolysaccharidosis type IIIB (MPS IIIB, Sanfilippo syndrome type B) is a lysosomal storage disorder caused by deficiency of the enzyme N-acetyl-α-D-glucosaminidase (NAGLU). Information on the natural course of MPS IIIB is scarce but much needed in view of emerging therapies. To improve knowledge on the natural course, data on all 52 MPS IIIB patients ever identified by enzymatic studies in the Netherlands were gathered. Clinical data on 44 patients could be retrieved. Only a small number (n = 9; 21%) presented with a classical MPS III phenotype; all other patients showed a much more attenuated course of the disease characterized by a significantly slower regression of intellectual and motor abilities. The majority of patients lived well into adulthood. First signs of the disease, usually mild developmental delay, were observed at a median age of 4 years. Subsequently, patients showed a slowing and eventually a stagnation of development. Patients with the attenuated phenotype had a stable intellectual disability for many years. Molecular analysis was performed in 24 index patients. The missense changes p.R643C, p.S612G, p.E634K, and p.L497V were exclusively found in patients with the attenuated phenotype. MPS IIIB comprises a remarkably wide spectrum of disease severity, and an unselected cohort including all Dutch patients showed a large proportion (79%) with an attenuated phenotype. MPS IIIB must be considered in patients with a developmental delay, even in the absence of a progressive decline in intellectual abilities. A key feature, necessitating metabolic studies, is the coexistence of behavioral problems

The tubarial salivary glands:A potential new organ at risk for radiotherapy

Introduction: The presence of previously unnoticed bilateral macroscopic salivary gland locations in the human nasopharynx was suspected after visualization by positron emission tomography/computed tomography with prostate-specific membrane antigen ligands (PSMA PET/CT). We aimed to elucidate the characteristics of this unknown entity and its potential clinical implications for radiotherapy. Materials and methods: The presence and configuration of the PSMA-positive area was evaluated in a retrospective cohort of consecutively scanned patients with prostate or urethral gland cancer (n = 100). Morphological and histological characteristics were assessed in a human cadaver study (n = 2). The effect of radiotherapy (RT) on salivation and swallowing was retrospectively investigated using prospectively collected clinical data from a cohort of head-neck cancer patients (n = 723). With multivariable logistic regression analysis, the association between radiotherapy (RT) dose and xerostomia or dysphagia was evaluated. Results: All 100 patients demonstrated a demarcated bilateral PSMA-positive area (average length 4 cm). Histology and 3D reconstruction confirmed the presence of PSMA-expressing, predominantly mucous glands with multiple draining ducts, predominantly near the torus tubarius. In the head-neck cancer patients, the mean RT dose to the gland area was significantly associated with physician-rated posttreatment xerostomia and dysphagia >= grade 2 at 12 months (0.019/gy, 95%CI 0.005-0.033, p =.007; 0.016/gy, 95%CI 0.001-0.031, p =.036). Follow-up at 24 months had similar results. Conclusion: The human body contains a pair of previously overlooked and clinically relevant macroscopic salivary gland locations, for which we propose the name tubarial glands. Sparing these glands in patients receiving RT may provide an opportunity to improve their quality of life. (C) 2020 The Authors. Published by Elsevier B.V