80 research outputs found
Maintenance of bone mineral density after implantation of a femoral neck hip prosthesis
<p>Abstract</p> <p>Background</p> <p>Stress shielding of the proximal femur has been observed in a number of conventional cementless implants used in total hip arthroplasty. Short femoral-neck implants are claiming less interference with the biomechanics of the proximal femur. The goal of this study was to investigate the changes of bone-mineral density in the proximal femur and the clinical outcome after implantation of a short femoral-neck prosthesis.</p> <p>Methods</p> <p>We prospectively assessed the clinical outcome and the changes of bone mineral density of the proximal femur up to one year after implantation of a short femoral neck prosthesis in 20 patients with a mean age of 47 years (range 17 to 65). Clinical outcome was assessed using the Harris Hip Score. The WOMAC was used as a patient-relevant outcome-measure. The bone mineral density was determined using dual energy x-ray absorptiometry, performed 10 days, three months and 12 months after surgery.</p> <p>Results</p> <p>The Harris Hip Score improved from an average preoperative score of 46 to a postoperative score at 12 months of 89 points, the global WOMAC index from 5,3 preoperatively to 0,8 at 12 months postoperatively. In contrast to conventional implants, the DEXA-scans overall revealed a slight increase of bone mineral density in the proximal femur in the 12 months following the implantation.</p> <p>Conclusion</p> <p>The short femoral neck stem lead to a distinct bone reaction. This was significantly different when compared to the changes in bone mineral density reported after implantation of conventional implants.</p
Population Pharmacokinetics of Cabotegravir Following Oral Administration and LongâActing Intramuscular Injection in RealâWorld People with HIV
Longâacting cabotegravir has been studied mainly in the stringent framework of clinical trials, which does not necessarily reflect the situation of people with HIV (PWH) in routine clinical settings. The present population pharmacokinetic analysis aims to build realâworld reference percentile curves of cabotegravir concentrations, accounting for patientârelated factors that may affect cabotegravir exposure. The second objective is to simulate whether dosing interval adjustments of cabotegravir could be considered in specific subpopulations. Overall, 238 PWH contributed to 1,038 cabotegravir levels (186 during the initial oral administration phase and 852 after intramuscular injection). Cabotegravir pharmacokinetics was best described using a oneâcompartment model with distinct first orderâabsorption for oral and intramuscular administrations, and identical volume and clearance. Our model showed almost 40% faster absorption and 30% higher clearance than previously reported, resulting in a time to steadyâstate of 8âmonths and an elimination halfâlife of 4.6âweeks for longâacting cabotegravir. Sex and body mass index significantly influenced absorption, and bodyweight affected clearance. Modelâbased simulations showed that cabotegravir trough concentrations in females were 25% lower 4âweeks after the intramuscular loading dose, but 42% higher during the late maintenance phase. Finally, simulations indicated that in females, despite significantly higher cabotegravir concentrations, longer intervals between injections may not consistently ensure levels above the 4âfold proteinâadjusted 90% inhibitory target concentration
Do linden trees kill bees? Reviewing the causes of bee deaths on silver linden (Tilia tomentosa)
For decades, linden trees (basswoods or lime trees), and particularly silver linden (Tilia tomentosa), have been linked to mass bee deaths. This phenomenon is often attributed to the purported occurrence of the carbohydrate mannose, which is toxic to bees, in Tilia nectar. In this review, however, we conclude that from existing literature there is no experimental evidence for toxicity to bees in linden nectar. Bee deaths on Tilia probably result from starvation, owing to insufficient nectar resources late in the tree's flowering period. We recommend ensuring sufficient alternative food sources in cities during late summer to reduce bee deaths on silver linden. Silver linden metabolites such as floral volatiles, pollen chemistry and nectar secondary compounds remain underexplored, particularly their toxic or behavioural effects on bees. Some evidence for the presence of caffeine in linden nectar may mean that linden trees can chemically deceive foraging bees to make sub-optimal foraging decisions, in some cases leading to their starvation
Comparative study and histomorphometric analysis of bone allografts lyophilized and sterilized by autoclaving, gamma irradiation and ethylene oxide in rats
Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study
Background
A structured approach to perioperative patient management based on an enhanced recovery pathway protocol facilitates early recovery and reduces morbidity in high income countries. However, in low- and middle-income countries (LMICs), the feasibility of implementing enhanced recovery pathways and its influence on patient outcomes is scarcely investigated. To inform similar practice in LMICs for total hip and knee arthroplasty, it is necessary to identify potential factors for inclusion in such a programme, appropriate for LMICs.
Methods
Applying a Delphi method, 33 stakeholders (13 arthroplasty surgeons, 12 anaesthetists and 8 physiotherapists) from 10 state hospitals representing 4 South African provinces identified and prioritised i) risk factors associated with poor outcomes, ii) perioperative interventions to improve outcomes and iii) patient and clinical outcomes necessary to benchmark practice for patients scheduled for primary elective unilateral total hip and knee arthroplasty.
Results
Thirty of the thirty-three stakeholders completed the 3Â months Delphi study. The first round yielded i) 36 suggestions to preoperative risk factors, ii) 14 (preoperative), 18 (intraoperative) and 23 (postoperative) suggestions to best practices for perioperative interventions to improve outcomes and iii) 25 suggestions to important postsurgical outcomes. These items were prioritised by the group in the consecutive rounds and consensus was reached for the top ten priorities for each category.
Conclusion
The consensus derived risk factors, perioperative interventions and important outcomes will inform the development of a structured, perioperative multidisciplinary enhanced patient care protocol for total hip and knee arthroplasty. It is anticipated that this study will provide the construct necessary for developing pragmatic enhanced care pathways aimed at improving patient outcomes after arthroplasty in LMICs
Atributos crĂticos de satisfação em serviços de arquitetura: visĂŁo do cliente Ă visĂŁo do arquiteto
Lumbar spinal stenosis: Are there objective reasons for fusion or instrumented surgery? A Spine Tango registry study
Resection of a chest chondrosarcoma invading the spine and the aorta.
A 34-year-old man presented with a large chondrosarcoma of the chest invading six ribs and the vertebral bodies of five adjacent thoracic vertebrae. En bloc resection of the tumor with six ribs, the anterior part of five vertebral bodies, and the thoracic aorta was performed through a thoracotomy and a paravertebral incision
Resection of a chest chondrosarcoma invading the spine and the aorta.
A 34-year-old man presented with a large chondrosarcoma of the chest invading six ribs and the vertebral bodies of five adjacent thoracic vertebrae. En bloc resection of the tumor with six ribs, the anterior part of five vertebral bodies, and the thoracic aorta was performed through a thoracotomy and a paravertebral incision
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