Influencia de la vía de abordaje y de posición de la cúpula acetabular en la luxación de la artroplastia total de cadera: estudio caso-control

Tanto la vía de acceso quirúrgica como la posición de los componentes se han relacionado con la presencia de una luxación en las artroplastias primarias de cadera. Hemos estudiado la presencia de esta complicación en una serie de 758 artroplastias no cementadas modelo Bihapro. Encontramos 21 luxaciones. Por otro lado se seleccionó de forma aleatoria un grupo de control de 42 pacientes que no habían presentado luxación. Se diseñó un estudio de casos y controles que englobaba por tanto a 63 pacientes que tenían implantada una artroplastia de este modelo. En el grupo de casos observamos que el porcentaje de luxación fue sensiblemente mayor en el sexo masculino con un 66,7%, en comparación con el sexo femenino que fue de un 42,8% aunque esta diferencia no fue estadísticamente significativa. No se observaron diferencias en la frecuencia de luxaciones en relación con la vía anterior o lateral, pero sin embargo en la vía posterior la luxación se produjo en un solo caso (4,8% de todas las luxaciones) con una incidencia claramente menor que en los abordajes anterior y lateral, siendo esta diferencia estadísticamente significativa (p=0,005). También observamos diferencias estadísticamente significativas en cuanto a un mayor porcentaje de luxaciones cuando la inclinación del componente acetabular era mayor de 50º (76,2%), o cuando la anteversión del cotilo era mayor o igual a 20º (54,4%). La vía de abordaje posterior con reconstrucción capsular y muscular presenta un menor porcentaje de luxación después de una artroplastia primaria en comparación con la anterior o lateral. Una inclinación mayor de 50º o una anteversión mayor de 20º favorecen la presencia de una luxación.The surgical approach and the cup position have been related with the dislocations of total hip arthroplasty. We have studied the presence of this complication in 758 Bihapro™ cementless arthroplasties. We got a case group of 21 dislocations; then we selected a control group of 42 patients without luxation to design a case-control study. The case group had a higher rate of dislocation in males (66.7 % versus 42.8 % in females) although this difference was not statistically significant. We didn’t observe any difference in the frequency of luxations relating to the anterior or lateral surgical approach, however in the posterior approach the dislocation appeared only in one case (4.8 % of the all dislocations) with statistically differences (p=0.005). We also observed statistically significant differences of luxations when the acetabular cup inclination was higher than 50º (76.2 %), or when the cup anteversion was equal or higher than 20º (52.4 %). The posterior surgical approach with capsular and muscular suture presented a lower rate of dislocation after a primary arthroplasty compared with the anterior or lateral approachs. An inclination bigger than 50º or an anteversion bigger than 20º seems to be a risk factor of luxation

Limited Ability to Activate Protein C Confers Left Atrial Endocardium A Thrombogenic Phenotype: A Role in Cardioembolic Stroke?

Background and Purpose—Atrial fibrillation is the most important risk factor for cardioembolic stroke. Thrombi form in the left atrial appendage rather than in the right. The causes of this different thrombogenicity are not well-understood. The goal herein was to compare the activation of the anticoagulant protein C and the thrombomodulin and endothelial protein C receptor/activated protein C receptor expression on the endocardium between right and left atria. Methods—We harvested the atria of 6 monkeys (Macaca fascicularis) and quantified their ability to activate protein C ex vivo and we measured the thrombomodulin and endothelial protein C receptor expression by immunofluorescence. Results—We found the ability to activate protein C decreased by half (P 0.028) and there was lower expression of thrombomodulin in the left atrial endocardium than the right (52.5 19.9 and 72.1 18.8 arbitrary intensity units, mean standard deviation; P 0.028). No differences were detected in endothelial protein C receptor expression. Conclusions—Impaired protein C activation on the left atrial endocardium attributable to low thrombomodulin expression may explain its higher thrombogenicity and play a role in cardioembolic stroke

Characterizing Usage Patterns and Service Demand of a Two-Way Car-Sharing System

Urban mobility is directly linked to the demand for communication resources and, clearly, its understanding is useful for better planning of urban and communication systems. However, getting data about urban mobility is still a challenge. In many cases, only a few companies have access to accurate and updated data. In most cases, these data are also privacy sensitive. It is thus important to generate models that can help to understand mobility patterns. We here characterize the demands of a two-way car-sharing system. We explore data of the public API of Modo, a car-sharing system that operates in Vancouver (Canada) and nearby regions. Our study uncovers patterns of users’ habits and demands in the service, which can be explored for urban and communication planning

Shopping centre siting and modal choice in Belgium: a destination based analysis

Although modal split is only one of the elements considered in decision-making on new shopping malls, it remarkably often arises in arguments of both proponents and opponents. Today, this is also the case in the debate on the planned development of three major shopping malls in Belgium. Inspired by such debates, the present study focuses on the impact of the location of shopping centres on the travel mode choice of the customers. Our hypothesis is that destination-based variables such as embeddedness in the urban fabric, accessibility and mall size influence the travel mode choice of the visitors. Based on modal split data and location characteristics of seventeen existing shopping centres in Belgium, we develop a model for a more sustainable siting policy. The results show a major influence of the location of the shopping centre in relation to the urban form, and of the size of the mall. Shopping centres that are part of a dense urban fabric, measured through population density, are less car dependent. Smaller sites will attract more cyclists and pedestrians. Interestingly, our results deviate significantly from the figures that have been put forward in public debates on the shopping mall issue in Belgium

Cosmological Analogues of the Bartnik--McKinnon Solutions

We present a numerical classification of the spherically symmetric, static solutions to the Einstein--Yang--Mills equations with cosmological constant $\Lambda$. We find three qualitatively different classes of configurations, where the solutions in each class are characterized by the value of $\Lambda$ and the number of nodes, $n$, of the Yang--Mills amplitude. For sufficiently small, positive values of the cosmological constant, \Lambda < \Llow(n), the solutions generalize the Bartnik--McKinnon solitons, which are now surrounded by a cosmological horizon and approach the deSitter geometry in the asymptotic region. For a discrete set of values $\Lambda_{\rm reg}(n) > \Lambda_{\rm crit}(n)$, the solutions are topologically $3$--spheres, the ground state $(n=1)$ being the Einstein Universe. In the intermediate region, that is for \Llow(n) < \Lambda < \Lhig(n), there exists a discrete family of global solutions with horizon and ``finite size''.Comment: 16 pages, LaTeX, 9 Postscript figures, uses epsf.st