Femoral revision knee Arthroplasty with Metaphyseal sleeves: the use of a stem is not mandatory of a structural point of view

Purpose Metaphyseal sleeves are an option for patients with severe metaphyseal bony defects requiring TKA revision. Although sleeves are usually used with stems, little is known about the exact contribution/need of the stem for the initial sleeve-bone interface stability, particularly in the femur, if the intramedullary canal is deformed or bowed. It is hypothesised that diaphyseal-stem addition increases the sleeve-femur interface stability and the strain-shielding effect on the metaphyseal femur relatively to the stemless condition. Material and methods Synthetic-femur was used to measure cortex strain behaviour and implant cortex micromotions for three techniques: only femoral-component, stemless-sleeve and stemmed-sleeve. Paired t-tests were performed to evaluate the statistical significance of the difference between mean principal strains and implant-cortex micromotions. Finite-element models were developed to assess the cancellous-bone strain behaviour and sleeve-bone interface micromotions; these models were validated against the measurements. Results Cortex strains are reduced significantly (p<0.05) in 83% of strain gauges on stemmed-sleeve, which compares with 33% in stemless condition. Both techniques presented a cancellous bone strain reduction of 50% at the distal region and an increase of nearly four times at the sleeve proximal region relative to the model only with the femoral component. Both techniques presented sleeve-bone micromotions amplitude below 50-150μm, suitable for bone ingrowth. Conclusions The use of a supplemental diaphyseal-stem potentiates the risk of cortex bone resorption compared with the stemless-sleeve condition; however, the stem is not vital for increasing the initial sleeve-bone stability and has a minor effect on the cancellous-bone strain behaviour. Of a purely structural point view, appears that the use of a diaphyseal-femoral-stem with the metaphyseal sleeve is not mandatory in the revision TKA which is particularly relevant in cases where the use of stems is impracticable.publishe

Breast cancer "tailored follow-up" in Italian oncology units: a web-based survey

urpose: Breast cancer follow-up procedures after primary treatment are still a controversial issue. Aim of this study was to investigate, through a web-based survey, surveillance methodologies selected by Italian oncologists in everyday clinical practice. Methods: Referents of Italian medical oncology units were invited to participate to the study via e-mail through the SurveyMonkey website. Participants were asked how, in their institution, exams of disease staging and follow-up are planned in asymptomatic women and if surveillance continues beyond the 5th year. Results: Between February and May 2013, 125 out of 233 (53.6%) invited referents of Italian medical oncology units agreed to participate in the survey. Ninety-seven (77.6%) referents state that modalities of breast cancer follow-up are planned according to the risk of disease progression at diagnosis and only 12 (9.6%) oncology units apply the minimal follow-up procedures according to international guidelines. Minimal follow-up is never applied in high risk asymptomatic women. Ninety-eight (78.4%) oncology units continue follow-up in all patients beyond 5 years. Conclusions: Our survey shows that 90.4% of participating Italian oncology units declare they do not apply the minimal breast cancer follow-up procedures after primary treatment in asymptomatic women, as suggested by national and international guidelines. Interestingly, about 80.0% of interviewed referents performs the so called "tailored follow-up", high intensity for high risk, low intensity for low risk patients. There is an urgent need of randomized clinical trials able to determine the effectiveness of risk-based follow-up modalities, their ideal frequency and persistence in time

O corpo despido pelas práticas de desenhar: dos usos à disciplinarização do desenho

Inserido na problemática de investigação sobre os motivos pelos quais as práticas socioculturais de desenhar teriam adquirido e perdido o estatuto de conteúdo escolar, este artigo tem por objetivo refletir acerca dos diferentes usos dados à prática do desenho do corpo humano em duas atividades específicas: a atividade artística e a atividade médica. Parte-se do pressuposto de que a compreensão de características da vida escolar das práticas de desenhar exige a investigação dessas práticas em espaços não escolares. Como a prática do desenho do corpo tem atravessado os espaços escolares brasileiros, é nosso interesse, portanto, investigar como se pôde formar tal domínio de saber. Nesse sentido, nossa estratégia será analisar que problemáticas permearam tal prática durante o Renascimento, a fim de compreender possíveis implicações filosóficas, conceituais, técnicas e científicas decorrentes de suas diversas significações

UTILITY OF THE AZIDO-GROUP: ELECTRONIC STRUCTURE AND REACTIVITY OF o-OXOARYLNITRENIUM-BF3 IONS AND 2- (or 5-) AZIDOAZOLES DERIVATIVES

In the last decade, knowledge of the chemistry of N-arylnitrenium ions has advanced significantly and continue to attract attention arising from synthetic, theoretical and biological interest. Here we report the reactions of five 2-oxo arylnitrenium-BF3 ions generated from deactivated 2-oxoazidobenzenes, including 2-azidobenzenecarbaldehyde, 1-(2-azidophenyl)-1-ethanone, (2-azidophenyl) (phenyl)methanone , 2-azidobenzoic acid and 2-azidobenzenecarbonitrile, with Lewis acid BF3\u2022OEt2 in the presence of benzene, as a possible source of 2-anilino-oxobenzenes and/or acridines. Synthesis of azido azoles: According to the proton-lithium (or halogen-lithium) exchange reaction via butyllithium, the metallation of the methylimidazole, the methylpyrazole and the thiazole rings occurs regioselectively at the C-2 (or at C-5 when the position-2 is unavailable) and the resulting 2-(or 5-) heteroaryllithium was employed for the azido transfer protocol with tosyl azide

On the utility of the azido transfer protocol: synthesis of 2- and 5-azido N-methylimidazoles, 1,3-thiazoles and N-methylpyrazole and their conversion to triazole-azole bisheteroaryls

The azido transfer procedure of heteroaryllithium and tosyl azide was used to synthesize selected 2- and 5-azido azoles. This procedure, which is based on the fragmentation of the appropriate lithium triazene salt 1a-7a, successfully afforded 2-azido-N-methylimidazole 1, 2-azido-1,3-thiazole 2, 2-azidobenzo-1,3-thiazole 3, 5-azido-N-methylpyrazole 4, 5-azido-N-methylimidazole 5 (via 2-(trimethylsilyl)-5-azido-N-methylimidazole 6), and 5-azido-1,3-thiazole 7 (via 5-lithio-1,3-thiazole), but attempts to prepare 5-azido-2-trimethylsilyl-1,3-thiazole 8 from the corresponding triazene 7a failed, affording only the desilylated azide 7 in poor yield. The azides 1-7 underwent 1,3-dipolar cycloaddition when mixed with neat (trimethylsilyl)acetylene, giving 1-heteroaryl-4-trimethylsilyl-1,2,3-triazoles 1b-7b generally in very high yields

A convenient synthesis of λ-oxo-acrylates

Ethyl 2,4-dioxoalkanoates react chemoselectively with pyrrolidine acetate at the more electrophilic C-2 carbonyl, producing enaminone esters which on reduction with NaCNBH4 followed by pyrrolidine elimination, were transformed into γ-oxo-acrylates. © 1988

Jaw bone metastasis from hepatocellular carcinoma

NO ABSTRAC

Synthetic Approaches to Enantiomerically Pure 8-Azabicyclo[3.2.1]octane Derivatives

This review concentrates on methodologies that provide enantioselective routes to chiral substituted 8-azabicyclo- [3.2.1]octane nuclei. Moreover, synthetic approaches to several specific targets have also been included